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Oxycodone not effective?

Reformed1RReformed1 Posts: 257
edited 06/11/2012 - 8:47 AM in Pain Medications
I had a nerve block procedure done approximately 3 weeks ago and my pain level has doubled, day and night. I had been taking 5 Norco pills (10mg Hydrocodone) per day prior to the procedure, but after 2 days I increased to six pills per day (as allowed per my script) and I was still in terrible pain. I called my doctor's office and they got me in very quickly. I told my doctor that my pain has gone through the roof and that I needed something stronger, so he mulled it over in his head said that he would prescribe Oxycodone. I told him that I've used Oxycodone in the past and that 5mg did nothing for me. He suggested that I try 7.5mg, but my pain was so bad that I balked at that as well. He got a little angry with me and ultimately said that Oxycodone is three times stronger than Hydrocodone and all he was comfortable with is 7.5mg.

Well, 2 weeks later, I have been taking 6 pills a day of 7.5mg Oxycodone and I feel no better than I did on 10mg of Hydrocodone. I knew that this would be the case, but I don't dare ask my doctor to increase my dose.

I'm seeing him this Friday, and I'm trying to figure out how to explain to him that I don't seem to respond to Oxycodone the way he or any doctor before him thought that I should. (When I was going home from the hospital after my 2nd discectomy, the NS's PA gave me a script for 5mg of Oxy every 6 hours. I was incredulous that he thought that this was effective pain relief).

Is this just a matter of my body not responding well to Oxycodone, or do these doctors not really understand the difference in effectiveness between these meds?

I know that I asked this question within a different thread, but I wanted to ask again in a new post to see if anyone else has had this issue either with Oxycodone not being very effective or their doctor thinking that it is so much stronger than Hydrocodone, or both.

I could also use advice as to how to explain this to my doctor without coming across as seeking more drugs. I wish I could turn back time and not have had that nerve block.



  • Dave the best thing to do is be honest with the doctor. Tell him that it's not working. Then let him come up with an answer. I have had to work very hard at controlling myself when talking to my neurologist. I go in with all kinds of ideas on what to try and get very annoyed when he doesn't want to hear from me. So now I just ask questions on what he prescribes -- like how much, how often, what else to take or not take.

    The fact is that some drugs don't work for some people. I'm sure the nurses here could give you the science behind it but that doesnt matter. All that matters is this isn't working.

    Sometimes we have to dumb ourselves down in the interest of getting good care.
  • Oxycodone's effectiveness depends on what type of pain its trying to treat. For me it takes the edge off. Its not very effective for nerve pain, i.e. the burning and stinging. It does seem pretty effective for me on the deeper, harder pain. If your experiencing nerve pain, have you tried Lyrica, Neurontin, Cymbalta, Topomax, Savella? Those drugs are much more effective on nerve pain. I'm not able to take any of them, but lots of members have reported excellent results here.

  • I found the cousin to Oxycodone, Percocet to be more effective because of the combination with Acetaminophen. The Oxycodone in the Percocet is the same drug, just combined with Acetaminophen. For some reason my body likes the combination.

    I found that when certain meds weren't as effective as the doc thought they would be, I would have to tell him and ask if there were something else I could try. I didn't ask for an increase, just to try something different.

  • Thanks, C.

    Isn't Percocet just a brand name for Oxycodone? Mine is combined with APAP, so it is 7.5 Oxy/ 325 APAP.

  • I responded a little while ago to your other post regarding your nerve block. I am glad to know that you did contact your doctor and you have another appointment set up for Friday.

    When you go in on Friday, just be your pleasant self. Be honest about the pain medication not keeping your pain under control. Tell your doctor that you are taking it as prescribed, but unfortunately you are not getting adequate pain relief.

    Dave mentioned something that has crossed my mind, too. I'm wondering if some of the pain you are feeling is nerve pain? Can you describe the pain(s) you battle with?

    For instance, I have several different kinds of pain. My "major" pain is the deep, deep achy pain in my thoracic area and tailbone area. It is always there and this pain is best controlled with strong pain killers (Oxycontin and Percocet). I then have the annoying nerve pain in my lower lumbar area, throughout the thoracic area, my ribs and in my legs. When I was prescribed Neurontin, I swear, I thought it was a miracle drug! It works very well with me and my nerves. Muscle spasms are another source of pain and I get these in my lumbar and thoracic areas. When I get painful muscle spasms, my muscles will get very, very tight and painful. So painful that it sent me to the ER a few weeks ago. I didn't know what the heck was going on... kind of thought I had a kidney infection, as I have a history of those along with kidney stones. Turned out I was "locked-up" in spasms and the ER team took excellent care of me. Then, there is the osteoarthritis pain. I've got this throughout my spine and joints. It's most painful in my hands, knees, hips and tailbone. That pain is the stiff, hot and achy feeling. Kind of resembles having the flu? I was recently prescribed a new anti-inflammatory that works very well for the OA pain.

    There are many different kinds of pain and I just wanted to mention some of the pains I get. Perhaps one will sound familiar to what you are experiencing? I don't know if you are on any nerve medications or muscle relaxers, in addition to your pain meds.

    Please keep us posted, Dave. We want to see you get through this horrible episode since having that nerve block. Such a shame that it induced more unnecessary pain for you, my friend.

    Thinking of you,

    Tammy >:D<
  • Yes, that is what I was thinking- that rather than go stronger, your doctor is likely to just go an entirely different route.

    You are in a difficult place, being in so much pain that you need a drastic increase in pain meds with a relatively new doctor. Why do you think this nerve block increased your pain level so much?
  • My first thought is that oxycodone is not the appropriate medication for your pain. If it is nerve pain that you're fighting, you need something specific for nerve pain, like Lyrica or Neurontin. I'm on Lyrica right now for nerve pain in my right leg post-op lumbar fusion almost 3 weeks ago. Was on oxycodone post-op. The thing is, even though oxycodone is 3 times stronger than hydrocodone, it is not specific for nerve pain. All it does is take the edge off the pain and maybe make you not care so much that you're hurting.

    I'm a little surprised that your doctor hasn't thought of the nerve medications for you. My nerve pain is now nicely controlled with Lyrica and I've backed off the oxycodone completely and am just taking hydrocodone for backache over the surgical site. It's all I need for that kind of lesser pain.

    I hope you can get this straightened out soon. There's no reason you should be left in this kind of pain.

    2009 Foraminotomy C6-72010 PLIF L4-S1Multi RFA's, cervical inj, lumbar injLaminectomy L3-4 and fusion w/internal fixation T10-L4 July 17Fusion C2-C5 yet to be scheduled
  • Dave's new doctor will do his best to work with him on his pain issues. Although this is a new doctor, we all have been in that place as well... "Building a relationship with a new doctor".

    I doubt Dave will have an answer to why this particular block increased his pain, until he see's his doctor on Friday. Dave posted in another forum asking others if they have experienced more pain after this particular block he had.

    I know I sure am interested, as well as you HappyHB, as to why this particular block induced more pain for Dave. I just had a couple of blocks with a lot of injections a couple of weeks ago and I count my blessings that mine "took". What Dave has experienced, scares the daylights out of me.

  • I have tried both Neurontin and Lyrica without much success. Granted, the doses were never very high, but in order to keep me working, they didn't want to increase my current dose of Neurontin during the day (I take 600mg only at bedtime).

    I have a sharp pain in my lower back and it radiates into my right rear. This is the same pain that I have had since my second L5/S1 discectomy 15 months ago. My L5/S1 TLIF 9 months ago hasn't changed it.

    Since the nerve block, the pain is now much more intense. Additionally, I now have a strong achy feeling from my waist down. Please note that I NEVER had any sort of pain or discomfort on my left side. I was surprised and dismayed that they did the nerve block on the left side as well as the right side, when they knew my symptoms were all on the right side.

    The fact that it has been three weeks and the pain is not subsiding has me a little worried that they did some type of nerve damage. Hopefully, it isn't permanent (if that's what it is).

  • Totally agreed, let's not jump to negative conclusions. There are many things the doctor can do that don't include increasing his overall meds, so hopefully even with a newer doctor pain relief is in his future.

    And in my experience, irritated nerves can take quite some time to die down :) Hopefully it won't be too much longer!
  • Sorry to hear your pain meds aren't working. Let your Dr. know they wear off after so many hours or make your pain a 6 as opposed to 7-8 or don't work at all. I had to return several times to get a tolerable dose of meds. Just ask your Dr. what to do? I hope he can work with you to find something that helps you. Hope you have a productive appointment and hope he helps you this time. 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
  • There are other nerve drugs besides Lyrica and Neurontin. There is also Cymbalta, Topomax, and Savella to name a few. You could also discuss maybe using Trazadone at night. I take it off label for sleep but it also helps with the nerve pain. Problem with trazadone is it puts you to sleep. Before I went the route of the SCS, I tried all of the nerve drugs. I'm what my doctor calls sensitive to these type of drugs. you need to get that bag of tricks opened up to all possibilities.

  • Oh Dave, I so hate hearing that you are in this much pain. I really hope you can 'gain some ground' with your doctor Friday. I'm a little afraid with his response at your last appt, that he may be defensive that his block has caused you much more pain...but I hope not. I know some doctors are that way though...they just expect to fix or make everyting better with these procedures. I will be praying for you for this appt.

    Also, some people just do better with hydrocodone over oxycondone. Me and hubby are opposite. I think oxy works better and that's what I have Rx...and he thinks vicodin works better and when he "throws his back out" or whatever happens/strain...he gets those and they work great. It's just person to person. I don't however feel he really raised your dose. To me 7.5 of oxy to 10 of hydro...seems the same. Also...yes, you are using the generic name for oxycodone and some get the name Percocet which contains tylenol which sounds like what you have as well. There is oxycodone that comes without tylenol, which is what I take for BT pain b/c we figured I didn't need all that tylenol everyday. But you are right about the name.

    I hope you get your pain taken care of. It really seems to me that you need a longer acting med with hydrocondone for BT. But I'm not a doctor...just a nurse who doesn't even work anymore...so I don't count. :)

    God bless
  • Oxycodone is also available in combination with acetaminophen (Endocet, Percocet, Roxicet, Tylox, others); aspirin (Endodan, Percodan, Roxiprin, others); and ibuprofen (Combunox). This monograph only includes information about the use of oxycodone alone. If you are taking an oxycodone combination product, be sure to read information about all the ingredients in the product you are taking and ask your doctor or pharmacist for more information.
    I used to get Percocet and Oxycodone without any additives to reduce the amount of Acetaminophen I was consuming daily. I was unaware that they combine it with so many different meds.

    Hope you feel better soon.

  • I was thinking in the beginning that maybe you were just having a flare,but three weeks is a bit long,so maybe a new normal? I hope not,but you never can tell.
    The 7.5 oxycodone is considered a lateral move as far as your previous Rx of 10mg hydrocodone,and not three times stronger as your Dr suggests.I wonder why a Dr would say or think such a thing because you would think that a Dr who is presribing these medications should be more knowledgeable about what they are Rx'ing.Maybe one or more of his patients mentioned this in the past and it stuck in his head.We've all heard though (ad nauseam) that we are all different and what works for one and blah blah...

    In any event,I hope that your appt. goes well and that you are feeling better soon!
  • I found a nice web site this morning that has an Opiod Narcotic Converter. The equivalent dose of Oxycodone to your original 10mg Hydrocodone is 6.67 mg. So being bumped to 7.5 mg is an increase, albeit a small increase. It's not a lateral move.

  • Interestingly, the 3x number is all over the place on the internet, along with a million other numbers.

    Howver, this:


    VA dosing guidelines lists Hydrocodone has having 30 mg equivalent to 30 mg of morphine. Oxycodone has 20 mg equivalent to 30 mg of morphine.

    20oxy= 30hydro so oxy = 3/2 hydro or 1.5 That's the most common number I've seen on reputable sites. You can see where the 3x number comes from- someone just dropped the /2.

    Hope this helps :) (interesting link, too). I didn't see any sites with the information dave published, so couldn't comment on it. Anyway, according to these numbers, 7.5 oxy is about 11.25 hydro. BUT- it still depends on the individual. And honestly, I wouldn't challenge your doc on this, he doesn't seem like he would take it well.

  • I'd be more than happy to PM the link to anyone that wants it. It has advertising on their page, so it would be a forum violation to post it. It would look pretty bad if I had to edit my own post for a bad url. It's from the clinician's ultimate reference web site.

  • Dave I'd be happy to edit your posts anytime :))(
  • I'm one of those people that percocet does not seem to work on. When I was in the hospital last year they had me on diulaudid (sp?) in order to go home they said I had to be on oral meds and that they would give me percocet... it was a 10mg at a time but it did nothing for my pain. The following day they tried again and this time in addition to not doing anything for my pain, it made me quite ill. I finally asked if I could use vicoprophen instead as that did offer some relief. they did and I went home the following day.

    I mention all of that because my mom and brother both had surgery this year and they sent them home with 10mg. percocet... neither of them seemed to get any relief from the percocet and after talking to the md. went back to vicodin as well.

    Could it be that it really doesn't work for some people? I really hope you are able to get some pain relief from your doctor, being in pain sucks the life out of ya :(
  • I hope you get the results you're looking for at your appt, Dave. I agree with the others, just be honest, tell him the meds aren't working, so what can he do for you? And leave it at that. Doctors tend to get wound up when people go in and start asking for or suggesting specific meds, especially concerning narcotics, unless you have that good of a relationship with them.

    I take oxycodone for BT as well, and it doesn't really help with my nerve pain either. I take neurontin, 600 mg is actually a pretty low dose, if you like it, maybe he can increase that? The best I've been on was Lyrica for nerve pain relief, but I gained about 20 lbs in just a couple of weeks, so stopped that one pretty quick. I just started Cymbalta this week, to replace my anti-depressant for anxiety, but we're hoping that the combo of it and the Neurontin will work some wonders in the pain area as well, I'll let you know!

    I only know from my experience of my last RFA, that the nerves can become very irritated, and that it can last a long time. With me, it's now been over 4 months since the procedure, and the area where it was done is still very painful and hyper-sensitive. It has got better considerably, but it sill hurts like the dickens, so maybe the same sort of thing happened with you. Hope the doc can help you out, let us know!! Take care;
    APROUD CANADIANveteranButNOTa doctor, my thoughts are my own
  • Dave, where are you? How did it go today?
  • Hi everyone. I'm so sorry for the radio silence, but I have been trying to keep up with work and several appointments this week and I haven't had much time to keep up here.

    I'm seeing my doctor at noon today. I really appreciate all of the advice, but I'm very worried about what might happen today. My pain is back at the same level as it was at about 3 weeks post-op from my fusion. Something went wrong with the nerve block because I'm going on 4 weeks since the procedure and I haven't improved at all.

    I will go into the office very calmly and very humbly and I will tell him that, unfortunately, the Percocet gave me no added relief. I need to tell him that the pain is so bad that I have been very unproductive at work because I can't sit still long enough to accomplish any real work. I will keep it very brief but will ask him what, if anything, can be done.

    I'm praying that this man will meet me halfway and do something both short-term and also long-term. I had a genetic test done (CYP450) and it suggests that I should avoid SSRI's, but if he feels that he can carefully prescribe the right dose of Cymbalta, I will go along with it. But again, I need something to address my immediate pain.

    If I don't sense any compassion from him and if he doesn't offer to step up my meds in some manner to relieve my immediate pain, then I'm going to go to plan B (yet to be determined), but it is likely to not include him as my doctor. Please keep in mind that my wife came with me to my last appointment and she was ready to walk out on him because he was such a jerk. So, I don't think this is just me.

    Again, Thanks for all of your support and guidance. I'll let you know what happens. I'm shaking in my boots right now because I'm afraid that he won't do anything, and I really do not want to try to find yet another doctor. Worse yet, I desperately need some pain relief. :SS

    Take Care,
  • dave you should not have to feel this way going to see your doctor who is supposed to make you feel better...esp a PAIN man, doc, whose job is to make his clients comfy from the pain...I'm so sorry you have to be shaking in your boots...I hope your wife is going with you again. Please let us know the update. I guess I got confused and thought yesterday was Friday and kept looking for your post and didnt know where you'd post it.,.. but I'll check back here in a few hours. God bless.
  • Thinking of you and I really hope you have a good visit with your doctor today.

    As Tarheel said, it is just terrible that you have to "dread" a visit with a doctor. That's just... so wrong!

    I, too, will be looking for a post from you on your visit today.

    Prayers your way that you get some answers today and some new pain relief prescriptions. Hate to know that you are suffering like this.

    Tammy >:D<

  • Seems like everyone agrees that we are all different in what med works for us. My cancer surgery stopped me from being able to get back surgery. Was trying to cut down on back meds to help my liver, and was doing too much, not staying in bed. Praise God, realized on my own and with others who had been down same road, I needed to take the hydro with 725 tylenol faithfully 4x a day, and stay in bed. My experience was not good when I tried to cut down on meds and do chores or shopping myself. Now I know I need surgery, and most importantly, need to stay on meds and do nothing so I can handle pain.
    We will get through this, and I look forward to helping others who may not have friends or finances to hire help when they cannot do work themselves, and to give emotional support and encouragement that they will get through this, and they will one day, be able to have an acceptable quality of life. You are in my prayers that you are able to find right meds for you and that doctor is able to hear you. :)
  • Dave? I know, I know...I'm a bit impatient...not even allowing you to get home from work yet but I'm just so anxious to hear how it went today. Let us know when you have time!! We've all been thinking about you! Blessings....
  • Dave, I can tell you that I'm so very relieved to hear this. Your approached worked well! Perhaps going in with a high pain score puts him in a defensive mode off the start? You know, the ego. So, it makes sense why he was smiling walking into the office. You did well and with that, you were able to calmly talk together about a plan to keep your pain level down. I hope you did get an ER pain med...I think it does take several visits before you get to this point with the pain docs. First and foremost, they want to try their procedures they were trained to do, which help some, not others as you saw. Then over a few appts, they begin to see the nature of what they are dealing with...all the while forming that opinion that you are an honest person. That was a very nice compliment and I think it describes you to a 'T'. :)

    Have a blessed day and let us know how your new med regimine works for you!
  • HUGE sigh of relief! I am so glad! And we can get the medical gossip later, for right now we're just all totally thrilled that you left a happy camper!

    You know, I don't think it was your ego you needed to put aside as much as your fear of being hurt. Those barriers can be as much a blockade of communication as any nefarious intention. Taking medication before the appointment was a brilliant idea!
  • Good news and glad your Dr. is working with you. It sure is a relief to have a plan and some much needed pain relief. Thanks for the update. 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
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