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zuzu23 11-27-2006 08:48 AM

Long-term use and tolerance.....end result???
I have had this thought from time to time in the last year or so. I noticed now after almost 3 years on the same medicine (Perc.), instead of 4/day, I need 6/day usually. Now, my doctor told me last month that I cannot ever have more than 6. If I'm at 6 now, when m body adjusts to the new dosage and my tolerance catches up, what do they do when they can't increase your meds. b/c you're maxed out???:confused:

I now there's a med. ladder, and maybe they can switch meds. for me (and probably should, if I had better medical advice) but eventually when you've climbed every rung on the ladder, and you're at the top and maxed out on that, what do they do?? I just keep picturing me at somewhere around 45 (I was 25 when I started on meds.) or 50 maybe, laying curled up in a ball on the floor, thrashing around in pain. :eek: I know how bad the rippig pains can be, and I can't see living without something to reduce the pain.

babs17 11-27-2006 08:52 AM

Re: Long-term use and tolerance.....end result???
What doasge are the Percs? Why only 6/day?
How long have you been with this doctor?
Hope you feel better soon.

be well

zuzu23 11-27-2006 09:05 AM

Re: Long-term use and tolerance.....end result???
They are 5mg/325mg Tylenol. I've been with him for 3.5 years. He said it would be b/c of liver damage. I've asked him for the same dug w/out the Tylenol, and he insists it doesn't exist (although I know of several on here who take it.) I only live in Canada, so I'm sure we have it here. No pain doc's though, so this is just a family doctor.

butrfligirl28 11-27-2006 09:33 AM

Re: Long-term use and tolerance.....end result???
You can be upped to percocet 10/325. Same amount of tylenol, but twice the oxycodone. It sounds like an excuse to me. Do you take a long-acting med? That would be the best thing for you. You could talk to your doctor about long-acting oxycodone (Oxycontin), with percocet for break-thru pain. Your tolerance increases faster with short-acting meds, and you have the "roller-coaster" effect of pain. This doc sounds like he is not doing his best by you, in my opinion.

babs17 11-27-2006 10:08 AM

Re: Long-term use and tolerance.....end result???
6 Percs would mean 1950gr amt of Tylenol a day. The max amt is 4000gr daily, but long time use is 2800mg daily (I heard this hearsay not quote me) I agree with the post above. It sounds like an excuse. It surprises me since he has been your doctor for so long.
Be careful asking for the 10mg. He does not sound like he is really on your same wave length right now and asking for that may seem like you are directing your care, not him. Not sure what to offer for advice here. Building up a tolerance is totally normal, so maybe if you ask for a liver enzyme test monthly along with a small increase in the amt you can take??
Let us know what happens. and good luck
be well

zuzu23 11-27-2006 10:22 AM

Re: Long-term use and tolerance.....end result???
Well, I did ask for something stronger, or a higher dose. Several times now, trust me lol. He keeps saying there is nothing stronger for the med. I take. Then a few months ago, he gave me Morphine Statex (tiny blue pills) instead....didn't work (at least the dose he gave me) and made me so ill. So then it was right back to Perc's after maybe trying the Morphine for 10 days.

But I'm hoping somebody will be able to answer my original question: What happens at the end of the Road? When you've maxed out on every drug there is, what do they do???? Or are we all just playing against time, hoping they find new developments for our respective conditions?? If I was only 25 when I started having chronic pain, how can I possible hope to make it to 75 or even 70 without maxing out on all there is?? I've already "maxed" out on this drug.....supposedly. So what happens in the end, 20 or 30 years or more from now???

ibake&pray 11-27-2006 01:22 PM

Re: Long-term use and tolerance.....end result???
Well I know for a fact that you haven't maxed out on the Percosets. I take the #10/325-up to 6 a day. I was taking 8, but they(whoever they are) now have findings that say that that much is "too" much. I gather they are talking about the Tylenol, not the Percoset. I also have the 5mg percoset IRs for breakthrough, and I am on slow release morphine.

Don't know about the end of the road. As many new medical things are being developed, we may not need larger quantities of drugs....wouldn't that be a delight. Good luck with finding better ways to control the pain...sounds like you need a change of doctors.

Shoreline 11-27-2006 01:58 PM

Re: Long-term use and tolerance.....end result???
ZuZu, You have a GP managing chronic pain. If you need a PM doc then you may have to travel or relocate. As far as the percs, your on step two of dozens of options with long acting versions of oxy, morphine, fentanyl patches, methadone, long acting dilaudid, short acting dilaudid and you are corect, Purdue makes OxyIR in 10 and 20 mg tablets that contain no tylenol. However you can't really expect your GP to manage CP that requires meds that would have only been prescribed for cancer just 10 years ago. All the LA meds and the high strength pure opiates have all come out in the last 5-10 years, Newer ones hit the market each year. You simply can't expect a GP to be versed in PM and all the alternatives.

So what happens when you tolerant to 600 mgs of long acting morphine a day and 30 mg Oxycodone tablets barely touch the pain? You can have an intrathecal morphine pump implanted, that's when no other method of pain management is effective or the side effects of other meds are too severe to manage your problem. It sounds like the only method of pain management you have been exposed to is the pain meds your GP is willing to prescribe. Prior to 96 and the invention of long acting pure opiates, PM docs used other methods to manage pain, some help, some are a waste of time and some resolve some peoples roblems entirely.

You have to look at this as how your going to spend the rest of your life. If you had cancer, you wouldn't except a death sentance from your loocal GP because he was trained in oncolog., You're basically facing the same thing. Honestly , you probably shouldn't jump on the increrase train and jack your tolerance through the roof untill you have explored some options that don't result in dependence on opiates.

There really is no ceiling on the amount of pure opiate one person can take. The ceiling is created by the side effects, Too sedating, too much urinary retention, too constipating, too much nausea, or the docs own discomfort with high dose patients. Side efects do deminish with time, a couple of increases in morphine and some time to adjust to the side effets may have allowed morphine to be a viable option. However, your doc claims not to even be aware they make a drug stronger than percs, so it's time to start looking into real PM if you need these meds to function.

It's not like these meds are harmless though, There is a price to be paid for everything. Physical dependence is a huge priice, and dependence on 6 percs a day is nothing compared to seveeral hundred mgs of long acting pure opiate.

600 mgs of morphine may sound like alot, but it's the difference between being able to walk and being bed ridden for me, It's not a matter of comfort. There is no dose that would eliminate all my pain or even rekieve more than half my pain without sedating me. Honestly there are days I wish I could be sedated. All you have done is see the limits of your own GP and know you need a specialist if you can't manage with what he has to offer.

Even among PM docs, not every doc can offer every modality.Some use opiates, some don't,some do interventional procedures and some simply write scripts. There are dozens of non opiate methods to manage chronic pain. Opiates are the easiest solution, but come with a huge price. In Canada, you have to have a special licence to prescribe methadone which can be very effective, It's not the next step on the ladded but it's something out there your present doc will never be able to offer. He'll never offer an implanted morphine pump or a spinal cord stim, can he teach you self hypnsosis, Bio feedback or guided imagry? Does he use anti seizure meds and anti depressant for their chemical effect.

The same goes for techniques uswed by real PM docs. Not every PM doc can or will offer Interventional procedures like nerve blocks, epidurals, trigger point injections, use of Botox or even surgery if that may bring relief. Your doc isn't a PM doc so he will not be offering anything he's not familiar with. If you needed surgery or had cancer, he would admit his limitations, He's simply not comfortable prescribing more than 6 percs a day. He does want to say that's his personal limit, he's just saying he won't prescribe more than that.

That's his choice, but you have the option of seeking more qualified help.
If someone will only participate in PM if it's conveinant, doesn't interfer with their life or have to drive more than 30 minutes, It's hard to call that life altering pain that requires the most potent meds and most agressive methods to treat pain. If your pain is that severe, you will travel or be bed ridden or simply more uncomfortable than you are now once you grow more tolerant.

The only real limit you have run into so far is local doc selection and his willingness to prescribe stronger meds. Perhaps he wants you to go find a PM doc with a background in anesthesia so he can try some of the non opiate interventional procedures. Traveling sucks, but it's better than allowing pain to manage your life rather than you manging the pain.

It's not that your docs a bad guy, He just doesn't want to test his prescribing limits on the few patient he may presently be helping. If percs are the strongest thing he uses, I kind of doubt he's going to prescribe fentanyl loli pops that are a hundred times more potent than percocet.

Good luck and you may be surprised by all the options true PM docs can offer.
Take care, Dave

twisten 11-29-2006 10:15 AM

Re: Long-term use and tolerance.....end result???
ZuZu, I also live in Alberta and yes there is a form of oxycodone with no tylenol, iburprofen etc. It's called oxyir. I was on it up until a few months ago. I'm not sure how strong the doseage goes to though the only ones I've been on are the 5mgs and the 10mgs but I'm sure they go higher.

aussie_jono 11-29-2006 02:48 PM

Re: Long-term use and tolerance.....end result???
There IS no end of the road with morphine or hydromorphone, you can keep increasing the dose as your tolorance increases.

Adding chlorpromazine can add to the pain relief offered, as can celebrex or naprosyn

Rrector 11-29-2006 03:31 PM

Re: Long-term use and tolerance.....end result???
Usually given for breakthrough pain, Oxycodone or Oxy IR is pure Oxycodone. There is no Tylenol or anything in it. It is available in the US in 5, 15, and 30 mg doses. There are generics available.

There isn't a ceiling on opiate meds as several posts have indicated. It just depends on what you are able to tolerate, as far as side effects go. The higher the dose, usually means an increase in side effect problems occurring.

zuzu23 11-29-2006 03:41 PM

Re: Long-term use and tolerance.....end result???
[QUOTE=aussie_jono]There IS no end of the road with morphine or hydromorphone, you can keep increasing the dose as your tolorance increases.

Adding chlorpromazine can add to the pain relief offered, as can celebrex or naprosyn[/QUOTE]

I thought this way too, but then I considered how an overdose happens then?? I mean, obviously if someone uses these drugs illegally, and takes a massive dose at once, then overdose happens and lots of times they die. But even for me, with almost 36 months of tolerance built up, if I were to stay on this same drug 20 years from now, let's say for argument. Right now, I take 30mg a day. 20 years from now it may be 100mg or whatever. Isn't there a "ceiling" when your body just can't tolerate the drugs anymore??? And I am aware that if I took that much of THIS drug, it could kill me b/c of the acetaminophen damaging my liver.

Please excuse my lack of understanding and my ignorance....I have gotten this information at one point or another from the doctor in question. I am aware that he isn't knowledgeable and has given me false information here. That's why I'm here, so I can sort through the information and find the real truth.

Thanks again guys!!!

Rrector 11-29-2006 03:56 PM

Re: Long-term use and tolerance.....end result???
Hey Zuzu: As I said in my earlier post, there isn't a ceiling when it comes to "pure" opiates. By that, I'm talking (as I said before) about pure Oxycodone. It's called Oxy IR. Same as Percosets, but without the apap (Tylenol) which damages your liver. The only thing that would be a problem, is if you got to a certain dose and your body just had too many side effects to continue taking the medication. In other words you aren't able to go any higher. That doesn't mean you couldn't be changed to another med that you could tolerate and it would cover your pain.

I hope you can understand and make some sense out of all this that I'm trying to explain to you.

twisten 12-01-2006 07:11 AM

Re: Long-term use and tolerance.....end result???
Just as an example of high we can safely be titrated up my friend who just died was on 108mg of morphine every hour before she passed on. Once she got that high though they switched her to something stronger but I don't remember the name of it. I'm not sure how long it took to reach that dose but it was quite awhile. What are your pain symptoms and/or diagnosis's? Surely your GP could refer you to someone who could help you better? When he decides to come back to town I guess though heh.

Rrector 12-01-2006 04:38 PM

Re: Long-term use and tolerance.....end result???
Hey Zuzu: You have those tabs of Morphine Statex that you say makes you ill. Have you ever tried taking them as a suppository? It can be done. If you have the blue pills, they are 10 mg and should be more than enough to stave off the withdrawals from the Percoset. What do the directions say? Does it say you can take two (20 mg), as it might take more than one to keep the wd's at bay.

Hang in there, you've got a lot of people trying to help you.

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