Discussions that mention vicodin

Pain Management board


Hey Jenet, 1:1.5 is the standard conversion, Oxy is stronger and woman have shown to create serum levels fairly consistatly about 25% higher than men given the same dose.. It just means women seem to metabolize oxy Better.

NO Oxy Doesn't last 12 hours.

Ideally if your taking a LA med you shouldn't need BT meds more than once or twice a day. Otherwsise the BT meds are just a supplement to the la med. What do you do when you have real BT pain if you use BT meds every day, every 4 hours. Even the manufactures recognize that if the patient needs BT meds more than twice a day they should consider adjusting the LA dose. What's the point of an LA med if your still taking something around the clock.

Most likley this flair is from the ESI. They can really through people for a spin or may be helpful. Cevical ESI tend to cause more pain afterwards because there isn't as much space for the meds to disperse and cause an increase in pressure untill it can igrate and be absorbed. Pirecing a nerve during the ESI can cause a flair, so it's not unusual.

You may or may not have a problem getting your doc to go to TID dosing which would allow you to actually use BT meds as neeed, not as a routine. IF he will increase hoping to make it lastst longer, the next step wold be 60 mgs twice a day, 40's and 20's, 2 20's as a 40 mg dose and you have the ability to dose TID. I'll never tell. ;)

As far as BT meds, that amount of hydro is rather weak if they are the 5's. For BT meds to be effective they have to be able to create a proportional diference. If a 5mg vicodin is only 1/20 or 5% of your daily consumption I doubt it would be effective. With 40 mgs BID the manufacturer suggests using 20-30% as a BT dose, 10 mgs of oxy, or something equivelent like MSIR 15mg would be 25% of your BID dose and likely proportionate enough to make a difference. 2mgs of Dilaudid is about equal to 10 mgs of oxy or 15 mgs of morphine, 15-20 mgs of hydro would be in that neighborhoodof 25%, so yes, your BT meds is weak and OXy doesn't last 12 hours. If you explain your BT med use, It should be clear your using it to bridge the gap between doses.

Hopefully he didn't get a leter from Purdue saying he would be puttng himself in a position of liability if he ignored Purdues' BID dosing instructions. Purdue did a huge campaign to enforce twice a day dosing and 12 hour duration about 2 years ago, It's BS. Purdue lost their patent and will censured by the FDA and there will be law suits over misinformation supplied during their patent application and during the legal battle to keep a generic off the market. Hopefully your doc knows what's going on right now with Purdue and isn't afraid to listen to his patients rather than a manufacturer.

That about covers it. ;)
Good luck and hope you recover from the ESI quickly.
Dave
Hey Janet, You shouldn't have to feel like a druggie because your need a med adjustemt.
It's really better to get the dose correct now than to have him increase every month you see him. That looks more like a problem than a patient that's just trying to get things right from the get go, rather than looking like you want an increase every month at the first sign of tolerance. The conversion is a standard conversion, but doesn't gaurentee how you will repond.

I think it would be a better idea to exlpain how the med effects you, when you feel it wear off, when and how much BT meds you use. That should carry more weight than 20 strangers on a forum saying Oxy should be dosed 3 times a day. Forget about how I think it should be dosed, explain to him when it wears off, what that means in terms of function and activity coming to halt to get pain back under control, or having to wait for the next dose and the clock watching for BT meds. Once the dose is right, you don't need a clock anymore, You can feel somthing wearing off and know it's been 8 hours or 7 hours. It shouldn't matter what the clock says. Your either getting the relief you need or not.

40 mgs tid may not be enough, You pretty much know what you need with oxy in a few days, It doesn't buil up. If a single 40 mg dose doesn't hold you for any length of time, than you need more than a 3rd dose added. If you not getting relief from the 40's, that needs to be increased and the interval may need adjusting to 3 times a day.

When they put my pmump in, they started it at 2 mgs per day, after 16 or so .3-.8mg increases I ended up around 12.2 mgs per day. It took 6 months of going in every 2 weeks but that's what it takes when your titrating a med. I didn't go through a pump implant to be miserable,. What's the point of going through all the opate negative stuff to still be miserable. Dependnent is ependnet, some docs won't agree about your use, but the disagreement shouldn't be about whether you need 80 mgs a day, 120mgs or 320. Your simply shooring for a level of pain relieve you can live with, what does the number of mgs really mean if you know all the pros and cons of opiate use, understand you dependent at either dose and the meds aren't hindering you more than your problem. Shooting for 0 pain isn't realistic but it sounds like you have realistic goals.

Sometimes it does take a change in docs if they get stuck on a number or dosing interval and won't bend. I had to change docs after they started me omn LA eds, He increased ther opiate and ZI stopped taking neurontin, Remeron, Zanaflex on top of soma and all the OTC meds I still tok every 4 hours, doc #1 didn'
t believe in BT meds,. She would through the kitchen sink at you and had her limts in dosage and opinin on BT meds. It's not breaking a contract to want to try something your present doc can't do and it dosn't burn bridges if you know your doc doesn't use say Botox and you want to try it. You ant to talk to a doc about a pump, althugh you have plenty of rooms wth oral mds, whatever is a good excuse to check another docs meods. If you decide to go with the other doc, do the rght thing, call your doc and tell him your changing, the new doc will be writing all scripts, you canceleled refills he had given yo and you apreciate what he's done but you wanb to try this other therapy, ther wwwwwwe are plenty to try.

But you are on your way, Titrating a new med is never fun, but you are close enough in the ballpark that you shouldn't be experiencing withdrawal. Maybe an increase or decrease in pain, but the charts get you in the ballpark that prevents withdrawal and are you are still safe. Now it' just fine tuning to reach your needs without impairment. You have alot of issues to be resolved so you may not get it all fixed in one visit. Actual dose, the correct nterval and the right BT med. BT med, but it's better than nothing and I'm sure you remember what nothing was like if you go back 15 years. I would work on he LA med first and then get the BT med right. Something, "what you have" is better than prozac, self hypnosis and a Tens unit. ;). It's actually good to occaisionally be reminded why you tolerate all the opiate crud and to reasure yourself ou have tred everything else you can.

Whatever makes you and your doc is comfortable, If he likes the bewildered patient that he has the magic answer for, act bewildered that this 12 hour med isn't lasting 12, how can it be :rolleyes: If he wants an educated patient that takes part in their care, Tell him about some research you did about BT med use and you think your using it too frequently and it seems disproportionate to your LA med. Here is the full prescribing info on OxyC, it helps to know what the manufaturer thinks, butpurdue is very much a 12 hour advocate of their misrepresented med.

Once you reach a point where your not clock watching it's like a ton of bricks has been removed and you can think abut other things in life other than the next pill and will it work any better than the last. Whats's the point of LA meds if you need BT meds every 4 hours . If you need 2 vicodin at the end of each dose to make it last twelve hours, that's what he needs to know. Ideally the BT med is going tobe 80-90% of your pain meds and BT is something we klearn to deal with. Docs that use BT mds, expect us to use them rather than go to the ER or call the office everytime the pain flairs. Hopefuly part of the pain is still from the ESI and things will get better.

Good luck, David