Less than 2 weeks before my next PM visit.

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cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 3/8/2012 12:04 AM (GMT -6)   
Hi All,

I usually post, looking for advice before I see my PM.

During my last visit, I asked to add or switch to a stronger time-release med. Instead, he wanted me to up my BT med use (I was averaging roughly 20 10mg hydrocodones and 5 oxycodones per month).

So, in January, my use was up a bit... 23 hydros and 7 oxys. However, February was a TERRIBLE month for me, probably my worst ever. I used 37 hydrocodones and 10 oxycodones. Only 3 days out of the month I was able to avoid any BT meds. Part of the increase was due to my trip to Toronto. Part as well was due to my wondering whether my Ultram ER was still making a difference, so I dosed out of it then started up again. From 300-200mg, not a big difference, but once I got to 100mg, blam! I still dosed down to zero, but after just a day, had to return to the 300mg. Those were really bad days and my pain was just unmanageable.

At least I know that the Ultram is helping and after a few days back at 300mg, my pain hasn't been too bad.

One thing I'll need is a refill of my hydrocodone. Though I usually only ask for one every 6 to 9 months, I'm already low enough after 3 months, I'll need more. But as I see it, this is a consequence of my PM's suggestion that I take more (and, I guess, a product of my Ultram experiment). I'm still fine with my oxycodone supply. I had 60 prescribed in October and still have 35 left.

So, I can just ask for Ultram and Hydrocodone refills or revisit the change in time-release meds. It would be nice to not have to think so much about taking BT meds and keep the pain down.

I wish a time-release hydrocodone was available, but in lieu of that, I'm again going to pitch the lowest dose of Opana ER to add on to the Ultram... unless anyone has other ideas.

Thanks.
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

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 3/8/2012 2:35 PM (GMT -6)   
Cogito....

Hmmm - just a few quick thoughts. Most docs want to up the ER meds; not the BT... so that's interesting. What was his reasoning for this?

I get what you are saying in that you don't want to consistently have to think about taking your BT meds.... but it's really basically the same thing - you are adding to your narcotic load either way... whether you increase your BT meds... or add on an ER med.

To me, it's really whatever is going to control the pain the best. I advocate being on the lowest possible amount of medication that keeps someone comfortable and gives him/her a better quality of life.

Maybe trying the Opana ER would better control your pain. Have you ever used it before?

--Tina
Moderator - Chronic Pain Forum

My faith and family sustain me even on my worst days... as well as my wonderful friends here at HW.

Health/Pain Issues - too many to list; feel free to ask

di43
Regular Member


Date Joined Jan 2012
Total Posts : 108
   Posted 3/8/2012 4:31 PM (GMT -6)   
Hi Cogito
 
I`m so sorry you had such a terrible month in February. I really hope your doctor will be able to put you on something that will help more. One ER medication I took that helped was Norspan which is a patch form of buprenorphine. I don`t know if it would help you or how much it costs in the US but doctors may be more likely to prescribe it than other opiates as it is supposed to have less abuse rate, I`ve found this anyway. I don`t know too much about what to advise you but I really hope you can find something more effective. Please let us know how you go. Love Di xxx

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 3/8/2012 9:24 PM (GMT -6)   
Thanks for the feedback.

I agree that my PM's recommendation that I use more BT meds came as a surprise. He explained his decision in terms of my rate of BT med use was low enough that adding on more time-release meds would likely net more opioids in my system than if I simply used some extra BT meds, and perhaps more than I needed. I assume that the quantity of "extra" he had in mind was maybe 20%-30% more.

Yet, as tolerance builds, I'm finding the duration of efficacy to be shorter. Even a year ago, 10mg of hydrocodone would still be working 7hrs after taking it. Now, I'm often taking a BT med at 11am-1pm then needing another at 5pm-6pm. Thus, because of the shortened duration, my noon-ish BT med isn't lasting through dinner time.

On the days I can delay taking a BT med until mid-afternoon, I'll typically just need one. Also, on days when I really take it easy (lay around watching t.v. or reading), I can bear the pain without BT meds.

So, further time-release may, realistically, be overkill (as then I'm subject to the medication for many hours and some days when I don't need it). But I'm worried about becoming a patient who needs refills at every visit.

I realize that the 12hr extended release is usually taken twice a day, but it might actually be a suitable option for me to take just one daily. I may need the Ultram ER every day, but I can imagine taking oxycontin or Opana ER when I first get up on specifically the days I expect to be working. A further time-release med 9am-9pm roughly 25 days per month would match well with my needs. But it certainly would go against prescribing norms.

I have found Opana IR quite effective, though it does have the side effect of making me have to urinate a lot.

di43's suggestion of a buprenorphine patch would likely be too much in my case.

It may just seen crazy to my PM, but I like the idea of an as-needed 12hr extended release opioid. Maybe that way, I could avoid the ramp-up of pain before I turn to a BT med and also avoid the daily weighing of should I/should I not as I consider how much pain I'm in, if I can just stop working for the day and rest, how many BT meds I have used lately, how many left, etc. etc..
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

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 3/8/2012 9:27 PM (GMT -6)   
Oh yea,

My wonderful wife picked up a box of oxycodonuts for me today... and not the generic type but name brand (Krispy Kreme). Yum.
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

flower123
Veteran Member


Date Joined Apr 2009
Total Posts : 856
   Posted 3/9/2012 4:51 AM (GMT -6)   
Hi Cognito. Now I want Krispy Kremes:)

So if you ask for Opana, you'll be taking Opana ER and Ultram ER? Then you'll rotate between oxycodone and hydrocodone for breakthrough pain?

I am pretty sure that most doctors don't have their patients on two long-acting medications, even though that make work best for some people.

Ahhh...just read that you want an as-needed ER medication. Hmmm. Maybe your PM will do that. You're really great at documenting when you take your medications.

I think your pain would be more under control though if you stuck to one long acting that you took twice daily. I bet you'd get a lot of relief that way.

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 3/9/2012 1:01 PM (GMT -6)   
Hi flower,

I just finished my morning dose of oxycodonut with coffee ;)

I can see your point about 2 ER's and 2 BT's. Though it may work for my situation, I can see that PM's have to be so careful about staying within prescribing norms.

When my BT meds used to last longer, they also had a prophylactic benefit, for they would cover a pain spike and still be helping for hours so as to mitigate additional pain during the day. Now, they wear off and so I often have to take an additional dose.

I guess I can just lay out the issue exactly as above and see what my PM prefers: more BT or my idea of a once-a-day 12hr med.
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

Lindaloo
Veteran Member


Date Joined Sep 2006
Total Posts : 1713
   Posted 3/10/2012 6:32 PM (GMT -6)   
My pain mgmt doctor thought I should try the long lasting pain meds.  I pretty much tried them all, including oxycontin and opana.  I couldn't take any of them.  I had severe side effects for the whole 12 and 24 hours.  So I have to stick to the every four hour medications of Oxycodone.  Like clockwork, every four hours I need it, plus I take Lyrica 200mgs twice a day.  This is for my fibromyalgia and occasional bad back pains, leg pains and foot pain.  I do have a back history as well.
 
Anyway, I wish you luck with your endeavors and hope you find a combo that fits your needs well.  May God bless you.
 
Lindaloo
Moderator in Chronic Pain and Fibromyalgia Forums.

Believe in yourself. Be kind to fellow humans and animals. Take time to smell the flowers and the coffee.

And by all means, when you are down, ask me for help. I will be there.


Linda
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