Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

How much is to much expectation?

I started in Pain Management about 2 months ago after years of being looked at like I was a whiner or even less savory things. My current regimen is (1) 25mcg Duragesic every 72 hrs (1) 12mcg Duragesic every 72 hrs and (1) 5mg Oxycodone every 6 hrs for breakthrough pain. This is after 14 years of prescriptions of muscle relaxers, NSAIDs, other narcotics etc. I now suffer from peptic ulcer disease from long term use of NSAID therapy. With my current medications my pain levels are still at a 7-8 most days with it going through the roof if I am late with my breakthrough medication. Occasionally I get better times where I could all it is 6-7 but those are few and far between.

I guess my question is where should my expectations be? I know that I will never be pain free, but should I be getting more relief? I''m so afraid of telling my doctors my "real feelings" because I'm haunted by the memories of the way I've been treated though the years.
L1/L2 compression fractures due to MVA in 2000.


  • At 37 mcg per hour of fentanyl, and the constant /around the clock use of breakthrough meds, I am not surprised that your pain levels are high....
    The fentanyl is supposed to be used for around the clock management of pain, and it should reduce your unmedicated pain levels by about 50%.......the use of breakthrough meds is never supposed to be used as a first line defense against increased pain levels. The use of otc remedies, ice, heating pads, hot showers, rest, topical rubs and creams, stretching and just plain rest, as well as the use of muscle relaxers etc if appropriate are all supposed to be used instead of reaching for the pill bottle as a means of relieving the pain. If there is not enough relief provided, then is when the judicial use of breakthrough pain medications are supposed to come in.
    Using breakthrough medications with any regularity, whether it is once a day, or around the clock, only serves to increase the baseline amount of medications in your blood stream and winds up making the breakthrough medications completely useless and you are left with no means of managing additional pain spikes.
  • 50% is the goal of the majority of pain management programs. If you are saying that your pain levels medicated are constantly a 7-8 or higher, what are your levels without medication?
    The problem is that patients who claim consistently high levels of pain, especially at levels above a 8, can not functionally take care of themselves in most situations., let alone concentrate ....higher than 8-9 tends to have people heading toward the ER.
    Most people tend to overestimate their pain levels , and doctors frown on that.

  • I was in an automobile accident that resulted in compressions fractures in my L1 & L2 vertebrae. The three surrounding discs are bulging according to my most recent MRI. I've been through countless doctors and physical therapy in the last 14 years finally being sent to Pain Management because my primary care doctor no longer could prescribe the type of medicines she felt I needed
    L1/L2 compression fractures due to MVA in 2000.
  • sandi said:
    50% is the goal of the majority of pain management programs. If you are saying that your pain levels medicated are constantly a 7-8 or higher, what are your levels without medication?
    The problem is that patients who claim consistently high levels of pain, especially at levels above a 8, can not functionally take care of themselves in most situations., let alone concentrate ....higher than 8-9 tends to have people heading toward the ER.
    Most people tend to overestimate their pain levels , and doctors frown on that.
    It had gotten to the point where I had no choice but to function at a pain level of 8+. I am a single parent of a toddler so regardless of how I felt I had to push through.
    L1/L2 compression fractures due to MVA in 2000.
  • Different figures I have heard as being the goal for pain reduction are 50-70% of your original pain. If you are 7-8, I would say that it is reasonable for you to expect more relief than you are getting. Have you spoken to your PM recently?
  • My next appointment is on Wednesday. I'm actually afraid of telling the doctor I'm still in a lot of pain. I haven't had the best experiences dealing with medical professionals regarding my pain. Most of the time when the word pain gets spoken I see something in their eyes just go blank. My PM doctor is the first I haven't had that experience with and I'm very worried about seeing that look again as I am finally getting some relief.
    L1/L2 compression fractures due to MVA in 2000.
  • I have experienced the same as you with eyes glazing over at the mention of pain. It sounds like you PM is not like that, though. Given his chosen specialty I don't think he will respond negatively to complaints about pain. He would just have to be accustomed to hearing them.
  • There are many different options that the PM doctor can offer, other than just medications to treat your symptoms. I also have a spinal cord injury, times two, so while the whole idea of going to pain management is a bit different, treatment for chronic pain being done by your GP is not the best idea.........it is not their specialty and honestly , once pain has become chronic, you need to be seen by a different specialty, such as pain management.
    My PM is a physiatrist- physical medicine and rehabilitation with a sub specialty in spinal cord injury, and I simply adore mine......
    There are tons of different options available, to treat pain to bring it down to a more tolerable level, and not all of them include more pain medications, but a good pm will explore those options with you, and direct you to more therapies as you need them to get better control over the pain. It is not about eliminating pain , it is about learning to manage it........
    Read the link below my post for some ideas about how the steps work to getting treatment......it might help
  • I believe that I may have finally found a medication regimen that works for me. My PM doctor increased the Duragesic patches to 50mcg/48 hours and only using my TENS unit and Tylenol for breakthrough. It has worked! My pain level has reduced to a more manageable 5/6 on bad days and a 3/4 as a baseline for good days! Although it may not seem as so but I'm using less narcotic pain medicine now. It is a wonderful feeling!
    L1/L2 compression fractures due to MVA in 2000.
  • sandisandi Posts: 6,342
    edited 04/08/2014 - 4:10 AM
    That is wonderful news Jennie.....sometimes, the additions of "breakthrough " meds can be a problem, because someone who doesn't know better or new to pain management thinks that that is the "treatment" when there is more pain.......and it is, but only after you try every other option, to manage any pain spikes, and even then, they should only be used as a last resort, and only occassionally. If you use them "regularly" and that means even once a day, your body will quickly learn to expect that little boost of extra opiates.....and you will soon see that "increased pain levels" are now occurring more and more often and the baseline amount of pain that the long acting should handle is no longer handling it....so you increase it and it starts all over again.
    Chronic pain is always going to be there, so we have to learn to "live" with a certain level of it, and learn to cope, within that level......I am glad to read that things are better, your post reads much happier.....good luck
  • Thank you Sandi. I wish PM clinics would tell you this! Through trial & error over the years I've realized what your saying is very true but I went through so much pain, frustration, even anger with my doctors at the start. You do great work here & it's truly appreciated! ;-)
    Osteoarthritis & DDD.
  • You aren't the only one who has been there and done that.........I developed Reflex Sympathetic Dystrophy after an anterior should reconstruction that went horribly wrong.......I was on more meds than you could imagine at the time, and they kept adding and adding to them----at one point, I was on no less than 18 different medications, most of them opiates of some sort or another.......300 mcg of fentanyl per day, 240 mg of methadone, breakthrough meds in amounts that would astound people today, 3600 mg of gabapentin, soma 4 times day, valium for spasms and contractures ......and no matter what I did, or the doctors did, the pain continued , and continued to escalate.....so one day, I decided I had had more than enough.....so I stopped all of it......boy , those were a rough few days.....not an experience that I ever care to repeat but each time that I talked to the doctor about wanting off some of this stuff, they gave me great medical reasons why that wasn't an option......so I decided it was and did it myself......
    I learned the hard way that less is more when it comes to managing pain, and that you have to use other modalities, no matter how little they offer in the way of relief, they do help, even just a tiny bit....you have to learn to incorporate some of the pain levels into your life.......you know it's going to be there, so work with it, around it, and through it...
    It will steal your life away if you allow it to, and that is no life.....I refuse to let the pain get in the way of living.
  • First off glad that the combination of meds is working for you jennelise83.
    Sandi you are so brave to have done that I don't know if I could have dealing
    with what you were and English Girl I agree with too. I have learned so much,
    jennelise83 from an old lady I am currently dealing with that exact issue.
    I have been in pain for 20 years and my meds were increased time and time
    again, to the point I got in exactly that shape they quit helping. Up to about
    2 years ago they allowed me to do the things I wanted to a point even though
    I would hurt like heck after. Then this past two years it has been a nightmare,
    I was so desperate. The PC at first cut my meds in half right off and I was
    angry as heck too much but now since Step of last year I am down to very little.
    Sandi talks about the pain increasing boy did it ever I had no idea what pain
    I was in. I have changed how I fill out my pain chart I was not at 7 or 8 before the
    med cut, except a few days. I am so passionate about this subject it is hard
    for me even deal with it. People have to control their pain in any way they can
    and then the meds. All the different meds have caused me so many health
    issues and now I deal with them. Once I do get out of this hole I am
    going to watch what I do and enjoy my life but not do things that will cause
    pain that requires more meds. Sorry to go on I just want to tell how it
    can end up. I even like others give up, have got my things in order not thinking I
    could go on or wanting to.
    I hope when I am through with this challenge that my Doctor and I
    can put together a plan to control my pain.
    Sorry I repeat myself I know but I just care about others and only want
    the best for them.
Sign In or Register to comment.