I see my PM in two weeks and want to explore some changes to my meds

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Veteran Member

Date Joined Oct 2010
Total Posts : 932
   Posted 3/20/2011 3:16 PM (GMT -6)   
Hi All,

I've been thinking about this for a while and want to be prepared for my next PM visit. My tolerance to opioids is building, and I don't think my Ultram ER is doing much for me any more. It used to help with the pain and also was working as an anti-depressant.

Also, I think my back is just getting worse. It hurts more often and more intensely. Aches have become pains, pains have become ready-to-scream-I-can't-take-its.

So I think I need some other time release med than Ultram. But I am very concerned about remaining alert. I have a long drive to work (2 days/week) and the sort of work I do (though mostly at home) requires considerable focus. My PM seems to be a big fan of morphine and regularly has recommended it to me. But I assume it will make me drowsy as will, I assume, oxycontin and Opana ER (I have used the IR versions of these). So far, only tramadol and hydrocodone haven't affected my ability to concentrate. But, of course, the pain's intensity also undermines my concentration. But, alas, no time release hydrocodone yet (they're enrolling for Phase III trials though if anyone is interested).

Any suggestions? Between a low dose of Kadian, Oxycontin and Opana ER, which should I pick? Which will mostly likely preserve my ability to concentrate and not make me sleepy?

Also, I'm wondering if I should start using an SNRI (or something more arcane). My insurance won't let me use Cymbalta unless I try other cheaper meds first. So, unless there is some other plausible option, I'm thinking the generic for Effexor. BTW, I can't take tricyclics because of heart issues.

For BT pain, I'll stick with what I've been using: Hydrocodone when I need to work and Oxycodone other days.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, Supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia).

Screaming Eagle
Veteran Member

Date Joined Sep 2009
Total Posts : 5005
   Posted 3/20/2011 3:51 PM (GMT -6)   
Cogito, of course it would be best to discusse this with your Dr, but maybe MS Contin (Extended Release, Morphine based)?

When I first started on the pain med's, there was some mental fog, but that quickly went away, or was at least a minimal effect for me. Is the Oxycodone you're taking Percocet? .....and if so did does it make you drowsy?

You might find that this effect will quickly go away. I'm at a loss for a good suggestion, and I understand what you're talking about, as I too need full concentration to figure math as a machinist. One little mistake and I could destroy $250,000 worth of parts. shocked

I do wish you luck on the next PM visit, and hopefully he/She will take you're request into consideration.

SE wink

Veteran Member

Date Joined Jul 2009
Total Posts : 2042
   Posted 3/20/2011 4:01 PM (GMT -6)   
Every one reacts differently. Me for example have never gotten the mental "fog" others report from opiods, but after a couple of years on morphine I did develop memory issues.

For the past 3/4 of year I have been taking dilaudid for pain and as yet have not had any cognitive problems at all. Currently I take 6 mg every 8 hours as needed and while it is working it is providing pretty decent relief. My only problem with it is that I only get about 4 hours of good pain relief, and by the 6th hour it is pretty much useless.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

Veteran Member

Date Joined Jun 2008
Total Posts : 6706
   Posted 3/20/2011 6:59 PM (GMT -6)   

I think it is hard to predict which meds are going to effect who how,in saying this when I went on the methadone from oxy-c I was warned that I would be lethargic to the point of semi-comatose. Now at higher dosed in the begining I was,fell asleep washing dishes,standing at the sink with my hands in the water for 20 minutes my kids said,never fell over,dropped the dish just woke up 20 minutes later and picked up where I left off!! rolleyes   I decided maybe I should try to titrate that dose a bit and did and have never had that happen again.

I cant take Morphine of any kind and sleep the sleep. Oxy depends on how much and how often and hydro,well lets just say I go like the energizer bunny for some reason and now some might think that is a good thing but when I stopped I was exhausted and in horrific pain so the methadone works the best and its cheap cheap cheap.

I think you will probably have to just kinda play the odds here and hope you get one that works for you and allows you to not get foggy but even that there are alternatives to help with the fog but that means taking another pill altogether and some of us take enough that we dont want have to take one more to counteract the effects of another.

I would be sure the Doc and I are on the same page and that they unerstand this is a trial run and you want to have the option to go back or try some other things.

At least you will have your homework done and at least know the outcome your hoping to acheive. Good luck!!

Disabled since 1999 from knee injury
DX: Bil knee meniscus removal with LTKR in 01. 6 knee arthroscopy for plica removal meniscus repair. Ank spondyl,ddd at L3-4 S1. disc collapse at L-3 with nerve impengement. legally deaf,copd,rt shoulder rotator cuff tear repair 06. some memory deficit post encephalitis,GERD
MEDS: methadone,xanax,cymbalta,zantac,maxide,K+,lasix,prempro,celebrex,combivent

Veteran Member

Date Joined Oct 2010
Total Posts : 932
   Posted 3/20/2011 8:35 PM (GMT -6)   
Thanks for the comments.

When I take oxycodone IR (generic), it does make me a little foggy, as does Opana IR. Of all the opioids I've tried, Nucynta has been the one that has made me the most drowsy... surprising because it is often compared to tramadol/Ultram, which is more activating for me. I've tried dilaudid, but it did nothing -- apparently some people can't metabolize it (and generally has low bioavailability).

Given my experience with my PM, he will encourage me to try a morphine option (MS Contin, Kadian). I wonder if anyone out there, when they first take it, don't get drowsy?

I suppose I'm having trouble dealing with the need to move to something stronger and am nervous about how it will effect me.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, Supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia).

New Member

Date Joined Mar 2011
Total Posts : 17
   Posted 3/21/2011 3:19 AM (GMT -6)   
As most of the others have stated, it really depends on the individual. How your body reacts, what other meds you take with it, many factors will determine how it will work or not work. For myself, I also have been on many different medications. I took 6 doses of either liquid morphine hydrocodone, or oxycodone daily for about 5 years now and it did not make me sleepy or foggy now or in the beginning. My PM doctor switches me out every 6 months so my body doesn't build up a tolerance to the medication. I have the total opposite effect. I have severe insomnia from them. I would be up as long as 36 hours before I could fall asleep and then it was only for 1 to 3 hours at the most. I wish they would make me sleepy , so I could get some much needed rest. The only time I have ever felt sleepy or foggy was during hospital stays and they give meds in my Iv or in my backside. I am not sure what it was but it took away most of my pain and i could sleep very well. I hope you find one that works for you to get the relief and minimal side effects as possible. My thoughts will be with you.
dx:Mal-absorption disorder causing severe vitamin deficiencies, osteoporosis,osteomalacia,14 broken/fractured bones,anemia,hyperparathyroidism,hypertension,IBS,kidney stones,abdominal adhesion's,immune suppressed,23 surgeries to date
Rx:must be liquid or patch form,massive vitamin supplement fentanyl,percocet,protonix,clonidine,klonopin,phenegran,synthroid,pain pump implant april 4

Veteran Member

Date Joined Mar 2011
Total Posts : 1276
   Posted 3/21/2011 3:32 AM (GMT -6)   
Hi Cogito - I can only comment based on my own experiences...

I can't touch morphine in any way, shape or form because it makes me as sick as a dog, but I take Oxycontin and I don't have too many problems with concentration or drowsiness except when my dose has to go up. My dose varies from 50mg up to 80mg a day (split into 2 doses) and it's only on the high end of that that I get sleepy. Are Fentanyl patches an option for you? They gave me excellent pain relief and no opioid-related side effects - my problem was that I had a severe allergic reaction to the adhesive on the patches (still got the scars three years later...)

Good luck with your appointment :)

CRPS since 1999, diagnosed in 2005 and since spread to full body, spasms, dystonia & contractures, gastroparesis, orthostatic hypotension.

On Oxycontin/Endone, Topamax, Mobic, Magnesium, Florinef, Somac, Cipramil. Have a spinal cord stimulator, intrathecal pump with baclofen & bupivacaine and doing physio.

Veteran Member

Date Joined Oct 2009
Total Posts : 5028
   Posted 3/21/2011 4:19 AM (GMT -6)   
I tried tramadol ER twice a day, found it doesn't work as well as the regular one at all, but it's good for allowing me to get to sleep. It just doesn't seem to have that serotonin kick like the regular one. I'm currently taking regular 50 mg 3 times a day 8,12,4, and an ER at night 8PM.

I also very occasionally take diapazam (Valium) which works well on muscle spasms. At first it made me sleepy at 1mg, now doesn't at 2 mg. It cuts back spasm pain the best of anything! But pain doc is adamant I will get addicted to it, so I'm humoring him and not taking it - for now. I've tried everything else under the sun for fibro and back pain (discs, scoliosis, muscle spasms) and either don't tolerate them or they don't work for me.

Muscle relaxants are another good pain killer for muscle spasms for back pain people. The only one I tolerate is Flexeril, but it gives me serotonin syndrome with the tramadol. They're worth a try.

For sleep I take Ambien. It's very short acting but lets me fall asleep and I'm normally able to stay that way.

Mrs. Dani
Veteran Member

Date Joined Jun 2009
Total Posts : 2787
   Posted 3/21/2011 11:05 AM (GMT -6)   
  Dear Lawrence,
     Good morning  :-)    It is good to hear from you. How are your pain levels doing today? I hope it isn't too bad. You sound fed up with all the pain increases! I cant blame you for wanting better coverage.
     You have gotten quite a bit of great advise regarding meds. Of course no matter what you choose, you will have a few days or even week before you become accustomed to the side effects. Perhaps starting it on the weekend would help. I would also suggest you try taking a muscle relaxer to go with your analgesic. There are many that can be taken in low doses that wont adversely effect your concentration.
    With regards to an antidepressant, I was surprised you were not on one already. I hear what you are saying about tramadol effecting the depression as well....but really all it is doing is effecting some of the side effects of depression. You should really treat the depression to truly get full relief of the depression and all its side effects. There are many that you can take that will need to be built up in your system, but eventually will work towards your advantage. The difference will be like night and day. Also, many work wonders on nerve pain and overall pain levels. So, multiple benefits.
     As you well know.. there are risks with analgesics and muscle relaxers being mixed. Same amount of caution when when adding in antidepressants. So, you likely have to go through the painfully slow increases as each is added into your pain management medications. You know how it goes. I hate that part about adjusting or adding in new meds. Those are the hardest months for all of us I think. I really hope you can get the medication overhaul. It will be nice to get everything updated and changed as soon as possible.
     Hopefully you can get through the next few days till your appointment. Try to rest when your body will let you.

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

Chronic Pain Moderator

Veteran Member

Date Joined Oct 2010
Total Posts : 932
   Posted 3/21/2011 4:26 PM (GMT -6)   
Thanks for the comments.

I've tried all the muscle relaxants on the market and none have helped. Some just seem to have no effect. Others make me feel horrible.

While the Ultram was working, my mood was up, I was focused on work, and very productive. I've never used anything else for depression, so I don't know how they will affect me. But regarding my mood and energy, my first 2 years on Ultram would be all I would expect from an anti-d... and would be very pleased to get back to that state. As for pain, it did reduce my hip pain -- comparing it to the occasions here and there when I forgot to take my Ultram. But it never did much for my back.

Currently, I'm lying in bed with my laptop -- back hurting too much and I've been taking too much hydrocodone lately. Actually, that's been the situation a lot this month: taking days in bed with no BT meds to make sure I have enough for days when I have to be active.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, Supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia).
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