help needed truly unsure what to do
 

I truely dont want to seem like a drug seeker to you all, and/or my pain management dr. I'm currently on two 30 mg oxycontin and one 10 mg/325 apap percocet a day. I've been on the two 30mg oxys for a year and a half, 6 months later the dr added the percocet for break through pain. I've been seeing this dr now for a year and a half. He added the percocet after complaining a couple times of me seeing him and telling him the oxys were working for the most part(made things more tolerate but def doesnt deminish the pain), while they were working. I've had the same problem I've been having since starting them. They only seem to work for 8 hrs, and even that is stretching it. I'm up at night consistently in pain, hence the reason I'm writing this at 230 in the morning. I've already been through this with him, so I'm not sure where to go with this. Another thing I'd like to add, the pharmacy I switched to about 4 months ago made a mistake two months ago, and gave me roxycodone 30 mg by mistake instead of the oxy I'm supposed to get. I didnt notice the difference until after a few days and seen the difference on the prescription, and doing a little research on the internet. The roxycodone actually took care of the pain, completely, but only lasts about 5-6 hours. After reading on the internet, I found out that one is long acting and the other is short acting. Even though the short acting was only a few hours shy of working as long as the long acting, and actually works!

Thats the predicament I'm in, and I'm not sure how to approach this issue. I've been on pain meds for about 8 years now, eversince about 6 months before my medical retirement from the navy. I have a type of neuropathy, along with a list of other medical problems. I know if I go into the drs office in a couple of days and start asking for meds by name hes going to think I'm a drug seeker. I'd even think twice about telking him I got on one of these forums asking for advice. I truely hate this aspect of society. A few drug addicts here and there make it very difficult for people like me (assuming most of the people on here), to get addequate relief. All responses are welcome, and any advice is much appreciated! Hopefully I'll be able to figure this out before I go to the drs.

Re: help needed truely unsure what to do
 

Honestly, I wouldn't bother even asking. (and this is in no way meant to be judgmental towards you in any way, this would be for anyone) There really is no way a doctor is going to move you from a long acting to a short acting med for chronic pain. He has to justify his prescribing habits and that would send up a red flag for the doctor, so like I said, i wouldn't even bother asking. You would be better off explaining that the ones you are on now don't really last the entire time and ask him what he thinks you should do, he may want to add one more a day to give you the coverage you need.

Also, are you on any nerve medications and a muscle relaxer? Opiates don't really help neuropathy as well as say Lyrica, cymbalta, etc. Remember pain management isn't about getting rid of the pain 100%, its about bringing it down to a level that you can still function. Many doctors believe if you can get a 50% reduction then that's considered a good result. Best of luck to you and thank you for your service!

Re: help needed truely unsure what to do
 

For the record, I was on a rather large dose of Oxycontin many years ago and the doctor that Rx'ed it recognized that it only lasted 8 hours. Therefore, I was taking it 3x a day instead of the recommended 2x. It just doesn't last as long as the literature put out by the manufacturer.

Good luck!

Re: help needed truely unsure what to do
 

The only difference between the long acting and short acting versions of oxycodone is the duration ( how long they last between doses). The medication in both versions is exactly the same. So one should not work differently than the other, but Oxycontin has been known not to last for the entire 12 hours, at least prior to the new version that was released.
As far as getting your doctor to convert you to the short acting version, I doubt that is going to happen, anytime. A chronic pain patient, is best managed by using long acting (extended release) dosing, since it is less pills per day, but it also provides more effective blood plasma levels than using short acting which exacerbates the ups and downs that come with those medications.
Since your pain is mostly neuropathic, I am surprised that he has you on opiates at those doses, since Lyrica, gabapentin, cymbalta, and the old tricyclic anti depressants are far more effective than opiates at treating that type of pain..
One problem with some patients that are converted to the long acting versions is that the patients tend to believe that the long acting version isn't working because they don't "feel" the immediate release of the meds like they do with short acting versions. So they tend to view them as not "being effective at managing pain", but that's not true.
If I were you, and you really feel that the oxycontin is not working well,nor lasting as long as it is supposed to, then I would tell him that and ask about adding a medication geared specifically toward treating neuropathic pain, and see about adding that to your medications , after it is titrated to the proper dose, you may find that that is working with the oxycontin to manage your pain levels much more effectively.
I would not however expect that he is going to convert you over to any short acting medication , simply because I doubt that he will,.

Re: help needed truely unsure what to do
 

To clarify what buck hurts says, the active ingredient is the same, but their is a difference in taking a 30 mg short acting oxy "Roxicodone" and 30mg of Oxycontin. The short acting version dumps the entire 30 mgs in your system within an hour where oxycontin is designed to release 30 mgs over 8 to 12 hours, The serum levels the two drugs reach are entirely different. You would have to take twice the dose of oxycontin to achieve the level of oxycodone in your blood as you do with roxicodone. More realistic is taking 60mgs of oxy every 8 hours would be equal to taking 30 mgs of short acting every 4 hours. The first thing that goes with tolerance is duration. The short acting wouldnt last 6 hours for long. I also agree its a request that any legitimate doc would be against as far as switching to short acting only. It seems your doc is pretty conservative given the amount of time you have been on 30mg oxyContin twice a day. Rather than asking for specific meds you to need to make him understand how it effects you and suggeset making some kind of change if what he is prescribing isnt effective.
Good Luck, Dave

Re: help needed truely unsure what to do
 

I agree. I would express to your doctor that your pain levels are up, and you especially notice that the Oxycontin does not last 12 hours (it is well known that many need to take it every 8 hours). Sounds like its time for some med changes. So have they ever tried you on adjunct type meds like Neurontin, Lyrica, Cymbalta, etc, and if so, are you on anything currently? Its rare / inappropriate to use opiates by themselves to manage pain. Best wishes.

Re: help needed truely unsure what to do
 

I agree with everyone who's suggesting you simply tell your Dr. how the med is working, and don't drop names or variants. What's interesting is this: most doctors encourage patients to gain as much knowledge about their meds as possible. That is, except for narcotics and other mood alerting drugs. In those instances, they'd prefer you didn't know that much. Anytime a patient starts asking for drugs by name, or even doses, doctors tend to get skiddish.

Re: help needed truely unsure what to do
 

Hi,

First thing that hits me is the issue of the roxicodone. Does the pharmacy know? They should have caught it when they did their med count at least. If and when this was done is seems they would have notified you and the dr.

I'm in VA and everything is automated, a report goes out at the end of each month to DEA from pharmacies, from drs., to drs from pharmacies. Lots of cross checking. Here when a prescription is written it gets automatically "queued" up at all the pharmacies then once it's filled it's checked off so it can't be filled twice. I think they started this in 2011.

So that would concern me right off. Cathy

Re: help needed truely unsure what to do
 

Thank you all for the responses!

To answer some of your questions, I tried all of the alternative meds, and had no luck. As far as the pharmacy cathching their mistake, I was never notified until the following month when I went to get my meds filled. The pharmacist told me he had given me the short acting version, and switched me back.

I'm up at a quarter to 7, and have probably gotten two and a half hours of sleep. Which is nothing new. I'm still not sure what I'm going to do. I brought up that the oxycontin wasnt lasting the 12 hours it was supposed to the last time I seen the dr. (About 3 months ago), nothing was changed, or even discused. I guess I'll just bring that up again, and see where it goes.

Thanks again for the replies, and all of your help.

Re: help needed truely unsure what to do
 

As a follow up to that statement, as well as saying this has been a continuing issue for months (reminding that you asked about it months ago), I'd be asking a question such as "What options do we have?".

What specifically have you tried? There may be some options as there are a couple newer meds. I agree that in pain management its annoying to have to play dumb with the doctor, as bringing up a med by name (unless maybe you are saying it worked for you in the past) is considered bad. Best wishes.

Re: help needed truely unsure what to do
 

What do you folks think of methadone? I am not taking much, 2.5mg four times/day. Hope to not need it after my next surgery in a couple weeks, but not optimistic.

Re: help needed truely unsure what to do
 

Methadone is a good pain medication, when taken properly. It is the only opiate that also treats both neuropathic and mechanical pain and it works well for many patients who use it to keep their chronic pain in check. You are at a very low dose and that's one of the good things about methadone is that the doses are frequently much lower than they would be on other opiates.
Just remember, like any opiate , when you are ready to stop taking it, work with your doctor to come up with a tapering plan to allow your body to adjust slowly to the titration of the medication.
Good luck with your surgery, hope it all turns out well.
Back

Re: help needed truely unsure what to do
 

I have an appt with him next week. I don't know what will happen with the post op situation, whether i could just stop and replace it with the post op course of the typical oxys then go from there. Assuming the surgery even helps relieve the pain. The methadone is ok, and i did not really want to increase it because of the surgery. I started in december, adter the max dose of nucynta stopped helping.

Re: help needed truely unsure what to do
 

Well, I figured I'd keep everyone posted that tried to help me out.. I talked to my dr, pretty much tokd him the same thing that I did the last time. That the oxycontin didnt last as long as it was supposed to, and infact was only lasting 8 1/2 - 9 hours if I was lucky... I didnt even bring up the roxycodone. After everyone making the point that the dr would be unlikely to switch me from a long acting med to a short acting (which after thinking about it def makes sense), even if it does seem to work better..

The doc didnt even really say a word about my issue after I brought it up.. Infact, he went started talking about things that had nothing to do with me, my conditions, or my meds.. So I think its time to try and find a new one. So that brings up a few more questions. I want to do everything the right way.. How do I go about this? Do I have to get another referal from my primary doc, or can I just call another pain specialists office and explain the situation??

no34evr, I'm a 100% disabled P&T veteran.. I've actually been seen at the local VA hospitals pain clinic, but went through the same situation shortly after I got out of the Navy.. It was actually ALOT worse though.. Right before I got medically retired, the navy dics had me on two oxy 10 mgs a day, and two percocets a day as well for break through pain. The pain clinic at the VA only wanted to give me 3 vicodin 5mgs a day though.. I'd like to go back to the VA again so it would cut down my medical expenses every month, but I dont want to go through the sane situation.. It didnt make any sense what so ever for them to do that! I was only rated at 40% at that point because the VA had my claim screwed up, which I had to fight them about for 4 years... I'll stop there though because I could write a book about that ordeal.. The reason I brought uo me only being 40% though, could that be the reason they were only trying to give me the vicodins?? I know that seems dumb, but the way the VA is set up crazy, and I could almost see them having guidelines saying that only a certain percentage and above warrents the stronger pain meds..

Any and all help has been appreciated, and will be. Thank you all again.

Re: help needed truely unsure what to do
 

I have no idea how the VA would work as far as pain docs - best course would be to ask, I suppose.

I switched pain docs at one point. Luckily I just called and made an appointment and got in without any trouble. It is a university affiliated hospital's pain management department. WAY better than the private practice I went to. I think he was more interested in doing procedures, and my problem can't be solved with injections.

Re: help needed truely unsure what to do
 

Dear living rock, If I were you I would ask the PM dr face to face again or call & leave a message asking the dr to call me & if i had to give reason i would say pain keeping me awake most of the night. And, I would say to his face or his ear that the oxycontin is not lasting but 16 out of 24 hours & that in that 8 hour period of time that I hurt too much to sleep & it is really an issue now & what can we do to fix it. Going to a new PM dr is too hard, having to wait for the trust to build, etc, I would give my dr another chance before leaving & ask directly what can we do this is affecting my life too much to ignore now.

P.s. Have you ever tried 20mg 3× a day or asked the dr about that option? Of course, they would have to be prescribed that way b/c oxycontin cannot be broken or cut.

Re: help needed truely unsure what to do
 

Living,
When I was considering changing PM doctors, I simply called a few practices around me, making it clear that I was coming to interview/consult with the new doctor regarding my treatment and to see what he thought he might be able to do or not. I knew full well that there was nothing surgically , at that point anyway, or injection wise that he could offer but wanted to meet the doctor, and find out what he thought he would do in my case...it turned out to be a great way to meet the new doctor, spend some time talking with him, gave him a chance to review my records, and I wasn't expecting him to take over my meds so it gave us time to talk-and I got to feel him out, he got to feel me out, go over my condition and go from there...
One of the mistakes that I see often is that a patient goes into a new doctor appointment expecting that the new doctor is one-going to give them prescriptions right off the bat, and two- just follow whatever the patient tells them. I didn't do that, in fact, the first thing that I said to any of the new ones that I interviewed was that, I had a current physician and wasn't happy with the current plan and wanted to see what they would suggest. At the end of the appointments, all reached the same conclusion ,medical management was the only option for me and they all offered to take that on if I wanted them to...it was far more relaxed that way, I didn't have any expectations of going and getting meds that they were not familiar with- I brought copies of my print outs from my pharmacy and all records/reports with me , so we could review them together...so I would do something like that .

Re: help needed truely unsure what to do
 

Great advice/post as to a solid,honest a realistic approach to meeting and hopefully retaining a new PM doctor

Ferd144 :)

Re: help needed truely unsure what to do
 

I agree with that advice. You can ask your primary doctor if there is any other pain specialist they refer to, but most only have one they typically refer to. Likely you will need to search out some options on your own. Schedule some appointments and treat them as interviews. Ask what their long term treatment plan would be for you. That would give you a good idea on their feeling of medication management.

Definitely have your records ready, as you will need to obtain them to give to the new doctor (they cannot request them until you are an established patient, and they need them before that). If you don't want to clue your doctor in that you are thinking of leaving, just ask to pick up a copy of your charts yourself, instead of having them directly sent to a new doctor. That way you can also make copies for multiple doctors, and have a copy for you as well (to review...check if everything is correct).

Be sure not to get any meds from a new doctor until you have notified your old docotr / cancelled any contract you have. Best to have an initial appointment with the doctor, they schedule the next appointment at your next refill date (or maybe the one after that, if its too soon). Then cancel your contract / notify your old doctor between that.

Good idea to find a new doctor as yours does not seem to listen. Its one thing if they do not want to increase your total opiate dose, but they should have some response and action to every question you ask. It can be tough to find a new (good) PM doc, but it should be good in the long run. Best wishes.

Re: help needed truely unsure what to do
 

Thank you all for the quick replies!

I think I'm going to take your advice, and 'interview' new PM docs. I was kind of already thinking I was going to go that route, but I feel a little more comfortable now that I know some of you have tried and were successful. I just want to get back to a life with some normalcy. It sucks that I cant even do the stuff I'd like to be doing with ny daughter (shes 7). I know my life wont ever be what it was 10 years ago, but not being able to function isnt an option either. Its 1am, and I dont see any sleep for me tonight. :(

Thanks again everyone.