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    Old 04-21-2009, 11:10 AM   #1
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    Would a different med be better?

    Hi all--

    I am contemplating a return to a PM doctor (GP has been prescribing since former PM doc moved) to see about getting on something other than Percodan. I'd love to be able to stop altogether, but when I've done that in the past it only takes a week or so for my neck to completely freeze up...makes driving to work QUITE the challenge when you can't turn your head!

    I've read a bit on here about the Fentanyl patches, but I guess they are just as addictive as anything else, right? What I struggle with is that I'm supposed to take 1/2 a Percodan up to four times a day, but after nearly three years, a tolerance has developed; now it takes a full tablet for me to even stand up straight and get ready for work in the morning (degenerative discs in my neck and SI joint issues).

    Of course I get that burst of "narcotic euphoria", my pain is lessened, and I feel better...until I crash horribly about 90 minutes later. I didn't experience the bad crashes until I started taking a full tablet at a time, and now I'm torn between feeling better for 90 minutes and dealing with the crash or perhaps asking if there is a better pain alternative for me. I just don't know how long I can deal with the crashes, b/c they leave me absolutely exhausted and it's hard to work. Unfortunately, the only thing that "cures" a crash is another pill...and I just can't go there.

    I appreciate any input any of you can offer!


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    Old 04-21-2009, 12:33 PM   #2
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    Re: Would a different med be better?

    The patch DOES last for at least 2 days but there are also other Long Acting Meds. I take MS Contin, LA Morphine. The patch worked for me but I had issues with sweating and over heating and getting too much in my system at once.

    Old 04-21-2009, 04:03 PM   #3
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    Re: Would a different med be better?

    If you've been doing this for years, you may want to talk to your doc (PCP or PM) about a long-acting med. I was on a rollercoaster every 4 hours for a while and it was awful. After my PM started me on a long-acting (Kadian aka LA morphine) py pain level was much more stable throughout the day. I don't get any dopey feeling at all and the effect is very steady. It's probably worth talking about.

    Old 04-21-2009, 06:00 PM   #4
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    Re: Would a different med be better?

    Originally Posted by Toonces1 View Post

    If you've been doing this for years, you may want to talk to your doc (PCP or PM) about a long-acting med. I was on a rollercoaster every 4 hours for a while and it was awful.
    Yes....Over time, LA meds become necessary. Here's why:

    When one first starts taking pain meds, the med raises your blood plasma level (BPL). Meds that are standard 4 hours, are more like 4-6, and depending on the pain, can last even longer. The meds stay in one's system for a long time. A urine test on a new CPer may pick up med several days after taking for example.

    Additionally, the pain is "silenced" by the med because the active ingredient in your Percodan (Oxycodone) effects your pit. gland....It surpresses your metabolism, digestive system, and nearly every bodily function. The med works because the Oxycodone tells your brain to not feel pain. It attaches to and suppresses the receptors in the brain....Some of these same receptors are the ones who experience euphoria, or the "excitement" experienced that you describe. BTW, I wouldn't use the language with Docs that you used here to describe the 90 minutes of euphoria.

    After a while, your brain figures out it's being silenced and it's not supposed to be silenced....So it cranks up the pain signals as a way to fight through the med. Therefore, you need more and more med...This is called tolerance. Additionally, because you've been taking the med for a while, it doesn't last as long in your system and your BPL drops sooner than it did previously. A person who regularly takes pain meds, metabolizes them faster, and this is backed up by a very short window of detection time in a urine test for example.

    Over time, this whole process gets more profound and the med that once lasted 4-6, maybe even 7 hours, now lasts 2-3 hours. In some, maybe even less.....1.5 to 2 hours. You yourself have even said 90 minutes. Additionally, your brain has cranked up the signals, which requires more med to silence the pain.

    When all this happens (which is where you are now it appears), it's time for a LA med. The med is taken around the clock, whether it be a pill or patch, and keeps your BPL elevated 24/7. This new regimen knocks out all the minor pain....And BT meds are now used for "flare ups." The BT pain can be the same active ingredient, but in a different form, or a different med. Many Docs used a different chemical as they feel the pain responds better to it.

    If you go onto some type of LA med, your Doc will undoubtedly have his own views on which med to use. I won't recommend a specific med, but I suggest you stay away, at least intially from one....I'd not recommend the patch initially for two big reasons:

    (1) It's the most powerful med out there and going directly to it is like going from a pistol to a Canon, and skipping everything in between.

    (2) The patch can be a bit irritating because it's a patch...You're always aware of it and can itch and etc.....Also, if you sweat at all, it can work loose, or even come off. Hence, it can dramatically effect which activities you can partake in.

    It's a great med, and works very well....I had a great experience with it, especially in the winter months....But it's more useful I think for those who are more sedentary and have used other meds. Fentanyl is the big gun...You should hold off using it until all else has failed. In PM, you have to leave somewhere to go. I bring up the patch, because you specifically refer to in your post.

    Hope all this makes sense. Please let me know if I can help further.



    Old 04-22-2009, 10:25 AM   #5
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    Re: Would a different med be better?

    You are talking about going from a pretty low dose of percodan, to a HUGE dose of fentantyl. I mean the patch is the strongest narcotic out there. there are many other meds in between, it seems like you might be really jumping ahead of yourself. first of all, being on percodan for so many years is not great for your liver, does your Dr ever mention this to you? I would rather take oxycodone IR its the same thing as percodan but it does not have asprin in it. percocet has tylenol in it. what dose are you on? even 1/2 a pill 4 times a day is only 2 pills a day this is not very much for a CP pain patient so your pain must not be THAT bad or you would have needed an increase after all of these years. I really think you need to see a PM DR as GP Dr's are not as up on prescribing meds for long term pain.

    there is oxycontin which is the same as percodan but its not got anything else in it and its a long acting med, where it releases twice a day in 8 hours. this would also be a good option for you but some Dr's are not keen on prescribing this. you need to tell your Dr your having a lot of pain spikes and that the medication is only holding for 90 minutes. be honest with your DR and let him come up with a new plan for you. I wouldn't mention the patch yet as you never want to really mention the strongest narcotic out there. let your Dr offer you some options first and if your not satisfied see a PM DR , But your talking about going from a 1/2 a perc to the strongest medication out there, this might be over the top. there are many other long acting meds out there that might be of some help for you. the good thing about a long acting med is that it gives you 24 hour coverage and you don't have the ups and downs as your body has a continual supply of medication in it. sometimes people need a break through pain med, along with the LA for in between pain spikes. sounds like its time to see your DR. or you will start running out of meds early if your supposed to take a 1/2 a tablet and are foreced to take a full one. this can be a slippy slope. better get it nipped soon good luck!

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