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Pain Medication

jcarmackjjcarmack Posts: 3
edited 06/11/2012 - 8:54 AM in Pain Medications
Hello everyone, I've got a question. I know I've got to go back and talk to my Doctor at the pain management clinic but I wanted to use you guys as a sounding board. I've suffered from chronic pain for years from osteoarthritis all over my body, bad feet, bad ankles, bad knees, herniated disks L5-S1 that I've had surgery on that has since reherniated, cervical narrowing, bone spurs / osteophytes at C5,C6 and C7 along with degenerative disk disease and a few other things. I've been on Tramadol, Lortab 5 mg and most recently Percocet 5mg (Oxycodone). I was finally referred to the pain management clinic at the VA by my primary care physician and the doctor there has placed me on MS Contin 15 mg time released to be taken every 12 hours and continued my Percocet 5mg (Oxycodone) to be taken every 8 hours for breakthrough pain. I have noticed that my pain levels have come down but they don't stay down especially if I am moving around or sitting upright, etc. If I'm standing I'm hurting after the first two or three hours with the sustained release morphine and a Percocet in my system. My question is this what would be the next logical step in progression with my pain management drug wise. Would an increase in the amount of Morphine and Percocet 10mg possibly make me be able to manage the pain for the full 8 to 12 hour period? My quality of life has increased due to my current pain medication regimen but it hasn't been fine tuned to the point where I can bear the pain levels for the time I am supposed to be able to with the current medications and levels. Any help or input would be greatly appreciated. I'm completely new to the Chronic pain management program and really don't have an idea as to the progression, etc. Before seeing my current doctor I had problems with my doctors even wanting to give me the Lortabs or Percocets. Thanks for any input or help you can provide.
James Michael Carmack, B.S. JPS, MSc / MSM, R.E.H.


  • Basically, extended release medications are supposed to cover the normal , baseline pain. The IR or immediate release medications are used only to cover increased pain levels which can not be managed any other way and should be used only sparingly. Using them on a regular basis, simply increases the baseline amount of medications in your system , so when they are needed to cover increased levels in pain, they aren't going to work as well, if at all. It sounds like you are taking your ER MS Contin every 12 hours, followed by the 5ng Percocet every 8 hours around the clock- and not for what is called breakthrough pain- severe increased levels of pain that is not normally managed by your base meds due to increased activity . What that is doing is /has increased your base amount of medication and thereby increased your tolerance.
    It is a mistake that many new to pain management medications, and their proper uses make.
    The best thing at this point, would be for you to discuss this with your PM doctor and hopefully , he will increase your base ER medication, leave the IR medication as it is but then you would need to use the breakthrough medication only when you have severe increased levels in pain that you can't manage by other means. Remember, your first line of defense when it comes to properly using pain medications is your base medication, followed by the use of ice, heat, massage, tens unit, rest, heat patches , simple tylenol or motrin if it is appropriate, before going to the "rescue" or breakthrough medications...
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