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Introduction and some questions

scmgurusscmguru Posts: 103
edited 06/11/2012 - 8:55 AM in Pain Medications
Hi Folks,

I've been on and off the forums for the last year and a half. I'm 38 years old and in good overall health, but for my spine.

About a year ago, I had an L5S1 fusion due to DDD which didn't go so well.

My pedicle screws were mispositioned and likely breached the nerve cortex and I now have ectopic bone growing in one of my foraminal canals due to my physician deciding to turn me into a science experiment using BMP-2 off label with a femoral ring, rather than the approved LTCage implant.

As a result, I've been in pain since about 8 weeks post surgery.

I've since had my hardware removed, but I'm still suffering from radiculitis down one leg and a ton of pain when sitting.

Up until about 3 months ago, my surgeon was managing my medications. (20mg Oxycontin 3 times a day, 10mg Percocet as needed (up to 3x day)900 mg Neurontin and Soma as needed).

After being discharged to pain management, my PM Dr continued the same regimen.

Unfortunately, my pain either a. become a lot worse or b. the pain med dosages I've been taking for 12 months just are not cutting it anymore.

Things definitely went down hill after the reformulation of oxycontins from OC to OP.

On my second visit, my PM Dr. bumped up my Oxycontin to 40mg (3x day) because I was still in a lot of pain.

The good news is, my pain level went down from a 7-8 to about a 2-3 with the increased Oxy dosage.

The not so good news is, I'm not really comfortable doubling my dose of Oxycontin.

Maybe I'm wrong here.. I'm not sure.. but I feel like I'm on a slippery slope and am scared to death about my dosages creeping up.

Is it 'normal' to need an adjustment in dosage of a medication after taking it for a year?

My other concern is the cost of Oxycontin, which is something like $800 a month to my insurance.

I suppose that's what insurance is for, but it seems rediculous!

On my last visit, I inquired about other options for pain management. Specifically, something that would last for a longer period of time and would be less expensive overall.

My Dr recommended fentanyl patches and prescribed a 50mcg (1 every 3 days).

I've read some horror stories with these patches and also some relatively encouraging stories on these forums.

I'm scared that the dosage I'm starting at is pretty high (as is my pharmacist).

My current daily oxycodone intake is about 80mg, maybe 90 or 100 on a bad day.

My pharmacist said the patches have really inconsistent delivery and I could die in my sleep from respiratory failure from them.

So.. I'm sitting on a script for my fentanyl patches and using up the last of my oxycontins I've got.

I'm really leery of getting the script filled because I'm under the impression that these patches are taking my medication "to a new level" (i.e It will be a nightmare if I ever wanted to stop - more so w/ fentanyl than oxycodone)

Also, I'm thinking of changing pain Dr's because I feel like my Dr's office is a bit of a mill and if I didn't instigate a meeting with my Dr. on each visit, I feel like the staff would be more than happy to keep renewing the same prescriptions month after month w/o any face to face time with my Dr.

I'm just really confused at the moment and feel like a chemistry experiment..



  • If you were taking the new formulation of Oxycontin three times a day , at 40 mg doses each time, then your base medication is 120 mg without breakthrough meds- the conversion of oxycontin to fentanyl patches is right on. Usually, there is a reduction for cross tolerance and even with the cross tolerance reduction of the usual amount of 10-25%, the conversion is correct. It is not too high a dose of fentanyl.
    Fentanyl used to be delivered through an alcohol based matrix, which had some difficulties due to manufacturing defects which resulted in leaking of too much fentanyl being released at once. Those patches were taken off the market.
    The manufacturer's have since changed the delivery matrix of fentanyl- most now have an adhesive delivery matrix. The fentanyl is embedded in the adhesive, so when you apply the patch, the adhesive releases a set amount of fentanyl through the adhesive matrix, which gives a much smoother delivery and more consistant one. And a much safer delivery for patients on fentanyl.
    You asked if it was normal to need an increase in oxycontin after a year and the answer to that is yes, in fact most opiate pain meds will require an increase from time to time, due to tolerance issues that occur in our bodies after being on a medication for a length of time. That being said, this also occurs in other types of meds , that aren't opiates as well. Our bodies become acclimated to the medication and therefore it doesn't work as effectively as before...
    Don't let the name fentanyl scare you, if you use it correctly, and your pain levels require it, you will find that it works well at managing pain and it has the added bonus of not having to take so many pills per day or keeping track of daily dosing.
  • Thanks Sandi.

    I have dipped my toe into the pool with my prescribed increased dose of oxycontin ((40mg) vs 20mg at each dose.

    Im hoping to go from 20mg , 3x daily + breakthroughs (more often than id like)

    Ive noticed the 40mg works really well in the am for a full 12hours, vs taking a 20mg and chasing pain all day with breakthrough meds.

    Im hopeful that i can be on 80mg day (40mg , 2x day) .. Which seems significantly more effective than my previous routine.

    Ive realized im probably taking more than 80mg daily total when using the 20s + perc 10/325s and its been less than effective.

    Id like to get 25mcg F patches to start... My pharmacist has Sandoz 50mcg patches, but cant tell me if they are the matrix type patches.

    She told me they are dangerous because by the time i may start feeling the patch is too strong its too late (medicine is already absorbed and will be released at that level for hours). Which equals a trip to the ER

    She also said that if it happens while im sleeping, i could stop breathng and die in my sleep.

    Basically scared the heck out of me...

    My only other experience wth fentanyl was after my fusion revison in a PCA machine.. It worked REALLY well without all the itchness i got from dilaudid.

    My pain management clinc seems more interested in filling scripts and getting me out the door. My dr over there didnt give me any instructions on how to use the patch, what to watch out for etc..

    I really appreciate the input.
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