Stopped taking hydrocodone -- headaches... see PM in 3 days

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cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 6/10/2012 11:34 AM (GMT -6)   
Hi All,

At my last PM visit (nearly 3 months ago), he again refused my request for a stronger time-release med and instead suggested I take more hydrocodone (20-30mg daily).

Though I found the extra hydrocodone helpful at first, it started to wane in efficacy and also give me headaches. I've been working for weeks trying to find some compromise dosing, but basically, I'm either not taking enough to manage my pain or I end up with a headache.

Last week, I took a few days off hydrocodone, then took some again (15mg x2) and had a terrible headache, that lasted 3 days (though the 2nd and 3rd days were not as bad as the first). So, I just quit taking it.

I see my PM on Wed and, of course, will describe the above to him. But if he again refuses to change my meds, I'm going to have to find a new PM. I don't know what has happened -- at first it seemed to me that he was very flexible, then a year ago, became intransigent (after I had bad reactions to Kadian and Savella).

My wife suggested that I write out a one page summary of the past 3 months and give it to the PM -- problems with meds, pain issues (e.g. staying in bed until noon to avoid pain of the day), and all else I'm doing (injections, seeing MD about possible surgery, etc.).

Any recommendations/suggestions?
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).

flower123
Veteran Member


Date Joined Apr 2009
Total Posts : 856
   Posted 6/10/2012 2:11 PM (GMT -6)   
I think your wife gave great advice. You're always so prepared, and document a lot (if I remember correctly), so I think you'll be okay. I do agree about (slowly) looking for a new pm if this one isn't working for you.

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 6/10/2012 2:23 PM (GMT -6)   
Cogito,

I would definitely recommend seeking out a new doctor if it doesn't go well on Wednesday. You need a doctor that listens to you... I think you've gone above and beyond doing things his way... if he doesn't agree to some type of compromise on Wednesday, I would immediately seek out a new doc.

I agree w/ documenting how this is affecting your quality of life... and bringing it w/ you.... It may or may not help - but at least you can say you did everything you could w/ him. I might even ask him why he seems to be resistant to trying other medications.

I wish you well on Wednesday. But keep in mind you've "hired" this doctor as a specialty in his field... but you are still the one ultimately that has to go home and deal w/ the pain issues.... Hopefully, he'll listen and you guys can figure out a compromise.

Take care, 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

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 6/10/2012 3:07 PM (GMT -6)   
Thanks for the support!

Given the past year, I know I can't bring ideas to him (though his PAs are willing to talk things through more) -- and so will as far as possible, just lay out what has been happening and see what he does.

IF it goes poorly on Wed, my plan is to leave without telling him that I am going to terminate with him (assuming he doesn't terminate me), then see my GP. I've only been seeing this GP for about 8 months, but he is a friend of a friend and we get along very well. Most appointments, we'll end up chatting for 30 minutes or so about politics, etc.. He is aware of my frustrations with my PM and -- hopefully -- will either take up my pain care at least temporarily, or do his best to get me into a good alternative PM (I know of two others in the area with good reputations). Once I know where I'll be, I can then send this PM a very gracious letter.

Nevertheless, I'm hoping that I can still stay with my current PM and we can get our relationship back on track. From 2009-2011, I was very happy with his care and hope that we can transition back to those better days.
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).

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 6/10/2012 6:06 PM (GMT -6)   
Good evening Cogito!

I'm sorry as the rest of us are, that you are having difficulties with this certain PM. I also agree with the rest of the troops here, that you may need to seek another PM, or like you said, see if your PCD will script for you.

Now I do have a question for you. Did you suffer any withdrawals while you were off of the hydrocodone. I ask because I did not see you mention of it, and thought it odd. If you are still at this point with your dependency or lack there of…that is great! If you are successful in getting the ER med's scripted, then that situation may change later.

20 to 30mg per day,... is still a very lose dose it would seem to me. I'm kind of wondering if an IR med change would do you better for the short term to see where your at. It could be that a med change might not only be more effective, but the headache may go away as well, and they could also last a bit longer than the Hydrocodone.

I think the PCD visit is the way to go though, and wish you the best of visits with him, and hope you get some better control of your pain.

Keep checking in here,….…you know Im a fan of yours…and love to read your post and the writting flair you seem to have.

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."

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 6/10/2012 6:45 PM (GMT -6)   
Hi SE,

Regarding withdrawal: nothing major, and also mitigated by the various other IRs I have around. I've taken a few days off from everything but the Ultram during the past few weeks, but most days, I'll end up taking something (oxycodone or opana IR -- both prescribed by this PM over the years).

If there is any withdrawal, it may be taking the form of lethargy. But no sweating, bowel issues, etc.. Also, I wonder if the multi-day headaches I've been having reflect both hydrocodone side effects and withdrawal. That is, the hydrocodone may cause the initial headache, then I take nothing for 2 days, and the headache continues -- the latter may be withdrawal related.

As for a different IR, I would give it a shot, but worry about it. I've used tramadol for as long as hydrocodone. The tramadol has been as an ER and I've not had any negative side effects (in fact, perhaps some positive due to its serotonin effects). So, at 300mg daily in a time-release mechanism, I've had no problems after 5 years. For the hydrocodone, I was fine using it at a lower level -- 10mg 3-5x per week. But once I started using it daily, I started to notice headaches.

Thus, I worry that if I were to use oxycodone or opana IR daily, I would end up in the same situation with it. The headaches may be due to the frequency of ups and downs of daily IRs, or may be it is Hydrocodone in particular. When I contrast the results of taking Ultram ER for 5 years and taking Hydrocodone for the same period, I don't know if the difference in side-effects are the result of the difference in release mechanisms or in drugs.
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).

Ryobi
Regular Member


Date Joined Apr 2012
Total Posts : 114
   Posted 6/10/2012 11:37 PM (GMT -6)   
I kept a chart for my doctor for two months it was very help ful for him, besides my normal aches and pains each day, I put down the pain level, as well as the temp outside, the pressure, and the dewpoint. This helped to lead to my RA diagnosis.
Mindy
Diagnosed Fibromyalgia 2010
Diagnosed Rheumatoid Arthritis 2011
Diagnosed Hypothyroidism 2012
Medications
Butrans 20 mg patch
Hydrocodone 10 mg BT pain
Ambien as needed
Valium as needed
Treximet as needed
Naproxen as needed
Arava

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 6/11/2012 12:00 AM (GMT -6)   
Cogito...

Just curious... I know you don't want to approach this doctor... asking for a particular medication... but just wondering if you have any thoughts on what might work for you.

I know you had an adverse reaction to Kadian right? Since you've tried the IR version of oxy and Opana... do you think LA of those might help you?

Just curious if you have an "idea" of one or two meds that you think might help you.

--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

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 6/11/2012 11:02 AM (GMT -6)   
Thanks Ryobi for the suggestion -- I have done such things periodically, though haven't included the weather. The basic problems I have are clearly anatomical (scoliosis, disk degeneration, spinal stenosis, etc.) but exactly which vertibrae, disk, etc. is responsible is hard to figure out -- maybe with a CT scan or some other imaging.

Tina -
I think the first need I have is that my PM trust me, my reports and research.
With that in mind, I would like to try levorphanol. It has no ER version, but has a very long half life so I may only need it once a day. My reasons favoring it is that it targets not only the opioid receptors, but also is an NMDA antagonist (since my pain is nerve related) and also has SNRI benefits. Thus, it strikes me as the best single-med replacement for the Ultram.

Have a look: http://en.wikipedia.org/wiki/Levorphanol

If that doesn't work, then I'm not sure if I would try oxycontin or Opana ER next. The Opana IR helps, but seems to vary in efficacy. Oxycodone has been the best med I've used, but I don't want to lose its efficacy and would like to keep it as a worst-day breakthrough med. For the past few years, I've been using 60 10mg pills every 9-12 months -- and fear undermining its benefits. So, with that in mind, I suppose I'm leaning to the Opana ER, with oxycodone as the breakthrough (unless he is willing to try levorphanol).

I've tried dilaudid, but it didn't help. I know there is an ER version of it now, but if the IR didn't help, I doubt the ER will.

As for others -- Fentanyl is likely too strong, methadone is more dangerous, and though I would be willing to try the Butrans patch if that is what he wants, I don't like the idea of a patch mechanism (other patches I have tend to detach while I sleep).
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).

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16274
   Posted 6/11/2012 11:29 AM (GMT -6)   
Cogito, there is a test that can be done to see which disc is causing your pain, its called a discogram. Each disc is injected and when they inject the disc that is causing the pain it is recreated immediately. Not sure if this test has ever been mentioned.....Susie
Moderator, Chronic Pain Forum & Psoriasis Forum

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 6/11/2012 12:39 PM (GMT -6)   
Thanks Susie,

One MD wanted me to have the test, but I thought it premature. From what I know it is very painful and usually only done to get info for surgery. Eventually, though I'll likely have one.

I also made an appt. on Thurs. with the interventional PM I see -- more injections and to talk to here about other options. The ortho I saw recently only ordered an MRI of my cervical spine, so I think I still should have one of my thoracic. I have problems in both areas as I think the thoracic curve is the cause of my back pain. Whereas the cervical is responsible for the vertigo, and left arm pain, numbness, 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 & 2-3x 10mg Hydrocodone daily. Oxycodone 10mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia).
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