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    Old 06-16-2004, 02:21 PM   #1
    LOVEQ
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    Why Oxycontin would not work

    My question is this!!!! Why would Oxycontin not work like it should if you are taking it the way you are suppose to???
    My reason for asking is my last pain management doctor was asking me when I was telling him That the drug was only working for 4 to 5 hours telling me. He said well you don't have any stomach Ulcers and you are not an Alcoholic, so they should be working. I then said Well I did have stomach problems years ago. Like pre ulcers, he rolled his eyes and basically pushed me out the door. So now that I am seeing a new Pain Management Guy, I want to know what would health problems or things would make this Drug not work like it should??? Now we all know it will never work for 12 hours but come on 8 would be great.

    Thanks for any feedback.....My next appointment is on Monday so the sooner the better.

     
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    Old 06-16-2004, 02:34 PM   #2
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    Re: Why Oxycontin would not work

    What dose are you on? And what are you taking it for?

     
    Old 06-17-2004, 06:47 AM   #3
    LOVEQ
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    Re: Why Oxycontin would not work

    Hello you asked how much I am on... I take 1 40mg every 12 hours for a number of reasons but primary for Interstitial Cystitis, Fibromyalgia, Back Problems, TMJ. As you can see a lot of things.


    Why do you ask, would that make a difference in if the meds work or don't work???

    Any help anyone????

     
    Old 06-17-2004, 09:54 AM   #4
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    Re: Why Oxycontin would not work

    HEy ove, Everyoneresponds to fifferent pain meds in differnt way, There is not one pain med at one dose that manages all pain.

    The way OxyC is designed, Taking 2 40 mg pills per day. The first release is at .6 hours, A 40 releases half it's contents at the initial release and then your serujm level slowly drops untill the 6th hour and then the the other 20 mgs is released.aperently your pain winds up before that second release and that dose isn't able to bring it back under control. Since you didn't mention BT meds, That may be a place to start. Finfd a doc that will treat your pain and doesn't think BT meds are the road to addiction.

    I would think, you either don't respond to OxyCodone well, like some don't respond to morphine or demerol as well. We all have a med that suits our pain needs the most. It sounds more like your pain spirals out of control to the point that by the second release it's not a high enough dose to bring a high level of pain back down. It's that theory that it's easier to keep pain in check than to bring a high level back down once out of control.

    The conditions you have are the type that flair up and you have extreme highs and then it may subside and for a few days, the meds are working when your not in a flair. You don't want to adjust your dose so high that it covers your worst pain when it's flaired up. You would be overmedicated on normal or better days. So they shoot for trying to releive 50-0 % of what you would consider your base level of pain. The middle of the road.

    OxyContin never managed my pain. It works well for some types of pain but not all. There are basically 3 types of pain. Neuro pain which is very difficult to manage with opiates alone, Somatic pain like back pain where you don't have neuropothy but deep type aching or stabing pain and then there is visceral pain, Visceral pain would be like post surgical pain where you have pain from the incision, stab wounds, gun shots etc.

    You have a combiination of different pain generators, IC would likely fall under neuro pain, but it flairs and calmes back down, Fibro is somatic pain, no neuro component like radiculopothy they can say it's from X nerve being compressed but still painful but also some thing can bounce from very high to stayng calm for a while.

    TMJ pain is also somatic, It flaires up if you chew steak or talk alot or grind your teeth. It's like havng a broken foot, It may be manageble up until your bear weight on it. In a case like yours where you have multiple generators that bounce from high to low does make it hard to find a level you can live with and the doc is comfortable prescribing an apropriate amount of meds. What mmanages it today, may not touch it tommorow if you ground your teeth all night, but it doesn't mean you should increase you base dose because the TMJ flaired up from dentalk work or teeth grinding.

    I don't think they really know what causes fibro to flair up. So it sounds like you have a very wide range when it comes to levels of pain, Hence, what works today may not work tomorrow but you can't increase your base dose with every flair. IT seems BT meds would serve you weel for flair ups.Just like you wouldn't ask or an increase because you ate a bowel of chili and your IC went nuts for a couple days, you can manage it with BT meds and then back down to a steady level of medication.

    That's why it's important to have more than just one modality to manage your pain. When the fibro flairs, gentle stretching, water therapy, light massage or Yoga can help. When your jaw flairs up you can also use ice, lidoderm patches, mouth gaurds to prevent clenching and grinding.Yo also have specific meds for IC and foods to avoid.

    Nothing confuses a doc more than having more than one problem going on at the same time. When you go to the doc I'm sure they ask what bothers you the most and that's what they shoot for. and hope the meds they prescribe to manage what you say is the worst will also overlap and help in other areas.

    The more pain generators you have the harder it's going to be to keep all of them in check. 40 mgs of oxy twice a day is not a large dose. There is basically a different treatment plan for every pain generator which makes it very difficult to put pain out of your mind, when your jaw is aching and your shoulders and neck hurt from fibro, the fibro eases off and your bladder goes nuts. It has to suck to be a full time patent with so many things needing attn. It's overwhelming to many docs but there are docs out there that like the chalenge.

    There isn't one med that will treat every generator. pain meds do work, but when your needs can double from one day to the next, the doc isn't going to be comfy giving you that kind of range to manage all aspects of your pain. You sort of have to lump it all together and except a dose that seems to give you the most relief for the most problems with the least side effects.

    If you have to double meds from one day to the next, your body can't become acomadated to the side effects and tends to make the patient shoot for managing more pain than is possible. To quell all three problems when all 3 are flair would likely inhibit your ability to function on meds more than improve your abilty to function. PM docs don't normally allow you the meds to knock yourself out on days you need it and then cut the dose in half when you don't, after doing this for a couple months, the lesser dose wouldn't quell the slightest pain because your body is used to taking a large dose.

    Not that your taking a large dose now but he's shooting for the middle "50%" reduction of 3 different generators. That's the frustration you see in your doc. What manages your fibro may not touch the IC, or when the IC is exceptable the TMJ skyrockets.

    You need to find a doc that can treat patients with more than one modality, and each time you have a flair , if you call, you become somewhat of a nuiscence, You need to learn to mange your flairs either with BT meds or other modalities. Compared to other patients that have one generator that can except 50% reduction and handle the spikes with Break through meds, Short acting meds to give additional relief when your LA meds don't work. You not exactly flying low and under the radar. A call about increased pain means alot more work than just your doc calling you back. The receptonist takes the mesages, puts her slant on it and tells the triage nurse, she interprets it, pulls your chart and it sits on the docs desk untill he can look at what's going on. Very few docs will make a med adjustment over the phone, so the best thing to do is just get in to see the doc that is handling the specific problem.

    I didn't see you mention BT meds, The use of them is contreversial, some PM docs don't belive we have the will power to let a bottle of morphine or Dilaudid sit in the cabinet and only be used for the most severe pain.

    You may need several specialist in adition to PM. treatment of TMJ can be done by PM docs but they don't have the training that someone who has a background in dentistry or oral surgery does. IC is a rather unique condition and there are docs that specialize in that problem and fibro can be managed by any PM doc. So in reality you may need 3 different docs all prescribing meds, but they can't all prescribe opiates.

    You need a more advanced system of pain management with one person overseeing things and watching for drug interactions and directing your care. With so many problems, It's kind of hard to be the ideal PM patient that has found a dose that works, stabalize and doesn't need constant attn. It's not your fault you need constant attn for one of the problems, meaning one week it's the fibro that is the most bothersome, the next may be TMJ and the next may be IC. You have a difficult case and different types of pain respond to different types of drugs and different modalities. Then when you though the human equation in, where different people respond to different drugs in different ways. Docs can become frustrated and think of you as their problem patient that calls weekly with a new complaint or a new flair.

    I don't think it's hopeless.

    continued on next post...

     
    Old 06-17-2004, 09:56 AM   #5
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    Re: Why Oxycontin would not work

    If I could arange an Ideal PM team for you, I would say see Dr brookoof at the university of Tenn. in memphis. He's a PM doc that specializes in IC, the meds prescribed for the pain of IC would likely manage the fibro or both can be treated with different meds, But then you need someone to manage the TMJ, Make the splints, possibly investigate a surgical solution and work with DR Brookooof together as not to have one doc prescribing Methadone or one prescribing OxyC and the other prescribing MSC.

    It's frustrating when you are stuck in the middle and nobody seems to be able to do it all. But if you developed cancer and it was causing pain, you would then need an oncologisty as part of your PM team.

    You just need to find docs that are willing to work with other docs without the attitude that doc #1 is the expert and has nothing to learn from a doc that treats IC because pain is pain. That's not entirely true. You need a nutritionist to help with IC, You need a dentist or oral surgeon to be working on the TMJ and a PM doc for the fibro.

    You didn't ask for 3 painful conditions and there are docs out there that will let an oral surgeon handle the TMJ portion as long as he is kept in the loop as far as what meds he may be prescribng. You don't need an oral surgeon prescribing valium for TMJ and a PM doc prescribing soma or flexerill for fibro. THat would be sloppy medicine and just too many different muscle relaxers, you wouldn't be able to function and when PM hinders function rather than improves, Unless your terminal the negative aspects begin to outweigh the positive and the use of opiates becomes hard to justify.

    You may want to look at treating the body as a whole with holistic docs that also use convention meds. What's causing the teeth clenching and TMJ disfunction as well as the neck muscles to tighten. What's the best way to keep the IC in check. Rather than looking for a PM doc that will just give you enough meds to kill the pain at any level, you need more specialized care from docs that tteat these problems on a daily basis. That's why it matters what the pain generator is or are.

    Start with the most bothersome, If you don't live in TENN you can still call Brookoffs office and ask for a referral to someone in your area that specializes in IC and PM. Get the dentist on board and likely the fibro can be controlled as a secondary gain from treating the other problems.

    Your case is very complicated and many PM docs wouldn't know what to do with you. because simply managing the fibro isn't enough, mangaing the TMJ disfunction isn't going to help the IC and the drugs used to treat IC aren't going to do much for the TMJ.


    This is where a patient really needs a multi faceted aproach to pain mangemt with a group of docs that all have different specialties and modalities to offer, Not three docs all prescribing opiates and muscle relaxers. You would be inetvertantly doc shopping evn though you can see this med is for this and this med is for that and the other opiate is for the TMJ.

    My PM group has Neuro's, Physiatrists, Psychiatrists, Osteopaths, counselors and you would need to see a doc that specializes in each condition grouped together to ensure some uniformity of care. You can find groups like this at major universities. Or at least find specilaties all under the same univerity hospital . You do have to be aware that a patient that can never be satisfied regardl;ess of med changes and dose increases may not apear to be the best cabndidiate for opiate therapy. Methods like Yoga and Bio feedback or self hypnosis may work great for fibro and do nothng for IC. But if you have the tools and techniques, You can use the apropriate modality for the apropriate symptoms, not try to maskl them all with opiates.

    Some docs love the tough caases, so don't be discourgaed. I've sen at least 12 PM docs in the last 11 years and everyone had a different phylosophy and felt their method was the corect way to manage pain. 12 docs, 12 methods???

    Good luck and don't give up. It took me 87 years and 3 monster surgeries before a doc prescribed pain meds. I had learned or tried every non oiate method to manage pain you could name and the whole time the group of docs I presently see was in my own back yard. But my GP and surgeons didn't believe in the use or oiates and knew that he did, so they intentionally kept me away from him and never mentioned that this was even an option.
    Take care, Dave

     
    Old 06-17-2004, 01:32 PM   #6
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    Re: Why Oxycontin would not work

    All I have to say is wow , what a great letter. You are a amazing person. How do you know so much about everything?? Just wondering. Either you read a lot or you are a doctor or Nurse. Thank you for all you suggestions. Believe it or not the biggest part of all my pain comes from my IC. That is about enough pain not to make me not to want to go on. Don't mean to sound like that, but I have been living with this for a long time and I am only 30 years old. You get sick of it after a while. I know you know where I am coming from.

    My PM doctor is OK, This will only be my 3 rd time seeing him now and I am not that comfortable with him yet. I hate asking for anything, cause I don't want him to pull me off any of my meds. I seen it happen to people and it scares me cause I don't know what I would do if that happened to me. Now he wants to do trigger shots on me. I had that one time and had a problem with it. Now he said he wants to try it, but I have never heard it helping any IC patient. I think it is a big waste of my insurance companies money. Shouldn't he be trying different meds on me?? This is the only med I have tried ( I mean in the opiate family for long acting) He talked to me about maybe the pain pump later down the road. I don't care what he does just as long as I can get out of bed everyday and go to work. I am single not married supporting myself. It is very scary. So don't you think he should be trying different meds??? Also the answer to your question is yes he did put me on Lortab after the 2nd time I saw him. But it was to late by that time cause I then when off in a ambulance to the hospital for 3 days because of my pain. He prescribed me 2 5mg pills a day and its not touching my pain. I really thing I have a tolerance to the Oxy now. I started on 40 mg and I am still on it a year and 3 months later. Isn't this normal with these drugs building a tolerance to them?? What way could I bring this up to me doctor??

    Well I really want to thank you from the bottom of my heart for all your warm wishes and suggestions.

    My Best To you,

    LOVEQ

     
    Old 06-20-2004, 02:12 AM   #7
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    Re: Why Oxycontin would not work

    Love,

    I am an IC sufferer and am also on oxycontin 40mg for pain. I had to have my meds titrated up over the last 2 years due to tolerance. If you have been on the same dose for over a year I would imagine you would need to up your dose of oxy. I totally understand your needing your medication just to get out of bed each and everyday. IC can be a debilitating disease. I would mention this with your pm doctor that the oxy just isnt providing the same amount of pain coverage as it initially covered. When I needed an increase I informed the doctor I wasnt having a flair and was taking more of my break through meds to cover the pain. This is when he would up my dose of oxy.

    I am so fortunate to have found my pm doctor and dont know what I would do without him. It is a scary thought and I understand your hesitance in not wanting to rock the boat, but, I have found if you sincerely tell your dr. whats going on and that your pain hasnt increased but the meds arent as effective anymore he should understand and you might mention you have read about tolerance and ask if this is what could be going on.

    I wish you luck and you might try checking around just in case for another pm doctor who treats IC with pain management. I know in my area I have 2 TWO choices and that is it regarding a dr. who will treat my IC with medications. I have tried all other treatments with the exception of the interstim but have read to many negative side effects happening with even some women ending up with permanent nerve damage - yikes.

     
    Old 06-21-2004, 05:47 AM   #8
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    Re: Why Oxycontin would not work

    Thanks for your reply.

    Its great to know that there is another IC person here on this sight to.

    Yes, without my meds you can forget me getting out of bed , its then also no fun to be around me either.

    Well I see my PM doc today at 12:30 so wish me luck and I will post back.....

    See ya..

    LOVEQ

     
    Old 06-21-2004, 12:32 PM   #9
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    Re: Why Oxycontin would not work

    Hi all. Just wanted everyone to know how my PM appointment went today.

    First when he walked into the room was not really listening to me. Then I said well Doc I was not that good at all this month cause as you can see from my new records I was in the hospital for 3 day due to the pain. He asked me how I thing the Oxy was working for my pain. ???? Well I told him not that great anymore I said in the beginning I found it worked better then it does now. So he said have you ever tried any of the morphine drugs I said no. He said I will be right back. He came back in 15 minutes later and said well after reviewing your records I really think we should try the Duragesic Patch and I will give you Vicodin 7.5 for breakthrough. So I guess it turned out ok. At least he left the office to read my records, cause from the questions he was asking me you could tell you did not take one glance at them until I said something.

    My question is this I was on Oxycontin 40 x 2 a day and the Vicodin only 2 a day. I am now going on the Duragesic Patch 75mg and the vicodins for breakthrough pain. What is the comparisons for this med?? What I mean is by Mg is it the same as the 40 mg of Oxy??

     
    Old 06-21-2004, 07:41 PM   #10
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    Re: Why Oxycontin would not work

    Hi Troubleq,

    I'm sure Shoreline could tell you the exact conversions. I use the Duragesic 50mcg patch and oxy for BT. Fentanyl is a very powerful drug. I would think the 75mcg patch would be more than adequate to cover the 40mg oxycontin you were taking. I wish you well. Take care.

    God Bless,
    Sherry
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    Old 06-22-2004, 12:39 AM   #11
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    Re: Why Oxycontin would not work

    A good p.m doc. would know that oxycotin doesn't work for 12 hrs! Mine does,i take 40 mg every 8 hrs.I know peaple who take 80mg 4 times a day. A lot of doc. are worried about the d.e.a Remember,theres a difference between addiction and tolerance.It can take months before your meds are adjusted to the right dose.

     
    Old 06-22-2004, 01:07 PM   #12
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    Re: Why Oxycontin would not work

    Hi Troubleq,

    I just wanted to let you know that the Duragesic is not 75mg, its 75mcg or 7.5mg. Thats how strong this med is. It's only 7.5mg in the whole patch so its equivalent to 2.5mg per day.

    I hope you are finding some relief. Good luck.

    God Bless,
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    Old 06-26-2004, 08:09 PM   #13
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    Re: Why Oxycontin would not work

    LOVEQ, I don't post much on this board....but I do go back and read the Urology and Pain management boards once in awhile....just because all of the support and help I have gotten (from being a lurker....lol)
    I do honestly have to say.....LISTEN to what Shoreline has to say! He has been my best supporter in what I have gone thru! Well, he doesn't know that...but he is!!!
    OK, here's my story: I've had urethral diverticuitis 3 times...had surgery 3 times to correct it in the last 4 years. The 2nd surgery was at Mayo....they told me it was rare to have it recur again. Well, it did. I hated Mayo......they put me thru hell post-op (gave me Toradol IV and tylenol after I had been on Oxycontin and Oxycodone for breakthru.....I screamed in pain for 4 hours postop til they finally got a morphine pump).....request my records!!!!!! I can prove it!
    Anyway, Jan 8th, 2004, I got the Interstim Implant done for chronic urethal pain/incontinence......I was on Oxycontin 10mg TID, Oxycodone BID for breakthru, Elavil, Ditropan, Topamax..........
    The minute they turned my Implant on.......the pain was gone
    I got off all meds and just passed my RN state boards 2 weeks ago!
    Shoreline doesn't know me.......but....I owe a lot to him!
    LOVEQ.....I've been there.....I do know the pain that you are in!
    Listen to Shore! He will be your biggest advocate!!!!!
    I am there for you too!

     
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