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roadiez 05-11-2014 09:34 PM

Swapping from Hydro to MS Cotin
I just went & seen my PM Doc & as usual I only seen a nurse for vitals & med review, The she asks is there anything you would like to discuss today with the PM or the PA? I said yes I would like to inquire about the "Very severe pain" I am having lately. She said do you mean regular pain or something for the "Breakthough Pain" I said honestly both.
Well here comes the PA jumping from end to end for over exerting myself. I said I had to because no one else was around to help out.
So she said to me what about a medicine change? I said what do you mean? She continues to go on & says that what if we change you from "Hydrocodone 10/325 6x to MS Cotin 30mg x2". I said up to you.... Although I knew this would be coming up soon anyways with all of the hoopla about the "Too much acetaminophen in the news over the last 6 months to a year now. She did give me a choice of the "IR or CR" I chose the CR.

So here I am with a new pain med. But nothing for a "Breakthrough Medicine" Has anyone had better luck with the MS Cotin? Does the MS Cotin control the pain levels better or worse? Or should I have stayed with the hydrocodone?

Just needing some insight. I get my Rx filled tomorrow morning. Am worried with what I read online from different sites & the manufacturers sites saying patient my be overseen the first 24 to 72 hours for "fatal respiratory depression"... That has me worried out the rear big time! I have never had any issues with any meds & such. But you never know.

tortoisegirl 05-12-2014 05:14 AM

Re: Swapping from Hydro to MS Cotin
I hope you do well on this new medication. It varies so much person to person, so its only a guess whether it will be a good med for you. The change from short to long acting is a good idea for constant chronic pain which hasn't responded to other treatments, and patients typically get much smoother pain relief.

The risk of respiratory depression is quite low when converting a low dose of an opiate to a low dose of another opiate in a non-compromised patient. I wouldn't take any precautions besides double checking with your pharmacist and/or online that the dose is a reasonable conversion, and to take the medication for the first time when someone else is home, and not directly before bed (so you can be monitored).

There is a lot of variability and they start conservative to be safe, so don't be surprised if a conversion table said this was half of what you'd be expected to just want to verify your doctor didn't completely mess up and give you something triple the strength for example.

I wouldn't be concerned about what you read. That risk is more geared towards for example elderly patients with respiratory problems on high opiate doses at the end of their life.

However, with any pain med switch, I think its important to keep an eye on how you are feeling, look for signs of potential withdrawal (which include anxiety, diarrhea, nausea, muscle aches, runny nose, insomnia, sweating, & yawning) vs. signs of potential overdose (including excessive sedation and shallow breathing) vs. serious side effects, and contacting your doctor right away with concerns in those areas.

Similarly, if your pain is still out of control after for example a week on the new medication, that would be a reasonable time to call and ask for an earlier follow up. Its likely the dosing frequency can be increased from 2 to 3 times a day, and the dose increased if needed (they typically start very conservatively when converting to a new opiate as cross-tolerance is variable).

They typically wouldn't start someone on a new long & short acting meds at the same time, since its much easier to evaluate the effects of one med, and the risk of over-medication is lower. Since you were converted from short to long, if you end up having significant breakthrough pain, once the long acting med is stabilized, they may add in a short acting med. It depends on the practice though (some seem to be doing away with that, while some give enough to take around the clock, and others give a few doses a week). Best wishes.

navy1987 05-12-2014 08:54 AM

Re: Swapping from Hydro to MS Cotin
Hi roadiez, how are the meds going? i had a change last week to ms contin 15mg er x2 a day. I have break through meds too. and started taking them and still need the break through meds. I see the PM in a couple weeks. i feel stuck and its hard to complain. I hope you are doing well. navy 1987

LUPUS, L3-S1 surgery x2, cervical fusion, spinal cord stim.

WhistleDixie 05-12-2014 09:51 AM

Re: Swapping from Hydro to MS Cotin
Hey there...I empathize with your concerns with your pain management meds. I also share your need for "insight" as I continue to STRUGGLE with drug trials. I started PM in January of this year, but have yet to find relief to ANY degree. My doctor from day one wanted me on Fentanyl patch, but I can't afford it. We've tried Methadone (because it's cheap and so effective for some w/chronic pain) Morphine ER (had potential, but dosage would have required major increase---constipation and danger of obstruction ended that) Oxycodone 15 mg 3xday currently since 4/17. The Oxycodone has given back my mental clarity, but frankly does not TOUCH my pain. I contacted my PM doctor 1.5 weeks into Oxycodone, but he refused increase and insisted I ride it out until my May 15 appointment. I am dreading Thursday because he does not seem "fully invested" in my treatment. He has told me that there are life-changing meds now available, but they are expensive and beyond my grasp with no prescription coverage. Good God, that's tough to hear as an American citizen in 2014.

I don't want to hijack your thread by any means. I just wanted to say that I can relate to your issues. I just feel SO ALONE and TRAPPED in a body that has betrayed me. The medical community seems to have deemed me "unprofitable" and therefore not worthy of proper treatment. I make too much money (ha) to qualify for assistance and too little to AFFORD "life-changing meds".

I am sweating profusely through my bed linens nightly...worse than menopausal night sweats EVER were...soaking through to the mattress. Is this withdrawal?


navy1987 05-12-2014 02:02 PM

Re: Swapping from Hydro to MS Cotin
My heart goes out to everyone on this thread. Whistle Dixie, i'm so sorry that you are in pain. Pain has taken over my life since 2009. I went on a plane ride for 13 hours and now 4 spinal surgeries later, I'm still in pain. I have Lupus and the md's and pm say that it has a lot to do with it. I know how hard it is to get your PM doc to understand and I think I would faint if they seem to care. I know that they see so many patients. But, I do have uncontrollable pain. I too just want help. How do we really talk to our doctors. How do we make them understand???
I pray for everyone on this thread to have support and comfort.
navy 1987
LUPUS, lumbar and cervical surgery

roadiez 05-12-2014 09:49 PM

Re: Swapping from Hydro to MS Cotin
Well I started them this morning.... MS Cotin 30x2.
I can also see why the PA swapped me to a non-apap medicine as well. But I asked for in the first place was for a Breakthrough Med. I didn't get that. So I am in the same place, just a different pill now.

I am glad that I was offered the choice of an immediate release or the extended release med. It is a start to try & control the pain.

I did have to go in to my PM today because the Pharmacist was alerted to the Morphine & Gabapentin alert. It is possible for the MS Cotin to amplify the effects of the Gab.

I still have lot's of pain. I have had 2 doses so far. I am seeing a little bit of difference. I only got my STABBING(level 8 or 9) pain 3 or 4 times today. But the constant ache/pain(4-6) is there constantly. Heat & ice failed, so did the hot shower. I can't prop my head with a pillow(too much pressure), my hand in a thinking pose(severe stab) or find a comfortable position looking at the laptop. I am constantly repositioning to lessen the aching.

I am going to give it a solid 2 weeks worth of trying before I honestly say "Yes or No".

I would like to thank all of you who wished me well & who are in severe pain I do whish them a good nights rest at least once in a while so you can enjoy a day with your friends & loved ones.

navy1987 05-14-2014 02:17 PM

Re: Swapping from Hydro to MS Cotin
Hi, I'm glad to hear you are getting some relief. It is so difficult for a pain patient. With all the laws and rules. When you suffer, it is hard. I'm praying and sending good wishes to you.

Lupus, spinal surgery x3 and spinal cord stim.

roadiez 06-05-2014 09:04 AM

Re: Swapping from Hydro to MS Cotin
Well I have been on the Morphine for close to 4 weeks now. I am getting very little sleep since I went on it. I even tried to go 24 hours without taking any pain reliever. Guess what. I actually slept more than 2-4 hours at a time.

I did call my PM yesterday. No call back yet. But will try again later today. I am going to try and go back to the Hydrocodone! At least with taking that I did sleep through out the night. My mother had a similar instance when she was put on Oxycotin for a month to try & get her off of the Hydrocodone. She didn't sleep either & was up forever too.

Anyone else have these issues with their pain meds?

Also I have found out what some of my pain is from... I have 2 broken screws at mid-shaft in my T1

BB07 06-05-2014 01:50 PM

Re: Swapping from Hydro to MS Cotin

You are tring to do the reverse of what you really should try-I would suggest that the mscontins are not lasting-long enough. You may need an increase in your base line(long acting med)either up to 3 times a day and/or an out right increase. You also need a break-thru med to go along with the extended release ms contin-DO NOT outright ask to be switched bak to the hydro. That would be a huge mistake.imho. You will find that once your blood levels even out with the right amount of the ms contin-then when you have those attacks of BT pain-they(the hydro or whatever is rx'd for break-through pain-you will find work much better. You once your blood levels of the LA med stabilize, when or if you have true BT pain-it will work better-you wont feel it "kick in" because you do have some level of opiate/opioid tolerance-but believe me it is working quietly in the background-and because BT meds release immediately-it works really well with your LA med, when such an episode, calls for you to take the IR/bt med.

That has been my experience, and hope it works the same for you.

I hope this makes sense to you. When I was on MScontin ER, I didn't level out with decent relief until I was at 100mg, taking it 3 times a day, and I was rx'd oxycodone for BT pain, and it worked out very well for me. By decent relief I mean I was getting 40-50% relief, most of the time and I was ecstatic! which is also considered excellent results in pain management.

But, as you know everyone is different, but it is still trial and error, and once the dosage that helps you the most is established- it seems really worth all the trial and error-but it will be happen, but you must be patient. 2weeks is a little long when you are suffering, I think after a week, is long enough to know the dose your at is helping or not yet-it's not a perfect system, but at least you know you are getting somewhere. You just need to be vigilant and let PM know your status-if you are having super unreasonable suffering-and it's been a week-clearly it is time to make an adjustment. Even 3-4 days of constant and/or increasing pain at this dose would be long enough for me to know the MS contin ER needs an adjustment.

Most folks need an immediate release/BT med-since you were using the hydro-I don't know how effective it would be for BT-but I would ask your PM if you could have an immediate release med for BT-let him suggest to you which one he would want you to use. That is if he believes a bt med is necessary, some PM's don't.

I have severe low back injury- and it radiates down my leg, an the worst is when my sciatic nerve becomes inflamed, it is a terrible pain, if you know what I mean and sometimes I really need that immediate release(bt)med, it really makes a difference in my case. But I can attest that when my LA med, taken as prescribed, is working well, and I do get an attack of BT pain, and for some reason, it usually happens at night=I take the one BT med, as prescribed=it really helps me and dampens that attack down pretty well.

Good Luck

navy1987 06-05-2014 04:19 PM

Re: Swapping from Hydro to MS Cotin
HI everybody, roadiez, hope your meds are working . i changed to ms contin first and no relief at all and then the fentanyl patch about a week ago, so i did get a small relief and they increased to get to a level that i can stop taking so much break thru med. It is so different with everyone. my lower back is at a 10 all day. it sucks when you watch the clock for your break thru med. talking to your guys helps so much. i know that you understand. thank you

navy 1987 Lupus, lumbar surgery x2, cervical fusion, multi blocks,

roadiez 06-05-2014 06:41 PM

Re: Swapping from Hydro to MS Cotin
Okay, let me kinda explain all of this to you. I no longer see the Dr. at the Pain Management Clinic anymore. I see the Physicians Assistant now because the PM Dr. said he can't really do anything else for me now except to try & control my pain at a decent level for me so I was switched over to see the PA from here on out.

The reason he has said that is because he referred me to a Ortho-surgeon & Neurosurgeon & they performed 2 cervical surgeries on me April 9th & 12th, 2013.

And now it's come to light with a CT Scan I have at the T1 level 2 broken screws in the middle of the shafts! I can't believe this at all. How does titanium snap?

The reason I was swapped out for the MS Cotin was because I asked for a break-thru med to start with.

I told the nurse that I was having severe pain at times & she said "You mean for a Break-Thru Medication?" I said yes. Well the PA came in & said that she couldn't up my dose of hydrocodone & said that she wanted to switch me out to the morphine & she left it up to me whether to be the ER or the IR. I told her that I wanted the ER because I needed it to last the whole time & not short acting like the Hydro.... Well that's what I was hoping for at least.

But what I am at is still having same pains as the Hydro. Just now I am not getting any sleep longer than 4 hours tops. At least with the Hydro I could sleep 6-8 hours most nights with the combination of my meds.
I don't know even when I go back in there that the PA will even do something then. It's to the point I can't even mow the yard without being in so much pain that I am taking an extra 1/2 or whole pill & well you know where that will lead you...

I know that I am probably going at this the wrong way that's why I posted it. I was really hoping for some good input & you guys have helped me.

I am just at my whit's end right now & I still have to wait until June 19th to get into the PM clinic.

I am going to try & have my wife go with me this time. That way maybe she can help me explain to the PA what my problem is. Whether the PA can up the MS Cotin & actually give me a "BT" med. Or just something period. I am so exhausted. I am tired. But yet I can't fall asleep.

Sorry for just rambling on & on.

BB07 06-06-2014 08:15 AM

Re: Swapping from Hydro to MS Cotin
have you been referred at all yet to a neurologist for a sleep study? If not, take your sleep issue more seriously and asked to be referred to a neurologist for a sleep study-They can help you with the sleep issue, perhaps-If you find a really good competent one.

Good luck

navy1987 06-09-2014 07:14 AM

Re: Swapping from Hydro to MS Cotin
Roadiez, i know this is difficult and painful. being in pain in endless. the md sends you to a PM and then they send to surgeon. the surgeon sends you back to the PM when they get done. the regular md says he cant do anything and you need the PM. we are at the mercy of the PM's. It is a good idea to bring your wife. I bring my husband to each appt. and it helps. he tells the PM how bad my pain is. how i cant do anything or sleep. even last night, i was up for hours crying in pain. the PM has to know this and take you serious. the problem::::: so many people try to get medication. however, you have proof: ct and testing to show you have a pain issue. that is good. right now i'm working with the PM to get the pain under control again. so I pray that they will listen. and yeah. i wouldn't bring up even mowing the grass. its crazy but the smallest thing . or at least at my PM's. they would say, oh you felt good enough to mow grass? i know it sounds crazy. but they don't see us for who we are, they see hundreds of patients and it is not an excuse. they should see us for who we are. in a perfect world. I give you support and hope everything works out.
navy1987 Lupus, spinal lumbar surgery x2 , cervical fusion, spinal cord stim.

roadiez 06-26-2014 04:07 PM

Re: Swapping from Hydro to MS Cotin
Well I went last week to my PM. She didn't like the results either that I was getting as well. I just could not sleep & my pain wasn't controlled as well. Just like the Hydrocodone. So I was swapped to Percocet on my next Rx fill date. She said it should control the pain a little bit better & takes effect quicker.

I was on Percocet last year after my 2 surgeries in April. I did notice that it did kick in faster to provide relief. But also it wore off a little bit sooner as well. So I am fortunate that she kept the strengths the same as the Hydocodone 10mg/325 x6. So that is a plus for me. I still didn't get my break thru meds. But I do hope this helps for a while. I was also hoping for a Lidoderm patch. I have a definite yes on my 2 broken screws in my T1 area. But all other areas C4-C7 anterior fused and C4-C7 fused. I also see that my C3 vertebrae is slipping onto my plates so I am sure those plates are coming out soon. The T1 posterior well that is a different can of worms. Unopened & not sure what will happen or what will be the Neuro & Ortho Surgeons meetings next week.

Thank you all who answered me & I will continue to give some updates on my meds & neck.

Shoreline 07-01-2014 04:57 AM

Re: Swapping from Hydro to MS Cotin
Hi Roadiez, Bt medication is generally a short acting med when the long acting med isn't covering your pain. When your taking short acting meds around the clock, prescribing additional short acting meds when you are alrerady taking shoret acting meds is going to through upo red flags to everyone. I really cant imagine a doc prescribing Percocet 10 every 5 hpours and then giving you dilaudfid , Hydro or Morphine for BT. The term doesn't really apply to your current situation. Had they left you on long acting they normal step would have been to increase the long acting m,ed dosage and perhaps give you a couple of doses of a short acting med only to be used when the pain got completely out of hand. Not a second short acting med so that you can make a personal choice as to what med you want to take every 4 hours or an alternate medication. Bt is generally a short acting where you base med is a long acting. Im not sure why they gave up on MScontin and switched you back to all short acting. This creates ups and downs, , highs and lows and you body knows as well as you mind when you waiting to hit that 4th hour to take the next dose. The benefit of long acting medication is so you aren't clock watching and not living your life in 3-4 hour increments. Would it be nice to go 8 - 12 hours and not have to sit around and wait for the next dose before you start you next activity. Its a dangerous scenario in witch you are constantly waiting for the feeling of Ahhh, I go t my meds on board and just felt it kick in. LA meds don't have that kick and if that's what your expecting you probably wont ever be satisfied with any long acting med and will always need excessive BT dosing. With all the LA meds available, although this may seem to work better for now, I cant imagine a legitimate PM doc continuing to treat long term pain with short acting meds, Eventually the short acting wont last 4 hours and you will be on a roller coaster all day and watching the clock all day for the next opportunity to take another pill. That isn't successful pain management, and sets you up for addictive behavior. If a LA med was dosed correctly, you shouldn't need BT meds on any kind of set schedule. The LA med should be doing 90 % of the job and you would only take a short acting med in an emergency situation or after unavoidable increased activity. Once BT meds become part of the daily routine what do you do if you have an accident or slip and fall and need something extra. The something extra is the BT med and if you take the max amount your allowed ever single day, then you really done have anything additional to take if a cold front comes through or you have an increase in pain because your BT meds just becomes part of your daily routine. Most docs limit the doses of BT med to 2 or 3 a day and if you need more they simply increased the long acting med to cover your base pain more effectively. Any doc prescribing 6 doses of BT meds a day is going to raise red flags with the DEA or the state medical board or just some pharmacist. The goal is to make your pain tolerable, not give you a wide variety of short acting meds and allow you to choose the desired strength every 3-4 hours. This would jack your tolerance through the ceiling and you would still be on the same up and down roller coaster every 3-4 hours. Clock watching and reaching for a pill at the very minute your allowed creates a habit that most docs don't want to see in their patient. It leads to abuse and self medication. You are using PM terms but you are using them incorrectly. Your doc really isn't dong you any favors keeping you on that same up and down roller coaster unable to exist outside of a 3 or 4 hour window after which the short acting med wears off. You can have pain relief without feeling a med kick in. IF you only associate relief with that warm fuzzy feeling when a short acting med begins to work, he is setting you up for disaster, a year from now you will be taking 30 mgs of short acting oxy every 4 hours and you will be watching the clock for the next 4 hour dosing time. That will again draw red flags with everyone that knows anything about PM. Long acting meds are used as the base dose and short acting meds are used for occasional increases in pain called BT pain. If you have BT pain every 4 hours the base dose is not effective and should be adjusted. Some docs don't use BT or short acting meds at all and shoot for managing you pain with LA meds entirely, if they can manage it 90 % of the time and drop your pain by 50%, that is considered effective PM. What he is teaching you with short acting meds is not anything that will last, it increases tolerance unnecessarily, the first thing that goes is the duration as far as it lasting 4 hours and then he is setting you up to run out early because you wont be able to exist on 6 doses a day, eventually you will need 3 hour dosing and be taking 2 extra pills a day and then need an increased dose to even last 3 hours.

I do wish you luck but docs do have to follow guidelines and this type of prescribing is only used for acute or post op pain, not chronic pain or as a PM plan. It puts you at risk or abuse or misuse and puts his license on the line which will leave all his patients looking for a doc when his license is snatched with little to no notice for his prescribing practices. Simply giving you what you want or what you think is the best way to manage your pain isn't always the best way to manage CP. IF it was, your GP could write you a script for 180 10 mg percs a month until you need 240 to get through the month and eventually that wont be enough and he will be writing for 15 mg oxy, then 20mg then 30 mg and with each dose increase its just a matter of time until it doesn't last 4 hours any longer. There is no method to this madness and it follows no guidelines in pain management.
Take care and enjoy this short felt relief, it will not last the way long acting meds can. Eventually you wont be able to sleep through the night because you will need to get up every 3-4 hours to take another dose. That is just the nature of short acting meds that you are calling BT meds. Dave

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