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    Old 12-14-2003, 12:36 PM   #1
    khoff
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    Question Pain meds questions, need help?

    I was prescribed percocet 5mg twice daily for pain for continued back problems. I had a nucleoplasty 10/20 but without success or help on my back. I believe the problem to be an annular tear in the disk (L5-S1). It is either chemical irritation of the nucleus leaking or the annular nerve fibers constantly sending pain signals.

    But my question: I have found that I have become tolerant to 5mg where it once was good for 3 hours at a time, now it is an hour at best. I feel I will need to go up to 10mg twice per day soon. So my question is, is this the way it works with pain meds? Do you just keep going up and up until you are at maximum dosages and higher class meds and it doesn't stop until you are tolerant to that too and eventually become addicted?

    Ken

     
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    Old 12-14-2003, 02:27 PM   #2
    Kimberbella
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    Re: Pain meds questions, need help?

    Dear Ken,

    Tolerace is a continued problem for CP patients unfortuatly. When the body becomes used to a continued dose of pain medication, then the effiviness wears off and it needs to be increased. The good side is that it generally takes a while before the body becomes tolerant to a specific dose, in most cases. The down side is-- what your experiencing of course.. that you are not getting the same pain releif as before.

    Percoset is a short acting pain, by that I mean that you will get about 4-5 hours of pain releif- if that. There are longer acting pain meds that you could try, if that was something that you were considering... Oxycontin for example lasts 8 hours (although the packaging says 12 hrs.). MS Contin I beleive is also a long lasting Opid..

    Another thing to consider... perhaps your pain is increasing and thats the reason for the lack of pain releif?

    I hope that you and your doctor will be able to figure this out and you will get the releif you deserve

    Love and Prayers,
    Kim

     
    Old 12-14-2003, 05:38 PM   #3
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    Re: Pain meds questions, need help?

    Kenneth, if people who are dealing with chronic pain only take there pain pills as prescribed by there doctor it is very rare for them to become addicted. They do however become physically dependant on them but addicted and dependant are not the same thing. Addicted is where you are only taking them for the high and dependant is where you need them to function. Kind of like a diabetic needs there insulin. If a chronic pain patient ever gets where they no longer need them then the doctor will usually set them up on a taper program so the withdrawal is not so hard. Also I don't believe there is a ceiling for opiate dosages. The doctors can continue increasing your doses if you do become tolerant which most people eventually do. Hope this info helps some.
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    Old 12-16-2003, 11:22 AM   #4
    mokita
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    Re: Pain meds questions, need help?

    Ken ~

    Just wanted to see how you are, and since I sometimes pop in on PM, saw your post....so, I'll give my opinion.

    I was on hydrocodone 5/500 a long time ago. My back pain progressively became worse, and I found a good PM doc who ran the gamut of testing and, as you know, I'm now sched' for Nucleoplasty 1/9. Since finding the doc, I am on oxycontin 2x/day and percocet 5/325 for BT 3x/day. This is sufficient for me to function semi-normally. I say semi bcuz there are still days that I am in more pain, say 7-9. But, that usually occurs w/ over-activity. Activity that, because of proper medication, I am able to do. Before, I was lucky to do much of anything. Now, I have some of my life back. Do I want to stay on meds? No, ofcourse not. Am I dependant on them? I am sure of it. Hopefully, my nucleoplasty will work and I can begin the taper process mentioned w/in the next year.

    But...you have plenty of room for increases in your medication if you so choose, and you have a doctor that will work w/ you to improve your quality of life. You probably s/b on a longer-acting medication. BTW that will also help w/ emotional ups and downs that can sometimes come w/ short-acting meds.

    Good luck and take care.

    Karen

     
    Old 12-17-2003, 04:39 PM   #5
    BonnieLee
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    Re: Pain meds questions, need help?

    Hi Ken,
    Tolerance is a problem with CP patients. I know I get tolerant very easily which is a very unfortunate thing. I know that in my experience, if my meds aren't working well, then my doc knows that I have become tolerant so he'll adjust the meds. Recently I was on Oxy and Lorcet for breakthrough pain. Now he has put me on Actiq, which works well. It comes as a lollypop and when you have pain you pop one in your mouth.
    If you feel that you are becoming tolerant talk to your doc, he\she will adjust your meds.
    BonnieLee

     
    Old 12-17-2003, 10:00 PM   #6
    lgriffincsa
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    Re: Pain meds questions, need help?

    Quote:
    Originally Posted by kennethhoff
    I was prescribed percocet 5mg twice daily for pain for continued back problems. I had a nucleoplasty 10/20 but without success or help on my back. I believe the problem to be an annular tear in the disk (L5-S1). It is either chemical irritation of the nucleus leaking or the annular nerve fibers constantly sending pain signals.

    But my question: I have found that I have become tolerant to 5mg where it once was good for 3 hours at a time, now it is an hour at best. I feel I will need to go up to 10mg twice per day soon. So my question is, is this the way it works with pain meds? Do you just keep going up and up until you are at maximum dosages and higher class meds and it doesn't stop until you are tolerant to that too and eventually become addicted?

    Ken
    Hello Ken, I suffer from very close to the same problem that you do. I have a a tear at L4/L5, and a bulge at L5/S1. I am currently on Oxycontin 20mg, 2x's per day, with Lorocet + for breakthru pain. I have tried ever since my Dr. put me on this dosage, to convince him that I need an increase. I am not asking for an increase in strength, I need an increase in doseing frequency. Oxycontin only controls my pain to a tolerable level a 5-6, and this is with light or no activity. I dont suffer from what I consider breakthru pain, the Oxycontin only lasts me 8 hours instead of the 12 hours that the company says it does.
    My Dr. wants me to have a 2nd Discogram in 8 months (not in this life time!!!!), followed by Nucleoplasty. I would like to know if this proceedure is very painful? How long did it take you before you could go back to work? Ride in a car? Sit up, or bend over? What odds of sucess did your Dr. give you? Sorry for so many questions, I have to make a desision on this proceedure January 14th, at my next appointment.
    __________________
    1998-Major rear-end colision
    1998-mid2000-Chiropractic care
    2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
    2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
    2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
    2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs.
    08JULY2003-Had Discogram, comfirmed pain comming from L4-L5 disc.Followup confirms tear at L4/L5, leaking and pushing on a nerve.
    JULY2003-Duragesic patch, had allergic reaction, switched to Norco. Norco provides no releif. Dr. wants me to have IDET. NOPE!!
    14AUG2003- New PM Dr. switched me to Oxycontin, 20mg/2x a day.
    Lorocet+ 2x per day, no releif. Need 3x/day Oxycontin, or ESI's to start to help.
    EMG says severe nerve irritation in lower back. Shows legs ok.
    06SEPT03-Severe butt/leg/foot pain, suddenly while driveing, feels like constant electrial shock, I am worried about symptom change.
    Sept.12,2003-ESI, no releif.
    Oct.6,2003-ESI, no releif.
    Oct.20,2003-Caudal epidural steroid injection. Provided @ 20% reduction in back pain. Nuccloplasty suggested by Dr. if Caudal fails.
    Surgery is NOT an option at this time, due to meds working good (better with 3x/day doseing), long recovery time, possible failure/ need to have surgery again in a few years due to DDD.

     
    Old 12-18-2003, 04:46 AM   #7
    mokita
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    Re: Pain meds questions, need help?

    Bonnie,

    Hello! I am scheduled for Nucleoplasty on 1/9 due to tear @ L4-L5. Am on oxy 20mg 2x/day and Percocet for BT. I'm doing ok on this dosing...am able to do much more than I was on 10mg but it doesn't 'take away' my pain...just makes it easier for me to have a life and 'deal' w/ the pain.

    There is alot of info on Nucleoplasty in the Back Problems section of the site. If you just do a search on the word, you will get all kinds of info, experiences, recovery time-frames, etc over there! Good luck!

    Karen

     
    Old 12-18-2003, 06:26 AM   #8
    forensicgirl
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    Re: Pain meds questions, need help?

    Quote:
    Originally Posted by kennethhoff
    I was prescribed percocet 5mg twice daily for pain for continued back problems. I had a nucleoplasty 10/20 but without success or help on my back. I believe the problem to be an annular tear in the disk (L5-S1). It is either chemical irritation of the nucleus leaking or the annular nerve fibers constantly sending pain signals.

    But my question: I have found that I have become tolerant to 5mg where it once was good for 3 hours at a time, now it is an hour at best. I feel I will need to go up to 10mg twice per day soon. So my question is, is this the way it works with pain meds? Do you just keep going up and up until you are at maximum dosages and higher class meds and it doesn't stop until you are tolerant to that too and eventually become addicted?

    Ken
    Ken I know exactly what you are going through, I am in the same boat. I have pelvic congestion (vein in the pelvis gets blocked with blood) it is very painful and I am currently waiting to have a vein embolization which I'm hoping will work. I see a pain management doctor and he also started me on percocet, but like yourself they stopped working so he switched me to oxycontin and percocet for breakthrough pain. The only problem is I got really sick on the oxycontin, so he put me on a fentanyl patch 50mcg which works really good but the percocet is still not helping with breakthrough. I actually wrote to a doctor about this and he said to stop taking the percocet if it's not working because of all the tylenol in it could cause liver problems so he gave me a list of pain meds. These he said are good for breakthrough, but it sounds like you really need something long acting like oxycontin or fentanyl, but here is what he said, actiq, roxycodone, oxy IR, and liquid roxycodone hope this helps and hope you can get some relief.
    Good-luck,
    Debbie

    Last edited by forensicgirl; 12-18-2003 at 06:29 AM.

     
    Old 12-18-2003, 07:52 AM   #9
    khoff
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    Re: Pain meds questions, need help?

    Thank you all for your advice so far.

    Lgriffinsca - I have done so much research and have had experience first hand in the past year with all this that I feel I know more than the docs.
    Before I had the nucleoplasty on 10/20 this year, I did 10 months of research on knowing everything about the procedure, my doc, etc ..... I even called the makers (Arthrocare) of the PercDwand that is used in nucleoplasty and talked with their medical director. They are very specific that nucleo is for "contained herniations" only. They make no claims to healing tears of any kind. Some docs will make you believe that it will work, but nucleo is decompression of the nucleus material that is presumed to be pressing on an exiting nerve root, and not healing of tears. Tears hurt for one of two main reasons, chemical irritation and inflammation of the surround nerves and epidural space, and/or all the nerves present in the annulus itself causing pain. I am still glad I took the chance because I would have never known and always questioned whether it could have worked. Mine helped a bit with the sciatica, but my pain is from a tear in L5-s1.
    Over many years I have had P/T, anti-inflammatories, epidurals, now percocet, and still I just manage the pain.
    I saw some orthpedic surgeons and they told me straight out, if you have tried all this and more over many months/years and it still does not respond to treatment, you either learn to live and manage the pain, or have surgery. Funny though, the orth surgeons say don't have fusion. It is a 50/50 chance, and most people end up having more surgeries in the next 5 years due to the stress it puts on disks at the adjacent levels. Good orthos are thinking about Artificial disc replacement. Problem for most of us is it is still in clinical trials, and not FDA approved yet. The three main makers of ADR are prodic, charite, and maverick. Most agree that ADR will be FDA approved by end of 2004, beginning of 2005.
    I have looked at IDET (terrible results there), laser endoscopic discetomy, and other options which are still not clinically truly proven.
    The real fact is, tears in the annulus do not heal on their own. They get no blood supply, no nutrients, etc...
    So for me, my plan is now to get the rest of my body (legs, stomach, back muscles, etc..) as strong as possible, continue with epidurals every 3/4 months, pain meds, etc... and try to last until ADR is approved. If I cannot hold out, I will try to get into a clinical trial.
    My pain level is at a 4/5 every day from morning til night, but I learn to tolerate it, exercise, and use percocet for now until I can discuss this with my pain doc.
    What other options do we have?
    If you need any back, nucleo or other help, just let me know and I'll be glad to answer any questions you have.
    Nucleo recovery is different for everyone, but for me it was more difficult than I thought it would be. The literature and hype says hey, 2/3 weeks you'll be back to work. I would plan more like 2 months and that is just to get to P/T. It all depends how bad you disc were to begin with.
    I wish I had more "real info" going in. I think my expectations would have been more realistic. Nucleo is not a panacea, just another shot at ending or lessening the pain.
    Hope you, and you too Karen, are doing well today, and have as much peace as you are able too.

    Ken

     
    Old 12-19-2003, 01:33 AM   #10
    inthezone
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    Re: Pain meds questions, need help?

    Way to go Ken, Debbie, and everyone else that takes the time. To many people just listen to what a doctor , PN, or other type of person tells them and then complains later that they didn't know. I applaud you for taking the time to learn these things for yourself, before having them done. Not everybody has the ability to understand the subject of medicine, but even less even try, when it's their own body that is going to have something done to it.

    If you let them a doctor will treat you like a 10 yr old (you know what I mean) and act like you don't have the ability to understand what he is telling you, so just trust him to do the right thing. There are a million messed up patients out there that had the RIGHT thing done to them. I will not even take a new pill my trusted (and I don't trust many) doctor gave me to take until I have personally read the prescribing information. If you don't understand what the doctor is telling you then ask him to explain it again, and as many times as it takes until you understand it yourself, cause if he can't explain it to you, how well does he understand it himself.

    To many people want to blame the doctor, pharmacist, of drug company when they wind up with a problem when it was their own fault because they had the ability to understand, but were to lazy to bother to check it out for themselves.

    Keep up the good work Ken, Debbie, and everyone else, after all "it's your body".

    Last edited by inthezone; 12-19-2003 at 01:39 AM.

     
    Old 12-19-2003, 03:57 AM   #11
    mokita
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    Re: Pain meds questions, need help?

    Ken,

    I hope that you can hold out 'til the ADR starts here. Ihave a friend that just got back from Germany where she had it done, and is doing quite well!

    I've said it before, it's very nice of you to be offering your knowledge from experience w/ the nucleoplasty to others considering it. Even if medical jargon is difficult to understand, if someone is really searching for answers, they will find this place. It's how I found HB ~ by doing searches on procedures, and Voila!

    I really hope you can get something that better manages your pain than just perc, like a long-acting med. I think you would find that the wait for ADR wouldn't be so grueling.

    Take care.

    Karen

    ps (hi Griff!)

     
    Old 12-22-2003, 01:13 AM   #12
    lgriffincsa
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    Re: Pain meds questions, need help?

    Wow Ken, you have really done your research, good for you! I have learned more from reading your little paragraph than all the medical "double-speak" that my Dr. has been giving me for the past 5-6 months. Thank you for taking the time to do the research on your own, and thanks for taking the time to share your knowlege with all of us. I wish you the best, and good luck waiting for the ADR to be approved. I truely hope that this becomes an option for you, myself, and anyone else out there who is suffering.
    Karen, hey, long time no talk. I am sorry I have become more of a lurker than a poster lately, but I am glad to see you are still here and doing somewhat better. Take care.
    __________________
    1998-Major rear-end colision
    1998-mid2000-Chiropractic care
    2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
    2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
    2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
    2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs.
    08JULY2003-Had Discogram, comfirmed pain comming from L4-L5 disc.Followup confirms tear at L4/L5, leaking and pushing on a nerve.
    JULY2003-Duragesic patch, had allergic reaction, switched to Norco. Norco provides no releif. Dr. wants me to have IDET. NOPE!!
    14AUG2003- New PM Dr. switched me to Oxycontin, 20mg/2x a day.
    Lorocet+ 2x per day, no releif. Need 3x/day Oxycontin, or ESI's to start to help.
    EMG says severe nerve irritation in lower back. Shows legs ok.
    06SEPT03-Severe butt/leg/foot pain, suddenly while driveing, feels like constant electrial shock, I am worried about symptom change.
    Sept.12,2003-ESI, no releif.
    Oct.6,2003-ESI, no releif.
    Oct.20,2003-Caudal epidural steroid injection. Provided @ 20% reduction in back pain. Nuccloplasty suggested by Dr. if Caudal fails.
    Surgery is NOT an option at this time, due to meds working good (better with 3x/day doseing), long recovery time, possible failure/ need to have surgery again in a few years due to DDD.

     
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