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    Old 12-12-2003, 09:22 AM   #1
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    Hydrocodone Pain/VS/withdrawals

    All: I am a 33 Yr old male with adolescent children and an 18 month old. I am currently a network consultant and have to see clients daily. I was hit by a school bus in March of 2003 (This year). I have gone through the barrage of test, 2 ESIs, PT, Chiro, etc. I have harniatation between C5-C6 and C6-C7. I am currenty prescribed 4 Norco 10 a day, Along with Robaxin 750 (useless). The pain in my neck has been increasingly worse the pat 6 weeks and the Hydro (4 a day) is not touching the pain. I have repeadedly told my doctor this but to no avail since they rarely call back. I have run out about three times in this period and have had to go through aprox 2 or 3 days of withdrawals...until my proscription has come in. I can live with the pain while on the meds but the doasge helps less and less as the days go on (Tolerance I guess)The main question is...Do you feel that the 40 mg is adequate (tough generic question) what is the average Hydr dosages you are taking...and I have a Disco sceduled for the end of the month...then on to fussion...after the long will I need the meds (If no problems) and then how long should the withdrwals last?

    Thanks so much...

    May 2003 Car Accident
    June 2003 MRI Herniation at C5 and C6 with impingement
    PT and Chiro since May 2003
    Vicodiin ES for pain

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    Old 12-12-2003, 10:26 AM   #2
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    Re: Hydrocodone Pain/VS/withdrawals

    I can't help you with the surgery issues at all, sorry. I'm not that familiar with Norco but I'm assuming it is a short acting med? Maybe if you could get your doc to put you on a long acting narcotic like Kadian or Oxycontin along with the Norco you would get better relief. I am on 30 mg of extended release morphine in the am and 60 in the pm. I also take 10 mg of pure oxycodone 3 times a day for breakthrough pain. Someone else will be along shortly to help you with the withdrawal questions (again out of my league!!) Just a suggestion but if your doc doesn't want to adequately manage your pain, maybe it's time for a new one?
    Crohn's disease, scoliosis, chronic myofascial pain, migraines, Osteoporosis, Trigeminal Neuralgia.

    Old 12-12-2003, 10:50 AM   #3
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    Re: Hydrocodone Pain/VS/withdrawals

    I have taken norco for many years and have done dosages from 4 per day under the guidence of a GP to 12 per day(which I feel is really to much tylenol to have to take, but that PM doctor would not move up to a Cll drug) under the guidence of a PM doctor. The normal dosage for most patients are 4-6 per day. If you need any more then you need to be moved up to a Cll medication, such as the ones mentioned by the previous post.

    As far as the WD's, I can understand why that is happening. If you don't follow your prescription to the letter, then the doctors will have no mercy on you when you run out early. Which you have done on several occasions. The first thing to learn about pain mangement is to follow the prescriptions directions excatly. If you don't you will find that they will stop filling your scripts at all, and you don't want that.

    If you need more that you are now taking then you MUST get permission from your doctors office first. Which I noticed that you said they have not been returning your call. Just for your information i had to go to three different PM doctors before I finnally found one that I got along with and took proper care of me. This also covered a 2 1/2 yr period of time.


    Old 12-14-2003, 03:48 PM   #4
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    Re: Hydrocodone Pain/VS/withdrawals

    Hi JKIII: I am sorry to hear about your accident. I had a fusion at C5-6 and my fusion shifted and it is now 1/2 in and 1/2 out of spinal canal. All vertebre above this level fell down; I have a great deal of pressure on my neck disks. The C5-6 nerves are "splayed", according to my MRI (splayed means spread apart). Where that fusion is really hurts or it is the disks on either side of the fusion that must take 25% more pressure now that I had to have C5-6 disk removed, as it totally blew out. I have 14 degenerating disks throughout my spine, neck and lumbar are the worse and I have spinal arthritis. I do know your neck pain. My entire neck is hurting. I have been on pain meds since 1999. I take 20 mg oxycontin 3 times per day and about 7-8, 5 mg of percocet. I still feel my neck pain and lumbar pain. I have thoracic problems, too. Will you be having surgery on your neck? This is the level of pain meds I am on, and I weigh abour 110 lbs (was heavier, had gall bladder surgery 11-6-03 and I still feel lousey with my guts all cramped up now!). So, this gives you my pain med level and perhaps you could speak with your doctor about a timed released pain pill along with the short term pill for break through pain (I just take them all the time, as my pain is in permenant break through!) Understand this, once the spine is traumatized, although you may have surgery to free up any nerve impingement, you may still have neck pain. The spine "tweeks" out once it is damaged and the nerves tend to "scream" it is hurting me; however, in reality, no damage is being done in the spine. You MAY still need some pain pills after your surgery. You MAY not. Know this, the longer you stay on the opiates and the more you take, the more difficult it will be to move off of them. You are under a doctor's care and the doctor should slowly wean you off. Ask your doctor (or your surgeon) how they go about weaning you off these pills. They should taper you down properly and it shouldn't be too bad. Take care, Patmg

    Old 12-16-2003, 08:44 AM   #5
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    Re: Hydrocodone Pain/VS/withdrawals

    Hi and sorry to read about your pain. I too suffer from neck pain, not fun. My doc told me I could take up to 6 hydo's #10 a day but no more than that because of the ty. that is in hydo's.
    Good luck and go back to your doc and explain it to her she can up your meds.
    Have a good pain free day
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    Old 12-19-2003, 01:35 PM   #6
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    Re: Hydrocodone Pain/VS/withdrawals

    Hey JK, Norco is a 4 hour med. So which 16 hours did you want relief? That's pretty much the choice your doc has given you.

    One of he major principles of chronic pain management with opiates is that it's easier to keep pain in check than it is to bring a high level of pain down. This requires meds around the clock. Otherwise, you wake up and can bearely move untill the meds start working or you chose to suffer at some other time of day.

    ITZ is absolutely right, the only way to keep a doc is to comply with directions. Being in pain doesn't justify self medication. If it did any of us should have access to as much med as we want. It doesn't work that way. So you except those 60 Long acting meds prescribed 2 times a day to last 30 days. My doc will prescribe a high dose of meds to manage my pain, but if I called and ask for something stronger or permission to take more he would make me come in. If I ran out early he would not give me anything but blood pressure medicine.

    For all he knows, you waited until your speech wasn't slurred and your were not nodding out to make your call. Or you may have taken a weeks supply in 3 days and he may ask you to bring in the remaining pills that don't work.

    They literally want to see the whites of your eyes. They also have to have an up to date chart and documentation to justify the use of opiate meds. I'm talking about pain management docs as well as GP's or surgeons. Each has his own function.

    IF you have ruled out surgery with several opinions then asking to be referred to a pain management doc is a logical request. However not every PM doc believes in the use of opiates. Before OxyContin only a cancer patients would receive a script for morphine or another pure opiate.

    Now we have PM docs for everything and some may use modalities like trigger point injections,TENS, TINS, Acupuncture, PT, ESI's, and Nerve blocks. Other docs will believe in using relaxation techniques like guide imagery,
    Biofeedback, self hypnosis, Chiropractic adjustments.

    Some PM docs will only prescribe mild muscle relaxers and antidepressans. If yo have nerve pain like arm pain from your neck, meds like Neurontin, Toppamax, Lamictyl and all the other anti seizure meds are the treatment dejour for nerve pain.

    Then you have docs that will use long acting opiates like OxyContin, MSContin, other long acting morphine preps or the Duragesic patch and methadone. What most PM docs will agree on, is that a multi faceted approach of medication and lifestyle change and some of the non opiate modalities combined is the best way to treat long term intractable pain.

    Some folks can manage their chronic pain with some of the non opiate methods. There is a treatment for every kind of pain and a different approach to it from every different doc.

    If you need something the only time to ask is when your sitting in front of your doc. It's not likely he will make a med increase over the phone. I's too easy for a drug seeker to just keep calling and complaining. If you are in pain you will make that apt and the doc needs to reevaluate you and chart the changes in your condition. There isn't a stronger med he could call in over the phone.

    I guess he could tell you it's OK to take more but when it comes time for refills, they don't always remember that you were told it was OK, or that he thought you would only use more on the worst days, not every day. Leaving a message and using the phone is a problem waiting to happen.

    They can cut you off at the pharmacy and call your doc just as easily as your doc can stop prescribing. For every prescription, a number of days supply is calculated and some insurance companies won't give you much leeway and some pharmacists won't give you one day early. So compliance is controlled by the doc, the pharmacist and your insurance if you have it.

    If he gives you 40 pills with instructions to take 1 pill every 6 hours, the pharmacist enters a 10 day supply. If you try to refill early a red flag pops up and warns the pharmacist of early refills. He has some ability to over ride things but can't override anything he wants. Your insurance may allow you to fill when you 90% complete but it's sill up to the doc to call it in and up to the pharmacist to push that over ride button if the flag pops up.

    Most Pain management docs that use long acting meds like some of us are on will not make a med change over the phone. They will be more likely to help you if you just say you need to see the doc and need an apt ASAP, rather than leaving messages with nurses.

    I'm not trying to dg you for running out, withdrawal teaches a better lesson than I can. But I did want to try to inform you what pain management is all about.
    Your GP will only prescribe for so long. If your in the care of a surgeon and your not a candidate for surgery, he will only prescribe for so long. Being labeled a drug seeker by some doc along the way is kind of like your initiation into the world of chronic pain. But there is a big difference between seeking pain relief and seeking drugs.

    IT took me 8 years and 3 lumbar surgeries to be offered long acting pain meds. I'm fused rom L1-S1 and I comply to ever word of instruction as not to risk being booted from the practice.

    I have tried or learned every non opiate modality I listed and probably a dozen other methods. It's documented in case anyone ever asks why does Dr X prescribe so much methadone and morphine to me? Because all that's been done didn't help and I was bed ridden before being Put on these meds.

    It's really not that hard to find pain relief these days but there are hoops you will have to jump through and definitely get several surgical opinion. If you can be cured that would be better than the strongest pain med you could find.
    Good luck, Shore

    PS. IF you can tolerate it, you could stretch your pills out. If you have less pain during the day then in the morning or evening, you could break a Norco in half and take it with a couple Ibuprofen for your day time dose, This way at least you have something in you for a longer period of time. That's if your not already taking an anti inflammatory. You don't want to take two different ones. A half a tablet every 3 hours may also work a little better.It's the same as a regular strength Vicodin every 3 hours and may keep things in check. It's OK to adjust your own schedule as long as you are not increasing you daily intake and running out early.

    I think it was twist that asked what Norco is. It's a combination of 10mgs of hydrocodone and 325 of Tylenol. The most potent C111 with the least amount of tylenol

    Old 01-08-2004, 11:01 AM   #7
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    Re: Hydrocodone Pain/VS/withdrawals

    Thanks Shoreline...I had my Disco-Gram two weeks ago, which produced pain at C-4/C-5 and C-6/C-7, and have my appt on the 16th with my Surgeon to discuss options.
    May 2003 Car Accident
    June 2003 MRI Herniation at C5 and C6 with impingement
    PT and Chiro since May 2003
    Vicodiin ES for pain

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