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Am I treating my pain properly with medication?

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:22 AM in Chronic Pain
This is my first post. I appreciate any insight! I could've posted this in the Scoliosis forum, but I felt the content was more relevant to the chronic pain aspect of the Scoliosis.

My name is Matt and I'm 31 years old. I've been dealing with scoliosis pain ever since I was about 18 years old. This past year, the sensation turned from a dull discomfort to... heightened discomfort. Sometimes it's painful, sometimes it's achey, but it is always, always very annoying.

This is the consolidated results of both x-rays I've received, word for word, without any omissions or edits:

"AP view of the thoracic and lumbar spine was performed. No bone abnormalities are seen. There is a scoliosis convex to the left centered at L2 measuring 49 degrees. There is a scoliosis convex to the right centered at T9 measuring 28 degrees. 49 degrees scoliosis convex to the left centered at L2. Six images are obtained. There is a marked rotoscoliosis of the lumbar spine, left. A Grade I retrolisthesis of L4 on L5 is noted. Moderate to severe narrowing of the LI-L2, L2-L3, L3-L4 and L4-L5 disc spaces is noted. The facet joints are well maintained. A rotoscoliosis of the lumbar spine to the left is demonstrated. Degenerative disc disease is demonstrated at every level."

After the x-rays were evaluated, I was prescribed Naproxen. This is essentially prescription Aleve. It did nothing. Then they prescribed me Tramadol, a generic form of Ultracet, which is a non-narcotic, synthetic pain reliever. Other than giving me a headache, this did nothing. Then they prescribed me Darvocet, a low-strength narcotic pain reliever. This did nothing.

One day last September, I missed work because I had aggravated my back the night before and it was difficult for me to stand up straight. I went to my doctor a bit angry, illustrating the above, that I felt that I was not being treated properly, and that I just want to manage the pain without having my back cut open for the installation of rods.

They suggested 7.5mg Percocet, which I've been taking ever since for the better part of 6 months. I'm prescribed 4 per day, but I take 3. One around 10:00am, one around 2:00pm, and one around 6:00pm. This DOES work. In the beginning, the opiate-induced euphoria was fairly strong. Now, not so much (especially when I take the third one of the day), but the pain is definitely dulled and I feel like I am being treated properly. I am also in the process of finding a pain management specialist that would work for me, as I'd like to be put on a regimen of physical exercise, massage, chiropractic treatment, etc.

The last time I visited my doctor, she suggested Oxycontin, on the basis that Percocet is used to treat short-term pain (broken arm, wisdom teeth extraction, etc.) while Oxycontin is used to treat chronic pain. She stated that I am a valid candidate for it, but I turned the suggestion down as my father has been in rehab twice for Oxycontin abuse and it makes me nervous. I've continued with the Percocet treatment.

Last weekend I was hanging out with some friends, one of which is a general practice doctor. She supported the Oxycontin suggestion, stating that the 7.5mg Percocets also come with a copious amount of APAP, which could eventually lead to toxicity of my liver. With Oxycontin, I'd have to take fewer and it would not be toxic to my liver.

With all of the information above, my questions are as follows:

01) Should I be taking medication at all?
02A) If yes, should it be Percocet or Oxycontin?
02B) If no, what SHOULD I be doing?
03) What should I know to avoid forming an addiction to Percocet and/or Oxycontin, if at all possible.

I appreciate anybody who reads this and, even moreso, anybody who responds with assistance. Thank you!
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Comments

  • to this awesome site. You will get a lot of helpful opinions, support and answers to your questions due to the experiences from other members. I am so glad I had found this site when I did. I am only 32yrs old and so I know how hard it is to deal with such pain you cant do anything! It is also hard to be on medication to be able to be functional when you are so young. But it is my experience that if the meds are working then that is great. Half of the people here don't get anything that helps. I understand your concern with the Oxycotin and understand the concern with the tylenol that is in the percocet. I stopped taking the percocet because of all the tylenol. BUT the doc said that you are allowed 3200mg of the tylenol per day. We changed my RX to Norco 10/325 I am now taking Norco 7.5/325. The doc has allowed 2 every 6 hours as needed. I take about 4 per day and then there are the days that I cant even get out of bed and take the 2 every 6 hours. They seem to help just as well but only have 325mgs of the tylenol instead of the 500+ that are in each percocet tab. If you are only taking 3 per day I wouldn't worry as much. But anyway to answer your questions
    1) IF the medication is improving your quality of life and helps with the pain then take the meds.
    2) Percocet vs. Oxycotin. That is a trial by error. I understand the concern because of the experience with your dad. But it does not sound like you have an addictive personality if you are taking less than prescribed as it is. I didn't like the side effects and stopped taking the oxycotin. Everyone is different and it is one of those things where you wont know for sure if it is right for you until you take them.
    3) As far as preventing the addiction, that is a tough question to answer, like I said everyone is different. ME personally thought that the oxycotin would be more addictive then the percocet. The euphoric high seemed to last and last and I couldn't sleep ever.
    Try the oxycotin and see if it is right for you. But if you are only taking 3 7.5's of the percocet I dont see why they would want to switch you. Maybe try the Norco and see if that will help you instead of trying the oxycotin.
    You have asked some hard questions and I hope they get answered for you.
  • Welcome and excellent first post. I'm curious to see the responses of the more seasoned spineys here. :)

    I'm 32 years old, damaged the C-spine and L5/S1 in an auto accident 3+ years ago. Taking (5) 10/325 Percocets per day to maintain an decent quality of life.
  • Welcome to Spine Health!

    I agree with melissaJo, if your pain can be controlled by small amounts of Meds, PT and Lifestyle adjustments, sounds like a winner.

    If you get a high from the Percocet, then I would be careful and definitely go with your idea of finding a pain management specialist. With a good PM doc your meds can be "dialed in" specifically for your needs.

    Once a back is cracked open, there's no guarantee things will be better and more so THERE'S NO TURNING BACK. You can't just peek under the hood and close it quick.

    That quick "peek" can lead to higher pain levels, greater need for stronger or more drugs and more surgery. So keep the lid on it as long as you can.

    Don't let 20/20 hindsight become your moto.

    Get with a Pain Management Specialist and go forward from there.

    Just my thoughts.

    "C"
  • 01) Should I be taking medication at all?
    If the meds are solving problems and not causing them, I would say yes

    02A) If yes, should it be Percocet or Oxycontin?
    The same narcotic is in both. (Oxycodone)

    02B) If no, what SHOULD I be doing?
    03) What should I know to avoid forming an addiction to Percocet and/or Oxycontin, if at all possible.
    There is a difference between "addiction" and "dependence".
    If you have been taking for 6 months, you would probably experience some withdrawl effects from the narcotic. This is your body'd "dependence" on the med.

    Addiction is taking for the "euphoria" and not the relief of pain. Period.

    ***Remember, This is my opinion/experience and is in no way the same as medical advice from a doctor.

  • Hi and welcome to our little community. ALthough it's growing by leaps and bounds, we are pretty tight-knit and do what we can for each other.

    First off, I am terribly sorry you have to be here at all. And I commend you for being as strong and determined as you are.

    I am assuming your doctor explained the scoliosis, correct? How there are different types - DEXTRO-scoliosis (meaning your spine rotates to the right), LEVO-scoliosis (meaning it rotates to the left) and RETRO-scoliosis which means there is a pronounced (or obvious) rotation of the spine. Sounds like the curvature in your spine is mostly mid (to mid-lower) back.

    Your PM doc was correct about the medication. The Percocets are more for short term treatment (as a broken bone, surgery, etc) because of the amounts of acetaminophen. Long term use can be toxic to your liver. Oxy does not have all that extra ibuprofen or acetaminophen, so it's better for long-term use - or treatment for chronic or intractible pain. There are some members here who have been taking oxy for years without adverse side effects. Some have found that the patches work better (they worked well for me too, but I kept forgetting to put on a new one, then went through withdrawals waiting for the meds to be absorbed with the patch). Mostly, though, everyone is on a combination of drugs for pain management.

    I am curious - do you have any respiratory difficulties? Are your physical activities significantly limited because of breathing problems?

    If you don't know how to go back to your doc and tell her you'd rather take the oxy without coming off looking like a druggie, you could always say that you did some research (which is the honest truth) and learned that the percocets are not healthy for long-term use. Someone on our website once said that the bigger the pill, the more the additives. The smaller the pill, the closer to pure form of medication.

    You are also doing a great job in the way you take your medication. I am sorry to hear about your Dad's problem. Hopefully, everything worked out for the best in that regard. Do YOU have any problems with addiction or drug/alcohol abuse? Some might say that you should be sure to mention (to the doctor prescribing the oxy) that either you have a problem with use/abuse or that there is a family history, you are concerned about the chance of use/abuse, or both. I say everyone is different and should let their conscience be the guide. An open, honest relationship with the person whose job it is to allow you to live as normal a life as possible is of the utmost importance. Bottom line is that Pain Management is a very long road, with lots of trial and error to see what combination works right for you. I am sure you will eventually find the combination that is best for you.

    At any rate, Matt, welcome aboard. Lots of great minds hang out here. I am sure you will be able to have any (if not all) questions you might think of answered at one time or other.

    By the way, are you employed? Did you have difficulty with the scoliosis as a child - did it significantly limit your ability to participate in activities?

    Lots of Luck Matt. And, it's been nice getting to know you!

    Jeaux
    :B
  • Firstly, thank you to everyone for your helpful answers so far. I'm glad that I found this forum.

    Jeaux - To answer your questions:

    01) No, the scoliosis specialist did not specify the various types of scoliosis, just my grade and that it mostly affects my lower back / coccyx. I was also told that, were my spine straight, I would stand at 6'4" rather than 5'10".

    02) Other than the normal breathing difficulties that come along with smoking cigarettes for 16 years, no, I'm not aware of any that are caused by my discomfort. My physical activities are not significantly limited by breathing, but rather by discomfort. If I walk an excessive distance, it's extremely hard on me. I have a hard time attending standing room only events as well, especially if the floor is sloped.

    03) I do not have any history of substance abuse at all. I have a history of substance use, though, but it's all very responsible. Social alcohol use and inexcessive marijuana use, to be specific. Come to think of it, marijuana was the only drug that helped me with my pain prior to percocets, but it was more of a distraction from the pain, not any sort of direct treatment for it.

    04) I am employed as a project manager at an IT consulting company. I've been there for 8 years. Most of my time is spent sitting at a desk, which is probably second only to heavy labor in the scale of employment-induced discomfort. Heh.

    05) I did not have difficulty with scoliosis as a child. I didn't even know I had it until I was about 16 years old, actually, when a gym instructor had pointed out that I naturally lean to the side when I'm told to stand straight. The discomfort / pain didn't start until my early-to-mid 20's.

    Thank you for your suggestions on pursuing the offer for Oxycontin. I know exactly what you mean when you say I need to avoid the "druggie" stigma. I found I was already battling the stereotype when I initially approached my doctor about percocets. The first 5 minutes of our discussion comprised almost entirely of my disclaimers to put them at ease. Doctors seem to be especially reluctant to prescribe anything that has street value anymore, which is a shame since those medications seem to be the ones that work.

    Any other input from anyone else who'd like to chime in is greatly appreciated. This is going to be a great place for me.
  • I strongly agree with both docs that suggested the oxy. For one thing you only have to take it once or twice a day. It does not effect your organs like the shorter acting meds. And chronic pain patients do not normally get the high from the meds only pain relief. I think that you will do fine at not abusing the meds since you are already aware that the potential exists and you have done so well with the percocet. I agree that you should tell your doc the truth in that you researched it and found that it may be a better safer long term option for you. I was just telling someone else about an article that I read stating that opiates would be a much safer pain med for senior citizens than the short term meds because of the fact that they will not damage the organs. Good luck and please keep us posted.
  • Welcome! My opinion for what it's worth. I'll keep it short. First of all, do you have any issues with addiction yourself? I know that you have already answered this but think it through. Studies have proved that only 5% of patients on Oxycontin become addicts and the other 95% do not. The 5% that do, have already abused some form of alcohol, or drugs, with cocaine being the most commen drug of all. I'm somewhat concerned over the idea that you smoke a little pot, not that I'm judging you, I was no angel myself years ago but, as long as you're not fooling yourself on this. If it's a take it or leave it kind of deal then I think you would be just fine. If you go on Oxy you would probably only need a very small dose such as 5mgs or 10mgs twice a day. From what you've said here I don't think you would need more than that. Also, the euphoria doesn't last long at all. I hardly had any but I was also coming straight from surgery and was on morphine for a week in the hospital. Plus all of the Demerol that I needed for the entire year before that for migraines. I'm on a really high dosage of Oxy and I am not addicted. My body has a dependency, if I were to go off, I would have to do it slowly to avoid withdrawals. But my mind wouldn't care at all since I can't even feel it anyway, I don't need or want to get high. Another thing that's very important, if you do go on Oxy, don't drink. You should never mix narcotics with anything else that can supress the respitory system. I would suggest that you try it but to be sure, discuss it with your pain mangement doc first. He should be able to calm any fears and answer all of your questions. Good luck!
  • If you drink alcohol and smoke marijuana,it sounds like you have a drug problem....If you were tested you might not pass a urine test and then the doctor wouldnt give you no pain meds....
  • Matt 13 years is along time and I am sure your posts will help us to help ourselves and welcome.

    The intention of the medication is to mask the peaks and troughs of the fluctuating pain and flatten out those at time natural reactions, either initiated by us through over exertion or of its own volition.

    The key things is dosage and finding the correct one for you will mean much trial and error, as has been mentioned the objective is to keep medication to a minimum where adequate function is still possible. Every day as you already know is different any finding the level of activity without the relevant increase in associated pain is always difficult for this invisible and fluid threshold.

    Coping is about pacing and working within daily limits, this is not easy and require doing the necessary thing you have to do rather than the things you would like to do and finding some peace within yourself and these restriction and the impact that this has.

    Your intended strategy is ok for now and should be continually evaluated and reviewed as time goes on, every day is a new one and we should aim to treat it as such.

    Take care and be kind to yourself. John


  • "If you drink alcohol and smoke marijuana,it sounds like you have a drug problem"

    If I have any problem right now, it's your bold and very personal assumption that I have one based on two posts that I've made.
  • I find the comment "once a back is cracked open" there is no going back true. I struggled for years with neck and back pain after being rear-ended three times in one summer (no kidding). Finally got so bad and starting having a lot of nerve symptoms and they ordered an MRI. Badly herniated disc with some pressure on spine. I had ACDF of C5/6 and really expected that would solve all of my problems. It didn't. Nine months later, I am actually dealing with more pain than before. The numbness and tingling in my hands got better for a while and now is worse again. I'm a little nervous about the follow-up CT scan they have scheduled for next week. My follow-up x-rays have been "ok" but don't show the extent of fusion that they would like. I did the surgery because I had exhausted everything else.....PT, massage therapy, acupuncture, trigger point injections, pain meds....everything. I still am taking pain meds and we are in the process of tweaking those so I get maximum relief as I am still struggline a bit. I think the surgery is good if you absolutely need it, but you need to be aware of the risks and what "after surgery" could be like. I wish I had found this site before my surgery so I would have been more prepared for the MONTHS of recovery. I still can't run (jarring hurts my neck like crazy) or do much physical exercise at all.
  • I wanted to add to what "Haglandc" had to say about "cracking the back". I'm in total agreement with that. To me, that is a last resort! I wish that I could go back in time and had the opportunity to try more things than I did prior to my surgery. One of the really big problems that happens once you have had back surgery is the scar tissue. It can grow out of control and make you worse off than you were in the beginning and there is nothing they can do about it.

    As to the comment about smoking pot, if it's a take it or leave it kind of deal then personally I wouldn't think there is a problem. Don't take my word for it, since I'm not a professional, but I smoked a little pot myself when I was a teenager. It was only for about a year, and I really didn't enjoy it. If a doctor were to ever ask me if I had used it in my past I would have no problem being honest about it. It has nothing to do with who I am now. And as for alcohol, social drinking is a far cry from having a "problem" with it.

    Most importantly, you are aware of the pitfalls of using narcotics in an irresponsible manner and have concerns about it. In my opinion, you are an honest person who happens to also have their head on straight.

    Good luck in whichever road you may choose!
    Jewels
  • For what it's worth, here is my .02 cents.

    I have some knowledge and experience in the pharmaceutical department, but that doesn't make me a pro by any means. But I know enough to know that when anyone begins a narcotic medication, chances are there will be some "euphoria" that comes along with it-until we've had some time under our belt taking the drug-then eventually (usually fairly quickly) that feeling wears off. Sometimes if our dosage is increased, the feeling will come back for a short time again until our bodies readjust to the new increased level. Some of us will feel nothing at that point. I don't get the feeling from most people here that they "enjoy" taking pain meds. IF a person DOES "enjoy" it, then probably they shouldn't be. But that's not for me or anyone else to say-a persons medication use is between them and their physician and pharmacist alone..period. Truthfully, it's nobody's business what or how much of what medication a person is taking, unless of course you're caring for someone and have to dispense to them or a similar situation.

    Having said that, I DO feel it is an obligation, at least for me, that if someone IS misusing a medication (valid proof needed, of course), like a friend/loved one, to say/do something about it. Most of us know that if a person does have a problem, most of the time they won't admit to it. However, I don't get the feeling at all that you have a problem, so I think that point can be dropped. I don't think it's any of our business if you enjoy an occasional drink or smoke-unless you tell us you have a problem. Those issues are between you and your doctor and not for us to make any judgements. BigCat was right on one thing tho and I think you should know this in case you don't already. Pain Management Physicians almost always require you to enter into a pain contract with them, and in this pain contract it is stated that you can and will be tested, usually by urinealysis, to see what and how much drugs are in your system. The only reason I'm telling you this is because if you do enjoy the smoke, you will test positive, and believe me, with your pain, that's not a road you want to be forced to take. As long as you're aware that could happen, then it's your decision to make as to whether or not you wish to continue the smoke. And with alcohol, it shouldn't be mixed with pain meds, as your pharmacist should tell you, but I'm of the belief that an occasional drink now and then won't hurt. I could be wrong, so I don't ever "advise" a person to go ahead and have a drink if they're on pain meds just because I don't want that on my conscience. Myself, I MIGHT have one drink a year on a special occasion, but once I grew out of my "party stage", drinking just isn't a big deal to me-besides, it gives me a headache! lol (even if I only have just one drink!) Not worth it for me. You're a big boy and those are your decisions to make.

    Now, regarding Percocet (oxycodone) and Oxycontin-it's already been mentioned that these are very much the same, with the difference being that the Oxycodone generally has acetaminophen in it, which is noted on the label, such as in the one I take, as 10/325, which means 10mg of Oxy, and 325mg of APAP/acetaminophen/Tylenol. Oxycontin is an extended release version and doesn't contain APAP.

    Personally, I would discuss with your doctor his/her opinion of you taking the extended release version of a medication, with the Percocet for breakthrough pain, if necessary. (break thru pain is pain that "breaks thru" the extended release med-in other words, you'll still hurt a lot at times and need additional meds to help that pain, but it's not all the time) For example, I take MS Contin, which is an extended release version of morphine. I take that twice a day, and then I have the Percocet/Oxycodone for break thru pain. I also take Lyrica for nerve pain, which I'm unclear if you have any nerve pain but if so perhaps a nerve pain medication would be beneficial as well. I would definitely discuss your options with your doctor but do it in such a way as to let him/her make the decisions. If you try to push them one way or the other they may label you as a drug seeker, which you don't want. It's an unfortunate truth that it happens all because of how a person "presents" themself to the doctor, so it's always wise to dress appropriately, practice good hygiene, and don't push "more drugs, stronger drugs" etc. Since you're only taking 3 pain pills a day, I don't feel you are doing anything "wrong". You merely want relief from your pain just as the rest of us do. I am certain that your doctor also feels this same way. So just tell them that you've heard of extended release meds, researched it, and think that might be a better, safer (no tylenol) route for you to be taking long term. If the doc agrees and puts you on an ER med, and you still have pain, be honest with him/her! You may need an increase in dosage or you may need a breakthru med, and that's easy to solve. It is likely that your meds will have to be titrated (tweaked) to full effect of managing your pain, so don't get frustrated too quickly, OK? Just be honest and you'll be fine!

    One last thing I'd like to say-don't make the same mistake I did when I first started on these meds...I thought that I should be pain FREE, and that's not the case at all. You should expect to have MANAGED pain, that should, for all intents and purposes, stay under a level 5 on the pain scale. If you come off as expecting to be pain free you may run into problems with a pain management physician. Just keep an open mind, an open line of communication, and keep it honest. Good luck with whatever route you go, but I really do feel you would benefit from the Oxycontin or some other extended release pain med. I think you'll be pleasantly surprised at the results once you start taking it-and don't even worry about the addiction aspect of it. It's no more addictive than the Percocet you're taking now. Just take your meds as they're prescribed and only for your pain (not pleasure), and you will have NOTHING to worry about. Dependance and Addiction are two very different things-you will find dozens of posts here and elsewhere on the net regarding that topic if you would like to learn any more about it, OK?

    Sorry this was so long but I wanted to be sure you were armed with all the info I could possibly give you in order to help you make the best decision for yourself, along with your doctor, of course. I hope at least some of it was helpful! Welcome to Spine-Health!! I hope you'll pull up a chair and stay for awhile. :D

    Take care of you..

  • EMT, you made some very valid points here! Especially about the expectayions of relief from the pain med's. I have stated this a couple of times before on different threads, if you are taking Oxy, or anything else for that matter and your pain is completely gone, you are being over medicated. What is expected by the government guidelines for physicians on this is to have the parient reach a level 5 on the pain scale. No higher, no less. Once a person has been dealing with severe chronic pain over a period of time, achieving a level 5 feels like a miracle! You have at least "most" of your life back. And as to the subject of alchohol, I too rarely drink, even before the med's but I will have one or two on special occasions. I usually plan ahead and will take a lower dose of med's that night instead of my full dose. At the same time I cannot offer advice on this subject to anyone else either, this is what I find comfortable for me.
    Peace Everyone,
    Jewels
  • I have been lurking around here for several years , enough to get to know of few personalities..

    The remainder of the post was removed because it was in violation of forum rules Ron DiLauro, Spine-Health Administrator, 09/03/08
  • I have been lurking here for awhile, and seems like controversy is huge here.

    This post has been edited by moderator paulgla. This reply has nothing to do with this topic and is only going to serve the purpose of creating an argument.
  • I think that what you are doing is pretty ok and you might succeed in this whole process. But I also believe that you must be very careful because you might need some Edited after taking all those pills.



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