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  • Is prescribing 3 different pain meds common practice?

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    Old 05-29-2006, 09:53 AM   #1
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    Question Questions about oxycontin and percocet, methadone

    I'm new to the board and want to say hi to everyone here. I been going to pain management for years due to head on collision car wreck. I've been on several meds in the past but I'm currently on oxycontin 20mg twice daily, percocet 7.5mg 3-4 daily for breakthrough pain and methadone 5mg once nightly. I had been taking methadone but it constipated me badly, and made my stools hard and I never wanted to take it again for this reason. Yet they want me to take it at night, the methadone 5mg was recently added on. No matter what type of laxative or stool softener I take nothing helps with the methadone constipation. I was also curious is it common for meds to be prescribed this way? I thought they would give you one type med and increase it as needed, and I always heard it was dangerous to mix meds in the past. But now it seems commonplace, or at least the place where I'm going does it quite often. Does anyone else seem to think this is dangerous?

    Last edited by twistedwhiskers; 05-29-2006 at 10:08 AM.

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    Old 05-29-2006, 03:48 PM   #2
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    Re: Is prescribing 3 different pain meds common practice?

    Most of us CP'ers have a long acting med (Kadian, OxyContin, MS Contin, etc.) with a short acting med (Oxy IR, Roxicodone, Dilaudid) for breakthrough.

    Three meds is unusual.


    Old 05-29-2006, 05:15 PM   #3
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    Re: Is prescribing 3 different pain meds common practice?

    As Alan noted, three pain meds is fairly unusual. Most of us on the Pain Management Board are on one or two. Being on Oxycontin with another med (usually SA) is normal. I'm on Methadone and don't have anything for BT pain. It just depends on the doc.

    Old 05-29-2006, 05:45 PM   #4
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    Re: Is prescribing 3 different pain meds common practice?

    Like the others have posted, taking more than one med is normal. I take Three, two pain, and one muscle relaxer. For me I take one LA med and a BT med.

    In your case they are using two LA meds and a SA med. Meth is usually considered a LA med along with OxyContin. So it does seem a bit strange that you are getting to LA meds. Probably OxyContin and Percocet would be just fine as 5mg of Methadone is a very small dose.

    Also, the OxyContin should really be dosed TID ( three times daily) for maximum coverage. It usally only works for about 8 hours max. By dosing TID you may be able to lower or even cut out your percocet.

    Welcome to the boards

    Old 05-29-2006, 08:20 PM   #5
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    Re: Is prescribing 3 different pain meds common practice?

    To reiterate, more than 2 PAIN meds is unusual. One long acting, one short acting for bt.

    Some PM Docs will add a muscle relaxant to the mix.

    Another thing I'm seeing some of, although still rare, is a long acting med combined with a short acting med with Actiq thrown in for extremely horrific bt.

    Old 05-29-2006, 08:27 PM   #6
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    Re: Is prescribing 3 different pain meds common practice?

    Welcome to the board, it's a great place for advice! After my injury I too was just a little concerned about the amount of meds my dr was prescribing me. I currently have in my cubbard: flexeril, ultram, oxycotin, vicodin, elavil, wellbutrin, celebrex, motrin, topamax, nexium, phenergan, and prednisone. All but three of these meds were prescribed to me within a three week preriod. One of them nearly killed me. I now have a new pm dr and he has me on just the topamax and motrin. Mind you it's not enough, but I think I'm better off--as nothing was working anyway. He has never told me I can't take them. A trip to the other dr sent me home with the prednisone just yesterday. I often wonder if she is a "pill happy dr". I worry about mixing the meds so I count on my pharmacist a lot. For a while there I kept thinking they must of thought I was some kind of druggie with all the pills the dr was sending me home with. I also keep a med diary every day. I am getting a better understanding of the meds and how to take them by reading the boards--so when I do have really bad days I have have a better idea of how to take them. Good Luck Angela

    Old 05-30-2006, 09:01 PM   #7
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    Re: Is prescribing 3 different pain meds common practice?

    Although it's not the norm, it actually makes good pharmacological sense. Methadone has qualities that other opiates don't have and often 1+1=3 when you combine opiates of a different class or in your case, hopepfully 1+1+1 =5 One class of opiates will bind may bind to specific receptors the others don't. Methadone is also the only opiate that blocks the NMDA receptor which has many benefits in treating chronic pain at the neurochemical level. If you ask him if he's using meth for it's NMDA blocking action, he might want to see how some patients do with Nemanda, a drug thused to treat parkinsons that has even stronger NMDA blocking ability. My wife has been able to return to normal work and reduce her opiate intake by 2/3rds thanks to Nemanda.

    I've seen mixing done more often in high dose patients, where a high dose of a single opiate alone simply doesn't work, but I have met one guy that wears patches, takes meth and kadian, He';s using an opiate from every family plus needs BT meds and basically covering every possible opiate receptor you can. Where one or two opiates may not hit every class and sub class of opiate receptors.

    Even using every class "family" of opiate This guy is still in terrible shape , but his condition warents it and the meds improve his ability to function rather than hinder.
    He was bedwridden for several years prior to mixing opiates. If your doc is comfortable prescribing them to you he's obviously knowledgable enough and feels your individual case warrents something outside the normal box.

    If you boil it down it's no diffeent than some people getting relief from vicodin or some getting relief from low dose LA meds where some folks take 600+ mgs of morphine or meth a day and some people have pumps. Each person and each case is different.How each person responds to opiates is different and the side efects each person is willing to tolerate is different. If that's what it takes, It's not unheard of. I've seen much more outragous stuff in my life than adding a few mgs of methadone.

    Some of the benefits of using meth and NMDA receptor blocking are decreased tolerance to opiates or at least slowing it. I used the same dose of meth for more than 2 years before needng an increase, but that was because my spine is continuing to deterioate not because I became tolerant. Disease progression can create the need to increase or add meds.

    Blocking the NMDA receptor also increases tolerance to pain and is supposed to help more with nerve pain than the other opiates. So it really makes more sense than jacking your oxy dose into the 300+ range when a few mgs of meth can keep your overall opiate dose lower than using a single opiate.

    Using multiple long acting meds is done for the same reasons using a different BT med from your base med is done, each med shares common traits and each med has it's own unique properties.

    I've been doing the PM thing for years too and have used many different things for constipation, and I finally found something cheap and easy you can get at a heath food store, It's called Cascara segrada and is the active ingredient in all these colon cleanse infomercials you see on TV. I spent the 60 bucks just to find out what the ingrediant was. Occasionally I use some Kristaloose with the cascara, but it's a maint thing when you take opiates. There is always something we haven't tried. If those don't work, Yakima fruit paste is used in hopspice care and I can give you the recipe for that if constipation continues to be a problem. It worked well too but takes some effort to make where cascara seem to work as well.

    Anyway,welcome and don't worry about mixing opiates, They all bind to the same group of receptors so adding a few mgs of one is no different safety wise that increasing the dose of one your already taking. It's smart but not something everyone requires. Even mixing opiates doesn't gaurentee relief ,but if that's what it takes to restore function to some degree and the benifit can be documented, there is no medical reason not too.

    Good luck, Dave

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