When are you done with pain meds?

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monk01
New Member


Date Joined Mar 2011
Total Posts : 3
   Posted 3/25/2011 4:44 PM (GMT -6)   
Hi,

Just joined because I am trying to sort out my chronic pain. Any advice would be most welcome and I will try to keep it short.

A couple of years ago I hurt my lower back quite badly (still not exactly sure how) and since then doctors have tried their best to diagnose. During the last couple of years I have tried a bit of everything: non traditional (acupuncture etc), diagnostics (mri etc), surgery (Microdiscectomy) and medication. My pain levels range from 3 to 10 and on average are a 5. My pain was not relieved after the surgery -- it just changed. It was a lateral move.

My current meds almost but not quite help me deal with the pain. I am on (all per day) neurontin (300mg*), percocet 10/325 (6 to 10 pills), oxycotin 60 (3 pills) and baclofen 30mg (3 pills). All of this is within my prescribed guidelines and I do not abuse.

Now my issues: It bugs me I take so much drugs -- especially the percocet. I feel like I should not be taking so much -- I talk to my pain doctor and he says that it is OK but it would be better if I could take less. But then there is the pain and so what do you do. I have read a few pain management books that say I should take less but more Oxycotin. I have tried less percocet and the pain came back hard.

I should note: I am able to function, work etc because when I take the drugs.

But then I started thinking that maybe I don't know what the baseline is anymore. Maybe I need to stop taking the drugs and see if I feel OK. Could the drugs be creating a vicious circle -- ie I subconsciously think I have pain so I can continue the drugs? Or the drugs are causing the issue -- for instance I had to lower my neurotin because I was getting Parkinson type side effects. Could there be more?

In short, how do I know when to stop? Should I feel bad about taking the drugs? Should I ask my doctor to lower my percocet but raise my oxycotin?

Any other insight?

cogito
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Date Joined Oct 2010
Total Posts : 932
   Posted 3/25/2011 5:24 PM (GMT -6)   
Hi Monk,

I've asked myself similar questions. I take Ultram ER daily and hydrocodone or oxycodone for breakthrough pain. Some days, the pain is way up there and I certainly need something to alleviate it. Other days, I'm in pain, not as intense, but take something because (a) I'm sick of being in pain and don't have the stamina for suffering any longer; (b) I want more out of my day than I would get given my pain levels.

But I do have good days, and perhaps once every three months or so can make it a whole week without any breakthrough meds. I sometimes also challenge myself to see how many days I can go and end up spending some days just lying in bed in pain, not able to get up to work because I'm forcing myself to not take any meds. I'm not claiming this is a smart thing to do, but I personally need the feeling of control.


For your mental well being, you might want to consider what people call a "drug holiday" -- that is, go a week or two without any medication. You'll experience withdrawal, and pain will be an issue, but then after 5 days or so, may get a clearer picture of your baseline. Certainly, you should discuss this with your doctor and probably will need to wean off your meds, but "drug holidays" are not uncommon practices for those in chronic pain.
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).

JCG32
Regular Member


Date Joined Dec 2010
Total Posts : 62
   Posted 3/25/2011 7:05 PM (GMT -6)   
Well when I was on a lot of meds my pain doc talked about slowly taking away to see what is working and not etc. I would think and I am no doc but that there could be a transition time where just from your body being so used to meds there will be a flare and adjusting. Sorry I am not much help. I hope you find what works for you.

Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 3/25/2011 11:51 PM (GMT -6)   
Quite frankly there are no easy answers to this. There are so many possibilities from you needing all of these meds to needs a med change to the meds causing the pain and any number of things in between.

The only way to know for certain is to, with the help of your doctor, to try different medications and doses and maybe even slowly tapering off and eventually going on a "drug holiday" for a few weeks.

The latter can be very rough as you may suffer a lot of increased pain, withdrawal symptoms, etc but once all the meds are out of your system and your body adjusts to not having them you and your doctor can figure out what is genuine pain and what may be pain due to dependence or the pain meds. The other positive to this is that when and if you go back on some pain meds your body may very well use the medication better and you may be able to get by on less.

I am not suggesting or recommending this, only giving you some food for thought. If you decide to do something like this ONLY DO IT WITH FULL KNOWLEDGE AND GUIDANCE of your doctor.

The final thing I wish to impart is that there is not one book out there that can say what is right for you when it comes to medications. Everyone's body reacts differently and only you and your doctor can discover and decide what is best for you.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1235
   Posted 3/25/2011 11:52 PM (GMT -6)   
First, hello Monk and welcome to the board.
I am a bit confused by your medication intake, so first let me ask if you can clarify what you are taking.
If I understand you correctly, you are taking 3- 60 mg tablets of Oxycontin per day, and are taking anywhere between 6 -10  10 /325 mg pills of percocet a day , 3-100 mg capsules of Neurontin , and 3- 30 mg tablets of Baclofen all within one 24 hour period? Am I understanding your dosages correctly? confused
 
Your base med, the long acting pain medication, which is the Oxycontin is what should cover your normal pain levels.  :-) 6-10 a day of percocet is a bit high for the amount of breakthrough meds per day, from most pain practices. Are you taking a minimum of 6 per day? Most days? The reason that I am asking is that percocet/oxycodone or any breakthrough medication is supposed to be used to cover pain that is above your normal, everyday pain levels, due to increased activity or a severe increase in pain. yeah
If you are taking it as I suspect you might be, to supplement your base med, then all you are doing is adding to your base med and then it will be ineffective for your increased pain levels, regardless of the cause. shakehead
If your base med is not covering your every day pain levels, then it might be worthwhile discussing this with your PM doctor so that he can increase the base med and then you won't be taking so much of the breakthrough medication. :-)
The breakthrough medications should only be taken for breakthrough pain. If you are supplementing your base medication by taking using BT medication doses, in the event that you doytuly reach a 10 on the pain scale, you won't be able to treat it. shakehead
It is a common mistake that many pain patients make in taking the BT medications to supplement their pain levels when the base medication isn't covering it and all you wind up doing is chasing the pain, constantly and then the medications become ineffective. sad
As far as the baclofen goes, you are at a substantial dose of that medication.
I believe the maximum daily dose is 80 mg.  idea It might be wiser for your PM doctor to reduce the dosage of baclofen and if needed , use an additional muscle relaxant like zanaflex or one of the others available.
One thing , make sure if you do reduce your dosage of baclofen that you do it in small increments.
 
 If you just stop baclofen it can cause baclofen withdrawal syndrome which can result in many other problems for you. Baclofen , like Lyrica, Neurontin and many other medications we take needs to be tapered up in dosage and down. Suddenly stopping any of those medications can cause problems. shocked
 
Neurontin is a good nerve pain medication, but if you can't take it because of side effects, most of which go away when your body adjusts to the dosage, then there are many others that you can try with the guidance of your pain doctor, Lyrica, Cymbalta and the old tricyclic antidepressants are very good at treating nerve pain.
 
I know this is a long response, but I hope that it helps you some.  As far as trying to reduce medications, I think that trying to reduce them to see where your pain levels are without them is a good idea from time to time. The one thing you have to remember when you do decide to reduce them is that your body has become habituated to them and as a way of trying to convince you that you need them is for the pain levels to increase for a bit. Usually after a month or so of no pain medications, you can start to assess where you are pain level wise and then think about whether or not over the counter or a lesser level dosage frequency or even a lower dose might be effective.
Best wishes to you,
Sandi
 
 
 

Chutz
Forum Moderator


Date Joined Jan 2005
Total Posts : 9255
   Posted 3/28/2011 1:22 AM (GMT -6)   
Hi and I also would like to welcome you to our Chronic Pain Family!

You've certainly received a lot of great information and ideas to consider. IMHO, one of the most important is do NOT reduce your pain medications without the help and knowledge of your doctor. Not only is it miserable and unnecessary but it can be dangerous. As a reminder to all who may be reading this thread, here are a few side effects of going cold turkey.

Severe and possibly fatal side effects of improper Oxycodone withdrawal include:

* Excessive drops in blood pressure
* Cardiac arrest
* Circulatory depression
* Coma
* Respiratory arrest
* Respiratory depression
* Shock


So Monk, do be careful and keep us posted on how you're doing, OK?
Chutz
Moderator on the Fibromyalgia and Chronic Pain forums
~*~*~*~*~*~*~
Daily Donnybrook: Fibromyalgia, Insulin Dependent Diabetes. Ulcerative Colitis, Rare form of Dermatitis, Collapsed Disk, Osteoarthritis (especially in right hand and neck) and a couple of other adjunct agitations.
~~~~~
Against the assault of laughter nothing can stand.
Mark Twain

monk01
New Member


Date Joined Mar 2011
Total Posts : 3
   Posted 3/28/2011 5:10 PM (GMT -6)   
Hi,


Thanks for all the responses and the supportive feelings. I should clarify that I am taking 10MG baclofen for a total of 30MG a day. Sorry for the confusion.

mrsm123: This is exactly what I have been thinking and reading. That the percoet is being "misused" --- that is, it is being used as a base med and not as a breakthrough med. Surprisingly, my pain doc knows this --- as I have discussed this with him. That is, I have told him that I am basically chasing pain and that if I don't take all of the meds then pain comes back hard. My feeling was that the meds should be used for when the base meds are just not enough for that day ---- but this should be the exception and not the rule.

Unfortunately, I cannot get my doctor to see it that way. Same goes for friends/family (one of whom is a doctor) --- they don't get why I am not happy about the meds. They simply say, the meds mostly let you deal and you are productive. Why complain.

All of which is becoming very frustrating and depressing. Couple this with the pain and it makes things that much harder.

My next steps will be to discuss all of this with my doctor in April (my next appointment). Maybe I can get him to appreciate my position.

p.s. It may not sound like it but I really like my Doctor. He has been very supportive and really wants to help. Not all pain docs are like that.


Thanks again.

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1235
   Posted 3/28/2011 7:03 PM (GMT -6)   
Try asking him to increase two of your daily doses of Oxycontin, for the times of day when you are most active, and reduce/not take the percocet for those two times and see if the increase in the long acting helps keep your base levels under better control.
The increase in the Oxycontin, should make it so that you aren't feeling the loss of the percocet . If this works, then the need for the percocet should be reduced. If not, you may need to increase all of the doses of oxycontin, and then decrease the doses of percocet.
You can also discuss with your pm doctor that you have read that increasing the base dose and then reducing the short acting meds might give you better and more consistant pain relief than using the short acting medications and needing to take so many of them on a daily basis, as well as the concerns over using that much acetominophen on a daily basis.
Anyway, I hope that he is willing to work with you, it sounds like he is a good doctor trying to do his best for you, and those are few and far between.
Sandi

nvrthesame98
Veteran Member


Date Joined Jun 2008
Total Posts : 6706
   Posted 3/29/2011 2:50 AM (GMT -6)   

Welcome to HW Monk,you have been given some great advice already and I cant add much more to it but wanted to say Hi and welcome.

I did want to say I agree with the others take on your base meds and your bt meds running together and I dont think I read anywhere about how long you have been on the oxycodone but it may be that trying another med altogether will work better for you. Im a bit concerned over the amount of tylenol in 6-10 percs a day over a long period of time.

I was a oxy user for CP for a good many years until finally had reached a point of my dosing being way too high to suit me even though my PM thought it wasnt too bad, I am glad you have a good Doc as we see so so many who dont,if he is willing to experiment and open to new things maybe looking into a different base med or possibly changing your b/t to roxy without the tylenol and it comes in 5,10,15mgs etc. It may even work out better as a b/t med for you.

If he isnt openn to trying a different base med or your not then at least an increase in that med and eliminating the percs and going to the roxy might help.

To most of us it is a puzzle of sorts to figure out what works when and how often and yet how much residule pain are we left with or can we live with and for some it takes years to find the right combo for us. Again it sounds as if you have a great Doc and thats a very good plus.


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

kim9807
Regular Member


Date Joined Mar 2011
Total Posts : 39
   Posted 3/29/2011 5:52 AM (GMT -6)   
Hi welcome, I am no longer on pain meds except tylenol and ibuprofren but thats because I dont have any insurance. It's not because I dont need them anymore. I have good and bad days also. As far as going off your pain meds I would talk to your dr about it. I was on percocet for a couple of years and when I quit taking it I didnt have no withdrawl symptoms but thats me not everyone is the same. The big thing is to talk to your dr. Gl.
Chronic back pain and Fibro.

monk01
New Member


Date Joined Mar 2011
Total Posts : 3
   Posted 4/12/2011 7:22 PM (GMT -6)   
Hi,

I went to my pain doctor and he agreed that I was chasing my pain. He had a lots of suggestions but he wanted me to tell him what I wanted to do. Mainly he suggested we try different drugs or up what I am taking. The alternate drug was methadone but that really scared me. Ultimately, I decided to increase my oxycotin from 180mg a day to 240mg a day.

So far there really hasn't been a change --- in fact, may pain seems to be getting worst. None the less I recently forced myself to decrease my percocet. This has been done to my detriment -- that is, I am suffering so that I can take less. Mind you this is not because I am afraid I will run out but because I am trying to meet the goal.

Either way I feel trapped. Changing my oxycotin does not seem to help, the pain is getting worst and I really don't want to switch to methadone or similar.

Not sure what the next step is.


Thanks for listening.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16793
   Posted 4/13/2011 4:33 AM (GMT -6)   
Hi Monk, I am sorry to hear that even with the increase in your medication that you are now suffering more than you were. My first thought is it sounds like you have built up a tolerance to the Oxycontin and need to be switched to something else. You know that happens more frequently to people on pain medications. Why not see if your dr will try you on Morphine or something like that. I understand you not wanting to try Methadone and I really do not blame you one bit for that. I always say Methadone is a last resort type of medication. I am very much aware that it can be a very effective pain medication and cheap to buy too.Take care.
Moderator Chronic Pain Forum

bsjaguar
Veteran Member


Date Joined Jun 2009
Total Posts : 974
   Posted 4/13/2011 5:24 AM (GMT -6)   
Not sure what type of doctor you are seeing but has your doctor ever suggested radiofrequency ablation?  With this procedure the doctor first does diagnostic nerve blocks to see what nerves are causing the pain in your back.  If the nerve blocks are successful the rf can be completed.  During rf the doctor inserts a needle into the affected nerve then the needle is heated, deadening the nerve.  I had this done about 6 months ago and am still receiving relief.  It is not total relief because I have so many issues but it was a definate help and can last up to 18 months normally.  This should be done by a qualified physician, my pain management doctor did mine.  There is alot of information on the internet about this procedure.
 
Not sure if you are still working or not but I was also taking narcotics and trying many different muscle relaxers with little or no pain relief.  I finally realized I needed to change my activity level and the activities I did.  I don't like slowing myself down and find it difficult to do but if I over do it I pay for it later and it was a visious circle.  With the decrease in activity I was able to wean myself, with my doctors help, off the narcotics and am using tramadol, a non-narcotic, pain med along with tylenol, neurontin and baclofen. 
 
The rf may not be an option for you but is something you can discuss with your doctor.  If it is not an option Straydogs suggestion of trying a new med is definately something to consider.
 
Good Luck and keep us posted!

sore42long
Regular Member


Date Joined Apr 2011
Total Posts : 235
   Posted 4/13/2011 12:59 PM (GMT -6)   
I wake up in pain go to sleep in pain ,with pain meds it different for ever one ,although when you take lots of meds to be able to work ,dont you think your damaging yourself more?Irealize you need to support yourself ,what about some kind of disabilty payments,if possible !All pain meds are addicting and you will get side effects when you stop taking them!I am on oxycontin but keep it down to 60 a day ,Ishould take more has my pain is still there and will not go away till surgery,at least Ihope!Its a person choice of how much you think you need,just remember pain meds are drugs and do have side affects,even if you never plan to get off them ,they may cause liver ,stomach damage.Ihave had to give up working ,driving ect,due to pain ,it sucks but hopefully wont be for ever!!one more fact I know is you do build up a tolerance to these meds ,where you need more and more .Its your body and your choice Ido hope this helps make the best choice for yourself,I appauld you for going to work but my honest opinion is thats alot of drugs to be taking .take care 

sore42long
Regular Member


Date Joined Apr 2011
Total Posts : 235
   Posted 4/13/2011 1:44 PM (GMT -6)   
hi monk ,yes I agree methodone is scary ,wise choice to stay away from !Iwas on it and never will take it again also not a effective pain killer at least not for me .I feel this site is so good for info ,has its so hard to deal with chronic pain that only you can feel.I was also given Lyrica and the side effects were so bad ,I gave up taking them,so thanks too whom ever said the side effects will go away .I'm going to try it agin? Iuse to be so active and enjoy life ,but now the pain is so bad every time i move my right arm !I have adapted to use my left hand only,The surgeon said 80%chance it will work ,thats good enough for me !The thing that bugs me most is the inability to do things due to pain ,I find even on oxycontin if i take another pill the pain is still there ,so why bother?but willgive LYRICA another chance
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