Question regarding Extended Release Pain Medication

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fireflyhillary
Regular Member


Date Joined Jan 2012
Total Posts : 148
   Posted 1/20/2012 12:14 AM (GMT -6)   
I see my Pain Management Doctor tomorrow for my follow up after radio frequency treatment. Since I am not better I am going to ask if he can prescribe an extended release pain medication. I am currently taking Percocet 10/325 twice a day. If he gives me a prescription for the ER pain medication, do I still take the Percocet? Anyone have any experience with this? What is your dosing like? Thanks!

spinal soldier
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Date Joined Dec 2009
Total Posts : 687
   Posted 1/20/2012 1:27 AM (GMT -6)   
you at all cost want to maintain a short/quick acting med like Percocet when taking a sustained release formulation. the ideal dose of a sustained-release med should allow you to need 2 or less breakthrough/activity pain medications per 24hrs. i do not find that is generally true and it is always in the literature from the new extended release med so it is a buyist view. some doctors are real tight on breakthrough medication and some are totally opposite and may believe copious amount of short-acting meds are better for some. if you have good insurance i think Opana ER may be the one of the best ER meds. right now if you find the dose you need. as far as a breakthrough medication i think if you can eliminate acetaminophen then that is good; Roxicodone, Dilaudid 2,4,and 8mg, and MSIR 15mg and 30mg and even Opana IR are all superior to percocet and probably fewer adverse effects. one side effect that you may want to inquired about if you read this is with these around the clock meds and maybe better breakthrough meds the chances of nausea or vertigo may happen, do not let that turn you off to the med because as soon as he writes your new Rx's they could also perscribe a first-generation anti-histamine like: Vistaril or Benadryl or a anti-cholinergic/mild tranquilizer called Phenergan, all would potentate the painkillers also. Meclizine is OTC under the name Bonine that would be just as helpful. best of luck to you. Nick

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 1/20/2012 1:33 AM (GMT -6)   
real quick, i just read your current dose of oxycodone, it is very low so a med like Opana ER could be started at 5mg or 10mg 2/day and your results would be great most likely. for the very bottom dose the new ER med called Exalgo (a once a day level dilaudid formulation). two Morphine ER meds that are higher quality and available at a low dose are Avinza and Oramorph SR.
L4,L5,S1 bilateral Laminectomies, Foraminotomies 2002
L4-S1 PLIF with instumentation 2008,

current Rx: MScontin 100mg q8hrs. , dilaudid 8mg q6hrs. prn, oxymorphone IR 10mg q6 ,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 1000IU, Fish-Oil1000mg EFA, B-Complex50 3x/day, ALA

Screaming Eagle
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Date Joined Sep 2009
Total Posts : 5005
   Posted 1/20/2012 4:42 AM (GMT -6)   
Hello Fire!

I think that Yes it is a good idea to keep an IR med on hand for BT. However it should be used for that only in my opinion, and not part of your total baseline. If your Dr can get you scripted correctly with a ER med that works best for you, in theory you should not need the BT med's except for when your having a flair or your activity has caused you more pain than you normally have. Sadly, there are many of us here who have used the BT med's on a regular schedule, because our Dr, have yet to get our ER med's to the correct dosage. Oxycontin is widely known not to last a full 12hrs for many patients, and many will have it scripted every 8hrs. This what I had done after a lot of complaining to my Dr about it not lasting.

As far as one med being better than the other, you have to be careful with opinions, as everyone is quite different. Oxycodone worked quite well on me for several years, and I mean several! I think a good Dr, would change med's every once in a while to keep tolerance levels down to a minimum. Once you build up a tolerance to a certain med, it can be a roller coaster ride for a long time before you get them changed to something else.

Dr's are finicky these days because of all the FDA hoopla, so it may not be so easy for you to get what works best for you. If Opana ER is a med that does not bring your Dr into the FDA spot light, then it may very well be a better med for you in the long run….because of these types of problems, and not because it is a better med for pain. I know that sounds bad…but really, you want it to work as well. What I'm saying is that Oxycontin may work better as a pain med, but if you can get decent relief with Opana ER, then in the long run you may be better off, and your Dr as well.

Spinal is quite right, if you are a long term CP suffer, that yes the 10mg percocet seems quite low a dose, but again, everyone is different. That was my daily script for a very long time, and was effective for me. I can remember when one 10mg percocet daily, was all I got for several months.

Also I think Spinal is correct in the fact, if you can be scripted the Oxycodone IR, it might be better than the Percocet, but at those levels of BT your on, you should have no worries about the amount of acetaminophen intake. You are allowed 4000mg daily, however it would be wise of course to stay on the lower side of it if possible. Currently you are taking a total of 650mg of acetaminophen, way way, below the daily allowance. You can always buy OCT acetaminophen if needed, if your scripted Oxycodone IR….just be careful of your daily intake.

Good luck, and I highly suggest that you let your Dr suggest the med's, unless he ask what you have in mind. I and a few others have a wonderful trust built up, and at least my Dr will ask that very question, but I always tell him to pick, not me. I will share my opinion with him, and he knows I have done my homework. Another thing I do….is to tell him what I do not want…(methadone, fentanyl)…is it sort of a trust builder if you know what I mean.

Never be eager to be totally pain free and I discourage it, as it is not realistic, and can be dangerous. You need to feel your body and any problems that may crop up. Understand? Stay on the lowest does that you can. For instance if he would happen to script you #30 Oxycontin, and you find that you are 100 percent pain free, you may want to have it lowered. I did this when my Dr started me out on #40's….it was too much, and I went back and asked him to lower the strength….again it is a trust builder.

Good luck, and let us know how it turns out for you. We also Thank you for your question, and posting it here on our forum…..this is exactly what were here for. Support!

SE wink
Moderator Chronic Pain Forum

Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

Post Edited (Screaming Eagle) : 1/20/2012 2:56:55 AM (GMT-7)


fireflyhillary
Regular Member


Date Joined Jan 2012
Total Posts : 148
   Posted 1/20/2012 3:46 PM (GMT -6)   
Thanks for the input everyone! I just got back from my pain doctor and he would not put me on an extended release or long acting pain medication. He said he only wants me taking 2 Percocet's/day, which is already what I am doing. I explained that is not helping, so he put me on a muscle relaxer Robaxin & I am to see him next month. I am very frustrated! Said that I might consider a spinal cord simulator, but I tried a tens unit one time and didn't really care for it, so don't know if that would be a good option or not. He also mentioned the dreaded "s" word- surgery. Said he may send me to a neurosurgeon to get his opinion. I feel like he's not listening to me! I know Dr's have to be cautious with what they prescribe, but goodness, I'm in severe pain. He said they wouldn't do an ER or LA on me until it got to the point where I am abusing my Percocet- well geez, that helps! I feel like I want to cry!
Current: Bulging Disc L4-S1, Arthritis L4-S1, Interstitial Cystitis, Vulvodynia, Restless Leg Syndrome, Bi-polar, IBS, Fibromyalgia, PTSD. In past 6 months have had epidurals, facet blocks and radiofrequency ablation.
Past: Endometriosis, Adenomyosis, Polycystic Ovarian Syndrome. 3 laparoscopies, 2 cystoscopies, total hysterectomy, appendix & gallbladder removal.
All of this and I'm only 33!

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 1/20/2012 4:24 PM (GMT -6)   
FFHillary,

I only have a quick moment on here right now but I'll write more later.... but please, please try to get a second opinion w/ another PM doc.

Some of the things that your doctor said to you are absurd! He doesn't want to give you a long-lasting med.... until you are "abusing" your Percocets? That doesn't even make sense.

In addition - and this is just my opinion - but I would much rather exhaust my medication options before I considered surgery. If you are taking 2 Percocet per day....even w/ the Robaxin (which is a pretty mild muscle relaxer)... this doesn't even seem like enough to touch your chronic pain :( Is this doctor just "anti-medication"?

Regardless, I just want to see you get the proper care - and get some relief! Are there any other Pain Management docs that you can go to, in order to discuss your situation?

I feel your frustration - I would be VERY frustrated! Please feel free to vent here any time and try to see if you can get an appointment w/ another doc. Hang in there; I know it's not easy :(

--Tina
I am a Christian mommy to 8 children - 6 wonderful boys and "surprise" identical twin girls. The kids are the love of my life, truly.
Health/Pain Issues - too many to list; feel free to ask
Medications - been on just about all of them; again, feel free to ask.... My faith and my children sustain me, even on my worst days - oh, and my friends here at HW :)

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 1/20/2012 4:39 PM (GMT -6)   
I thought I would chime in here since at my most recent PM visit, I asked to move to a stronger time-release med (currently taking Ultram ER) but my PM instead just suggested I use more BT meds.

His view is that if one needs fewer than 3 or 4 BT per day, no need to change time-release. He has also suggested that I vary my dose from 1/2 pill to 1 1/2 pills as needed. That may be something to discuss with your PM .... divide your total daily IR dose into smaller increments. If you can cut down the pain before it gets too bad, that may make a difference, such as leading to less muscle tension.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, 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). [/gray

AngelinaATF
Regular Member


Date Joined Jan 2012
Total Posts : 135
   Posted 1/20/2012 5:11 PM (GMT -6)   
I have to put my 2 cent in - totally agree w these other 2! Wow - this Dr sounds like a dud (at the very least ..not "good bedside manners" for certain!) BUT I know it's not always convenient or even plausible to switch Drs! Therefore...
1. True that if not exceeding maximum dose, they won't usually switch to extended or controlled-release medication so prob have to see how often u truly need it & if its more often than said-label, will have to make appt to go back asap & tell him where u are at.
2. His comment about "abusing" the meds doesn't bode well for how he understands CP. This just irritates me to no end but its not an uncommon opinion - sadly!
3. Agree w MOMOF8 @ finding a pain clinic or Dr - & soon! Even if u have to drive a little further. I've also found some Internal Med physicians more educated@ cp.
Let us know what happens! Don't just suffer in pain - Pls be proactive & take control of your condition! Love & hugs to you!
Angelina
age 41
dx: MCTD(LUPUS), RAYNAUDS, FIBROMYALGIA, L4L5 disc herniation, fracture in L3 fro EPIDURAL in childbirth
meds: Arava, prednisone, Nifedipine, estropipate, cyclobenzaprine, Cymbalta, sulfasalazine, gabapentin, hydrocod (4BTP), fentanyl patch, methotrexate - MTX (on hold), minocycline, clonaxepam (sleep), vitamin D, B stress complex, PRILOSEC, Transderm-Scop (on hold)

Draka
Regular Member


Date Joined Jun 2009
Total Posts : 256
   Posted 1/20/2012 5:20 PM (GMT -6)   
Just try to find out costs also.... and what your insurance will cover

My insurance wouldn't cover my Opana ER... I had to jump through some hoops to get it... the insurance company needed a fax from my Dr.... and I had to pay $500 a month for 30 mg... 60 pills for a twice a day dose....

The medication was by far the best I've tried, I found it lasted for around 5 or 6 hours but not the 12 like it states.

I don't take it anymore due to the cost :(
Posterior cervicothoracic decompression and instrumented fusion (three levels) for spondylosis and stenosis with severe radiculopathy.. surgery performed 3/31/11

fireflyhillary
Regular Member


Date Joined Jan 2012
Total Posts : 148
   Posted 1/20/2012 6:47 PM (GMT -6)   
Momto8kids- The area I live in there aren't many pain doctor's & I've honestly been VERY happy with mine until today. The fact that I was told I can't be put on ER or LA med's because I'm not abusing my Percocets didn't make a lick of sense to me either. I told him several times (well, actually her as I had to see his NP) in my appointment that the 2 Percocets aren't cutting it & she wouldn't even agree to letting me take 3 per day. She said she could try me on 7.5/325 3 times a day, but not the 10's- the 7.5's don't touch the pain and here lately the 10's aren't making much of a difference either. This is why I wanted an ER or LA pain med since the Percocets aren't helping much. I definitely don't want to even consider surgery unless it's an absolute last resort- I will do any medication before doing surgery. Not sure what to think about the Spinal Cord Stimulator- my husband had a tens unit at one point, but gave it to his sister and I tried it one time and didn't really care for it....wouldn't the spinal cord stimulator be about the same thing as the tens? Thanks for your concern!

Cogito- You only take Ultram for your pain? Wow, you are lucky that it helps as it never did a thing for me. She did suggest that I try to cut my pills in half, taking 5mg at breakfast, 5mg at lunch, and then the full 10mg with dinner. She said the 10's are scored so they can be split in half, but when I came home and checked, they are not scored. I was always told that if a pill is not scored then it's not meant to split in half....is this true? Plus, it's really hard to split a pill that is not scored....I have to do this my cat's medication and it's a pain in the butt and impossible to split right in half. Thanks for your concern!

AngelinaATF- My Dr had great bedside matters and has been very helpful in the past, but had to see the nurse practitioner today....I do not want to switch dr's as mine is excellent, but impossible to get to see for follow up appointments...They make you see the NP instead :( So I can't be switched to an ER or LA pain med if not exceeding the maximum dose, so what do I do? Take more than it says on the bottle? Then I would be "abusing" the medication and would come up as a red flag as being a "junkie." I can't win for losing. Love and hugs back to you as well!

Draka- I don't have a problem with my insurance covering anything, I have excellent insurance thanks to my husband. I did have problems getting them to cover Lyrica, but once the proper documentation was sent in it was no problem. $500 a month for Opana? My goodness! That really sucks that you can't take it due to the costs since it helped you a lot! I'm so sorry to hear that!

I really appreciate all of the input, you don't know how much it helps! Thanks so much!
Current: Bulging Disc L4-S1, Arthritis L4-S1, Interstitial Cystitis, Vulvodynia, Restless Leg Syndrome, Bi-polar, IBS, Fibromyalgia, PTSD. In past 6 months have had epidurals, facet blocks and radiofrequency ablation.
Past: Endometriosis, Adenomyosis, Polycystic Ovarian Syndrome. 3 laparoscopies, 2 cystoscopies, total hysterectomy, appendix & gallbladder removal.
All of this and I'm only 33!

Screaming Eagle
Veteran Member


Date Joined Sep 2009
Total Posts : 5005
   Posted 1/20/2012 6:49 PM (GMT -6)   
…just wanted to add one more thing to the mix of replies here. Dr's generally do not want to keep masking the problem when they feel there is a fix for the pain. My Dr gave me a choice, either corrective surgery or no more med's. I was told if I continued to put off the surgery that I would do more damage in the long run, and may never recover from it.

Others have different feelings on this I'm sure. There are no for sure bets with surgery, and this is why it's a tough choice to make. It appears that you have a Dr that wants to exhaust all options before going the route of long term pain management. In a way I cant say I blame him with the FDA and their current witch hunt, however I also feel that a patient should not have to suffer either.

Lets hope the muscle relaxer works for you. Many have shared their opinion and I guess I will too….well let me put it this way!…my Dr was talking about the SCS unit as well…and I said No Way! Period!

Good luck,

SE wink
Moderator Chronic Pain Forum

Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 1/21/2012 1:19 AM (GMT -6)   
this is the translation: i am not interested in treating your pain any more agressively than 2 pills a day and the muscle relaxant was just to get you out the door because it is a very poor med and if your pain is not controlled it would not help anyway. he was not only not going for a ER med he is not going for any more weak meds. do not let his lack of compassion get you into a surgery because you have a right to adequate pain control. you will probably need a different doc. you do not have to go to a surgeon. i wish you luck, THE INTRACTABLE PAIN PATIENTS HANDBOOK FOR SURVIVAL can help guide you by dr. forrest tennant foresttennant.com

AngelinaATF
Regular Member


Date Joined Jan 2012
Total Posts : 135
   Posted 1/21/2012 6:17 AM (GMT -6)   
It is true that there IS legislation out there (supposedly) to "protect" pain patients. That is the purpose of the "pain chart". But then the "War on Drugs" began -& the ensuing witch hunt over the last 5 yrs, it has created more roadblocks than help!
Dang - surgery or nothing! That's not a real choice & you need to be stern & insist u see your Dr rather than his inept NP (sorry but she sounds like she needs the boot!) Even if u have to call everyday. & be put on cancellation list!
Sorry fireflyhillary but the truth is sometimes the "squeaky wheel gets the oil"!
You have to be strong & tell them u are in excruciating pain &:the percocet.isn't touching it! Refuse to see the NP - seriously, tell the office manager what she said @ you needing to abuse it first! They need to know! Ok..off my soapboxed! Hugs!:)
Angelina
age 41
dx: MCTD(LUPUS), RAYNAUDS, FIBROMYALGIA, L4L5 disc herniation, fracture in L3 fro EPIDURAL in childbirth
meds: Arava, prednisone, Nifedipine, estropipate, cyclobenzaprine, Cymbalta, sulfasalazine, gabapentin, hydrocod (4BTP), fentanyl patch, methotrexate - MTX (on hold), minocycline, clonaxepam (sleep), vitamin D, B stress complex, PRILOSEC, Transderm-Scop (on hold)

fireflyhillary
Regular Member


Date Joined Jan 2012
Total Posts : 148
   Posted 1/21/2012 4:03 PM (GMT -6)   
ScreamingEagle- So what did you end up doing? Did you have surgery? Unfortunately the muscle relaxer has done nothing but make my heart race, so I'm not going to take it. I can't stand the feeling of my heart beating out of my chest. Thanks for the well wishes!

Spinal soldier- I feel you are right- the NP just wanted to get me out the door. I am calling them first thing Monday morning to tell them I can't take the muscle relaxer & insist on an appointment with the actual Dr! Trust me, surgery is not an option for me, I've already had 7 surgeries (not for back) and probably 15 in office procedures for my back; I will not have major surgery for my back. The first pain Dr I went to did epidurals, but they did not help, but the NP said she thinks I should try them at their office- won't it just be the same outcome? Thanks for wishing my luck and posting that website, I will definitely check it out.

AngelinaATF- It really aggravates me that the real people who need the pain medications have such a hard time getting them because of the people that abuse them. I am not one of those people- only taking two percocet's a day does not qualify me as being an abuser, so i feel I should be getting the correct medications I need. I agree with you- surgery is not a real choice- I've already had so many surgeries in my 33 years on this earth and I do not plan to have more. I have done procedures for my back that were in an office and then others in an ambulatory surgery center- that's as far as I will go. I am going to refuse to see the NP, even if it means I have to go through the office manager. I have worked in the healthcare field for 10+ years, so I know how offices are to be run, and this office is really making me mad. It really is a shame because the actual doctor is amazing! hugs back to you!
Current: DDD L4-S1, Arthritis L4-S1, Facet Syndrome, Interstitial Cystitis, Vulvodynia, Restless Leg Syndrome, Bi-polar, IBS, Fibromyalgia, PTSD. In past 6 months have had epidurals, facet blocks and radiofrequency ablation.
Past: Endometriosis, Adenomyosis, Polycystic Ovarian Syndrome. 3 laparoscopies, 2 cystoscopies, total hysterectomy, appendix & gallbladder removal.

sos007
Veteran Member


Date Joined Nov 2011
Total Posts : 615
   Posted 1/21/2012 5:38 PM (GMT -6)   
Firefly...I am confused because my doctor said exactly the opposite she did not want me using my BT unless I was having a flare or additional pain...she said she would rather up my slow release then to have me taking more BT. I would definitely get a second opinion....I hope you are able to get things strightened out...Take care

Blessings, Amy
Chronic Pain(nerve), fibro, mild depression and a few others

Screaming Eagle
Veteran Member


Date Joined Sep 2009
Total Posts : 5005
   Posted 1/21/2012 5:39 PM (GMT -6)   
…I did have a double fusion surgery. Mechanically supposed to be fixed, however left with nerve damage, some possible by waiting too long, and some caused from the surgery. I'm still in about the same amount of pain, if not worse. I have the same need and type of pain in the cervical area, and affects my shoulder as well.

Surgery you say?….hum…will wait as long as possible for the cervical. I have a friend at work that waited way to long, and will now forever drag his right foot because of it. It's a very tough choice, and too many unknowns. No guarantees!…but then again you are not guaranteed tomorrow either. I scoff at those who say what ever you do, don't get surgery, and at the same time I cringe at those who say jump on it! …and then,……. you will always have a "I told you so" no matter what happens! it's a personal choice, and you have to weigh the information presented to you.

Remember Dr's also have the right to refuse service as well! Get as many opinions as you can, it just may better the odds for a sound guess! LOL

Good luck,

SE wink
Moderator Chronic Pain Forum

Weekly Quote!

"Getting over a painful experience is much like crossing monkey bars. You have to let go at some point in order to move forward."

fireflyhillary
Regular Member


Date Joined Jan 2012
Total Posts : 148
   Posted 1/21/2012 5:50 PM (GMT -6)   
sos007- I am confused right there with you. What the NP told me completely contradicts what I have read here and what one of my close friends has told me as she is on ER pain meds and BT pain meds. Thanks for your response!

Screaming Eagle- I am sorry to hear that the double fusion surgery has not relieved your pain and that you have nerve damage due to it. This is why I am scared of the thought of surgery. I am not entirely against surgery, but want to try all other options first as surgery is a major decision and risk to take. I hope my Dr does not refuse to see me; I've been an excellent patient. When I call on Monday I do not intend to cause problems, I just want them to know that I would feel more comfortable getting the opinion of the actual Dr.
Current: DDD L4-S1, Arthritis L4-S1, Facet Syndrome, Interstitial Cystitis, Vulvodynia, Restless Leg Syndrome, Bi-polar, IBS, Fibromyalgia, PTSD. In past 6 months have had epidurals, facet blocks and radiofrequency ablation.
Past: Endometriosis, Adenomyosis, Polycystic Ovarian Syndrome. 3 laparoscopies, 2 cystoscopies, total hysterectomy, appendix & gallbladder removal.
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