Been a long time and need some feedback and advice

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shaw31
Regular Member


Date Joined Mar 2007
Total Posts : 167
   Posted 2/8/2011 5:59 PM (GMT 0)   
     Hello all its me!  I have been gone for a while due to job but I am back and have a few questions to ask you as many of you have or will experience what I am going to talk about.  If you did not know I was on several pain medications over the years and none seem to be the right fit.  Some did not last long enough others more consitpated etc.  I finally found one that was great.  It was methadone.  I was on it for about 2yrs and rarely needed to take b/t meds for pain flare ups (not much constipation either).  Anyway ,  about 6 months ago my doc informed me that his office could no longer prescribe methadone because FL legislators had passed a law that could put docs in jail for patients who died under their care while being prescribe methadone.  These docs could also be put to death.  So, needles to say I had to find something else or move to another state.  I tried opana and now I am on morhine.  I have been on many other long acting medications (avinza, oxycontin, opana, methadone and now morphine).  Two of the medications worked best for me.  The oxycontin helped with the pain the most but did not last long enough (even at 8 hr doses)  I felt I was just popping pills and I hated it so no more oxycontin.  Methadone helped the most.  Morphine (which i am on now) helps.  Heres the wierd thing.  The cr version of the morphine that i take last long enough and covers the pain enough for me to manage.  But,,,, when i have breakthrough pain or flare ups at work, in the yard, or on the roof I will take my morphine ir and it will do nothing.  How is it the long acting works but the short acting does not?  I have always taken oxy ir for breakthrough with all of my other long acting meds and it worked great.  My doctor switched me becuase he said I was going to morhine cr I might as well go to the ir version since its the same active ingredient.  I thought yea I quess your right.  So why am I not getting relief with my b/t med if its the same as the cr?  Also,   I am having very very very bad constipation with the morphine.  I have had constipation with other pain meds but it goes away and is not near as bad.  I have tried many laxatives and pills but they dont let me have a good bowl movement. 
 
     I have been talking to my doctor lateley about doing a taper off of the morphine and getting back to what I started on years ago when I first started pain management to sort of clean my body out and see how my pain reacts.  I am so tired of the side effects of all of these medications.  I cannot go on with the constipation issue.  When I find a medication that helps me there always seems to be a complication or side effect and I am worn out and tired of it.  My other option is surgery and I will not do that now.  I have heard horror stories about surgery.  I think this appointment with my doc I will ask about tappering down the morphine and trying something different for b/t pain.  What I really am looking into and have seen alot of people in PM online talk about it tapering down all your meds and see how your pain is.  The one medication you would take would be the one you first started on in pain management which for me would be hydrocodone 10/325.  I know this has acetamin in it but a small dose.  Also,  as I remember the hydrocodone gave me very little if any constipation.  If i could taper all my long acting med down and just take the as needed hydrocone maybe at the most 4 times a day do you all think that would be a good idea?  I just want to kinda start over and get this right.  I have been on medication so long I dont really know how I would feel without it.  Maybe I will not hurt as bad as I think and something like a short acting hydrocodone would do the trick.  I also have injections lined up in a month.
 
     To sum it up I am tired of trying to find a med that works for me.  My body is tired.  If I find one that works ... there is a side effect or some other thing that messes it up for me and i have to change.   I am thinking tappering everything down and getting on just something like hydrocodone for b/t may be my best bet or maybe i taper down and hurt like hell and have to go back up.  I dont know.  I would be very happy if you all could give me some advice.  Have any of you ever dealt with this?  What did you do?  I do know that I cannot deal with the constipation I am having and have to make a change soon.  Thanks and please respond with comments.

Trudy2
Regular Member


Date Joined Dec 2010
Total Posts : 213
   Posted 2/8/2011 12:11 PM (GMT -6)   
I tapered down off of 100mcg fentanyl patch every 48 hours. My b/t med was 15mg oxycodone IR. When I got the taper of the fentanyl patch down, my doctor increased my b/t med to 30mg oxycodone IR up to 7 per day.

I managed to do this, but I am disabled and do not work outside the home. You may find it too difficult to taper down while you are working as while you are tapering down, your pain naturally increases. I forget the exact name for it - but your pain increases for a few days to a week and when your system settles down again and accepts the taper, your pain decreases a bit. This is what happened to me and I just suffered through it because I wanted off of the fentanyl patch quite badly.

I applaud your efforts to try and reduce your meds. It is totally up to you what you do. I fully understand the feeling of taking pills constantly and not wanting to. That is why my doctor upped the b/t med to 30mg IR.

I would say that if your b/t med of morphine IR is not working, I would ask your doctor to put you back on Oxy IR or even the hydrocodone 10/325 that you started on. I don't know what dose your current morphine IR is, but it is possible to go to Oxy IR depending on the strength you need. I don't know if the hydrocodone would be strong enough.

As far as constipation goes, I do use stool softeners daily and use laxatives when needed. Many others have found that Miralax works for them. I tried it and it didn't work for me, but if you haven't tried it, maybe it would work for you.

Good Luck - I am sure that other members will probably be more helpful/informative.

Trudy
DX pyoderma gangrenosum, Acute Myelogenous Leukemia, Bone Marrow Transplant, Chronic Pain syndrome, Chronic Kidney Disease Stage 3, Major Depressive Disorder, Radiculopathy, Bilateral Hip Pain, Insomnia,Left Groin Hernia, Bulging Disk in Lumbar Spine, Tear in Lumbar Spine, Tendonitis and Bursitis in both hips.

Scarred_for_life
Veteran Member


Date Joined Jul 2008
Total Posts : 1560
   Posted 2/8/2011 12:53 PM (GMT -6)   
Hi Shaw. I don't think we have met or maybe we have...my brain isn't very good these days with all the medications I am on, so forgive me if I forget things.

I am going to address the constipation first, because I too have had many constipation problems with my medications. I would often go days without a bowel movement and this made sick and so on and so on. My doc recently switched my muscle relaxer to Baclofen and I can tell you that it has really helped with the constipation a lot!

But, my meds which are : Kadian ER and Oxycodone IR will cause the same problems.....constipation. So what I have done is found a really good otc that helps loosen me up so to speak. My PA recommended it. I think it was magniesum something, but I could never find it at our stores. But, I did find a probiotic that has helped with the constipation and I am truly happy with that.

Anyway, I hope you find a answer to your problem. Hope you have a low pain day.

Scarred
I live to "Tame My Pain!" 

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 2/8/2011 1:54 PM (GMT -6)   
Shaw, it sounds like you've covered most of the opioids and Trudy mentioned Fentanyl. I don't have anything to add regarding your PM, except that I'm angered by what legislators and corporations are doing to the CP community.

But I have a few suggestions for constipation. I, fortunately, don't suffer too severely from it but do get constipated periodically. When that happens, I'll take citrucil at night and have extra strong coffee in the morning. I'll also bring a book to the toilet and just give myself time rather than trying to force it. The combo works for me.

Citrucil, miralax, etc. increase water content in your stool, which helps it pass more smoothly. But the main reason why opioids cause constipation is that it slows intestinal motility. As a result, stool does not make it as quickly through the system and more water gets absorbed. In addition to Citrucil or miralax at night to help add bulk, consider a strong cup of coffee in the morning which works as an intestinal stimulant. Alternately, there's ducolax. Personally, I can't take it as I have mild IBS and causes considerable intestinal pain. But that is what my PM first recommended.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs)
RT hip and SI joint damage from car accident
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .5mg ativan as needed for sleep.

shaw31
Regular Member


Date Joined Mar 2007
Total Posts : 167
   Posted 2/10/2011 12:14 AM (GMT -6)   
Hello all and thanks for your comments.  I think I talk to my doc and maybe stay on the morphine cr but change my b/t med to oxy ir or hydrocodone.  I just worry about the acetomin in the hydrocodone.  I will talk with my doc and see what he thinks is best.  Thanks for all of your help and please continue leaving comments.

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 2/10/2011 11:09 AM (GMT -6)   

 

  

   Dear Shaw,

   Good morning  :-)   It is good to hear from you. I hope today is a little easier for you. I can tell plain as day that the pain is wearing you down. I am sorry that you have been forced to change your medications. It must be terribly frustrating.

     I don't have advise with regards to medications changes. I take a number of medications, each designed to handle different types of pain. I hope your appointment with your doctor goes well. Give us an update when you can and let us know what he says. Hang in there and stay strong!

*hugg*
   dani


TWO roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood

Chronic Pain Moderator
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mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1235
   Posted 2/10/2011 1:11 PM (GMT -6)   
Shaw,
Any of us who have been on opiate medications for any length of time know that dealing with the side effects is one of the things that goes hand in hand with opiate medications. As someone else said, it slows the motility in the bowel so the stool dries out and stays in the intestinal tract longer.
Drinking more water helps, as does using stool softeners regularly ( daily), and the occassional use of a laxative if necessary.
It is a trade off, pain relief versus the side effects. If the side effects become intolerable, then it is time to try something else.
Tapering off all medications for a while might work in allowing you to really get a measure on what your pain levels are but you would need to stay off all of them for at least a month to get a true picture of what your pain levels would be like.
Going back to vicoden for a time might work but within a relatively short time, I think that you would find yourself back to needing a long acting pain medication. And the other factor is that pain management doctors don't like using short acting pain medications , for long term , chronic pain patients, so I would discuss your pm's feelings about the use of short acting meds, long term with him prior to doing this taper. If he says that he doesn't have a problem prescribing them for the long term, then it might be worth trying.
Anyway, I hope that you find the answers that you seek.
Good luck
Sandi

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9664
   Posted 2/10/2011 2:01 PM (GMT -6)   
Shaw,
I'm so sorry your having to go thru this, I too had a medicine and it was working but then I started throwing
it up, so yes finding a medicine that'll help is hard, I too get consipated from meds, Raisins help, with
that sometimes, but I use gin soaked raisins. I alos have started Tart Cherry juice which is supposed to help
with pain and I take Lovaza (prescribe) omega3 as thats supposed to help with inflammation.
I hope you can get a low pain day soon and on a medicine that will help.
(((((((((((((((((((((((((((((Shaw)))))))))))))))))))))))))))))))
Healing Hugz
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
********>^..^<********>^..^<*******

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 2/11/2011 3:17 PM (GMT -6)   
hey SHAW, i have been following your plight since Florida passed that stupid law. if i recall when you were converted off methadone you were underdosed by a big margin. what dose of Morphine Sulfate CR are you on and are you using the 15 or 30 mg Morphine Sulfate IR for breakthrough pain? i think your CR morphine is made by Watson generics and if it is thats a pretty good one, the other generic i like is the Endo MSER. i do not think your doctor's logic of using the same agent for breakthrough pain is right in most people. Morphine has the best affinity for all the various receptors, more than any other narcotic pain medicine. by the way, the most important thing to remember is the cure or treatment is not the cause. it has been found that although tolerance occurs with some opioids, long term use does not make the pain of your paticular problem any different, you would still hurt but have less control if you taper down, you also would have a long term opioid-abstience syndrome unless the taper is very slow. opioid-hyperalgesia may be a myth or very slight if anything. if you want to try it without then the Suboxone taper is probably the most comfortable and not traumatic to your central nervous system. even using the Suboxone it's still good to have 1-7 clonidine patches on and have trazadone or amitrityline to fix sleep patterns and a type of benzodiazepine tranquilizer that strong for the "bad" times: Klonopin, Ativan, Valium are good. some doctors will not use benzo's with suboxone because of respritory depression possibility, instead they are doing trials with Rohypnol (date-rape drug stigma). i think instead of tapering down you should taper up and use a different agent for brkt. also try some adjuvants like soma, dextroamphetamine, bupropion, lyrica, neurontin, tizanidine. drugs like vistaril or phenergan can be potentators to opioids also. for constipation morphine is about the worst for that because it has such high affinty for the type of opioid-receptor in your guts. changing to a a more targeted opioid for brkt. can help this (fentanyl, oxycodone, hydrocodone). also taking a few apple-pectin tablets or capsules with meal can be a big source of good fiber that will also lower LDL's. a good quality pro-biotic complex will help (brand: New Chapter).
L4,L5,S1 bilateral Laminectomies, Foraminotomies 2002
L4-S1 PLIF with instumentation 2008,

current Rx: fentanyl patch 75mcg. , Roxicodone 30mg prn qid,vistaril 50mg prn nausea, Lyrica 150mg 2x,Adderall 20mgs 1x A.M. 10mg PM prn, Soma 350 mg 3X, Elavil 25 HS, diazepam 10mg bid prn, Supplements: CO-Q10 100mg, Vitamin D 2000IU, Fish-Oil1000mg EFA, B-Complex50 3x/day, GABA 750mg,

shaw31
Regular Member


Date Joined Mar 2007
Total Posts : 167
   Posted 2/13/2011 10:30 PM (GMT -6)   
WOW!  I am so happy with all the feed back you all have given me.  I will talk to my doc at the next appt and see what he thinks.  Its also time for another injection.  Its been about a year.  I wanted to give my body a break cause I have had so many of them.  Spinal, I really appreciate your info.  What you said about switching b/t meds I think might be a good idea for two reasons..... 1)  it should help with my b/t pain much better than the morphine ir and 2) there will be less morphine in my system which may in turn help with the constipation.  I have been having a good deal of b/t pain at work (more hours) and the morphine does not work and I end up limping out to my car.  Its not fun.   I was on oxycodone 15mg before for b/t pain and it helped wonderfully.  No matter what long term med i was on my doc always kept me on the oxycodone and it worked well.  I have only been with this doc for a few months now and its possible he just doesnt know me yet.  Anyway I will see about changing b/t med to the oxy or maybe something weaker like hydrocodone and see what happens with the pain and constipation.  I should have never agreed to change but I thought to myself hey if I am on this med for long term it must do the same for short term.  It is wierd that it works ok as a long term but not short.  Oh well who knows.  Thanks again for all of your feed back. You are all wonderfull people and I hope you have a pain free day!

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 2/14/2011 12:36 PM (GMT -6)   
i forgot to mention that Dilaudid is my favorite breakthrough med. because it works real good and the side effects are less for me.
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