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    Old 03-26-2004, 04:53 PM   #1
    khoff
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    Question Question on pain meds

    All -

    I used to take percocet (10mg/2x) for back pain after a procedure and when it wasn't enough I tried oxycontin (10mg). I found with both these meds, it gives me a dull thinking, unmotivated, memory fog feeling. I am trying to find another med that doesn't do this.
    Has anyone else had this effect on these two meds and is there something else, another med that still lets a person think fairly straight forward?

    Ken

     
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    Old 03-26-2004, 09:08 PM   #2
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    Re: Question on pain meds

    I think you will find that if you are taking narcotics that most will give you some kind of side efects like that, but sometimes and I know with me that after a short period of time taking them you will become more use to them, it does not take long,. You said you took that after a surgery, do you still need to take meds that strong?
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    Old 03-27-2004, 06:12 AM   #3
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    Re: Question on pain meds

    Hey Jen, Cowboy is correct. We noramally become acomadated to the saide effects after prolonged use, After awhaile all you have left is anelgesia.
    FYI, The 10 mg percs [prioduce twice the serum level of a 10mg oxyContin
    A 10 mg oxyC release 5 mgs after about an hour and another 5 at abouytt the 6th hour, where the Percs release all 10 mg in 4 hours.

    Although we do become acomadated, and I have taken meth for years, my head is clearer on morphine, Go figure. We all respond a little different. You might ask you doc to try 15mg MSIR or the longer acting versions of morphine. However most people find morphine more sedating at the initiation of therapy.

    IF your using meds PRN rather than around than around the clock the way long actying meds are intended, acommadation to side effects will take longer.
    Good luck, Shore

     
    Old 03-29-2004, 02:59 PM   #4
    khoff
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    Question Re: Question on pain meds

    Shoreline - What is MSIR (Morphine Sulphate ??????)

    What about Actiq lollipops (never tried that). Any thoughts from those who have?

    Ken

     
    Old 03-31-2004, 05:52 AM   #5
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    Re: Question on pain meds

    Hey Ken, Going from 10mg Percs to any strength of actiq is like going from calf ropeing to bull riding. The strength difference between a 10mg perc and the mildest Actiq pop, the 200mcg, that's micrograms is about 20 fold. Kind of a big step to go from percocet to Aqtiq.

    MSIR is morphine sulfate instant release. Actiq is fast acting but it also has a very short half life, minutes rather than hours. For 6-8 bucks a pop I think I would refer 3-4 hours of BT med= relef rather than an expensive 30 minutes of over sedation. You just don't have the tolerance for Actiq yet. If they were to start you on the Durageisc patch you should start at the 25 UGH patch, The 200mic aqtiq pop is about 20 times stronger although it only lasts 30-60 minutes.

    The liquid version of Morphine and OxyCodone do provide faster relief than standard oral pills or capsules and you wouldn't be making such a huge jump. The liquid products have metered dosing which makes dosing very precise and gives you a wide range of dosing options. Hang in there, Like many others I have tried every long acting med before settling with what I'm using now. It takes time to find the right med, the right dose and the right schedule. It doesn't sound like you have commited to a long acting med entirely yet, Using OxyContin PRN wll work for a while but eventually tolerance or dependence will catch up and you will need a more steady serum level of some type of opiate to maintain some degree of continous anelgesia.

    The 10 mg OxyContin isn't any stronger than taking 1 5mg percocet every 6 hours. You have plenty of room to increase the OxyC or find a dose of long acting morphine or methadone that may work before you need to jump to the most potent opiate any doc can prescribe. The FDA warning that Actiq is still only meant for cancer pain is still in place although many docs prescribe it for non malignant pain. No clinical stiudies have been done on Actiq on non malignant patients and because of this many insurance companies will refuse to pay the outragous 8 bucks a pop for actiq.

    It's also kind of nice to know there is still a stronger med out there should other meds fail to provide relief. But I think you have a long way to go and a lot of options before trying actiq.

    It seems every one that uses it is pretty pleased with it but they really don't have agood understanding of just how potent Fentanyl is.

    The only folks I have met that take more BT meds than they do base meds are the patients using actiq, which is opposite of all principles of pain management. I would be concerned about my doc that prescribes it without fully understanding the strength and how rapid your tolerance will grow once you become acomadated to Fentanyl.

    When one 200 pop doesn't work, just use 2, when that doesn't work just use an 800mic pop, when you get used to that the next step is 1200mics which is comparable to about 1000mgs "one thousand mgs" of morphine in a single pop but only lasts for an hour. Hold off on the actiq untill you become a little more acommadated to the effects of long acting opiates, Then your BT med can be adjusted to an apropriate strength.
    JMO, Shore

     
    Old 03-31-2004, 07:04 AM   #6
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    Re: Question on pain meds

    I just wanted to mention that the one and only narcotic that I ever took that caused me absolutely no side effects at all has been hydrocodone.The only problem is that they don't make a long acting med that uses it.Norco has a reletively low dose of acetaminophen,do you think that if you took two at a time, it would be strong enough to control your pain.Just a thought,as it dosen't make me the least bit tired or loopy.Good luck, marcia
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    Old 03-31-2004, 08:36 AM   #7
    khoff
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    Re: Question on pain meds

    I agree with you shoreline. Actiq would be too strong. The pain I have is post surgery pain from last October (herniated disk). I was actually trying to find one that is more long acting but not so strong that it made me ***** and mentally alert. The reason is not just even adequate pain relief, but still being able to have even a semi-normal function in life. I am slowly accepting chronic pain, just trying to manage it best now.

    Marcia - Thanks for the tip on hrydrocodone. I did try vicoden, but it was a bit light and no different with head fog. It may just be getting used to these meds over time to diminish side effects. The brain fog and tiredness of the effects is the worst becuase I try so hard to do physical therapy, eat right, and try to remain somewhat able to go out socially or support groups.

    - Ken

     
    Old 03-31-2004, 10:23 AM   #8
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    Re: Question on pain meds

    Hey ken, That transition from post surgery to chronic pain is a bear, but because it's esier to find a PM doc now that will continue to treat post op pain that has gone past 6 months and is starting to be labeled chronic the actual pain part isn't as bad, It's the psych part of excepting some degree of pain and all that it does to your life.Can you return to work? Can you spend 8 hours walking through a theme park with your kids? Can you support yourself and family? How long for SSD? All this crapola make's it so rough. Actually dealing with the pain has gotten medically easier, but if your on your own for the psych stuff it can be devestating.

    I'm not sure it's particularly a good thing not to try some of the non opiate meds and methods. You would pretty much have to discontinue the stronger opiates or simply use something mild PRN to know how effective the non opiate methods are, like elevil and self hypnosis, or nerve blocks and Biofeedback. There are plently of options for those that can't stand the brain fog. I can't say it goes away entirely but it is better with some meds but that's different for everyone.

    I've seen several discussions about taking a break from opiates after continued use or after a reasonable time after surgery to see exactly how bad you do hurt and how much some feel good PT and a TENS unit may help.

    I was forced to try all that stuff becasue there was no such thing as Oxycontin or 10mg percs. LOL No doc was going to refer a 28-32 year old to a doc they knew would prescribe MSContin or methadone for the rest of my life.

    I don't want to see things go back to the way they were, were people suffered needlessly for years and had surgery after surgery because there wasn't an option.
    Fortunately docs are much kinder when it comes to finding a PM doc willing to prescribe a stronger med when you haven't improved 7-8 months post op.

    Your doc is acurate though in saying it does take an entire year to recover from any back surgery and 2 years for a fusion. You may or may not need pain meds that long but if the head fog is too bothersome, I know a dozen PM docs right in my own town that would be more than happy to treat your pain without opiates or any head fog.LOL

    Sorry can't help the sarcasm, I just saw a chiropractor for a free eval to see what he could do, Not a thing for my failed fusion but can work on the rest of me for a small weekly fee.

    I can't say the non opiate methods were effective other than short term, Like while your doing the bio-feedback or self hypnosis, get up and walk away, drive 20 minutes home and it's back to the same old same ole. There are many methods of pain management and plenty of PM docs out there that don't believe that the use of opiates is apropriate unless your dieing, even then I think they would undertreat patients in hospice.

    If you want to try to see just how bad the pain really is and will other methods help, it doesn't have to be horriable withdrawal to disontinue meds if done properly. I can't help but respect peoples decision to take a break from opiates from time to time to see just how bad there pain is, can they live without being dependent on opiates?

    Being dependent is a huge cost that many don't consider untill they are going through withdrawal, Then the couple years of relief doesn't seem so worthwhile.

    I would not recomend discontinuing opiates for the purpose of taking a drug holiday, to try and reset your tolerance, your tolerance would be lower for about 2 weeks and you will be right back where you left off. Med vacations do not work. IMO

    Although they don't make a stronger Hydrocodone product than Norco 10/325, your doctor can right directions for a compounding pharamcy to create a long acting version of Hydrocodone. I've met a couple people over the net that use compounded hydro. Your doc needs to determine the amount of hydro and dextromathorphan but it is done.

    I know a lady that took 100mgs of compounded LA hydro 3 times a day. Your doc needs to come up with the rest of the compounding info though. How much dex to use? and I'm sure it's more expensive tha pre made pills but when you buy quantity it's cheaper.

    Take care, and Ken, I'm not suggesting you need to take a break from the meds to see how bad you hurt. That's a very personal decision. I just don't recall the converstation coming up at this forum., Perhaps it deserves it's own Thread.

    Last edited by Shoreline; 03-31-2004 at 10:35 AM.

     
    Old 03-31-2004, 04:42 PM   #9
    callie3
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    Re: Question on pain meds

    Have you thought about the Duragesic patches? I was on vicadin until I switched to a PM Dr and the first thing he did was tell me to get rid of the short acting meds and go for the Duragesic. We started at 25 mc then went to 50 mc every 3 days and when I advised him I felt more pain on the 3rd day he changed it to 50 every 48 hrs and its been great. So far after I got used to the initial nausas feeling the first week on the 50 I have been fine. The dizziness lasted about a week then my body adjusted and I haven't had any more side affects. Your Dr could give you vicadin or percs for breakthru if needed but you may not need it if they find the right strength of Duragesic. Its nice not having to worry about pills all day. Just change the patch every 2 days and those free covers from Jannson make it fit snug

     
    Old 04-01-2004, 09:48 AM   #10
    khoff
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    Question Re: Question on pain meds

    Haven't tried duragesic yet. Thought of another option, but thank you for the suggestion.

    Shoreline - If I go onto percocet or oxycontintin at a higher dosage, how do I keep it there and not go higher by using dextromathorphine? I rememeber reading there is a OTC product called dexalon which is supposed to be a 30mg capsule of straight dex. Do you just take it with pain meds or is there a trick to it (if you know)? Is the compunded version of dex better?

    Thanks again,
    Ken

     
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