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Extended Release Pain Meds...

sleeprgirlssleeprgirl Posts: 695
edited 06/11/2012 - 8:46 AM in Chronic Pain
Hey Spiney friends,

Got a question? I have been on Percocet since my fusion last Nov. I hate being on the roller coaster ride with this medication, but I have severe pain..level 8 every afternoon/night.

I see my surgeon on Thursday, and want to talk with him about adding an extended release med. He is typically very scared about prescribing drugs, and he would not even give me a pain pump in the hospital after my fusion.

What I'm thinking about is a drug a little less potent than oxycontin. I think he might go for that without issue.

I need some input about some of the Ex Release drugs that anyone has tried, and how they work for them.

I'm also going to ask him to start my on Cymbalta. Lyrica helped some of my nerve pain, but the swelling was profound.

Thanks so much!!!!

Lisa
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1

Comments

  • First thing that caught me was your mentioning a pain level of 8. Five is moderate pain. Who is prescribing the Percocet? It sounds to me that you need a pain management doctor.

    Best wishes,

    Marianne
  • I just saw a PM doc for the first time on Thursday. He did an endoscopic lysis of adhesions around my fusion site due to severe scarring. He does not give discussed pain meds on the first visit, and advises his patients to continue getting those with the surgeon.

    I'm seeing my surgeon on Thursday. I'm not seeking to stop the Percocet, just add an extended release, and hopefully in time, as this procedure helps with pain, that I can take the percocet only as a rescue.

    I'm stuck in this situation for now, so I'm trying to make the best of it, until my PM doc will handle my pain meds.

    Any input about Extended Release drugs will help me with my surgeon.

    Thanks so much,

    Lisa
  • Below oxycontin is MS-contin. Below that is Ultram-ER.

    Does that help?

    I'm on MS contin, it does help. Ultram ER is extended release tramadol.
  • How does it work for you? Have you ever tried the ultram ER?

    I'm just trying to decide what to ask for considering my pain level. My surgeon is clueless, when it comes to pain mgt. I have had to do my own mgt. for the last 9 months.

    Sad..huh!

    Lisa
  • I did the Ultram ER for a while, but at your pain level I can't imagine not going for the big guns- but then again, I can't imagine not having your pain managed by a real doctor, you know? Can't he call the PM doctor for advice? You need a lot more help than you're getting if your pain level is an 8.

    The MS-contin (morphine-continuous release) is definitely much stronger than the ultram. When my pain level went above 5 on a regular basis I didn't find ultram (tramadol) that helpful, but I know others have. Also, I couldn't go above 100 mg because I was on cymbalta and they worry about serotonin syndrome.

  • Good deal...I didn't know about serotonin syndrome. Glad you mentioned it, since I'm going to ask for Cymbalta as well.

    Thanks so much for your insight...

    What is going on with you...did I read in another thread that you were considering surgery?

    Lisa
  • Yes, I'm kind of excited about it. The doctor is confident that I'll get at least some relief from it. He's going to rip out the broken stuff and straighten me all out!
  • That's great, I so hope that it is a success for you.
    I will be very interested in your progress.

    Take good care of yourself!

    Lisa
  • Lisa:

    You might want to ask your PM doc about Opana ER and/or Fentanyl patch - which is what I use on a daily basis. Fentanyl can be started at a low dose (12 micrograms) & increased if necessary. Alot of people on this site use it. I use it in combination with Lyrica & Cymbalta for constant low back pain.

    You could still use the Percocet or others mentioned above as breakthough meds. Good luck... Tom
  • dilaurodilauro ConnecticutPosts: 9,715
    Lisa,

    I believe that for many chronic pain patients, going the route of Extended Release pain medication is helpful.

    I know in my situation, I was on all the different immediate release pain medications, and over time, the doctors just kept on increasing the dosage or shortening the time periods.

    When I first went on extended release pain medications (Oxycontin), I never got that 'instant' pain relief high, but instead had a constant level of pain relief.
    It didnt remove the pain, but it made it much easier to manage it.

    I strongly believe a combination of extended relief medication along with breakthrough medication can be the right vehicle to help chronic pain patients

    But as always, the final decision on all of this is up to your doctor and yourself
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • are you telling me this dufus of a doctor would not give you a pain pump after your fusion? back surgery is one of the most painful surgeries there is. I've had 4 and have had a pump with each one. I had gall bladder surgery last year and i had to have emergency post surgery and they even gave me a pain pump. they even offered to up the dosage if i wanted to. i would talk to this guy and tell him denying a pain pump borders on malpractice. that is horrible. time to get a new dr and please find a pain dr also. these guys seem to understand pain better than an orthopedic surgeon.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • For all the input...food for thought. I always like to go in with a plan, since you have less than 5 minutes to state your needs to your doctor.

    Lisa
  • kissed my doctor when he put me on the Fentanyl patch. What a relief to not have to take a pill every 4-6 hours! Those things last for three days at a time. I wore them before and after surgery. I stopped using them about two months after surgery. They were a life saver.
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • I take 200 mg slow release Tramal and an Oxycontin 10mg slow release every morning and night and take Endone in the day when I need it and also Valium 5mg in the morning and 10mg at night..Also I have found a 8 hour extended release paracetemol and these combined do help somewhat with sleep at night..

    I have also used Fentanyl and Norspan patches and found them helpful also..
    Take care Lisa
  • Hi. You've gotten great advice. I guess that I'd just like to add that a list of extended release medication that I know of. There may be some that I have missed.

    --morphine
    --Opana
    --Oxycontin
    --Exalgo (hydromorphone)
    --Ultram ER
    --Fentanyl Patch

    Now, I know that Exalgo is a relatively new medication and only used for people who are very, very tolerant to opiates.

    The others make doses that are on the low end. Oxycontin comes in 10 mg. pills, Opana comes in 5 mg. pills, Fentanyl comes in 12.5 mcg. patches, and morphine comes in 15 mg. pills. So, my point is, that even though these are potent medications, they still come in lower doses.

    Maybe you can research them a bit, and talk to your doctor about it.

    I'm so surprised that you didn't get a pump after surgery. I hope that the doctor gets your pain under control.

    In reply to your question (just re-read your post), morphine is not as strong as Oxycontin on a mg. per mg. basis, but every drug works differently for everyone.

    Flower

  • The problem I am dealing with, which I think is a common issue, a) surgeons have little pain management skills, b) PM doctors don't want to prescribe narcotics. This is just from my personal experience.

    Giving anesthesia for many years, I'm an expert at acute pain relief....but this chronic pain is a different kind of animal.

    I've gone from a very smart, confident person, to someone who is scared and passive...that is how debilitated I've become due to chronic pain.

    After having my endoscopic lysis of adhesions last week, my pain is somewhat improved during the day...the afternoon/evenings are still pure hell, but I'm still dealing with surgical pain...good news though...my feet are not as numb...YEA!

    I'm going to get my Mojo back for my visit with my surgeon on Thursday....

    Lisa
  • Go get'em lisa!!! :H
  • Sounds like Morphine ER is what you are looking for, there is also a brand name Kadian. Problem is since most there really aren't "true" conversion tables, the docs usually start you at lower dose, like 15mg twice a day of Morphine ER, but you made need a higher dose.
    I don't get PM's that don't prescribe narcotics? There is no specialty more appropriate to manage these meds.
  • I am having GREAT luck with Exalgo 16mg. I take one of those every morning, then take 2mg dilaudid for break through pain.

    The first week was rough adjusting to the Exalgo, but it got better after that. Pain is still there, but managable. I also don't get a cloudy head that much.
  • Optimist and Will,

    I am having to wait till I see my PM doc on 9/14. This will only be my second visit with him, and he absolutely doesn't prescribe any meds on the first visit, as I had a procedure that day...and not sure that he does on the second visit. I am going to insist that we explore the options however.

    Lisa
  • with your PM Dr. appointment. I hope you continue to feel better from the lysis of adhesions. But hope you get something for your pain management. I also take Cymbalta and it's helped me more than Lyrica also.

    I was so surprised that my PM Dr. told me that after my final injection ESI on Oct. 7th she will recommend Fentanyl patch to my Family Dr. who gives my meds as my Dr. is hesitant about giving me the patch without the PM Drs recommendation. I told the PM Dr. I had a colonoscopy and they used twilight sedation and Fentanyl IV and I had quite a bit of pain relief after so she said she would recommend it to my Dr.

    With all this reporting to the Government all Drs must let them know who is on Oxycontin so they can monitor the drug. I don't really like that and would prefer to not take any more pills also and get some more pain relief. I think it's important to have relief to be able to do daily chores and an exercise program like walking etc. without being in so much pain. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • What about your PCP? I have had several PM Dr.s and found the same thing they dont want to prescribe the meds. I have my PCP write all meds. I do go to PM and they will tell my PCP what they would like to see me on and then she will write it. I have found this the best since spine surgeons come and go over the years, and PM Dr.s just want to treat with tests no meds. Its a insane set up they have I would have to say...Maybe see your PCP and tell them you would like them to write the scripts if a PM Dr will suggest what meds. You want to build the best relationship you can with the Dr that writes your pain meds, and a PCP is a long term Dr. It took me a few year before my PCP completely understood my condition and the pain associated with it. But when I am in between surgeries I lower my meds so if the pain is bad and I ask for ER meds she will give them with no questions, its a hard spot to be in and hopefully it will get easier. I hope you find the right pain meds for you and looking into lyrica is a great option also. Cymbalta will help you get threw it, also there are some muscle relaxers that are designed for spinal cord pain Zanaflex and Baclofen(sp)? I love Zanaflex cause you can take up to 6 pills a day instead of 3 with most, great for the real bad days.

    Have you heard if you have a solid fusion yet? have you tried ice therapy, tens unit with a heating pad wrapped around it they have ones that are like a belt you can make the heat on high and tight or lose on warm depending on your likes . Also has very long cord I use it when cooking alot.



    Paula

  • I have only seen the PM doc one time, but a friend of mine worked for him, and told me to ask him to change me to an ER med. I see him again next Tuesday for a procedure, and will ask about it then.
    My surgeon has been prescribing all my meds. We just changed from soma to xanaflex last week. I'm calling them tomorrow to change the Lyrica to Cymbalta, since the Lyrica causing such swelling. Then hopefully next week I can get the Extended Release meds, and I will be in good shape.

    I am just beginning to fuse, and have been wearing a bone growth stimulator for about 3 months. It seems to be working, since I had no fusion at all 3 months ago. Maybe in 3-6 more months I will have solid fusion.

    Thanks for all your advice. It is all about getting to the most optimal state of wellness you can!

    Lisa
  • that my PCP is the one who gives me my pain meds. I think the surgeons are fairly clueless and don't even get me started on Pain Management Specialists. I think there's a big misnomer there -- I don't believe I will ever go back to a pain management doc.

    Linda
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • I'm right there with you on PM doctors. My PCP manages my pain as well.
  • I guess I'm confused...of course I stay that way quite a bit these days.

    I thought that pain management was what the PM doc is for. I know that dealing with the surgeon has not been working, and that is why I started going to this PM doc. He is an intervnetional doc, but I did sign a contract with him, so doesn't that mean he manages my pain????

    It is quite inhumane to me, how my pain has been managed. I took great pride in making sure that my patients had "steady state analgesia" while under anesthesia. That is the only way that patients wake up without horrible pain in my view.

    Anyway, it is my hope that SOMEBODY will do the same for me. Extended release makes sense. I could be more active during the day; sleep better without waking up every 3 hours. Maybe even need less pecocet. It would be nice to be able to do simple things without having to worry about how bad the pain is going to be while I'm doing them, or how bad it will be afterward. I'm sick of the isolation that the pain has caused.

    I'm done with my rant...I work myself up because I'm scared that they will leave me in this situation.
    Guess I will know next Tuesday.

    Lisa

  • I guess I'm confused...of course I stay that way quite a bit these days.

    I thought that pain management was what the PM doc is for. I know that dealing with the surgeon has not been working, and that is why I started going to this PM doc. He is an intervnetional doc, but I did sign a contract with him, so doesn't that mean he manages my pain????

    It is quite inhumane to me, how my pain has been managed. I took great pride in making sure that my patients had "steady state analgesia" while under anesthesia. That is the only way that patients wake up without horrible pain in my view.

    Anyway, it is my hope that SOMEBODY will do the same for me. Extended release makes sense. I could be more active during the day; sleep better without waking up every 3 hours. Maybe even need less pecocet. It would be nice to be able to do simple things without having to worry about how bad the pain is going to be while I'm doing them, or how bad it will be afterward. I'm sick of the isolation that the pain has caused.

    I'm done with my rant...I work myself up because I'm scared that they will leave me in this situation.
    Guess I will know next Tuesday.

    Lisa

  • Hey Lisa,

    If your having issues with a pm doc giving you meds, what about seeing a physiatrist? I have one and he is great. He controls all the treatments I get and receive, along with all my meds. My primary doesn't want anything to do with prescribing long term narcotics. The physiatrist I couldn't be more happier with. While i just finished a surgery not long ago and my surgeon is prescribing post surgery meds. He is very aware of those meds and also prescribing to fill in for the damage i already suffered that will be long term. His goal is to control the pain till surgery becomes a must.

    I have used cymbalata for a long time. Cymbalta was just approved by the FDA for chronic back pain as well. I had to stop it for some bladder retention issues and I do miss it. We are not sure if we will be able to restart it again. It is has known side effects to the bladder and kidneys, so be sure to keep those numbers in check.
  • Seems like there are two types of PM offices. Some are interested only in injection type relief. Others are more prescription oriented.

    I finally found a physiatrist and the best part is he is joining the PM office. So I will get the best injection type PM doc and a physiatrist who hopefully will manage the PT and other therapies to provide relief.

    My hope is that this physiatrist will take over as my primary doc which will reduce the visits to the neurologist (not much reason to see him since we know what is wrong) and consolidate the pain management into one office visit a month.

    Lisa keep positive. If you go to your appt with a good attitude you will get good results. Remember more bees with honey...
  • There's a great article written by John Revord, MD that is here on Spine Health.
    Spine Health Article said:
    We can classify the most widely used techniques in terms of the degree of intervention they involve:

    * Noninvasive non-drug pain management
    * Non-invasive pharmacologic pain management
    * Invasive pain management
    Here's the complete article. http://www.spine-health.com/treatment/pain-management/pain-management-techniques
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