Discussions that mention vicodin

Pain Management board

Hey Barbie, Short acting meds are not designed to deal with long term chronic pain, The first sign of tolerance is shorter duration, the next sign is lack of anelgesia. I don't know if you thought you could take the same short acting Lortab or norco or hydro product for years with the same results but that is not the intent of short acting pain meds. What you consider strong meds, or the big guns are the same drugs only in LA form or in higher strength.

All CP patients have been on the short acting roller coaster, take a pill, wait 45 minutes and then try to cram a life into a couple of hours of relief.

Although docs prescribe meds every 4-6 hours I have yet to take any short acting med that last 6 hours, none do, so going to every 3 hour dosing is just an attempt to maintain a constant serum level so your pain doesn't spiral out of control, A year on SA meds, without surgery and someone is being very compassionate but not doing you any favors.

If you have taken Vicodin, lortab, norco or any hydro for 9 months straight you will be just as physically dependent on SA meds as you would to any of the "stronger meds" The DEA is in the process of reclassifying all Hydro products into the same class "11" that the more potent meds are in.

So you can't fool yourself into thinking your taking something benign that doesn't cause physical dependence, Hydro products are the most abused pain meds in the country, hence the DEA's desire to reclassify them as a class 11. Same class as morphine, Demi, OxyC or the short acting class 11 meds Like percocet, tylox, and Dilaudid.

At some point your surgeon needs to say you either need surgery, or your not a surgical candidate and you need to find a way to function without popping a pill every 3-4 hours. It's no way to live.

The idea of long acting meds, used in pain management is to treat pain that hasn't responded to any other therapy, Somewhat the last alternative after you have tried ESI's, Trigger point injections, weaker meds , learn relaxation techniques, tried acupuncture, chiro, TENS, TINS and all the other pain relieving modalities.

The idea behind LA meds is that it's easier to keep pain in check by creatng a constant level of meds that reduces your pain 50-60%, nobody is going to shoot for 0 pain, It doesn't hapena and the only way to maintain a 0 is to continually increase your dose.

Most LA meds can be taken once a day, twice a day or 3 times a day or there is the patch. But living in 3 hour increments hoping to get the same relief you got 9 months ago just isn't realistic. So you either have the surgery your doc suggests, get other opinions or start looking into pain management.

A clinic setting will usually have more modalities to offer than a doc in practce by himself. The more tools he has the broader range of perople he can help. If you simply look for a doc to prescribe stronger meds, with the present atmosphere about PM and these LA meds, you may get lucky and find a guy generous with a script pad, but becomng dependent on these meds is the trade you make when it's your only choice and the benefit outweighs the negative aspects.

The whole dependence Vs addiction thing isn't that complicated, Dependence means you are physically dependent, meaning you would experience withdrawal syndrome from abruptly dsiscontinuing a med, It happens with opiates and it happens with other clases of meds like SSRI,'s anti anxiety meds and some muscle relaxers.

You haven't avoided dependence by not going to the strong pain meds. Continued use of any pain med causes dependence, but proper use improves quality of life where I can't think of a way addiction can possibly improve quality of life. Addiction is a set of destructive, non compliant behavior with a goal of taking meds for how they make you feel rather than to increase ability to function.

I had 3 spinal surgeies, the last 2 were failed fusions , the last one a 6 level that failed and I've broken both sets of hardware. I had to learn and try every non opiate method to manage pain including a half dozen ESI,. Nerve blocks, and all the modalities mentoned above.

Things are different now, I have no doubt you could find a doc to medicate you with LA opiates, are you ready to be dependent on opiates or still looking for an alternative?
Although dependence is not addiction, you are still dependent on the doc, the med, the pharmancy to have your meds, the list of fun things that tag along with the use of these meds go on and on. So you way the pros and cons and continue to seek treatment. Just because Vicodin no longer works doesn't mean you should be moved to a stronger long acting pain med. The use of opiates maint pain mangement needs to be justified and documented by listing every other non opiate method you have tried and that failed.

The doc you like that has kept you well supplied for months without a surgical option has done no more than make you dependent on "weaker opiates", not really, because mg to mg Hydrocodone is just as strong as morphne, the only difference is the apap they put in hydro products and the strength it's available in. But dependence on Hydro is more common because it's more often prescribed for prolonged perriods.

The problem is, that should you need surgery, the normal meds used for post op pain are no longer as effective. You will have to step up to something stronger should a surgical fix be presented, some docs won't even operate on a dependent patient because they believe they will never be cured and will contnue to ask for meds even months after a successful surgery due to fear of withdrawal,and the sense of increased pain while going through withdrawal.

10 months post injury I would be jumping up and down about why nothing has been done that is effective, one ESI is hardly the long road of pain management although I understand your feelings about them. One study showed they are no more effective than saline, that placebo effect actually works if the steroids don't eat up your bone and cause Osteo perrosis or cause scar tissue.

If your asking what do you do now, the only options are pain management, increase the strength and duration of the pain meds, surgery, or you learn to live with it through non opiate pain reliveing modalities. Not everyone going to pain management needs to be on OxyC and they don't put everyone on it that goes, half the PM docs out there won't prescribe a Vicodin during your worst flair.

10 years ago, anti depressants and relaxation techniques were the opiate phobic PM docs tools, There was no such thing as OxyC or a 10 mg Percocet. Now it's anti seizure meds , anti depressants and nerve blocks, trigerpoint injections, and when everything else fails and you feel everything you have tried has failed and there is no surgical solution or your surgery has failed, then LA opiates are out there and some docs will use them, But just seeing the meds some of us take is not an indicator of the norm.

If you can imagine a bell curve like the grading system used in HS in the old days.LOL
All chronic pain patients fall somewher on that curve, the far left may do find with Ultram and physicall therapy, the far right may have had 1-8 failed surgeries and tried every modality known and the only option left was LA meds or implanting a pump or spinal cord stim. Your somewhere on the curve.

How quickly you move up and over the curve depends on the docs you see, how hard you pursue PM and what your willing to try before commiting to being dependent on LA opiates, But most PM docs that use pain meds only use short acting meds for rescue pain or breakthough pain "BT pain" due to the tolerance issue you have already experienced. Tolerance does and can occur with LA meds but not as quickly as tolerance to SA meds.

Ideally you get injured, you are given pain meds, you get better and slowly stop taking them so they don't loose their efectiveness, Or you get injured, have surgery are given pain meds and over the next few months as you recover the pain meds are decreased and weaker and you discontinue as you heal.

continued on next page
Right now Barbie your on a path to nowhere, no surgery in the furture, PM is likely in your future but you haven't taken a step towards either option. It's OK, to expect that eventually things will get better , but your surgeon shouldn't keep you on pain meds indefinitely, that's not his specialty nor are they knowledgable about tolerance and the needs of high dose patients.

If the meds aren't working, if surgery isn't an option, the next step is pain managent or detox depending on the views of your doc or the PM doc he sends you to. This happens alot too. If he cut you off today you would spend a couple days in the bathroom and a couple days trying to sleep but you haven't avoided anything by not stepping up to the stronger meds other than your surgeon is still willing to prescribe the meds he's comfy with.

Once you tell him they don't work, It's either time for something more invasive or time for pain management which doesn't gaurentee pain meds. I went through PM doc after PM doc for 8 years before, during and after all the surgeries and LA opiates were not even mentioned untill the last surgery failed and I was bedridden.

Views of docs that will prescribe are more open to using meds to keep people at work and functional, so you don't have to become disabled before you find help, but I would expect to try to DC the meds , try other modalties and meds before moving on to long acting opiates. Unless you have a line on a doc you know wlll prescribe, But if this doc has that rep already and you know about it, It's lkely other people including police and medical board and pharmacy board officials also know about some doc playing dr feelgood.

PM docs need to document other efforts to manage your pain before throwing OxyC at a problem that may or may not get better or respond to other modailities or may or may not improve with surgery.

Are you a candidate for surgery? Are you willing to try PM , of any kind. If you just want pain management to prescribe stronger pain meds and are unwilling to try anything else your road will be harder or you end up with a doc that is just a script writer waiting to get busted.

Idealy you can find a PM clinic that offers differnt modalities and the ability to offer treatment to everyone on that bell curve. If a PM doc only has one tool aside from the script pad your missing out on possibly very effective therapies. If you have neck problems you might do well with Robaxin infusions, trigger point injections, a tens unit, occipital blocks and learn some relaxtion techniques. Opiates are not the only answer and one opiate is no worse than the other. You can become dependent on Hydrocdone just as quick as Oxycodone or morphine. Probably not what you wanted to hear. But the idea that you are somehow safe or protected fom opiates by only using Vicodin, I can show you rehabs and chat rooms filled with Hydro and vicodin addicts. The Oxy addict usually starts out as a hydro addict because it has been easier to obtain, over the internet, and soft touch docs, But if the DEA gets it reclasified, a doc may as well prescribe what works rather than what appears to be safer because it's a class 111 and not a class 11.
There are more non opiate modalities to try than there are long acting opiates, so don't worry about nor having any other option aside from stronger pain meds.

Being simply physically dependent, a smart doc could taper you off relatively easily, I'm not suggesting your an addict, just already dependent after 9 months of everyday use. Time t make a dicision though, pursue furhter diagnostics leading towards a surgical cure, or try PM and start with the less invasivemodalities and non habbit forming meds before you decide to move on to being depemdent untill someone figures out a cure for your problem or the odds improve of having a succesful surgical outcome. There are options today that were not around 5 year ago, the options 5 years ago were not around 5 years before that. medicine is ever changing and most surgicalprocedures are not FDA aproved, They are trying to get a specific type of hardware ot technique aproved but many are not and you roll the dice hoping this is the answer.
Good luck and welcome, Dave
Last 9 months I was put on Percocet during cervical spine problems (and throught the years during various operations or severe times), alternated to Oxy immediately after both surgeries for about a week then back down to Percocet.

Rhuemy of 18 years informed me of the PM doc he prefers and started seeing him in Feb. Started on Vicodin because at the time that's what worked and thats what he wanted to try before anything only now it's not affected.

Pain problems:
While my back may be herniated I need a new MRI to determine if surgery is an option or should I need to wait longer. I will request this next week

Knee severely arthritic but not arthritic enough to be considered replaced. Ligaments are totally shot, surgery is not an option for repair.

Severe pain in shoulders, hands, hip, all arthritic related, all again, not deemed severe enough for replacements.

Have IBS, Microcytic Colitis and overall pain from EDS and FMS/CFS (doc's aren't sure which one I have, could be both).

Have been to some of the best ortho's in the world for treatment or surgery options, they don't exist at this point for me. Have EDS destroys the joints, there's no preventative.

Still do bio feedback, meditation and focal point. Swim daily, weather permitting, in our pool. Gentle stretches and pain meds along with the standard arthritis and anxiety meds.

I've ran through the gammut of therapy, physical and psychological, I don't need more. In fact I could teach a class I swear. I've been doing this for a very long time, longer than most folks who suffer CP. It's been a daily part of my life every day. In fact I do not ever recall a day when I didn't suffer.

Do I want stronger meds? Not really but if that's what it takes to get the pain under control then so be it. I was more wondering if it was reasonable to voice this concern with my doctor.

I am aware of addiction and dependancy, even wrote an article on it some years ago after seeing a show about dependency and have been interviewed by Newsweek magazine regarding my illness and pain. I'm no stranger to it not better than anyone else, I suffer the same.

I take pride in being able to maintain for 28 years, to live life one day at a time and not complain, or complain little, but I can't do this anymore, I've grown old and tired and the future honestly only promises to be worse unless a miracle drug is found.

So that's where I stand, it isn't recent as you see, its been a life long struggle for me, day in and out and now my son is starting to show the same pain symptoms I have from our genetic disorder.

I guess I'm somewhat scared about stronger meds, i'm not sure how to view them. I don't want to be labled and that's been my problem for years between a bit of selfish pride thinking I could manage. I can't manage anymore. I had to quit a very high paying job when I was placed in a wheelchair because the feeling in my legs was gone. The company wouldn't accomodate me so I had no choice.

At any rate I'll read through your advice again, but hopefully this will give you a better understanding of where I'm coming from and realize this is nothing new for me (the pain)


- Barbie