Darkstar, well arne't you an interesting fellow! (I'm not sure why I think your a fellow as apposed to a gal, but I do) And I mean that. I enjoyed reading you. Articulate and interesting. Thanks for writing.
And sometimes it's good for me to hear from folks that have had many more complex pain issues than myself as it is quite humbling. I see that I really don't have life so bad. Still though, things are not great, but much better than a few days ago.
I can tell that I'm going to do some Googling today regarding this "theory", or at least "proclamation", that Oxycontin gives 12 hours of steady state blood plasma level. Isn't it Purdue that makes Oxycontin ? Whatever. I do know that whoever makes it claims 12 hours. I call BS on that. If there were a 12 hour steady plasma level, then a twice daily dose of 40 mg would not leave me with 3 hours twice a day of pain and withdrawal symptoms, correct?
When my GP made the switch from three 20's to two 40's, I figured things would be better(and they are), but since she made no statement on how many 5mg immediate release oxy's were to be had, I was kind of left to my own devices. I've tried one 5, seven hours after dosing the 40, and it has nil effect. Takes two. That works. But I fear she will not go for for that many I.M.'s a day. Realisticly, it would probably take six a day to truly cover. Problem is, she has demonstrated that she is one of those people that seems to think that "less is more". Heck, I was already taking eight of those a day, plus the twice daily dose of 10 mg methadone.
I am shocked at how much oxycodone it is taking to take up the slack from the lack of such a small amount of methadone. And I think she will be too. I guess I just didn't realise how much those 20 mg's of methadone were doing to me. I can tell any one-- one thing, and that is that now that the methadone has pretty much cleared from my system, I really "feel" those 40 mg Oxycontins. And I really don't want to "feel" any thing but pain relief. I consider any "feelings" unwanted side effects. They are unwanted distractions. I don't have time to be sedated, high, or anything like that. It P's me off, costs me money from lost time at productivity. If I recall though, it will pass. What DOESN'T pass, if I recall, is the "mini"-withdrawal and recurrance of primary pain that begins occuring approx 7 or 8 hours after doseing with oxycontin. And I think that this confuses and confounds these doctors. I'm not sure what the definition of "breakthrough" pain is. You know, the pain that is typically treated with I.M. release something, between doses of E.R. something. Is this it, or is it something else.
Who said their doctor doesn't believe in I.M. beds for "breakthrough pain? Was that you Darkstar?
Said they believed it was too dangerous? I would like to hear an elaboration on that philosophy.
It's just that-- over the years, I have established that if we can find some stable combination, I'll stay right there for years. I don't come back begging for more, more more. That's one of the troubles with narcotics for chronic pain isn't it. The "it's never enough" sydrome which can be brought on by the phenomana of "tolerance". It's a difficult nut to crack. Takes discipline, determanation. And a willingness to suffer some darn unpleasn't side effects every now and then. It turns us into liars sometimes, since we know from experience that if we tell our doctors, then they start fishing. And when our doctors start fishing, we suffer. What I do, is when I figure it's as "good as it gets", I tell the doc, that "it's good enough". I guess that's not really lying. But crap, I wish my old doctor was still around. He understood that I am the one taking this stuff. It's MY pain. I am going to know MY PAIN, and how these meds affect me. I'm so sick of doctors listening to me, then going to the BOOK and reading what IT says, seeing a discrepancy, and then believing the book, instead of me. 12 hours my butt. Not for me anyway. Maybe the twelve hour thing is true for the Opoid naieve, and that is where that comes from. Dont know. That does seem to make sense though, now that I think about it.
Anyway, I am completely rambling, and sorry for it. I DO wonder about an earlier statement about Methadone, and not being able to "just stop", even with other Opoids availiable. Makes me wonder if that is still a part of my problem, and that in another week or so, things will settle down.
Lastly, I want to share something a physiatrist told me many years ago regarding long term chronic opoid use for pain. I'll have to paraphrase, I can't quote. too long ago. He said when a patient is considering jumping into chronic opoid use, that the patient needs to be aware of the many difficultys involved. Like, social stigma. Fighting doctors. Fighting pharmacists. Opoiphobic professionals in medical community. Doctors on vacation. Insurance companies that think opoids are for the dying only. (but for Gods sake, don't get the terminally ill addicted!!, so don't give even them too many!) His list went on a bit, I can't remember all of it now, but every now and then I sure do think of him. Aint it the truth. And sure there are alternatives. The descision is a heavy one. Indeed, ALWAYS best to try all the SAFE alternatives prior to chronic opoid treatment. But who decides what is safe? I took Celebrex for a year, Viox for six months, so DON"T tell me that the FDA has their s--- together. We gotta use our heads and do our own research. Even then, it's a dangerous world. And who to trust? You, that's who.
Well, I see that I've begun to rant. I've a day ahead, so here I go.
Best of luck to all, and see ya around,
Post Edited (raku) : 7/5/2008 1:04:29 PM (GMT-6)