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    Old 07-02-2008, 05:13 AM   #1
    rich57
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    New medication...need information and advice

    My doctor is getting ready to change my pain meds. I am presently on 10/325 percocet, about 40 a month. We discussed that maybe that wasn't enough and I suggested increasing the amount per month. My doctor said that he wanted me to try the patch. I said I would give it a try. Am I making a big mistake or is the patch better than percocet for pain management. Any insight you people could provide me will be greatly appreciated.

     
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    Old 07-02-2008, 07:50 AM   #2
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    Re: New medication...need information and advice

    is that oxycodone actually working for you at all? if it is,it would not be a really great move here to actually go from something a bit less strong like the oxy and bypass all other alternatives and just go with like the strongest narcotic out there when something less will do. trying the longer acting form of oxycodone would make a heck of alot more sense at this point. it can be titrated up til you feel some relief. if you actually get relief from oxy at all,there is just no good reason(from MANY standpoints) to place you on something that will create alot of issue down the road when it doesn't work for you anymore, or if you have to even have a surgery at some point,it will be an issue with good pain management too you know what i mean? its just kind of a big jump to just go right to when other types of meds should be tried first,thats all. there are just much better alternatives for your situation than going with the highest level of narcotic at this point. i know alot of people here are on the patch but i do believe the majority only got to it AFTER other methods had been tried and they just needed a higher level of pain management. to go right from percs to fent is just a big jump when something less could actually work for you ya know? just my opinion. fent,for me and my pain,is something that i tend to think of as a go to med when my oxycontin no longer will work for me. and MS is also a consideration as well. i just feel like your PM is not doing you any huge favors in the long run by possibly placing you on something this strong when you probably would do better just with the longer acting form of oxy,thats all. i would seriously speak up to him about possibly trying just the longer acting form of oxy first to see how it goes. it could do wonders for you but you wont know til it gets tried. i do wish you luck with this. please keep me posted on how things go.Marcia
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    Old 07-02-2008, 10:46 AM   #3
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    Re: New medication...need information and advice

    I strongly agree with Marcia. To be very honest and candid, I don't think your Doc knows much about pain mgt. He is proposing that you go from a pistol to a rocket launcher....And skipping everything in between.

    According to Janssen, the makers of the Duragesic patch, the lowest available patch is 12.5mcg (micrograms). It comes in micrograms instead of milligrams because it is so potent. Many will tell you that fentanyl (active ingredient) is the strongest pain med available.

    The lowest level patch, 12.5mcg, is equivalent to 45mg of morphine. Oxycodone is twice as strong as morphine, so 45mg of morphine is equal to about roughly 22mg of Oxycodone...Daily. You are receiving 40 10mg Percs per month, or 1.33 per day, on average. Thus, the Doc is proposing at least to double your meds, which is unreasonable IMO. Furthermore, as Marcia says, he's proposing you switch from one med that's working to another chemical all together....For no real reason. This is all assuming he's going to put you on the 12.5 and not the 25 (most people start with the 25). The 25 is appropriate for those who are taking a range of 60-134mg of morphine (according to Jansssen). If he put you on the 25mcg, he would be increasing your med potency by 4X.

    Thirdly, the patch is a 24 x 7 med because it dispenses a precise amt every hour all day/night...Meaning your tolerance and physical dependance will skyrocket. Why start with a 24/7 regimen when you don't have to? You'll be forever tied to pain meds @ that point...Much more so than you are now. I would try to avoid a 24/7 regimen as long as possible.

    Personally, I would try to increase the # of tablets per month whereas you could still control the amt you take. I feel sure some days are better than others and you probably don't need much, if any. By skipping days, you can prevent physical dependence. One perc per day is nothing. If the Doc objects, then the only thing I would consider would be Oxycontin, which is the same active ingredient as Perc....10mg would give you 10mg spread out over 12 hours. You would probably start @ 10mg 2x day, or 20mg per day.....Still a significant increase for you for no reason all at once. I would wait to move to OC until I needed to....Usually when the # of short acting meds each day is equal...So, when you got to 2 10mg Percs per day, it would be time to switch.

    The patch is a great med....I have found it to be the best of all pain meds. However, it's the "big gun" and should be reserved for such. Lastly, not sure of your "lifestyle", but the patch requires some changes in most cases because it's a patch....It's effected by sweat, heat, & etc. Do a search on the subject and you'll get lots of good threads on this site.

    Good luck, and I hope this helps some.

    Ex

    Last edited by Executor; 07-02-2008 at 10:53 AM.

     
    Old 07-02-2008, 10:58 AM   #4
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    Re: New medication...need information and advice

    Rich,

    Can you share a little about your condition and narcotic history?

    It would be helpful to know what you are treating and what you've tried before, narcotic and otherwise, and what has worked for you. This way it's much easier to give insights.

    One thing I believe may influence your doc's recommendation regarding the patch is that you are right in the middle of the OxyContin war zone. West Virginia was one of if not the very first state to report excessive ER visits for OC overdose and addiction, along with deaths. I bet meny docs in your area are reluctant to prescribe OC and large amounts of oxycodone, the active ingredient in your Percocet.

    As others have written, fentanyl, the active ingredient in the patch, is super potent, at least 100 times more potent than morphine. At your current level of narcotic use it is very uncommon to go straight to fentanyl. Physical dependence on narcotics is something all of us regret, but find it is inevitable if we are to get any kind of decent relief. You are at the entry level to dependence, and a transition to the patch would make you as dependent as the rest of us, as Ex pointed out so well. If I were you, I would not want that level of dependence yet.

    So, please provide a little more info and we can be of more help.

    steve

     
    Old 07-02-2008, 04:17 PM   #5
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    Re: New medication...need information and advice

    The Oxycodone was working for me except I needed it every 4 hours on the dot. So instead of increasing them, the Dr. switched me to the Patch. I've been on the patch about 3 weeks. It is helping. Still have the pain but I am able to go about 6 hours in between Oxycodone doses. So, in my opinion I think it may be good to try the Patch. Good luck with everything.

     
    Old 07-02-2008, 06:49 PM   #6
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    Re: New medication...need information and advice

    WOW!! That is a long time. You must be a tough cookie.

    I think the best thing might be to see a pain management specialist. They are much better at working out a schedule. Frankly, your current schedule doesn't make a lot of since. Does your headache know which day of the week it is?

    You would be much better off getting just enough med to control your pain to a tolerable degree than bombing it. All narcotics have side effects. The bigger the dose the bigger the side effects. You can get caught between which is worse the pain or the side effects as you have to increase the dose over time to get the same amount of pain relief due to developing tolerance.

     
    Old 07-02-2008, 07:13 PM   #7
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    Re: New medication...need information and advice

    Quote:
    Originally Posted by Jack24 View Post
    I think the best thing might be to see a pain management specialist. They are much better at working out a schedule. Frankly, your current schedule doesn't make a lot of since. Does your headache know which day of the week it is?
    I would agree. With all due respect, the schedule your therapist has you on is ridiculous. Not only does pain not have a "schedule", but the Percs are short acting and are "in & out" in 4 hours. Because you've been on them for over 3 years, they are probably lasting 2-3 hours. This schedule is completely out of line and not medically appropriate.

    I would seek out the services of a pain mgt specialist. You are not getting appropriate care.

    Good luck and please let me know if I can help further.

    Ex

     
    Old 07-02-2008, 07:37 PM   #8
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    Re: New medication...need information and advice

    I agree about a pain specialist (PM Doc).

    How do you expect your shrink to react to your getting Norco from your GP?

    In the PM world, getting narcotics from another source is grounds for termination of treatment. I can't speak to drug seeking, but it's clear you need better pain management. And it should come from one doc, preferably a PM doc.

    I have found that opioids do not help my headaches. I've had migraines since I was a teen, and I'm now 52. And I've tried everything. I found two treatments that work. One was from a visit to a chiropractor that used a device kinda like a tuning fork (can't recall the name). He applied it to my head, forward and below my left ear in the jaw joint area. Got this treatment a few times and my migraines went from daily to 3-4 per week. In my mind that was miraculous. Then I found Imitrex Statdose. The only time the Imitrex doesn't work is if I'm suffering a pre-cold virus migraine. I found that the narcotics caused rebound headaches and eventually could no longer use them for headaches.

    About the drug seeking comment from your therapist - you allowed that she may be right. Only you know if you have a drug problem. If you do, then you need treatment for that before taking another step towards pain management. The very last thing you want to do is feed an addiction with increasing narcotics. The depths from which you will be forced to recover will make your search for pain relief look like a piece of cake. Why does your shrink have your sister dealing out your percocets?

    If you are drug seeking purely for pain relief, there's a name for that - pseudo addiction. It's real and it happens too often when docs under-treat pain. Again, the solution is to get into PM.

    Please make sure that one doctor manages your use of narcotic meds. You should not be using norcos from one doc according to one set of instructions and then using percocet from another doc with another set of instructions. In addition, you should be getting all of your narcotics from one pharmacy. Prescriptions for strong narcotics are tracked and patients getting them from more than one pharmacy are subject to investigation, as are the pharmacies and prescribing doctors. Do yourself a favor and use one pharmacy.

    I do hope you can find relief for these unending migraines. I know what it's like to get them daily for years because I suffered the same thing. It makes you crazy and willing to do anything to get relief. And I really hope you can find it. Try a PM doc if you can.

    steve

     
    Old 07-02-2008, 08:00 PM   #9
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    Re: New medication...need information and advice

    Hi,

    I am a CP patient and my hubby is Bipolar, I manage all of his meds, so I understand this post pretty well.

    People who have never been close to a person with a mental illness have a hard time understanding behavior as a sickness. with bi polar, bad and irresponsible behaviors are actually part of the symptoms.

    The big problem, particularly after the patient has been diagnosed and medicated, Is that for the majority of the time, they are fine and perfectly reasonable, responsible people. then there are times when they arent.

    With Bi polar this can mean anything from gambling away your home in a single night, or deciding to self medicate with your meds, even though when you were on an even keel with your symptoms, you would never ever do that.

    I'm guessing that is why his sister has his meds, and thats why I always have control of hubbys meds.

    Rich, You need pain management even more than most people do, and surprisingly, the mental health professionals are not always the best person for the job.

    What I have seen is that they arent used to prescribing narcotics, and tend to over prescribe, maybe putting too much pressure on a patient who may be stable now, but might not remain so if allowed to take percocet whenever they want, for one thing, their other meds make their short term memory almost non existant. they could take 2 and 10 minutes later forget and take 2 more.

    Rich, you have my utmost admiration at the struggle you face every day, for anyone to deal with both these issues just boggles my mind.

    My advice is to ask the primary to take over the pain meds, thats what hubby and I have done, his primary seems to have the best overall veiw of the situation, and is also careful to always check med interactions.

    Hang in there Rich, please keep posting, and if I can be of any help, just holler.

    Your Friend, Fabby

    ~We have members here who suffer from both CP and Bi-polar (manic depressive) disorder, I won't identify them, will leave that up to them, but my guess is someone will post who actually lives with both, and just like Rich, you all have my utmost admiration.

    Last edited by Fabrashamx; 07-02-2008 at 08:05 PM. Reason: PS

     
    Old 07-02-2008, 08:15 PM   #10
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    Re: New medication...need information and advice

    Fabby,

    Thanks for posting. I have little to no knowledge of Bi Polar disease or those who suffer from it, which is clearly apparent from my post to Rich.

    Thanks Again.


    Rich,

    Please disregard most of my previous post. My suggestion is to follow the advice from Fabby. I'm very sorry for being so off-base. I didn't understand.

    steve

     
    Old 07-02-2008, 08:40 PM   #11
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    Re: New medication...need information and advice

    Quote:
    Originally Posted by Fabrashamx View Post
    My advice is to ask the primary to take over the pain meds, thats what hubby and I have done, his primary seems to have the best overall veiw of the situation, and is also careful to always check med interactions.
    I think Fabby has given you some excellent advice.

    Ex

     
    Old 07-02-2008, 08:59 PM   #12
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    Re: New medication...need information and advice

    Steve, dont apologize, you were being helpful and as far as what you knew, your advice was right on the money.

    This is really one of those things you have to live with to understand, no shame in not knowing something.

    I always look forward to your warm and humorous posts, you are a very caring and insightful person.

    Hugs, Fabby

     
    Old 07-02-2008, 09:11 PM   #13
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    Re: New medication...need information and advice

    I do think this is why your doctor wanted you on the patch, its much harder to forget or double a dose, and almost impossible to abuse. Your sister would only have to come over once every 2-3 days, remove the old one, and put on a new one.

    I am not sure how the patch interacts with the liver, but liver health is a constant battle for the bi polar folks. they need a healthy liver in order to successfully maintain a lithium or depakote level, that needs to be consistant or their illness will spiral out of control.

    Good luck Rich!

     
    Old 07-03-2008, 08:33 AM   #14
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    Re: New medication...need information and advice

    i really am glad you found us rich. i can soo relate to so many of your issues. i have a bi polar son with a liver transplant and a brain injury and i have to be incharge of his healthcare and his meds too. i also have been getting migranes since i hit puberty,at 13,i am now 46. have you ever tried midrin for your migranes? this was a miracle med for me way back when and is still working today for me. it did not hot the market til i had already suffered with the 7-10 times per month migrane hell for over nine years. it changed my life for me like almost overnight. just one med that could possibly work for you that you take as an abortive? you just take it when the aura starts and in 45 minutes,you can function and your eyes clear. just a suggestion.

    having one person actually treat your mental health issues and having one person treat your pain issues really would be the best way to go overall i think. going into a pain management type of program i really do think would be your best bet right now. you just really need,in your situation,very direct guidance and also the level of oversight PM can create for you. how well do you normally comply with your meds when you are the one one charge? do you have any issues with not following what is rxed for you to the letter when you have that power? i am not in any way implying anything,just having the situation you are dealing with can create those types of issues. how would you do with just having yourself or someone else simply handle a med tray and you use your meds that way? i had to do this for my son and then with myself just to make sure we are both taking what we need when we need it. the med tray thing just really helps alot. it also helps me stay more compliant having 'just' that one little compartments day of meds right there. i also have an addiction history(was completely clean for well over a decade when my life turned upside down on me) so i have to do everything from a different standpoint than some others who have not had that issue.

    you just really need to get the docs down to the one who will handle your ongoing mental health and one who will handle your pain control issues. your body sounds alot like mine with having to keep seeing other specialists for one thing or another and surgeries. but these other people are just part of your hrealthcare 'team' with those two main docs as the leaders that all others would be accountable to and all working together to keep you up and running,you know what i mean? but your main accountability would be to the pain doc.

    also,just writing out your actual med plan for the day with the exception of the as needed meds(but these also need to be written down when taken too so you know for certain when and how much went in you) really would help you too. you just keep it out and insight at all times so you can simply see it when you need to take meds.

    you just have alot of different issues all going on at the very same time. anything at all you can do to minimize the hassle,the stress and just for you to KNOW exactly what is expected of you really will help with keeping your bipolar symptoms down too. anything that affects us also affects our brain as far as what chemicals can be released that create other problems with certain mental health disorders. the more 'predictable' and organized you can get the things around you,trust me hon,the easier it will be on you and for you as you go thru out your day. simple is good. the more direction you have right now and in the future the better you will just feel overall about you and all the issues you are dealing with. there are just sometimes a few changes we can make in the way we are doing things that can make things soo much less stressful and scarey and those fears will not feel as overwhelming for us either.

    i really am hoping that things can get changed in the way you are doing things right now.there are just way too many people trying to govern your healthcare and not everyone is even on the same page. believe me,as you already feel,that is not good to do to someone with a bi polar disorder. too many things out of our control can create their own issues for us. you are just getting way TOO much direction right now from too many people and seem to be stuck in this and need to bail out and get things down to a more handlable level for you. you need to find YOUR comfort zone in all this. that alone will create a much more balanced/better controlled feeling for you inside your head,trust me on that one.

    i really do think just getting into a good pain management doc right now should be a priority. once you get there and they are aware of your whole situation,they can help you just come up with a good PM plan for you. once they take over tho,anyone else Rxing any narcotics is over. this will be the best thing for you right now. you just need to get your power back from all of the people who are currently holding it BUT you,ya know what i mean?

    simple changes can really make all the difference in what you are currently dealing with. knowing just what your true limitations are with regards to what you really think you can manage and would have problems with would really help to know rich. marcia
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    Old 07-03-2008, 08:39 AM   #15
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    Re: New medication...need information and advice

    Rich,

    Here is what I replied to your post on the BiPolar Board....

    I am a Chronic Pain patient as well as BiPolar and PTSD, Cluster Migraines and a Seizure Disorder. I'm on Fentanyl 50mcg every 48 hrs as well as Ultram 200mg/day, and Norco 10/325mg for BT pain. I also take Topomax 100mg, Lamictal 200mg, Seroquel 450mg, Zoloft 50mg, Neurontin 600 mg and Singulair 10 mg. I also use Axert for onset Migraines. So I as well am on tons of meds but have never had a problem with my pain meds affecting my BP meds.

    I don't know if this will help you or not, but if it can here it is.

     
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