Rapid increase in tolerance

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cogito
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Date Joined Oct 2010
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   Posted 4/11/2012 12:43 PM (GMT -6)   
Hi All,


I upped my hydrocodone to 20-30mg/day per my PM's recommendation, and it was great for a week or so.

But three weeks later, I'm finding that there has been a rapid increase in tolerance.

For example, today I woke up in pain (very damp here) and took 15mg around 9am. It helped but not as much as it used to.

Now it is about 1:45pm and just took my second BT dose... but unlike in the past, I'm not even expecting the pain to be significantly mitigated. Right now I would rate my pain at about a 6. The hydrocodone might bring it down to a 4, whereas in the past, it would take away or down to an incidental 1-2.

So, although tolerance is inevitable, I'm surprised by this sudden acceleration. Have others experienced the same?
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 & 2-3x 10mg Hydrocodone daily. Oxycodone 10mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Snowbunny21
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Date Joined Jan 2010
Total Posts : 3557
   Posted 4/11/2012 1:30 PM (GMT -6)   
Wow....that's amazing that you used to get your pain down with just Hydrocodone to a 1 or 2.....I haven't been that in over 11 years!!...

I live between a 5-7 each day....that is with all my medication from MSContin to OxyIR for breakthrough....a muscle relaxer...sleep med....exercise, PT, injections, acupuncture, massage, TENS unit, aqua therapy.....etc....

So...it's really about using other things/modalities to help lower your pain and never just rely on an opiate to bring your pain down all the levels....Each thing should help by a 1/3 point...half point or point....

So...when it's at a 6 after taking the med....then it's time to add some ice or heat....take a nap....add a muscle relaxer....do some stretching......anything else...

This will also help keep your tolerance level from being so low and having to increase the amount....

I haven't increased my dosage of meds in over 3 years....

Obviously we are all different...and I'm not a Dr...just stating my experience..

The hard part about increasing breakthrough medications, especially hydrocodone which is on the lower end of strength, which are also short acting.....are that your tolerance won't be very good as it's only going provide that short burst of pain reduction....and that's it....It's not like upping a dose or strenght of a long acting medication.....

So...it's not surprising it didn't last very long...I would suggest talking to your Dr.

Keep us posted...
SB and "the pup who snores loudly" 
 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006
 
 

Jim1969
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Date Joined Jul 2009
Total Posts : 2042
   Posted 4/11/2012 2:58 PM (GMT -6)   
While I have never experienced anything like you are talking about with my pain meds it is entirely possible that your system is "simply" becoming extremely desensitized to the hydrocodone and that any further increases will be equally short lived.

A talk with your doctor about exchanging the hydro with some other med for BT pain may be in order and/or possibly trying another extended release med.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.
Moderator Depression Forum.

cogito
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Date Joined Oct 2010
Total Posts : 926
   Posted 4/11/2012 3:33 PM (GMT -6)   
Well, I might have spoken too soon.

Yesterday, I was chasing pain the whole day. I took 10mg of hydrocodone in the morning and another 10 around noon. Then, just before dinner, another. By 9 or 10 I was still in pain and took a nucynta as I can still fall asleep after one.

Today, I went back to 15mg at a time (which is what I was doing for the first week at this new level). The first dose didn't do quite enough, but the next dose kicked in shortly after 2 and I've been doing fine.

So, maybe 10mg x3 just doesn't get ahead of the pain. I'll return to to 15mg x2 and see how that goes.


I suppose I'm lucky that it can still take a bite out of the pain when I dose it right.
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 & 2-3x 10mg Hydrocodone daily. Oxycodone 10mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16278
   Posted 4/11/2012 5:09 PM (GMT -6)   
Wow, I am impressed, 10mg three times a day and it knocked the pain down. Oh, I would stick with what works and do the 3 times s day deal rather than run the risk of the pain spiking back up there. Spreading the dose out may just be too much. Hope the pain remains low...Susie
Moderator, Chronic Pain Forum & Psoriasis Forum

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 4/11/2012 6:47 PM (GMT -6)   
Good Evening Cogito!

…..I'm wondering if the road trip you took has been part of the pain spike you are having…..yes maybe it was a couple of days ago that you got back…but it is possible. How long have you been on the Hydrocodone's …several years? If so your tolerance could be creeping up on you….but I see things are settling down for you now….so it's hard to judge that when your pain is fluctuating like that.

If your getting down to a 1-2 on the pain scale…that is simply wonderful….and many of us would love to experience that. smilewinkgrin I'm happy for you though…lets hope you can continue that type of relief. I'm kinda like Snowy…at a 5 to a 7 most of the time…just more than a likable quality of life….wish it was a 4 or less. rolleyes

Hang in there! We understand the frustrations this CP throws at us….and the curveballs as well.

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 4/11/2012 10:04 PM (GMT -6)   
I can't believe you are able to get your pain levels so low- even with my medications I'm never below a 5, and am usually a 6-7. So glad you are able to get it down to a manageable number!
Current: DDD L4-S1, Arthritis L3-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.

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 4/12/2012 2:24 PM (GMT -6)   
Hi SE,

There are certainly other factors that influence pain. In Feb, though the weather was mild, I was in almost continually dealing with pain in the upper end of my range. At the end of the month, I flew to Toronto, which was very difficult and then in March, the pain settled down a bit. Last week I flew to Seattle, but that wasn't too bad.

Pain will vary for me relative to weather and is also quite sensitive to activities and posture. I suppose like most, the more I stay in bed, the better.

As for the benefits I get from opioids, 15mg of hydro or 10mg of oxy can really take away the pain for a while at least. I was up to a 5 or so around 10:30am and by 11:15 or so, the pain was negligible. I rode in to work (I usually get a ride), spent 10 minutes with the secretaries going over a few things, then sat in my office for about a half an hour. So, basically from the pain I was in when I arrived (and took 15mg of hydrocodone) to when I felt better, I was mostly sitting.

I'm now back at home and would say my pain is heading back to about a 5. I'm going to take 15mg again and it should keep the pain down for 2-2 1/2 hrs, then it will start to creep up again.

Although the 15mg does really help, it gives me a bit of a headache and unfortunately, doesn't last long enough. But it (and Oxycodone) do bring down the pain for a few hours (they used to help for 6-8, now more like 3-4).
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 & 2-3x 10mg Hydrocodone daily. Oxycodone 10mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16278
   Posted 4/12/2012 2:36 PM (GMT -6)   
Cogito, every PM dr I have been to all say to stay out of the bed as that is one of the worse things a CP patient can do. By being sedentary we lose so much muscle strength. I was down in bed for nearly a year before getting my pump and I cannot tell you what that life style did to my body. It was a long hard road getting built back up strength wise.

My current pump dr questions me on every visit about my physical activities and if I am having any problems doing things, if so she wants to know why. If it is because of pain then she will adjust things accordingly. Of couse mentally, we do feel much better when we are up and able to do some things.

I hope you can keep things on an even keel....Susie
Moderator, Chronic Pain Forum & Psoriasis Forum

cogito
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Date Joined Oct 2010
Total Posts : 926
   Posted 4/13/2012 7:59 AM (GMT -6)   
Thanks for the input.

I went to see my GP yesterday (his office has an online appointment system which is great -- saw a time late afternoon and took it).

He and I discussed RF ablation and also he mentioned that there is a laser procedure that can open up the foramen space. So that's something else to investigate.

He also wanted me to give Lyrica another try. It made be feel terrible when I used it about 5 or so years ago, but he suggested that with shifts in brain chemistry due to all the opioids, it may be different this time. So, I agreed and now have a $175 bottle on my dresser that I'm building up the nerve to open. 50/50 I take it for three days, feel cruddy and then just give up.
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 & 2-3x 10mg Hydrocodone daily. Oxycodone 10mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 4/13/2012 8:22 AM (GMT -6)   
 
    ..morning cogito!
 
       My PCD wants me to try Cymbalta again as well...in addition to the Gabapentin I'm on....and I'm not looking forward to it either...I had the same reaction...made me feel crummy. He also brought up Lyrica...so that is a possibility as well.
 
 The laser procedure sounds interesting!....maybe check into it a bit more. They are doing that here in this area as well...but I have not talked to anyone who has had it done yet.
 
 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."

tmjpain
Veteran Member


Date Joined Oct 2008
Total Posts : 2024
   Posted 4/13/2012 8:37 AM (GMT -6)   
I know everyone has different reactions to meds, but when i tried Lyrica it made me feel so spacey, like bad, and i felt i was walking on thin air, like a foot above the ground, awful awful for me.
 
Cymbalta didn't touch me. Big dose of this too.
 
Gabapentin made me sleepy at the beginning and otherwise nothing and i was on 3600mg a day. Not a tiny dose in the least.
 
Suzane

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 4/13/2012 11:32 AM (GMT -6)   
I haven't tried Cymbalta, but did give Savella a shot (another SNRI). There was a 2 week titration period and I couldn't make it past the first increase. The head-exploding feeling was too overwhelming. My PM is also worried about Serotonin Syndrome given the Ultram.

I was going to try the lyrica, but am not doing well today. I was in a lot of pain yesterday and didn't take any meds in the evening, just took a hot shower, laid in bed and suffered. It is very damp here and not only is my back giving me trouble, my hip and leg made it hard to fall asleep last night and are still hurting this morning.

I'm sure you all know the feeling of psychological exhaustion from the pain. Sometimes, you have it in you to deal with it, sometimes not. Yesterday, I said no to evening meds in order to cut back a bit, and was just suffering.

I'm not up to it today. At 9:30am, I took my 15mg of hydrocodone -- all my pain areas are flaring -- right hip, right leg, upper left back, shoulder, arm, neck. But it didn't do enough. At 11:30, I took another 10mg and finally the pain has gotten tolerable.... from a 6 to now about a 3, though at the cost of grogginess.
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 & 2-3x 10mg Hydrocodone daily. Oxycodone 10mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray
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