pain medication stopped working suddeny

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redtiger
New Member


Date Joined Jun 2012
Total Posts : 7
   Posted 6/6/2012 1:32 PM (GMT -6)   
hi, i am new to the forum and found it because i was researching a problem i am having. i have a t7-10 SCI i got from an on the job injury in 1985. at first they tried all the lesser pain meds on me, anti-depressants, epilepsy meds until about 15 years ago the VA gave me morphine. i have severe neuropathy in both legs. i take 60mg sr twice daily and has worked well with no dosage increase all these years. about a month ago it was like i was taking no meds at all. pain was back so i took some breakthrough morphine but that works for an hour or 2. VA will not increase my doage or give any other med but i have a private dr. that i know for 20 years. is it advisable to up my dosage or switch to oxycontin which this dr. prefers. i want my life back. this private dr. is very flexible and always open to new suggestions. he was my mom's dr. before she died last year. he will go along with my requests. any help will be appreciated.

Screaming Eagle
Veteran Member


Date Joined Sep 2009
Total Posts : 5005
   Posted 6/6/2012 3:16 PM (GMT -6)   
 
    Hello redtiger!...and Welcome!
 
        I'm getting ready to hit the road here in a second...but will post a reply as soon as I get home.
 
     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."

straydog
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Date Joined Feb 2003
Total Posts : 16783
   Posted 6/6/2012 3:43 PM (GMT -6)   
Hi Redtiger and welcome to the chronic pain forum. From what you are describing with the Morphine it sounds like you have built up a tolerance to it which happens when we have been on meds for a long period of time and they just stop working for us, this is normal. This can happen with any kind of medication not just pain medication.

You talk about having neuropathy in your legs, well most pain medications do not work that much for nerve pain, you need to be on a medication that works specifically for nerve pain, such as Neurotin, Lyrica, Cymbalta and recently they have added Effexor.

You asked about Oxycontin, we are seeing a real pattern here of people not being able to get it from the pharmacies, so I don't really see that will help you any at all. What good is a script if the medication is not available. Your best bet would be t get under the care of a good reputable pain mgt dr and let him figure out what meds he thinks would work best for your condition. They are specialized in handling pain issues and know more in the area of pain than regular drs. Its really your choice to make on what you want to do rather than asking people that know nothing about you or your condition and none of us are drs here. We speak from our own personal experiences.

Keep us posted on how you are doing. Take care...Susie
Moderator, Chronic Pain Forum & Psoriasis Forum

Screaming Eagle
Veteran Member


Date Joined Sep 2009
Total Posts : 5005
   Posted 6/6/2012 5:54 PM (GMT -6)   
OK!…I made it home! LOL tongue

I agree with Straydog here in that it may be a tolerance issue you are dealing with, if you have been on them for 15 yrs. The good news is that you can build that back up, but may take a very long time to do so…and of course in the meantime, you will have to switch to a different med.

While it is true that Oxycontin may be difficult to get filled at some pharmacys…I do not believe that is the case all across the USA. I have had no problem here in KS getting my scripts filled with it. However my script was never more than the #30's. The higher dose may be a problem…but again,…. I do not believe it is, here in this state. If you are on the 60mg morphine, I believe the equivalent dose in Oxycontin should be around #30mg's according to the conversion charts…or close to that.

Your Dr may want to start you out on Percocet's (IR) to see how well you will do on the oxycodone, or he may just script you the straight Oxycodone (IR). The Oxycontin is an ER med. There are several options for you as far as pain med's….but like Stray says, let your Dr suggest what he feels is right for you.

I myself, just got off the Oxycodone products as I too,... built up a tolerance to it, and was not near effective as it used to be. He now switched me over to Fentanyl, and I must say it is a bit more effective, but what I really have noticed is how smooth the transition is as it approaches the pain, and again, at the end of the 72hr cycle,... the transition is much smother, and not like falling off a cliff, quickly back into pain. The Oxycodone products cycle is much quicker, in that the relief may be noticed much quicker…but then again the down cycle can be rather quick as well. This is where I have become fond of the Fentanyl.

There is nothing worse than pain kicking in on the down-cycle and early withdrawal symptoms setting in at the same time. What ever your Dr scripts, please be careful with your med's and try to stay at a tolerable level with them.

Again!…I extend a warm Welcome to you, and hope you enjoy the forum!

Take care,

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) : 6/6/2012 4:58:49 PM (GMT-6)


grainofsalt
Regular Member


Date Joined Aug 2010
Total Posts : 215
   Posted 6/6/2012 7:23 PM (GMT -6)   
I agree with Screaming Eagle. Some narcotics are only partially cross-tolerant with each other. By this I mean if you are put on another opioid, you previous tolerance will play some role but because its receptor activation isn't exactly the same for some opioids, you get additional relief from the receptors it was only activating weakly.

To explain this better, all opioids are active at the Mu Opioid receptor sites (aka morphine receptor) and most as agonists, some with weak binding affinity and some like morphine with stronger binding affinity. However, while most opioids are active at the Kappa receptor sites, some have much less binding affinity at the Kappa sites.

For example, oxycodone has stronger binding affinity at the Kappa sites than hydrocodone and (if I remember right) morphine. Therefore, if switched from morphine to oxycodone, the oxyocodone has stronger Kappa properties and you could achieve better pain relief. Kappa is responsible for spinal anglesia. Also, some opioids are more selective on what receptors they specifically affect, adding to the partial cross tolerance theory.
 
There is a newer pain medication called Nucynta which a bit less potent than oxycodone, but has dual mechanisms of action (opioid and NRI), which might be worth looking into as it builds tolerance slower. Because it isn't as potent of an MU receptor agonist, it could be beneficial to reducing the tolerance built up and its NRI actions means it will have atleast some efect on pain. Lyrica and cymbalta are also worth looking into.


Tolerance to Mu opioid effects can be slowly reversed with the help of a daily "normal" dose of dextromorphan. Also nalo It is something to discuss with your doctor or a pharmacist. Also, Naloxone is a prescription only medication that is an antagonist. It has been shown to help "reset" receptors and may play a role when used in ultra low doses to help reduce/reserve opioid tolerance. This medication CAN percipitate withdraw and your doctor would have to tailor such a plan in order to ensure minimal withdraw and positive reset effects.
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.

Post Edited (grainofsalt) : 6/6/2012 6:29:23 PM (GMT-6)


White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3702
   Posted 6/7/2012 12:23 AM (GMT -6)   
Hi redtiger and welcome to healing well chronic pain forum. You mentioned that you get your morphine from the VA. Do you get all your meds and care from the VA? I am retired military and have 60% disability and I get some of my meds from the VA but not all. It is very difficult to get pain meds of any type from them, even for an injury that is service connected. I mostly use civilian doctors  and just keep the VA updated (records wise) as to my medications and any new surgeries that I have had, or procedures. I avoid using the VA for any medical as much as I possibly can! I go to them twice  a year for blood work and see a doctor to get my BP and Ulcertive medications and that is it! Although I get majority of my disability for my back, I stick to civilian doctors for my treatments and care! I see a spinal pain management doctor for my back and I am on Oxycontin 40mgs every 8 hours, and it works really well for me.
 
Anyway I would think your civilian doctor would be a good place to start and ask him to make you a referral to a spinal pain management doctor.  Thoracic disk can really be difficult and nobody usually wants to touch them unless paralysia is involved. I know the disk at T12 ended my nursing career, and they keep me comfortable with the spinal pain management. My other disk they will operate on but not the thoracic ones.
 
I do wish you well and am glad you came to this site. I think you will find this is a very good place to  come if your experiencing chronic pain. When you are here you are with family that really does understand what your going through!
Again I Wecome YOU!
 
White Beard
Moderator Chronic Pain
After spending nearly 22 1/2 years in the USAF, I retired in Sept, 1991. I then went back to school and became a licensed RN in 1994, and I worked on Oncology and then a Med Surg Unit, I became disabled in late 1999 and was approved SSD in early 2002!-- DDD, With herniated Disk at T-12 and L4-5. C5-C6 ACDF in Sep 2009, C6-C7 ACDF in Mar 1985, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications:Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV I am White Beard with a White Beard!

redtiger
New Member


Date Joined Jun 2012
Total Posts : 7
   Posted 6/7/2012 9:44 AM (GMT -6)   
this is kind of a reply to all who have been kind enough to reply. in the 27 years since my injury i have taken neurontin and other epilepsy med, elavil and other anti-depressants and a wide variety of other meds. i have been to several neurologists, had surgery and when all of the drs. threw their hands up, narcotics was decided. 1st few years oxycontin from the dr. i am going back to, then VA only gives morphine so i have been using that with great results until a month ago. it just stopped working suddenly, not gradually, no warning. the reason i mentioned oxycontin is because i know this dr. likes to prescribe it and i would need about 1/2 the dose compared to morphine. i am seeing him today. there are no new meds i am aware of and this dr. is a re-hab and pain mgmt. specialist so i'm sure he will know of any new stuff. i saw him a month ago for another problem and we always talk about the lack of any new meds for my condition. i just think i need a change, even the slightly different formula from morphine to oxy might work. i realize this is probably a tolerance issue after all the years. VA will only give morphine and refuse to up the dose which i'm kind of glad which is why i'm opting for a change to oxy unless i get news of some new drug today. i will post again with results of my visit but i'm pretty sure i will be taking a narcotic, the only type of drug that works, just remains to be seen which one he chooses. things like percoset and weaker narcotics only can be used for break through pain in my case which if i'm doing well on my main drug i rarely use. talk to you all soon.

Screaming Eagle
Veteran Member


Date Joined Sep 2009
Total Posts : 5005
   Posted 6/7/2012 9:58 AM (GMT -6)   

 

       Diluadid...and Fentanyl are a couple of others to think about. Hope your Dr visit goes well, and plase come back and share what happened at your visit.

   Your welcome here anytime!

      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."

grainofsalt
Regular Member


Date Joined Aug 2010
Total Posts : 215
   Posted 6/7/2012 2:59 PM (GMT -6)   
I have to strongly agree that the VA should be used limitedly for medications and if possible procedures.

The VA is extremely cost conservative and they tend to place risk management above actual pain treatment. Furthermore, the VA might see a request for increased or stronger medications as an indication that the disability claimed is more significant than the current benefits provided to the patient.

Civilian pain management doctors will generally place treating the condition at the highest priority and use risk mitigating mechanism to ensure proper risk management (example: drug tests, minimally invasive procedures to reduce the amount of medications needed, ect).
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.

redtiger
New Member


Date Joined Jun 2012
Total Posts : 7
   Posted 6/7/2012 5:53 PM (GMT -6)   
again a reply to all. my old, new dr. gave me 30 mg twice daily oxycontin to try. i took my 1st dose 1 1/2 hrs. ago. i'm hoping to get some sleep tonight. i will keep you all posted and thanks for your support and help. you guys know what i'm going thru. both the dr. and pharmacist said it sounded like a tolerance problem like many of you did. keeping my fingers crossed. i don't know how long the transition will take so i'm kind of anxious. ptsd does not help. been a long day. a 1 pm appt. turned into 3:30 and 3 drugstores later 5:30. going to try and get a nap in. see you guys later.

redtiger
New Member


Date Joined Jun 2012
Total Posts : 7
   Posted 6/7/2012 9:26 PM (GMT -6)   
it is 10 o'clock. just woke up from a needed nap. feeling much better. i have a question to ask now that the crisis seems to be over. my monthly dose costs $350.00. i have a $5000.00 yearly cap for all my meds. now that i'm not getting my pain meds thru VA the pain med alone reaches my cap. i notice some of you take more expensive meds. without prying, and no one has to answer me if they feel uncomfortable how do we pay for this now. because i'm serice connected my meds from VA were free. now i'm screwed. i make too much to get medicaid, but this will break me. don't have a clue what to do. suggestions will be appreciated

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16783
   Posted 6/7/2012 10:52 PM (GMT -6)   
You contact the maker of the drug company, usually online and see if they offer any type of discount on their medication. Just about all of them do now a days. You may get it free or just pay a small charge, its usually based on your income. Also, look in CP101 at the top and go to the section that gives you info on medications, there is a list of places that help people get their meds at a reduced rate.

Never be embarrassed or afraid to ask us questions we have all pretty much been there & done that in our life. The cost of medication is criminal.

Susie
Moderator, Chronic Pain Forum & Psoriasis Forum

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3702
   Posted 6/8/2012 12:01 AM (GMT -6)   
redtiger,
My neck and that is considered service connected, and your right they do not give out much in the way of pain meds, since I am retired military, I have Tricare and  what meds I don't get from the VA I get from Tricare my co-pay for my pain meds for a month is 12 dollars and 5 dollars for the percocet and another 5 for the Baclofen. But without having TriCare I would not be able to aford the meds either. The meds I do get from the VA PB meds and meds for my UC I pay nothing for.
 
I think Straydogs suggestion was really good. Have you tried checking with any other VA facility? Have you tried contacting your VA rep?  I know it isn't right!  If you have a service connected injury or condition they ought to adequately treat it! With having SSD and medicare  along with my TriCare I use civilian facilities most of the time and avoid using the VA.
 
I wish you well White Beard

redtiger
New Member


Date Joined Jun 2012
Total Posts : 7
   Posted 6/8/2012 7:20 AM (GMT -6)   
ok now i'm back to my original problem that i thought was solved. last night i felt a little better. today i woke up with the same pain as with morphine. i hear there is a new, weaker formula oxycontin. do i need more or do i need to wait a few days to feel the results? dr. said to call him monday. is that too long? he is then planning to send me for a new mri to check my 25 year old injury. is this really necessary? i have had no change in all these years so i don't think an mri will reveal anything new or does he have to check me out before upping mt dose. very frustrated.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16783
   Posted 6/8/2012 12:33 PM (GMT -6)   
What you have is the new, they have made it so that it could not be injected if I remember right. With any change in medications you should give it a few days to make the transition from one to another. The old formula is no longer available and there is no difference in the strength. If you will recall it was nicknamed hillbilly heroin. If you are to call the dr Monday that is when I would make my call. Yes, it is important to have new MRI's done from time to time, they can check the progression of what the initial problem was, look for any thing new as well. The drs also need all the ammunition they can get to document the need for a patient to require narcotics, and an MRI can carry a lot of weight in this dept. No dr is going to give out narcotics to someone with no type of testing to document the problem, Anyone can walk into a drs office and say I hurt here or I hurt there.

Hopefully things will settle down for you. Take care....Susie
Moderator, Chronic Pain Forum & Psoriasis Forum

redtiger
New Member


Date Joined Jun 2012
Total Posts : 7
   Posted 6/8/2012 5:18 PM (GMT -6)   
thanks susie. i called dr. today and he told me what you said i need a few days to feel the effect of the change. i wish he would have told me at the time instead of me feeling like i'm going thru a complete withdrawl. i thought that one would replace the other. as far as mri. i have a sci for 27 years, surgery in 99. tyhere is no question of my need for pain meds. i have been taking opiads for 20 years, from this dr. then VA and now back to him because VA only gies morphine. i don't want the stress of taking an mri unless someone has come up with a cure for sci. it is of no benefit to me. i just want my pain stopped or at least managed. he knows how injured i am. it is a question f getting me on the right med/dosage not if i need meds. i wil have to tough it out this weekend. i think all these drs. are inompetent. too bad i and others need them.

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3702
   Posted 6/9/2012 1:02 AM (GMT -6)   
redtiger when they changed the formula of the Oycontin, allot of people found that the new only lasted about 8 hours, so like me allot of the Doctors, changed from every 12 hours to every 8 hours. I know for me it made a big difference.
 
I agree a new MRI should be done, I am really surprised that they never did one allot sooner!  I would just about bet that they will find changes, even though you might not personally notice any difference, that doesn't mean that there isn't. I know I don't like having them either, but I know for me, my within two years they have found some major changes in my lower back. Heck when I had my surgeries in my neck, within  a year I had some major problems develop. So from my experiences I would think it probably be important for you to have it!
 
Good Luck to you .....White Beard
Moderator Chronic Pain
After spending nearly 22 1/2 years in the USAF, I retired in Sept, 1991. I then went back to school and became a licensed RN in 1994, and I worked on Oncology and then a Med Surg Unit, I became disabled in late 1999 and was approved SSD in early 2002!-- DDD, With herniated Disk at T-12 and L4-5. C5-C6 ACDF in Sep 2009, C6-C7 ACDF in Mar 1985, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications:Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV I am White Beard with a White Beard!

redtiger
New Member


Date Joined Jun 2012
Total Posts : 7
   Posted 6/11/2012 7:35 AM (GMT -6)   
i appreciate all the calls for a new mri but my condition has been stable for years thru many mris and even with a change in my condition at 64 yers old i am not going to get another spinal surgery when there is no cure for a severing of the spinal cord. i have 4 missing vertebrae and they messed me up last time so there is really no point in getting a new test. the issue now is pain relief. i have now doubled the dose from 30 to 6o mgs every 12 hrs with some relief. i have now taken a dose after 9 hrs and called the dr. but you all know how that goes, answering machine. i am using up my months supply so i don't know how that is handled even if it works since they are so strict about 30 days. i am concerned about what can be prescribed if it does not work. talk to you later with an update.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16783
   Posted 6/11/2012 10:25 AM (GMT -6)   
My point on the MRI is the dr has to have something current in your chart to warrant the meds he is prescribing to you, this covers him from any potential problems. I am not talking about office visits every 30 days when you go in and say you hurt here or there and your pain scale is high. I don't know how much you have kept up with things that has changed in the past two years or so concerning pain mgt, but it is not as cut and dried as you may think it is. Lots of changes and attitudes towards pain mgt.

I can understand your worry on the meds running out before you can get a refill. If the dr doubled your dose then he should know you are going to run out early.

Take care...Susie
Moderator, Chronic Pain Forum & Psoriasis Forum
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