Pain Management Doctors - How to Handle Tolerance Issues

forginon

This is done quite often, it's called opioid rotation. I like this better than just continually raising doses.

Once all have been tried then methadone is frequently employed. It's actually too bad they use it so late in the game. It's got NMDA antagonist qualities that actually work to halt or reverse tolerance. There are other meds that can also do this. Dextromethorphan is also an NMDA antagonist, as is Tagamet. Sometimes these are prescribed along with an opioid to help keep tolerance in check.

steve

brianpain33

Kev,
Can you tell us what you are currently taking and how long you have been taking the current meds? Also what other narcotic meds have you tried? This might help us answer you better and make other suggestions.

brina

cmpgirl

My PM has changed up my meds just like Steve described. Especially muscle relaxers and my BT, as I have taken them even longer than the LA meds.

He is still doing increases with my Oxycontin because I'm not even near max levels with those. He recently changed my Soma to Flexaril, and I believe at my next appointment he's changing my hydro to Percoset for BT.

Take Care, cmpgirl

SpinalMalady

My PM employs the same "opiate rotation" tactic. It has worked fairly well for me.

I've had 3 dosage increases in 4 years. I just recently requested a dosage demotion or decrease. I'm handling it pretty well. Added to the mix massage when I decreased, and it's WONDERFUL! I'm a new woman!

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Executor

I'm sure this gets you even more credibility with your Doc! Not many do this, that's for sure. It also has to help when you do need more meds at some point....I seriously doubt they would question you.

Ex

Kev32

Yes. I'm not taking anything right now but my history is as follows: I was on Lortab 10 mg 4 ea. x day for a short period. I was then prescribed Methadone for about 2 years (highest dose 60 mg/day). I was then moved to Oxycontin 80 mg 3 x a day and 8 ea x day OxyIR 5 mg for three years. I got to the point that I was feeling pain again every 4 hrs and having that yawning/achie feeling I typically associate with withdrawl symptions. When I came off the Oxycontin, I was taking 80 mg 4 x a day plus around 12 OxyIR's.

We never tried the Duragestic Patch because she was afraid it would not work well since I used to sweat a lot. I tried the Moriphine capsules 100 mg 2 x a day for 3 days and I really hurt and had to go back to the Oxycontin.

I moved to Suboxone for 11 months since my former pain management doctor refused to deal with my Tolerance/Dependance. My current pain management doc. said I was limited to what he could treat me with as long as I was taking Suboxone of course. I therefore came off of suboxone 4/09. I see my pain management doctor 4/22 and want to be educated this time as to what to do when my tolerance rises again. Going the Suboxone route turned out to be a big mistake as that is associated with addiction. I have fibromyalgia and degenerative disc disease C5, C6, C7.

forginon

I should have written that it is done but not often. I have not been personally involved with a doc that practiced this. It only seems to come from those on the cutting edge, those that publish. I sure hope we see more of it. I belive either Shoreline or Conductor wrote about another, more potent NMDA antagonist, one used for Alzheimer's disease. Namenda maybe?

I even asked my PM doc and she really didn't seem interested.

steve

forginon

I believe the site I read suggested two doses of 400mg daily. I tried two doses of 200mg daily, which is the OTC recommended dose. I really saw no improvement over a two week period.

steve

forginon

I can easily see why you'd say that - they do sound very similar if you work it out long term. I would say that dimishing tolerance, or even sustained tolerance, would allow a patient to remain on a stable dose for an extended period of time. Much longer than if tolerance grew. Kinda like my experience with methadone, where I was able to stay at 80mg daily for a really long time. Opiate potentiation would simply increase the potency of an opiate.

Hope this helps.

steve

brianpain33

Maybe you could go back to the Methadone and not have the same experience. I would guess that the reason you sweat alot is because of the Oxycontin. You might not sweat so much without it but I could be wrong. What about some other med like Lyrica or Cymbalta, have you tried those. I'm sure you know that narcotics tend to be not very effective for nerve pain and the Lyrica & Cymbalta are good for doing that

brian

p.s. If you want to try a different narcotic med, you could try Opana(oxymorphone) ER with Opana(oxymorphone) for BT med, or even Dilaudid(hydromorphone) for BT med. Those 2 medications are supposed to be a step up from oxycodone

Executor

I don't know anything about "diminishing tolerance", but in my extensive research over the years, I have run across articles and message boards about "potentiation." Apparently, some abusers will do about anything to increase their high....Therefore, they have experimented with "cocktails" of other meds in conjunction of their pain meds. I'm not sure if there is much to it or not, but I don't think potentiation as any place in pain management.

Re: tolerance, I think the only measurable effect is reducing your dose or abstinence.

Hope this helps.

Ex

forginon

Mush,

I do think you are right. Is two weeks long enough? No. But I realized that I wouldn't be able to afford it on a regular basis anyway. So I aborted the test.

Other terms that refer to reducing tolerance are 'opioid tolerance and adjuvant medications.' Or 'opioid tolerance and NMDA antagonists.' Or 'NMDA antagonists and chronic pain.' Ketamine is another example of an NMDA antagonists that is believed to control tolerance. Methadone is the best example of an opioid with this property built in.

steve

Kev32

Thanks Brain and all. I have tried Cymbalta, Lyrica and Neurotin and they did not do any good for my pain. I guess I have been on about everything over the past 5-6 years. I wish something like that would have worked for me though. I did not know about Opana - Thanks---Kev