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Need advice on Meds

SublimisSSublimis Posts: 7
edited 06/11/2012 - 8:56 AM in Pain Management
I have been under the care of a pain management clinic for 11 months. I have had 7 epidural steroid injections and I currently take Neurontin, Arthrotec, Zanaflex and Percocet. I had been having inceasing back pain and called my pain management doc. She told me to take more of the zanaflex. I put up with the pain as long as I could and finally went to the ER. The doctor told me to tell my pain management doc that I need a new MRI and suggested that I be put on a Fentanyl patch. She said that I most likely have developed a tolerance to the percocet. I am on 5/325 of percocet. Though my percocet doesn't seem to be working anymore, fentanyl seems like a big jump to me. Does anyone have any advice on what my next step should be?


  • Generally the jump from Percocet to an extended release opiate is to something less potent than Fentanyl. I was treated with Oxycontin as the first extended release medication used.

    With the mixture of medications you are currently taking do you have one doc that is doing the prescribing?

    Bummer that you had to go to the ER. Have you been able to schedule an appointment with your PM doc to discuss everything?

    Best Wishes,

  • My pain management doctor prescribes all of my medication. I have an appt. with them next Tuesday. I also have a follow-up appt. with my primary care manager on Monday.

    I am just curious as to what the next logical step would be.

  • Good deal that you have a follow up with your primary care doc! My primary care doc is the one who tracks everything and makes referrals if necessary to see any specialist. Have you ever been evaluated by a spine specialist or a neurologist?

  • Hi sub, Well the next logical thing would be is what dr recomends,
    I am not sure if anyone is realy able to tell you here what meds you should go on next,
    It will all depend on what spine issue you have and if medication is the answer or surgery,

    I am on the fentynal patch but i already had a number of surgery so if nothing more can be done is when they usualy have to put you on stronger meds i believe.

    I am not sure i would want to be on stronger meds then you are already on without knowing whats causing it, All alternative treatments should be done before doing surgery unless dr sees something so serious where surgery is a must have!

    Good luck and let us know what hapenes,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • I have never seen a neurologist or spine specialist. The way my insurance works, I have to go to a physical therapist (did for 9 mos.) then pain management (in it for 11 mos.) before the neurologist will see me. I am hoping to get a referral for a new MRI from my primary doc on Monday, then get a referral for the neurosurgeon once we get the results. I had an EMG earlier this month that showed new nerve entrapment at L2. Hopefully, that will be enough to warrant a new MRI and a referral to the neuro.

  • The pain management doc diagnosed my condition as Spondylosis and Facet Arthropothy. I have annular tears in the lower disks and am developing bone spurs in the upper lumbar levels.
  • If you get the new MRI, then they should be able to give you a more directed diagnosis. Spondylosis is simply arthritis in the spine and facet arthrosis is facet arthritis.
    Anti inflammatories might help with some of the pain, and again, your PM doctor will decide what type of medications would best work for you and your conditions. I hope that the new MRI is ordered for you, that should help clear things up and get you on the right track.
    Fentanyl is usually used much later in the treatment of chronic pain, after trying many other medications that aren't so high up on the pain medication scales.
    There are many, many other options available between 5 mg percocet and fentanyl. Fentanyl should only be used in a patient who is opiate tolerant, and tried the other available options.
    Talk to your PM doctor.
  • I have had surgery (ACDF) and also have had two spinal cord stimulator surgeries. Fentanyl was added to my regime over a year ago to try and counter my continued pain issues. I was not on any long lasting pain relief prior to that, only a short acting Lortab and muscle relaxer (Zanaflex), which I still use in addition to the Fentanyl patch. I would love not needing it. Even a low dose patch is addictive. That would be my only reason to avoid it, but for 2 out of 3 days, my pain is much more manageable with the patch.
    Good luck to you.
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