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    Old 04-14-2013, 07:18 AM   #1
    cspineguy
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    Another bad night

    Oh sleep how you evade me

    So had another restless night. Such pain and couldn't get comfortable to really sleep. And there are is only so much muscle relaxers will do. I've told my pain center I have trouble sleeping and the long acting MS Contin doesn't cut it. It does do better then Oxycotin, which was like taking nothing at all, but still have so many restless nights.
    So what they have told me is take some more zanaflex to get back to sleep. I take it everyevey night to fall asleep. But it only works for a few hours and then I am up again!
    This is one area where I have issues with my pain clinic. They keep hopping on the long acting pain meds, but they don't work on me. They don't last and after a few hours I am in pain. I have even asked to move to just having two oxicondons at night, but they won't go for it.
    I have an appointment this week and really have to get my point across, as aside from the sleeping issue, I am in pain all day. The oxy only gives me about three hours relief and I feel I don't stay on top of the pain. I end up suffering for an hour until I can take my next dose and then the wait for it to take effect is awful. Again, have to get this across to them this week.
    One thing I am thinking of doing is if I don't get good results, as it is the nurse practitioner who prescribes the medications, then I need to talk to the doctor. I feel enough is enough! I have been going to this place since last June. Every visit the first question they ask when they take my vitals is do you feel the medication you are taking is adequately helping your pain. Of course I always say no, but still get no results.
    In their defense they have tried other things to help, morphine, fentanal patches, and recently Nucynta. Out of everything I have tried Oxycondon helps the most. Nothing totally takes my pain away, but it gives me the best relief. Just need to get the right dose and for some reason the NP doesn't seem to want to increase it. I am on 15mg 4x's a day, which I don't feel is all that much.
    Oh well, we'll have to see what Thursday brings.

    So one thing I wanted to ask everyone out there out of fun and curiosity was what do you when you can't sleep? What helps to at least relax you and help you to get some rest?
    For me it's movies. I'll put on a movie I have seen a million times so I don't feel I need to pay attention and can try to dose to it. I have a set list that I call my "soft kitties" (term from the tv show the Big Bang Theory). They are the 40 Year Old Virgin, The Hangerover and Big Daddy.
    We'll enough babble for now, hope everyone is have a better pain day

     
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    Old 04-14-2013, 09:17 AM   #2
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    Re: Another bad night

    Hi c spine, Im trying to get the meds you are taking straight because i got a little confused when you listed those that have been tried. Currently, you are taking MS conti for long acting & oxycodone for bt, right? MS contin is it a tablet or capsile & how long does it last? Supposed to last how long? Avinza or kadien is all my dr will prescribe considering continuous release ms,, because he believes that these 2 last the full time they are supposed to last 24 or 12 hours. I had the sleeping problem until my dr rx'd trazadone for sleep only, with fentanyl patches & msir for bt. I hope that the DR can work with you to correct this problem!

    Last edited by gmak; 04-14-2013 at 10:40 AM. Reason: clarification

     
    Old 04-14-2013, 10:03 AM   #3
    cspineguy
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    Quote:
    Originally Posted by gmak View Post
    Hi c spine, Im trying to get the meds you are taking straight because i got a little confused when you listed those that have been tried. Currently, you are taking MS conti for long acting & oxycodone for bt, right? MS contin is it a tablet or capsile & how long does it last? Supposed to last how long? Avinza or kadien is all my dr will prescribe, because he believes that these 2 last the full time they are supposed to last 24 or 12 hours. I had the sleeping problem until my dr rx'd trazadone for sleep only with fentanyl patches & msir for bt. I hope that the DR can work with you to correct this problem!
    Hi Gmak,
    I take MS Contin extended release at night. This is supposed to last me thru the night, but some nights I wake up after a couple hours and have to take zanaflex to knock myself out.
    Some nights I am up in pain at 3 or 4 and lie their in pain till I have to get up, as if I take it too early I would be messed up the rest of the day. This is one of my problems.
    The other is I take oxycondon immediate release during the day. But they only last about three hours and I don't get enough for the entire day. By that 3rd hour I am in so much pain.
    Hopefully the doctors can work out something so I don't have to suffer. I understand about over drugging and I don't want to do that, but I don't feel I should have to be in suffering pain.

    Thanks

     
    Old 04-14-2013, 10:15 AM   #4
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    Re: Another bad night

    Sorry you are struggling. You definitely need to be seeing the doctor, not the NP, if your treatment isn't working for you. Sounds like you need a longer acting med than Oxycontin or MS Contin, both of which are known to be some of the shorter acting long acting meds. Something like Avinza, Exalgo, or fentanyl patches. Sounds like they may have not titrated the other meds you trialed to the ideal dose for you.

    They are unlikely to switch you form a long acting med to a short acting med, even for night, as they are more likely to be abused, and its counter intuitive that the long acting med isn't lasting long enough so you want a short acting one. But since you have the breakthrough med four times a day, do you then just take a dose of that with your nightly MS Contin dose, and does that help?

    If the breakthrough med dose is inadequate, you may also want to discuss that. One idea they may bring up is to prescribe it as 1-2 of the 15mg Oxycodone tabs at a time, but keep it at four pills a day. Having four doses of breakthrough a day is actually quite generous, and not all that well advised.

    If you take all four doses every day, that is around the clock (as Oxycodone is typically prescribed every 6 hours), and therefore it won't work so well for actual breakthough, as it is essentially part of the daily dose. If a patient needs a breakthrough med four times a day, that can be a sign the long acting med dose is inadequate (or the patient is aiming for too much pain relief).

    Often patients need a higher (or lower) dose on a different med than the conversion may say. Also, have you had a sleep study? You want to rule out anything in addition to the pain waking you up. They test for more than sleep apnea, but ruling out sleep apnea for folks on opiates can be important, as sometimes opiates suppress your breathing, and that is only recognizable at night.

    Another option if you still have issues waking up during the night after your pain meds are optimized is adding in something specific for sleep. Similar to the Zanaflex. You may want to discuss with your doctor if taking Melatonin at night would be safe for you. There are also some adjunct meds for pain that could be trialed that can also help sleep.

    If your clinic isn't taking any action when you say your pain relief is inadequate, you may consider finding a new clinic. Talk about your pain goals and ensure they are reasonable...for example, a reasonable goal may be 50% relief, definitely not 100%. I'd interview some, asking what their treatment plan would be for you, while keeping your appointments with the current clinic. Just be sure not to get any meds from them and its ok.

    As for what I do when I have trouble sleeping. I try to keep the same schedule so my body is used to when it is time to go to bed. I spend some time in the evening winding down for bed. Studies show that using tvs and computers in the hours before bed is overstimulating and can lead to trouble falling and staying asleep. Ideally I like to take a warm shower and then read in bed until I start to nod off.

    Similarly, I follow basic sleep hygiene techniques such as avoiding caffeine after midday (and not having too much to begin with). I also take Tizanadine to help fall asleep, but I don't too often have issues with waking up in the middle of the night. What dose do you take? Its possible a higher dose could last you a bit longer.

    Is it obvious you are waking up due to the pain itself, or could you be sleeping lightly and wake up due to something else? If it is possible it is the later, using earplugs and an eyemask could help. Best wishes.
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    Old 04-14-2013, 10:19 AM   #5
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    Re: Another bad night

    Oh wow so you actually only take the MS Contin at night? Sounds like you need a long acting med taken consistently. Taking it only at night doesn't get the full impact of it as a long acting med works best when it is taken often enough to reach steady state in your body. You need to have a heart to heart with your doctor to see if they are willing to listen to your concerns and respond accordingly. Otherwise, its definitely time for a new doctor. Disregard what I said about the Oxycodone for breakthrough then, except that its a poor choice to be taken around the clock due to the ups & downs. It is a short acting med, not for use for chronic pain around the clock.
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    Old 04-14-2013, 10:44 AM   #6
    cspineguy
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    Quote:
    Originally Posted by tortoisegirl View Post
    Oh wow so you actually only take the MS Contin at night? Sounds like you need a long acting med taken consistently. Taking it only at night doesn't get the full impact of it as a long acting med works best when it is taken often enough to reach steady state in your body. You need to have a heart to heart with your doctor to see if they are willing to listen to your concerns and respond accordingly. Otherwise, its definitely time for a new doctor. Disregard what I said about the Oxycodone for breakthrough then, except that its a poor choice to be taken around the clock due to the ups & downs. It is a short acting med, not for use for chronic pain around the clock.
    Hi Tortoisegirl,
    Thanks for all the great advice. The reason for using more of the short acting medications is I had gastric bypass surgery and I really think because os this the long acting medications don't get absorbed as well as, that is why they don't seem to work on me. I did have this talk with the pain clinic and we tried fentenal patches. But this didn't work. I found so little relief from them and was in so much pain while on them. To say I hated them was putting it mildly.
    I do feel it is the pain waking me up and it is keeping me up, as when I have a bad night I am I so much pain and toss and turn and just can't find a comfortable position. And those time I mentioned having to wait to get up before taking my morning medication, well, I lie there in awful pain in tears just wishing it would stop.
    So I guess I will talk with them this week and see what we can do as I really need to get on top of this.

    Thanks again for your advice and kind words. So good to have such kind people on this board willing to help and show their compassion.

     
    Old 04-14-2013, 10:56 AM   #7
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    Re: Another bad night

    Cspine, i dont think i was very clear on above post. My dr wouldnt let me take MSER or MS contin because alot of people have problems with it not lasting the full 8 hours & i was wondering if this might be happening to you. Kadien, which comes in generic is dosed gor 12 hours i think & avinza 24 hours & both are extended release MS as well. Does the MS contin last as long acting during the day, how long is it supposed to last & how long do you think it is lasting?

     
    Old 04-14-2013, 11:12 AM   #8
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    Quote:
    Originally Posted by gmak View Post
    Cspine, i dont think i was very clear on above post. My dr wouldnt let me take MSER or MS contin because alot of people have problems with it not lasting the full 8 hours & i was wondering if this might be happening to you. Kadien, which comes in generic is dosed gor 12 hours i think & avinza 24 hours & both are extended release MS as well. Does the MS contin last as long acting during the day, how long is it supposed to last & how long do you think it is lasting?
    Hi Gmak,
    I only take the MS Contin at night. Originally we tried oxicontin but that never helped. I think the ms is supposed to work for 8-10 hours, but for me it isn't.
    I take oxycondon during the day. We have kept it this way as long acting hasn't helped me. I think it has to do with the fact I had gastric bypass surgery and don't absorb things as well. We did try fentenal patches but that didn't go we'll

     
    Old 04-14-2013, 03:53 PM   #9
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    Re: Another bad night

    My dr thinks that it would be unsafe if i took tablet form of extended release MS & likes the delivery system of the capsule & beads in avinza & kadien because i have so much stomach acid, gastric spasms, dx of zollinger- ellison syndrome, hx of ulcerative colitis , gi system "runs fast" & he thinks i would absorb too fast also. Maybe if you asked your dr about generic kadien instead or avinza the ms would last longer like it did with me. Kadien is 12 hours ,avinxa 24 hours according to my dr.

    Last edited by gmak; 04-14-2013 at 03:57 PM. Reason: typo

     
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    Old 04-14-2013, 07:46 PM   #10
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    Re: Another bad night

    Sorry about your night-time troubles. I started recently receiving Ambien from my Pain doc and it does help at times but I've found something OTC that works almost as well without doing all kinds of stupid stuff I don't remember. It's Benadryl and I can get like 100 capsules at WalMart for around $5, although it's their brand it's all the same. The capsules are 25mg and I take up to 4 at night and the make my eyelids droopy within an hour or so. I'm not necessarily recommending you do the same but try possibly one and see if you don't feel tired. Not getting good sleep is a real problem and I wish you the Best!

     
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    Old 04-15-2013, 12:59 AM   #11
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    Re: Another bad night

    Cspineguy, when you rest your neck on the pillow, do you feel pain?

     
    Old 04-15-2013, 03:58 AM   #12
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    Re: Another bad night

    Quote:
    Originally Posted by nochange View Post
    Cspineguy, when you rest your neck on the pillow, do you feel pain?
    Hi nochange,
    I guess it depends the night. Sometimes it will be my neck, sometimes the shoulders will hurt. I have times where I have to keep turning back and fourth from my back to the side as each will hurt after a while.
    Then sometimes it's my arms. They hurt so much that I can't get comfortable.
    I did get a posturepedic pillow which has helped, as a regular one was awful.

    I always find sleep a challenge and while the zanaflex will help me to fall asleep, it only last a few hours and if I am having issues, I am up again. So it is a vicious circle and how many times can you take the drugs? Especially when it gets close to morning, as if I take it then, I'll have a hard time getting up for work.
    This is the worst time as I just lie their in pain with tears wishing for the clock to move

    One good thing, was so tired yesterday that I went to bed early and had a better night. Only up once and get back to sleep. I think my body was just so exhausted!

    Last edited by cspineguy; 04-15-2013 at 04:02 AM.

     
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    Old 04-15-2013, 06:38 AM   #13
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    Re: Another bad night

    When you lay your neck on the pillow, do you feel your muscles are tight?

    How were you injured?

    Last edited by nochange; 04-15-2013 at 06:38 AM.

     
    Old 04-15-2013, 04:51 PM   #14
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    Quote:
    Originally Posted by nochange View Post
    When you lay your neck on the pillow, do you feel your muscles are tight?

    How were you injured?
    I don't think they are tight. More sore. The other problem is I have nerve damage so I get pain all the way down my arms. When this acts up it will cause a restless night.
    Their was no injury. They found by accident in an MRI (treatment I was getting for headaches), that I had herniated disks and a condition known as OPLL (ossification of prosterior longitudinal ligament) which is the hardening of the ligaments and in my case was pressing on my spinal cord. They don't know why this happened, accept that it is a often found genetically in Asian descent, which I am half.
    I guess I just lucked out!

     
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    Old 04-15-2013, 06:52 PM   #15
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    Re: Another bad night

    One of my friends had OPLL but the NS said it was because he balanced & carried central air conditioners on top of his head while climbing into attics for 30+ years! He had no symptoms but only said he had a constant migraine!

     
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