It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board

  • Questions on medications dosage and the norm for chronic pain.

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 08-28-2012, 11:53 PM   #1
    sandiemas
    Senior Member
    (female)
     
    sandiemas's Avatar
     
    Join Date: May 2010
    Location: California
    Posts: 205
    sandiemas HB Usersandiemas HB Usersandiemas HB Usersandiemas HB Usersandiemas HB Usersandiemas HB Usersandiemas HB Usersandiemas HB User
    Questions on medications dosage and the norm for chronic pain.

    I have been in Pain Management for chronic pain since befor my two back surgeries. I am currently in a serious siatic flare and daily pain levels are 9 to 10, can't move. I have laid flat on my back for days, many other things but to long to mention.

    I have stenosis, fbss, nerve pain, migraines, neuropathy, mylopathy, spasms, muscle weakness, drop foot, anxiety, just to name current issues.

    During the past year plus I have been prescribed 6, 10/325 percocets; 2, 350mg soma, 2, 300mg gabapenten daily. So is this above the norm, is it to much not enough? Some guidance on what should be expected is greatly appreciated at this point I don't know where to turn. This has normally kept my pain level to a 6/7 level if I am inactive. During the past 3months I have told my dr it isn't working, I am depressed have no quality of life, can not enjoy my children, participate in everyday activities due to pain levels. I am laying in bed, flat on my back, staring at the ceiling. I use ice 20min/heat 20min every two hours, a tense unit, foot brace for drop foot relief that I have bought myself.I use a cane or walker because of leg weakness and falling, also self paid no script from doctor. My pcp says he is at the end he, can't move any higher on my meds and has no suggestion for me. I have asked for a long acting med and something for break through pain from reading these forums. He just looks at me, sympatises, and writes the same script and sends me on my way. I have no insurance and my hands are tied.

    But I can not live like this, I don't know if I am being unreasonable in my thoughts but after basically 2yrs on the same regimin is it un reasonable to ask for an increase? Who do I talk to? Where do I turn? My family is suffering, my life is suffering. I can't get up walk around the house, going potty is a 30min ordeal just to get to the restroom and then to sit down, showering is a nightmare, chores forget it, I can't do anything but lie flat on my back the past two weeks have been the worse, labor was easier than this. I am truely suffering. I have MRI's, EMG's, X-rays to back up my complaints with herniated disc, ostephites, stenosis, muscle spasms, lesions, and sevdral other foriegn terminology. I just want relief just a few hours a day I can sit at the table and eat dinner with my kids, enjoy a trip to the store, sit on the porch and watch kids play, help with homework, maybe help around the house a bit. In my mind I don't feel this is to much to ask for.

    So, what do I say to my doctor to make him understand? What do I look for in a new doctor to start all over? Where do I turn? I feel so helpless, depressed, and lost any guidance would be so appreciated.

    I know I ranted a lot but needed to get that out to. I know I need a counselor to process all this with and will get on in the mean time this is my therapy, so thanks for.listening.

    Hope everyone is having a better month than me
    __________________
    Sandy

    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.


    C5-C6 tear/buldge
    C6-C7 ACDF
    T1 - T5 neuroforaminal, lesions, facet arthropathy
    Disectomy L5/S1
    Anxiety
    PTSD
    Chronic Pain

     
    Sponsors Lightbulb
       
    Old 08-29-2012, 05:38 AM   #2
    NeckIssueGuy
    Member
    (male)
     
    NeckIssueGuy's Avatar
     
    Join Date: Feb 2011
    Location: The backwoods of Oklahoma
    Posts: 55
    NeckIssueGuy HB UserNeckIssueGuy HB UserNeckIssueGuy HB UserNeckIssueGuy HB UserNeckIssueGuy HB User
    Re: Questions on medications dosage and the norm for chronic pain.

    Hi, I so feel for you, the thing with LA Meds is alot if not most PCPs don't and wont write them. I went a few years before the anesthesiologist that does my cervical injections actually helped me out, as he don't write he likes the needle HMMM... but he got me going for a 10 day supply Oxycontin and called my PCP and advised her it's time and she changed it to morphine because the oxy worked for like 7 days.
    So I guess you're going to have to find a pain management Doc. or a specialist that you have seen to advise it and then your PCP may justify writing it, as it was the only way mine would even think about it.

    I know how hard it is without insurance as I didn't have any for my first series of injections and they were 1300.00 a pop three of them jeeze robbers.

    I think you my be able to call your surgeon and MAY get help there, but they like to refer to pain management so that's most likely you're best route and it could take a while to get in.

    Almost forgot usually the norm I suppose would be a long acting med twice a day and 3 or less percocet as thats what my Doc. is trying to up the LA Meds to lower or stop the every day percocet and use as needed so 6 a day any specialist or pain management would advise against it I bet.

    Good luck to you and I wish for better more painless days ahead

    Last edited by NeckIssueGuy; 08-29-2012 at 05:47 AM. Reason: the norm My thoughtrs on it

     
    The Following User Says Thank You to NeckIssueGuy For This Useful Post:
    sandiemas (08-29-2012)
    Old 08-29-2012, 08:52 AM   #3
    Ilovemycutedog
    Senior Veteran
    (female)
     
    Ilovemycutedog's Avatar
     
    Join Date: Mar 2009
    Location: East Coast, VA, USA
    Posts: 547
    Ilovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB User
    Re: Questions on medications dosage and the norm for chronic pain.

    Hi there...

    I am a bit confused in that you say you have been in Pain Management since before your surgeries....but then later in the post you say your "PCP" is not comfortable going any further with your medications...

    Are you not being seen by an actual Pain Management Dr? If not...then you need to find one. Many PCP's are moving away from prescribing opiates as the laws are changing in many states to require more training, certification, and testing to continue with treating anyone with chronic pain.

    Those Drs. that are actually trained and Board Certified in Pain Management are the most knowledgeable in chronic pain.

    So, unless I misunderstood, I would be making calls to PM Drs. to see if you can get an appt. It is NOT considered Dr. shopping if you are going to just see if it's a possible match as you would not ask for/or get any prescriptions at that appt. Telling them over the phone that you are just looking for a new Dr. that provides a comprehensive approach that includes all modalities in treating chronic pain.

    As far as your meds go in just my personal knowledge of things....you are not on an effective level of gabapentin. The therapeutic level of that med is usually 2400 to 3600mg. 600mg is probably not touching your nerve pain.....

    So that is something that can be adjusted now if you speak with your Dr. to at least try and offer more pain relief. Opiates are not effective at all for nerve pain.

    And if you have been on the Soma for a long time...then asking to switch to another muscle relaxer to see if it will help better is another option that you can do now until you find another Dr. There is Flexeril, Robaxin, Skelaxin or Baclofen.

    My Dr. believes in rotating through different medications over the years instead of going higher and higher on the dosages and this has worked very well for me.

    I do think that if you find an actual PM Dr...that they will move you to a long acting medication and then have a short acting one for breakthrough pain. This is more the "norm" for chronic pain patients over 6 months...

    I moved away from Percocets after 2 years to OxyIR for my breakthrough as my stomach started reacting to all the acetaminophen every day. You are certainly within the levels set by the FDA at 1950mg a day. But for me...I was having nausea and loss of appetite and as soon as I made the switch I felt so much better. This way, I can add Advil when I need to for inflammation. Or if I get the flu or have a fever...then I can take Tylenol to help.

    The logical step for a Dr. would be to put you on Oxycontin at starting 30mg, twice a day to see how you do. That would be the same amount of Oxycodone that you are taking now. The reason for staying the same in the beginning is as I mentioned early....if you start taking the regular amount of gabapentin....your pain levels may drop a few points or so just by doing that. Same thing with tweaking the muscle relaxer...

    The key is not relying soley on the opiate to bring the pain levels down but using all the medication together that helps each type of pain. As well as continuing to use other modalities...

    Like a TENS unit daily...
    Exercise
    Aqua therapy
    Injections (both lidocaine and cortisone)
    Physical therapy
    Acupuncture
    Massage


    And you mention the depression. Many chronic pain patients are put on an antidepressant which can help both emotionally but also with pain. So I would be making an appt. with a Psychologist or Psychiatrist to speak with them about how hard it is to deal with the pain levels. I went to counseling for both my divorce and chronic pain for about a year that gave me so many good ways to help deal with my pain.

    So....hopefully you can speak with your Dr. now and at least work on the muscle relaxer and nerve pain med to get some of the pain back down. As well as making calls and finding a PM Dr. to go see that can take over your care and provide a better comprehensive pain program for you.

    Good luck..

     
    The Following User Says Thank You to Ilovemycutedog For This Useful Post:
    sandiemas (08-29-2012)
    Old 08-29-2012, 09:06 AM   #4
    Shoreline
    Senior Veteran
    (male)
     
    Join Date: Jun 2003
    Posts: 3,519
    Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
    Re: Questions on medications dosage and the norm for chronic pain.

    Hi Sandie, Their really isn't a norm for PM when it comes to dosage. You can go up to 3600 mgs of gabbpentin a day, which is the drug most likely to help with the sciatica. Nerve pain is tough to treat and opiate pain meds just dont have the same effect on nerve pain as they do other types of pain. As far as normal, most PM docs that use opiates do prefer to use long acting meds so that you can get away from trying to live your life in 3-4 hour increments. How high the dose goes depends on the docs comfort level with prescribing and the results your getting. Ive seen people take as much as 400 mgs of long acting oxy or 600 mgs of morphine a day depending on their situation. That's what I would consider on the high side but ive met people that take more than double those doses, their really isn't a normal dose other than normal starting doses, which are usually based on your present short acting dose and how effective it is. The use of opiates is still very contreversial and finding someone thats willing to treat with opiates can be difficcult. I'm sure you know that some docs wouldn't even give you the percs you are presently on where some PM docs would imediately switch you to a longer acting med and some PM docs dont use opiates at all. So their really isn't a normal in PM. Have you tried any procedures for the sciatica, nerve ablation, TENS, TINS, acupuncture, etc.
    Good luck, Dave

     
    The Following User Says Thank You to Shoreline For This Useful Post:
    sandiemas (08-29-2012)
    Old 08-29-2012, 01:35 PM   #5
    backhurtz
    Senior Veteran
    (female)
     
    backhurtz's Avatar
     
    Join Date: Oct 2008
    Location: NY, USA
    Posts: 818
    backhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB User
    Re: Questions on medications dosage and the norm for chronic pain.

    Hi Sandy,
    I'm sorry that you are suffering so much but I think that if I were you, I would be doing three things- first, I would be making another appointment with your surgeon to see if there is a worsening of your condition that is causing /contributing to the flare up. The second one is making an appointment with a pain management doctor or asking for a referral from your primary care doctor so that you can see a proper pain management doctor, who can work with injections and titrating to a proper dose of the right combinations of meds to help you. A GP as the others have pointed out, usually will not prescribe pain medications long term, and while they are usually familiar with the off label uses of gabapentin and others, they don't get enough training to properly treat back problems.
    The third thing, which is going to most likely be the most difficult is to stop laying around in bed. The longer you do that, the weaker your muscles become, and the more difficult it will be for you to stand for any time frame, or sit down in a chair for any time. No matter what, you need to walk, even if it is back and forth in your home, several times a day, sit for a few minutes at a time if you have to, then stand for as long as you can , then sit again...but stop laying in bed staring at the ceiling.
    It sounds like you really need to be reevaluated by a surgeon, either the one who did your previous surgeries, or a new one, and you need to find a proper PM doctor, who can offer you more than what you are currently doing to get you up and moving around again. Physical therapy would be a good thing to help you properly learn to use those muscles again too. Injections may help to ease the swelling and inflammation and the PM doctor can offer you several different medications that will help both the nerve pain and ease the depression symptoms as well.
    Good luck
    Back

     
    Old 08-29-2012, 02:46 PM   #6
    sandiemas
    Senior Member
    (female)
     
    sandiemas's Avatar
     
    Join Date: May 2010
    Location: California
    Posts: 205
    sandiemas HB Usersandiemas HB Usersandiemas HB Usersandiemas HB Usersandiemas HB Usersandiemas HB Usersandiemas HB Usersandiemas HB User
    Re: Questions on medications dosage and the norm for chronic pain.

    Thank you for all the wonder responses and suggestions! You have given me a lot of good information. To answer some of your questions if I have moved from Arizona to California so I no longer have access to my original surgeon. I have no insurance until November so I am trying to just get by. I did call my PCP and ask for a referral to a pain management doctor and have to call them today after two. I was told that pain management doesn't like to take patients without insurance because of the cost of epidurals. I have had several epidurals in the past and nerve root burnings. I also look forward to having them done in the future.

    Right now I am just trying to find some relief until November so that I can function on an everyday scale... I do get up and try to walk with my cane and/or walker it is very limited at this point and totally agree pt, additional movement of sorts is so important. My pain levels have NOT been this high in such a long time it is very hard for me right now. Big, long, story. But I will take the suggestions, information to my new pm doctor and maybe he can do something to keep me on my feet until I can continue with epidurals and such. I did pay outta pocket for Cervical MRI, and Lumbar MRI which shows several issues that could be causing my pain. Normally I am an even 6 and can handle but since a massage I got two Fridays ago it is unbearable, unliveable, no relief day after day really wears you down. I need to find a way to find some relief even for a few hours a day. I am missing out on my grandson's birthday coming up, not getting the home clean, shopping, decorations I think that is what is really getting
    K
    __________________
    Sandy

    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.


    C5-C6 tear/buldge
    C6-C7 ACDF
    T1 - T5 neuroforaminal, lesions, facet arthropathy
    Disectomy L5/S1
    Anxiety
    PTSD
    Chronic Pain

    Last edited by sandiemas; 08-29-2012 at 02:51 PM.

     
    Old 08-29-2012, 04:10 PM   #7
    Ilovemycutedog
    Senior Veteran
    (female)
     
    Ilovemycutedog's Avatar
     
    Join Date: Mar 2009
    Location: East Coast, VA, USA
    Posts: 547
    Ilovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB UserIlovemycutedog HB User
    Re: Questions on medications dosage and the norm for chronic pain.

    Thanks for sharing more of your journey...That makes sense that you are just trying to hold out until November when your insurance kicks in...And yes...many places, especially PM clinics/offices don't like to take patients without insurance. I am very blessed that I was already seeing my PM/Neurosurgeon (in the same spine institute), when I lost my insurance after my divorce and they know me well and have been helping me out with the cost of appts. and giving me samples when they can.

    And as I wrote...you want to ask any new PM Drs. offices over the phone that you are "looking for a PM that will work with me on finding the best comprehensive pain program that includes all modalities"...Something like that...LOL....But the key is not directly asking if they prescribe opiates as many of them will say no, even if they do, because of drug seekers unfortunately. But if they say they use all modalities...this usually means they use medicine as well. And if they ask you what you mean...you can just say injections, physical therapy, muscle relaxers, nerve pain meds...etc"...Again...this will look good to them that you are open to all of these. Then when you meet the Dr...they will see that you have had no issues in the past with any pill counts, early refills, failed UAs...

    So until Nov....I would be asking your Dr. now if he can up the gabapentin...as many of us wrote...you are on way too low of a "normal" dose to be really effective. So going up in stages to 1800, 2400, to 3600mg if needed.

    And then maybe try to switch to a new muscle relaxer...

    At least you can try these things now if he isn't willing to up or change the opiate as well. And who knows...maybe if he sees that you are wanting to try these other things...that he will prescribe even one more Percocet each day.

    My PM and Neuro are actually against the use of any canes unless it's used for a very short period of time (a week or so). Because it causes our spine to be so misaligned...along with causing possible knee issues on the other leg...I ended up buying The Rollator at Sam's club. It is one of those walkers that has 4 wheels...so you roll it instead of trying to pick up the walker each step...that is also terrible for those with spine issues. This has brakes for you to put on and then a seat to turn around and rest if needed.

    It is great..it was less than $150 and great investment as I bought it for my mom a few years ago with her knee and back problems...and then when I aggravated me lumbar herniations this July...I used it for those weeks. It is great because you stand up perfectly straight when using it but just use it to keep from falling. But it's perfect for indoor/outdoor. Again...the more you can walk even for a few minutes at a time....Or even do gentle stretching when laying down or sitting on the couch...the more you can keep those muscles from getting stiff and sore and keep the blood flowing...

    I know it's hard...and having such high levels of pain is so taxing on us emotionally too So please keep posting here for support!

    I really hope that you can tweak some things with your meds with this Dr. to at least help your pain until November...And just a suggestion but since PM Drs. are in demand...I would be making appts. for November starting next month...that way you don't wait until then to be told an appt. is months away....

    Keep us posted!

     
    The Following User Says Thank You to Ilovemycutedog For This Useful Post:
    sandiemas (08-30-2012)
    Closed Thread

    Tags
    back pain, chronic pain, pain medication, stenosis



    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 07:03 AM.





    © 2021 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!