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    Old 02-02-2005, 12:04 PM   #1
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    Question Newbie with question about meds.

    Hi everyone,

    I am new to the boards and usually lurking over with the "foot problems." I just had a couple questions regarding pain medication and thought someone here might be able to help. Short back ground info, 6 months ago I broke my right foot and tore the ligaments in my ankle. I am still have a tremendous amount of pain that was be treated with percocet 5/325, which didn't help but Doc would not give me anything stronger. Change Doc's and within the last week started neurontin 600mg (1) at night for 1 week and progressing to 2 then three, 20mg Oxicotin once a day in the morning and Percocet 5/325 for breakthrough pain.

    My first question is how can I wake up? I am trying to work 10 hour days and still have time for my family. (10 hour days because I cannot drive, right foot, so I have to depend on my DH to get me to and from work around his schedule.) I just feel like I am in a constant fog and I am not productive at all.

    My second question is about neurontin, it seems that most people take it several times a day and not all at once. I have not had any relief. Does it take a while to work or is it a short acting pill so by the time I am waking up in the morning the benifits of it are gone?

    Sorry this is so long and I hope it makes sense because I can't think straight.

    Thanks in advance.

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    Old 02-02-2005, 03:06 PM   #2
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    Re: Newbie with question about meds.

    Hi Crazy girl, Believe it or not, people that abuse these meds like that fog, fortunately when using it for chronic pain those types of side effects dissapear over time as you become acomadated to the higher dose of OxyCodone. Once a day is kind of strange, I guess you are allowed pain relief to continue working and then your on your own at night with BT meds? That's kind of odd.

    As far as Neurontin, It can make you feel a whole lot more stupid than any opiate can. One of my favorite nicknames for Neurontin is Morontin. It's very normal to titrate this med upwards, you can start with 100 mgs once a day then 200 or you can start with 300 and then 600 and the doses can reach as high as 3600 mgs per day. I don't know how you can function on that kind of dose but some people can tolerate it.

    Just like any med and side effects, some are more severe than others and everyone reacts differently.

    You may not be able to function at work on these meds. After a year and a half my wife is tapering off as many meds as possible and reducing doses as much as possible.
    She had one foot fused and one totally reconstructed from a degenerative disease called CMT, she also has someother problems but the drugs were hindering her more than helping. She just can't function that way. Fortunately she recognized it herself and I can help her taper smoothly and she has the proper dose sizes to do it. She's discontinued the antiseizure meds, on les than half the dose of methadone she was 3 weeks ago and has only had one slightly bad day.

    These meds were designed as a last resort when nothing else has worked, OxyContin as a frst line treatment to manage chronic pain is somewhat reckless IMO and may leave your doc open to problems if he can't justify the use of the med. You need more than a patients complaint to justify such a potent med with so much scrutiny.

    Your pain has lasted 6 months which reaches the point of calling it chronic, However if you haven't tried other methods besides opiates and normal PT after you get out of a cast or space boot, they may not be apropriate and the doc may have a hard time justifying his prescribing practices.

    Pain management is different for everyone. All PM docs don't have the same phylosophy. Many PM docs will have you try dozens of none opiate modalites and methods to control pain before feeling comfortable prescribing the top shelf meds for the worst pain. I don't mean to imply that your pain is any less than anyone elses, but when I say worst, I mean hasn't responded to any other treatment.

    How many different antidepressants have they tried, Have you had other surgical consults to see if something went wrong and your doc hasn't picked up the problem ror won't admit it yet? It's hard to evaluate the effectiveness and atribute side effects to either med when you start more than one at the same time. The neurontin may have you in a fog or it may be theOxyC. It's diffcuclt to isolate a problem med when you start more than one new med . However this dose of OxyC shouldn't cause a huge problem after 6 months of percocet unless you used them very sparingly.

    The 20mgs tabs don't sustain 20 mgs in your system though. They release about half their contents at about 45 minutes to an hour and their is a second release at about the 6th hour. It's called a dual phasic release system. It basicly sustains roughly equal serum levels that taking 2 5mg percocet every 6 hours would. Going from 5 to 10 mgs in your system isn't a huge leap. The only thing in between would be the 7.5 mg percocet.

    A 10 mg OxyC sustains the same as taking 1 5mg percocet every 6 hours, not much difference between what you were taking before. Both meds contain the same Oxycodone, the only difference is no tylenol in OxyC.

    When I say trying other methods of pain management, there are lots of pain mnagement docs out there that don't prescribe opiates to anyone, there are some that prescribe opiates only to the worst cases, there are some that believe in BT meds and some that will only prescribe long acting meds.

    I was disabled and bedwridden before I was even offered the long acting meds. I spent 7 years and 12 pm docs learning to live with it in between surgery after surgery. My doc can easily justfy the meds he prescribesin my case vbecause of all te other ethods I have tried and learned. Tings like Every antdepressant you can think off, slef hypnosis, bio-feedback, guyuided imagry, acupuncture, Tens Tins, nerve blocks, medial branc blocks, esteroid injections, trigger point injections, acupressure, chiropractic and a whole lot of other methods to learn to live with broken hardware and an unstable spine.

    Not everyone can fucntion on these mds at work or it may simply cost you your job, for sleepng at work, making erros, etc. I can't magine having to try to work while your adjusting a new med and you haven't become acomadated to the side effects yet. Most side effects from opiates do deminish, but whether you can function at work on them is entirely up to your own system and what you can tolerate.

    If you have vacation time, I would take as much as you have if your going to go the med route, because it's truly trial and error, There are about a half dozen other antiseizure meds that all cause drowsiness, and 4 basic choices of long acting opiates right now and finding the right dose, adjusting to the drowsiness and other side effcts take time. Everyone wants that easy way ut of a problem and just take a pill has beecme the mantra of many people that don't think they shold have to deal or live with pain because these meds are available. But there are all kinds of consequnces. ZSay you work you way up to a fairly high dose of meds and can still function, then you find your only chance at lasting relief is another surgery. Some docs wouldn't touch you untill you are detoxed, some docs will operate on you and give you nothing to take home for post op pain because you are already on a high dose of meds. Some surgeons havbe te knowledge and expertise to manage the post op pain even with a high dose chronic pain patient. But finding the right doc or a willng docs may becme more diffcicult and even then, they are quick to egt you off the meds because what thy learned 10 or 20 or 30 years ago was that opiates are addicting and will ead to faiure of surgery and constant requests for more and more and continued meds when the patient should have been cured.

    Now we have PM docs so surgeons and GP's that get tired of dealing with requests for pain meds can shuffle off every patient t o Pain management of some kind and pass the buck for someone else to deal with or to prescribe and put their licence at risk or practice at risk.

    The drowsiness usually gets better with meds like neurontin and opiates, or you find you do OK up untill a certain level. I got up to 1500 mgs of morontin, It really didn't help, but when the doc raised it to 1800 mgs, I would forget where I was going before getting out of my neighborhood. Anti seizure meds are used to treat neuralgia, nerve pain, If you don't have burning type neuralgia, the meds may only sedate you whcih some people can tolerate and some can't.

    The funny thing is, if I wanted to stay a zombie all day, Neurontin would do it, But the first dozen PM docs that used adjunct meds and meds for off labl purposes like antidepressants and antiseizure meds would give me all the mind numbing meds you can take and nothing for actual pain.

    You found a doc on your first go round witthout jumping through any hoops to get there. It's not up to me to say tha's the right way to prescribe long acting opiates,. He did explain you become pysically dependent on opiates didn't he. It won't be a great surprise if you try to stop abruptly and you experience withdrawal. If you have been takin 40+mgs of oxycodone in the way of percocet the last 6 months, you are probably allready physically dependent, not to be confused with addiction, which many peple do.

    The difference is dependnece is simply a psysiological response to opiates. It happens to everyone eventually and happens with other meds. Yu can't stop antidepressants cold turkey, or any of the benzo's, sleep aids, even steroids can put you in the hospital if stopped abrutply after continued use..

    But the reason for using them is very different betwen an addict and a pain patient. If they improve your quality of life and ability to function, thats the complete opposite definition of addiction. Addiction is destructive with no regard to anything else, the spouse could leave, your could loose your job, and home and as long as you can go day to day getting whatever an addicts drug of choice is, the addiction and mind set puts everything else on the back burner.

    Statistically addiction rates in dependent chronic pain patients is fairly low. But you have to weigh the benefit versus the negative aspects. Does it improve function after you have given it a fair chance to accomadate to the side efects, like the fuzzy head. If the fuzzy head never goes away and the meds themself become the reason you can't work or the reaon you can't function, then it's hard to justify the use of these meds.


    Last edited by Shoreline; 02-02-2005 at 03:07 PM.

    Old 02-02-2005, 03:09 PM   #3
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    Re: Newbie with question about meds.

    IMO, Too many peple are going straight to long acting meds without thinking about the long term consequences. They are safer than meds that conatin tylenol, they do no organ damage, There is virtually no ceiling on the dose you can take of a pure opiates as long as you aproach the dose safely. But I have seen folks go from 20 mgs twice a day to 160 mgs 3 times a day and still not be satisfied, or be so physically dependnet that the withdrawal they experience when trying to discontinue the meds becomes their only reason to continue taking them.

    Tapering off the meds isn't an impossible task, but the doc has to know how to do it without sending a patient into terrible withdrawal. Unfortunately every doc knows how to write a script and can claim to be a pain management doc. Pain management isn't really a recognized specailty in the medical community and virtually nothing is tought in medical school abuout pan control asdide from 1 3 credit hout course where they all learn how addicting and bad pain meds are.

    They recognize the need, But a PM doc can be a GP, A neurologist, a Physical medicine and rehab doc,Psychiatrists, DO's , anesthesiologists, internal medicine or if a podiatrist wanted to treat chronic foot pain he could. Anyone that wants to enter the field can hang a pain management sign out front. But it doesn't mean they know any more than what the manufacturer drug rep has told them about the med or the proper way to discontinue meds without causing physical withdrawal.

    I do wish you luck, I understand your foot may be extremely painful when you walk on it and after yo have walked on it, But you have to decide if the cons are worth using this clas of med to manage it. Taking the edge off is the most some can hope for, some ge more relief and can work, and some of us are dcompletely disabled and the meds are the only way we can walk or get out of bed. I have a pump implanted that delivers morphine. Yes I am physically dependnet on morpihine. It's better than being bed ridden. But there is still a price. FAmily and friends can be very understanding in those initial recovery months, but people have this expectation, that your suposed to get better. It wouldn't be uncommon to loose friends because yorur not as fun, or you can't participate or they think your taking thre meds simply because you like them. Being called a drug adddict at some point is pretty much par for the course. Some doc somehwere won't agree with your treatment and will have no problem voicing his opinion andrecmending you go to drug rehab. Pain relief should be available for those that need it, but to think it doesn't come with a price is foolish.

    I'm going to bring a post up to the front page and it's about someones OxyC nightmare where their life spun out of control. They have a problem and blame the doc because he was convicted and labeled a drug addict. But a doc with a drug problem doesn't make people take these meds. People go to them and say I can't live or function or whatever without some kind of pain control. They aren't passed out like samples in the grocery store. You have to seek them and ask for them and explain how nothing else works and you can't functin without them. The more this person took, the less they could fucntion? Is it the docs fault?

    Good luck, Dave

    Old 02-03-2005, 06:57 AM   #4
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    Re: Newbie with question about meds.

    Thanks for the advice Dave, I think I caught most of it but my brain isn't working so I wanted to explain a little more of my story. This is a workmans comp case so I am limited on what doctors that I can see. I have not had much success with the doctors they offer. I just seem to get the runaround. I have not has sugery (yet) Doc said he would do the surgery if a PM would say that I did not have RSD. PM released me say that I did not have any symptoms and majority of the pain was mechanical. After that the Doc said he stil wasn't sure so NO surgery. I continued in PT for a total time of 12 weeks. I have been on several meds Daypro, Vioxx, Viccodin, Bextra, Limbitrol, percocet and now the neurontin and Oxy. The reason for such a low dose of Oxy and only once a day is I refused to start with more. I am only allowing myself that and the max of 2 percocets a day. I just want to get the edge off and I will deal with the rest of the pain. I just don't like the way they make me feel and I hate taking any kind of pills.

    I did get a second opinion had the Doc said that he would not do surgery now because of how far out it is for the original injury, but if I am not better in 3-4 months come back and he might consider it. So now I am back in PT, not walking, in a fog and trying to work and have a life. Eventually something has to give right? (sorry that is just the frustration talking). \

    Hope your are doing well, thanks again.

    Last edited by crzygrl_78; 02-03-2005 at 07:08 AM. Reason: Add additional information

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