Need help in med discussion with PM - Info please

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Retired Mom
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Date Joined Feb 2010
Total Posts : 1753
   Posted 3/10/2012 6:17 AM (GMT -6)   
Hello all my HW friends,
 
I know I should have a better understanding of meds (since I take so many), but I am still leary of leading discussions of pain meds with my PM and will be seeing him (the actualy DR) for a RFA on the 17th.  Right now, for my cp, I take Ultracet 37.5/325 4xdaily, Oxy IR 15 4xdaily, and Soma 350 4xdaily.  I also take some BP meds and my Xanax (3mg XR)...along with a slew of other things.  I'm completely off of the ambien.
 
So, on to my question.  I am interested in an extended release med instead of all of these pills, but the only one I have tried was Opana ER and it was WONDERFUL for the first 6 hours, then felt like it dumped the balance of the med in my system all at once and I thought I was OD'ing.  It was awful and I took the med back to the Dr and swore off of controlled release meds.  Of course, my xanax is controlled release and, to be honest, is not showing up in my urine as it should...basically, it shows that I haven't taken it in 2-5 days when I take it every day (exactly as prescribed).  I've tried to think of every explaination, but to no avail.
 
So now my pain has so many spikes and I find myself in an odd situation for me...needing more meds than I am prescribed.  I used to need less, but things have changed.  I am trying to do more to gain muscle strength and perhaps that is affecting things, but this morning is agony.  I have had some days that are much, much better...but they are just days and I am still taking my meds as directed (for sure).
 
So I come to you wonderful people to ask for advice on how to discuss this option with my PM.  He is very strange (to say the least) and I know he is not a big fan of chaning meds.  I don't know what to ask for or how.  I used to take dilaudid and it worked great until I developed a tollerance for it.  That's when I started the Oxy IR and it worked great.  It still helps a lot and I would be lost without it, but I don't want to keep having to ask for increases and it looks like that is where I am heading.  They just don't last long enough...maybe 3 hours...instead of the 6 they should.  Any suggestions friends???
Failed TLIF L5-S1, Miltiple Bulges/Herniations, Scoliosis, Pituatary Disorder, Fibro, Failed Bladder Surgery, Failed Nissen, GERD, OCPD, GAD, MDD, CFS, TMJ, Migraines, HBP, Idiopatic Reactive Hypoglycemia w/Diabetic reaction to HGH, Bi-lateral CTS (now trigger finger), Edema, Tarsal Tunnel Syndrome, Peripheral Neuropathy, Plantar Fascitis, Tibular Tendonitis, Adult Onset Flat Feet, & Vision Issues

grainofsalt
Regular Member


Date Joined Aug 2010
Total Posts : 215
   Posted 3/10/2012 5:32 PM (GMT -6)   
I had the same issue with Oxy IR when it was previous prescribed for pain relief. Its been quite some time since I was on it, but I remember I'd get about 3 hours of pain relief. It kicked in fast and helped with the pain but it wore off too quickly. Sometimes it seemed like as little as 2.5 hours or up to 4 if I was really lucky but regardless it surely wasn't 6 hours of relief.

I am hoping someone else can give you advice on what to do. Just know I had the exact same issue, which is why I will not request oxycodone as my pain medication and feel satisfied on my current regiment (for the most part).
MRI revealed disc bulge and test injections revealed RA. Radio Freq procedures helped for months, but pain is up and im having the procedure done again. Currently on 75 mgs of Nucynta (tapentadol - A MOR + NRI) 2 to 3 time per day and Soma 350 as needed.

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 3/11/2012 12:05 AM (GMT -6)   
Hi RM,

I do understand the anxiety that comes along w/ talking w/ your PM doctor about medication changes.... that being said, I think I would approach it in a very similar way to how you said in your post.

I would explain that you would really like to reduce the amount of pills you have to deal w/ on a daily basis. That you were able to get off of the ambien (good job on that, btw!)... that the oxy IR works really well for you - but that they don't last long enough... so you thought if you were on an extended-release, it was cover the peaks/valleys with your pain control.

Anyway, something along those lines!

As for what to use - there are a number of different options.... But morphine comes in an ER version... that might be a good starting place for you? See what your doc says.

That's weird about the xanax thing! That reminds me of when I was pregnant.... and my heart medication (at the time - labetalol) turned up as methamphetamines. I guess it can show up as that as it breaks down in your body.... well, that would have been helpful to know!

I really hope your appointment goes well... please try to update us! --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

NiNi53
Veteran Member


Date Joined Mar 2011
Total Posts : 816
   Posted 3/11/2012 7:04 AM (GMT -6)   
Hi RM, I can only tell you what my experience with extended release meds is and that is, I take 60mg of ms contin er.  This medicine which is morphine sulfate has a very long life.  The thing is with er meds is there is not immediate nor quick relief from the pain.  I take percocet 10mg as needed.  This combination seems to work very well with me.
 
My biggest problem is that I want instand gratification (pain relief) which the er does not give, so I am making myself be more patient and try to wait for the er meds to begin to work.  I take the percocet each morning with my ms contin er, and neurotin.  When it comes time for my noon time meds, I am not taking percocet at all.  I was beginning to run short last month (of the percocet), because I didnt want to wait for the ms contin to work.  I am working very hard to gain control back and not use the percocet as much.  As the weather will be changing soon, April is around the corner and warmer weather is on its way, I wont need as much of my bt meds.
 
Good Luck and take care,
Kathy
degenerative disc disease, fibromyalgia, osteoarthritis, neuropathy, lumbar laminectomy july 1998 no help, rechargeable neurostimulator unit low right back w/lead wires to left side and right leg unit not working just sitting there.i am 57 years young in may will turn 58. i have 2 grown daughters, 25 and 29. i have 2 grandchildren, 9 year old grandaughter and 5 yr. old grandson

Jacey86
Regular Member


Date Joined Mar 2012
Total Posts : 124
   Posted 3/14/2012 9:25 AM (GMT -6)   
The best combo for me is an extended release med along with something for breakthrough pain. Like you, the Oxycodone only lasts a couple of hours sometimes. Hard for docs to understand that I think.

Maybe the Opana ER dose was too strong for you. I had that problem with the Fentanyl Patch. Not only that but when it wore off, the pain I was in was incredible. I finally found a good dose that works. I really feel nothing while I'm on it, just hopefully less pain! There may be some playing around with that for you.

Unfortunately dosage increases come with the territory of pain medications. My tolerance seemed to build very quickly, which kind of freaked me out. I've been on the same dose now for about 3 yrs but sometimes get no relief, and then sometimes enough to get me through.

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 3/14/2012 11:30 AM (GMT -6)   
Hi Retired Mom,

I am currently dealing with related issues... and before I move on to yours, here's my present problem:

It used to be that an IR medication would last 8hrs and so one is all I needed most days. But that has decreased over the years and maybe eighteen months ago, it was down to 6hrs, and now, 4hrs. I had been limiting my use despite the shortened duration and when I asked my PM for a stronger ER last visit, he said no, recommending instead that I up my IR use. The result, though, is daily anguish about whether or not to take something, how much, when, etc.. So either I need to become more comfortable with more IR's or move to an ER.

As for ER options, I've been using Ultram ER for 5 years now and since you're taking Ultracet, maybe one simple move is to switch to the 200mg or 300mg Ultram. Your PM doesn't like med changes, but this would just be a new delivery method of the same drug. Maybe he would be more comfortable with it? You'll get more Ultram, and hopefully a steady dose.

about a year ago, we tried Kadian (morphine ER) and I didn't react well. Maybe like you, it just released too fast and it just knocked me out. If so, then it may be that some release mechanisms will work better than others for different people. In my wife's case, who takes Xanax ER, she has the pharmacy special order one particular generic because the others she's tried don't seem to work -- her body doesn't seem to absorb them (as you noted your urine tests were negative for xanax).

Let us know what your PM says. I see mine next week and am anxious about it.
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

Retired Mom
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Date Joined Feb 2010
Total Posts : 1753
   Posted 3/14/2012 12:07 PM (GMT -6)   
Thanks Cogito,

I actually only have one brand (generic) filled too because the other one did not work at all for me. It was strange because one brand seemed to work and the other did nothing. I wish they would fill with the original formula and see what happens with that, but apparently it is considerably more expensive and not an option with my insurance.

I will let you know what happens in this and I would appreciate the same, if you don't mind. I didn't see the change coming from the soma to the baclofen and I have no idea what he will say when I try to talk to him on the 17th.
Failed TLIF L5-S1, Miltiple Bulges/Herniations, Scoliosis, Pituatary Disorder, Fibro, Failed Bladder Surgery, Failed Nissen, GERD, OCPD, GAD, MDD, CFS, TMJ, Migraines, HBP, Idiopatic Reactive Hypoglycemia w/Diabetic reaction to HGH, Bi-lateral CTS (now trigger finger), Edema, Tarsal Tunnel Syndrome, Peripheral Neuropathy, Plantar Fascitis, Tibular Tendonitis, Adult Onset Flat Feet, & Vision Issues

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 3/16/2012 8:19 PM (GMT -6)   
i would go back to hydromorphone for flares and give sustained release Morphine Sulfate a try. a few versions: MScontin, Oramorph SR, Avinza
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

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1753
   Posted 3/17/2012 2:53 AM (GMT -6)   
Thanks for the suggestions!!! I called the Dr's Office on Friday (yesterday) and talked to the "chief nurse", but he won't be in until the day before my procedure....so I'll have to deal with it the best I can until then....

I did discuss the issue with her and I KNOW she is the one who will lead the discussion when I go in to see him because she will have prepped him about the call. She actually made the comment that she understood because she knew me a lot better now and understood my many medication allergies...and I told her I appreciate her and that I know that she is aware what a "nervous Nellie" I am and that I can't help it. I even talked to her again about the Xanax thing too and explained that I am going to get with my psych on Monday to discuss brand only prescribing on that one for a couple of months to see what happens.

Anyway, I got with my pharmacist and was given a ton of info about the meds and have some research to do from what he gave me. The MSContin was the first one he suggested and then there were some others like Exalgo (or somthing like that). Again, I've got some serious discussion with the PM before one of those is given and I'll have to see what happens.

Thanks again everyone!
Failed TLIF L5-S1, Miltiple Bulges/Herniations, Scoliosis, Pituatary Disorder, Fibro, Failed Bladder Surgery, Failed Nissen, GERD, OCPD, GAD, MDD, CFS, TMJ, Migraines, HBP, Idiopatic Reactive Hypoglycemia w/Diabetic reaction to HGH, Bi-lateral CTS (now trigger finger), Edema, Tarsal Tunnel Syndrome, Peripheral Neuropathy, Plantar Fascitis, Tibular Tendonitis, Adult Onset Flat Feet, & Vision Issues

Nolita
New Member


Date Joined Mar 2012
Total Posts : 2
   Posted 3/17/2012 3:59 AM (GMT -6)   
I understand that each person differs in what meds will or will not work for their pain. Personally, I have been on the Butrans patch for extended release pain relief, and it has surpassed my experiences with any other medication of it's kind. The patches stay on for 1 week each, delivering a steady stream of medication so that I don't have ups and downs with the medication kicking in and wearing off. I would speak highly of this medication and discussing it with a doctor to anyone in need of an extended release painkiller!

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 3/17/2012 9:36 AM (GMT -6)   
the Exalgo is expensive! not many people have been one it yet to have a accurate report. as far as i hear the most liked SR med right now is OPANA ER but it is very pricey also. good thing about MSContin is a few generic equivalents are available that are quality products. about your anxiety med, have you ever tried Klonopin? it has a much longer active time than most other benzo's and you may be able to save on the brand name Xanax. Klonopin comes in 0.5mg, 1mg, 2mg. L-Theanine, L-Glutamine, GABA, L-Taurine, and 5-HTP are anxiolytic supplements you can use concurrently with the medications. Rhodiola Rosea root, Schizandra berry, and Scullkap are herbs that work well.
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

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 3/21/2012 2:12 PM (GMT -6)   
Hi RetiredMom,

You asked that I let you know what happened with my PM appointment.

Well, again, a dis-appointment ...

I saw the PA this time, went through how bad the past few months have been, and that I would prefer a stronger time-release med to replace the Ultram ER or add a low-dose time-release on top of the Ultram, such as the 5mg or 10mg Opana ER.


I explained that I was hoping a time-release would overall keep my pain levels lower, vs. taking a BT med only after they ramped up. I also discussed my hope that with a strong time-release med, I wouldn't have to deal every day with deliberations about whether the pain is bad enough to justify a BT med, whether I should wait longer, etc.. I wanted to find some time-release option that more or less took away the need for daily BT meds.

But my request was shot down again. The PA brought the options to the MD who provided the same argument he used before: I would net more opioids in my system with any other time-release than even if I were taking 3x the amount of hydrocodone I currently am.

ARG! I could only push the point so far, but their math was just wrong! As last time, I mentioned the 5mg and 10mg Opana ER as examples. Given its 10% bioavailability and relative strength, the 5mg level would be in the same ballpark as my average BT usage. The Opana prescribing information makes this VERY clear.

So, I am completely frustrated. Although the Opana ER may not end up doing what I hope, the doctor's reasoning is predicated upon either an arithmetic error or a lack of information about doses. I wanted to make this clear, but I feel that he would be offended if I pushed any harder or was more more explicit about his mistake.

The recommendation, instead, was again just take more BT medication! I was told that 15-20mg of hydrocodone daily is a "baby dose" and I simply just shouldn't worry about it. The PA said the MD wanted me to take 30mg every day! When I balked, she said that I should at least take 10mg late morning (when I usually need a dose) then another 10mg 6 hrs later, letting the third dose vary based upon need.

She asked that I at least try it for a few weeks, and so I guess I will. She also emphasized that I do not have to ration my meds as I have been, there is nothing wrong with my phoning to ask for refills between my appointments, 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
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