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    Old 09-22-2005, 07:45 PM   #1
    bucky77
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    methadone or oxycontin

    I have a question for shoreline or anyone elce, I had back sugury 3 years ago after falling 20 feet and landing on sment, they went in from my back and cut the rest of the disc out in front that bulged out and scraped bone off my hipps fixed my l4,l5,s1 with I think cages plate and screws, then after sugury the pain was bad, and it took my weeks to walk again, and I still half a nub left leg, since my sugury I have been oh heavy pain killers, for the last 3 years 2002 when I had my sugury I have been taking oxy contin it keep going up I was up to taking 100mg 3 times a day but sometimes I would run out early, Well my doctor got mad cus I didn"t take them how I was sopose to, I told him the pain was worse some days, but he said you half to follow the way it says, so now he referred me to the pain clinic and I have now been switch to methadone, the pain doctor said it's works better for cronic pain, cus I do have scar tissue to now, well it's been 3 months now of taking methadone, and I hate it, I work for petro {oil company} and I do customer service, and methadone has to many side effects for me, I'm sleepy all the time dizzy, confused and just cant focus at work,and many other side affects I work with numbers all day and service contracts, and this is not working for me, when I was on oxycontin I had none of these problems, now with oxycontin I was up and down I guess the best thing is to find a dose of oxy that works for me and stick to it, my pain doctor said methadone will get better with time, it's does take my pain down but it's hard to work and even drive on this stuff, it's just not working, so my question is should I tell him that he should put me back on oxycontin cus that works for me better, and send me back to my family doctor, cus there is nothing elce he can do,thats what he told me,some people still have lots of pain after sugury and I'm one of them, and methadone just dont work for me,
    please tell me what I should do thanks so much
    I have a family and just want to get on with my life I'm only 30 years old

     
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    Old 09-22-2005, 10:15 PM   #2
    wolfmarket
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    Re: methadone or oxycontin

    My experience is that you can't tell the Pain Doc what to do. You might make a suggestion, or even make an offhanded request. But no Pain Doc is going to take a command from any patient!

    Alan

     
    Old 09-23-2005, 09:07 AM   #3
    madhatter
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    Re: methadone or oxycontin

    Someone once told me that long term use of meth. makes your bones brittle[little like pinholes in the bone] Myself,i take oxycotin 60mg tid for about 6 months,and its working fine[so far] many peaple i've talked to that were on o.c say there tolerance went up quicker than any other pain med. I believe it depends on the induvisual.

     
    Old 09-23-2005, 09:14 AM   #4
    Rrector
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    Re: methadone or oxycontin

    Hey Bucky:
    I feel for you man, being 30 years old, on Methadone and trying to work too. You didn't say what kind of dose they have you on, but I can really understand your concerns. It will get somewhat better with time, but some of the problems your having being on Meth won't go away entirely.

    I'm twice your age and I've been on Methadone for two and a half years at 180 mg per day. It's still hard for me to focus sometimes and driving, especially any long distances is almost impossible. I do ok around town, but to get out on a freeway and start driving several hours is bad news. If I have to do that, I take just enough Meth to keep me going and suffer until we reach our destination.

    When I first started having pain issues I was on Oxycontin and at the end I was at 160 mg TID, but I didn't have the problems. Just like you I could drive and focus much easier, but I too would find it hard to stay on schedule with the meds. Finally, my doctor upped my break through medication to 30 mg of Roxicodone q4h and that made it easier to stay on track. I was also on a huge amount of narcotics everyday.

    I finally ended up on the Methadone because of the better pain killing properties it has over other opiates, especially with nerve pain. You might mention to your Pain Clinic doc you did much better on Oxy and you're having problems at work, but Alan is right, they like to call the shots and you have to tread lightly and almost make them think it was their idea if they switch you. Good luck and hang in there.

     
    Old 09-23-2005, 12:56 PM   #5
    Shoreline
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    Re: methadone or oxycontin

    Hey Bucky, I feel for ya, I had my first surgery at 27 and second at 30 and 3rd at 33, It's hard to believe I've been disabled 6 years now.

    I haven't had script insurance the last 4 years so switching to meth was my only financial option just to allow me to walk. However I know the meth blahs very well. No motivation, concentration, no color in life, no labido, it's a very gray world on meth and I couldn't imagine working and focusing if I was able to sit any longer than 30 minutes with meth head.

    The only real answer is to get off the meth but compliance with the way the meds are prescribed is an absolute must if you want your pain managed. Taking an extra pill isn't an option if living with the level of pain isn't an option. A 30 day supply means 30 days, not 28 or even 29, my doc tracks fill dates to the day. Prior to the monthly DEA apts that started this year we would get 3 months worth of scripts, "if we were stable on a dose" but each script had a fill on or after date exactly 30 days apart. Running out early meant being discharged. So a bad day is better than a day with no meds.

    Now with the DEA so involved My clinic does monthly DEA apts where they do pill counts, check fill dates and may request a UA. We don't get a second chence, we have contracts where any form of non compliance means discharge with no taper.

    I'm sure you have come to the same conclusion that something is better than nothing.I I don't want to harp on the compliance thing, you know the deal now but earning your docs trust back is tough to do. I would normally say try LA morphine and you would be amazed how color returns to life, but you need a doc to give you a second chance with meds he thinks are abusable.

    The crazy thing is, if you wanted to abuse meth you could, It's not like you can't get high on meth and people do abuse it but docs think it's less prone to abuse. Maybe it is because I simply didn't feel good on it and more just made me feel worse. I was able to stay at the same dose for several years. A 20% increase pushed all the side efects over the top and I wanted off the stuff asap. Without script insurance my only option was a pump, Medicare will pay for a pmp and the meds.

    Maybe prooving you have been compliant with meth will allow the clinic to try another shot at a drug they see as a greater risk. But I would simply tell them what you told us, about how it makes you feel. If they are willing to do a pump trial and you can't function without opiates, it's an option they know you likely won't try to tamper with. I have heard stories of people doing stupid things with a pump so I can't say it's absolutely absue proof but they will catch on if someone doesn't kill themself trying to suck meds out of the pump and inject them IV.

    Swithcing to the pump from meth was like re-entering the technicolor world. It hasn't solved the spine problems but it does relieve enough pain that I can function somewhat around the house. Shop, cook, clean etc. It just takes longer and kicks my ars. But that's still a huge leap from being bed ridden.

    All you can do is talk to the PM clinic about all your options. Explain if you were trying to get high you could do it with meth and it's even more dangerous to play with. Maybe they will give you a chance with a patch or a LA morphine product or if they aren't comfortable with the abuse potential, a pump or SCS pretty much rules that possibiliy out. Why not do a trial and see if it works better and has less side effects?

    The willingness to try anything that may help is the difference between folks that can't function without PM and those that simply feel better from opiates. Although you are able to work, I don't doubt you need pain relief. The goal of an implanted pump is to relieve 50% of the pain, any more is just a bonus, But 50% pain relief may mean you are able to return to work, where it means I'm able to shower without my wifes help. So that same 50% is very subjective.

    Hopefully the clinic has more to offer than just a script , I started PM long before anyone used opiates to treat non cancer pain, Oxy C wasn't even on the market untill after my second failed surgery, It wasn't offered untill I had tried everything you can imagine, some things helped, some are a waste of time. But that's the advantage of a clinic, they should have more to offer than just a script. They should also have counseling so that folks with severe pain understand N0 pain isn't what they shoot for.

    If a doc gives you BT meds those are what you use on bad days. If you use BT meds as part of your daily routine, same amount every day, when you do have a bad day, they aren't any more effective than they were every other day you take the max amount allowed. When reaching for the BT meds you have to ask yourself is this just to be more comfortable or to prevent you from calling the doc or going to the ER because the pain is so out of control.

    Personally I don't see how having the clinic discharge you and say there is nothing else thay can do will help your situation, you may have burned the GP bridge already. If the clinic can't offer anything else, doesn't do pump/SCS management or implants or have anything else to offer, you may want to ask your GP to get you in a different clinic and do some research on things you haven't tried before you tell the clinic they aren't helping or you can't tolerate twhat they are ofering. See what another doc has to offer or another clinic has to offer versus where you are at. But I wouldn't ask to be discharged because you don't like meth unless your prepaired to take a break from opiates. You don't know if your doc will continue the meth or continue any med. It's a huge liability to give someone enough opiates that they could kill themself with, especially after you screwed up once.

    Have you had nerve blocks of any kind, have you learned any relaxtion technique, Bio feedback, self hyppnosis, guided imagry, tried chiro for the other levels of your spine that tend to over compensate, Acupuncture, float tanks, more PT because all PT is not the same. Have you ever gone through a scar management program to deal with scaring from surgery, myofacial release. There are dozens of modalities that may add to whatever med you happen to use. If you could reduce the meds using other tools the side effects aren't as severe.

    Basically there is alot more out there than oxyC or meth and if you GP just started prescribing because you still hurt after the surgeon discharged you, he really didn't do you any favors by not offering anything but more and more opiates.

    I do think it's easy to run into a wall where you can't tolerate meth any longer, and you need to look for other options and be willing to try anything you haven't already tried. I don't know if a pump would work better or morphine or a patch would be better, but I do know people do benefit from some of the non opiate modalities and the process of trial and error with meds and modailities is something you have to go through with your docs.

    One PM doc or clinic may not be able to offer what another one can. It depends on the doc and clinic and their phylosophy on PM and opiates.

    To prevent having to detox from meth with nothingt else, I would find out what else is available in your area before asking to be sent back to your GP. You can call medtronics and get the names of pump and SCS certified docs in your area. You could talk to your GP about other options and other clinics if this one isn't doing it.

    I went through a dozen PM docs, 4 clincs, 3 surgerries and 7 years before I found someone that could even put a dent in my pain. Not everything I learned or did during that time was a waste, If I learned something that helped along the way I kept that knowledge or technique and just add it to the tools I have to manage my pain. IF a doc or modality was useless I tossed it.

    I can't think of a quick answer or how to shortcut PM to go directly to pain releif. Even with opiates there is no gauerntee. You may meet PM docs that don't use opiates, you may meet docs that would never prescribe more than 120mgs of oxy a day, Everyone has their own phylosophy and it's trial and error as far as what works and who can or is willing to do it for you. I've waited 3 months to see the head of the physcial medicine dept at a major med school only to have her tell me she couldn't do a thing for me in the first 5 minutes. So, you move on to the next doc or clinic.

    Ideally you have one stable force in your healthcare/ PM program and that may be a shrink or GP that may not prescribe the opiates but helps in other ways, He can answer medical questions and perhaps point or refer you in the right direction.
    You can't get around the PM maze without referalls and someone trying to help you.

    Wat else have you tried to manage your pain?How many different PM docs have you seen and have yo ever talked to one about a pump or scs. The type of pain you have determins what method of pain nagement would work best. Is most of yo pain back pain or leg pain?

    If you can answer some of the things I asked I may be able to tell you more about specific things for the type of pain you have, but you still have to find a doc willing or capable to do them.

    Good luck, Dave

     
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