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Starting to wonder if I even need narcotic pain meds anymore

LC84LLC84 Posts: 599
edited 04/07/2014 - 4:44 AM in Pain Medications
Sometimes it can be difficult to differentiate, nerve pain, from joint pain, to deep muscle pain. All my Dr suspects I'm dealing with. I keep a log of my symptoms and most if them seem to be nerve pain related ( I think?). I'm currently switching from Lyrica to Neurontin for nerve pain, the Valium helps relax my muscles and reduces spasms, but I'm also taking Percocet 7.5-325 mg every 6 hours. I've been on Percocet pretty consistently since last July and it use to help at least take the edge off. My pain has worsened over the past several weeks ( my surgeon will increase my Neurontin once I'm completely off the Lyrica if no improvements) but the Percocet doesn't seem to touch the pain like it used to. I have backed off from taking it every 4 hours to every 6 hours. I plan on discussing my pain meds with my PCP this week but I don't know if I need to try a different pain med or just kick it completely since narcotics don't help with nerve pain. I know that no one can answer this question or advise me on what I should be taking, I'm just not sure I even need it anymore. Maybe my body has built somewhat of a tolerance to it. My mom is a nurse and said that sometimes pain meds are more effective if you take them before the symptoms reach such an intense level as apposed to taking them when the pain is already hitting full force. Even when it does help some it doesn't seem to last very long, sometimes 20-30 minutes of very minor relief. I don't expect much advice, I just feel better writing out my thoughts.
Progressive DDD
Osteoarthritis
Chronic S1 Radiculopathy
Discectomy L5-S1 2002
Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
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Comments

  • dilaurodilauro ConnecticutPosts: 10,045
    when pain medications provide a level of comfort or take the edge out of your pain, but dont really reduce it that much.

    I was at that point a couple of years ago. I was just tapering off from Oxycontin and was on Oxycodone 5mt IR as my primary pain medication. I was taking on my worst days 8 to 10 tables, but my norm was about 6. I dropped down to 4 and really didnt see much of a difference. At the 4, I still have daily pain, but the medication does what I want to do and help me get through the day.

    My physiatrist and I are now dropping it down to 3 a day. I see this as a very good thing. I know my body will adjust to this. The times I generally need pain medications are after 7:00pm. Thats when the 'melting/slashing' pain starts in my arms and legs. Dont know how else to describe it. I need to walk around and keep on rubbing my thighs and shaking my arms. Laying down or sitting is worse. But when I take 1 tab, 30 minutes later I am ok.

    I want to get down to 2 pills. I asked my physiatrist if that will become my norm. She said its hard to tell. With the number of surgeries and flares up I have had since 2006, I really havent had a norm.

    Sitll she feels that for many low dosages (which Oxycodone 5mg is) on a daily basis might be the norm.

    What your mom said is so true. If you take the pain medications before you are having intense pain, you will probably bypass that pain, if you wait until that happens, 1, 2, 3, or 4 pills will probably not help. But how do we know when that
    intense pain is going to happen? I think for post surgical patients, you can figure that out.

    But for long time chronic pain sufferers , its a bit different.

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I have a great, well established relationship with my doctors. I know from past experience that I can say 'I want to titrate down on this med to see what good it's actually doing' & my PM will support my decision..and importantly he will let me change my mind! I don't like taking any meds but sadly there are those I just can't function without a little of. If you consider it in terms of 'spoon theory', I don't have enough spoons no matter what I do. My level of narcotics gives me a few extra spoons.

    In an ideal world you should be able to do the same as me but I'm aware that you're in the process of building new relationships with some of your specialists. I'd be worried that if you make this decision & live to regret it you could have trouble getting your meds back. I'm just being honest. I don't like it but in your position I'd try titrating down on your own & see how it feels. Be aware you could have a little increased pain just because of withdrawals. You're just getting over surgery, take things slow & steady. I know it's hard. ;-)

    If you can get by without meds that's great! I wish I could. I know you're just thinking through ideas. This is just my take on it.
    Osteoarthritis & DDD.
  • For the past few weeks the pain has been constantly intense. Instead of giving a number, I can tell you that I haven't been able to do any normal daily activities. I spend a lot of time off my feet but push through the pain to make frequent walks around the house. I try stretches but some have caused my leg to go numb. The pain can hit full force even when I'm off my feet. I don't know when it's going to go from bad to worse unless I'm on my feet for too long. That's why I'm EXTREMELY anxious to try other treatments. I'm up for anything at this point to get the pain under control so I can be more active. The last thing I need is to cause more problems by not moving enough. I'm hoping the combinations of increasing the Neurontin and the SI Joint injection will provide enough relief to start physical therapy again. I forgot to mention that I take ibuprofen 800mg 3x daily, per my surgeon's instructions to help with inflammation.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • sandisandi Posts: 6,302
    edited 04/07/2014 - 4:32 AM
    It may be that the neuropathic pain is one big part of your overall pain picture and once you get to the correct dosage of gabapentin, you might find tremendous relief .......battling nerve pain is one of the toughest ones, simply because most of the mechanical pain we can treat rather easily- reduce it most times, neuropathic is a bit different and it is difficult at times to get a handle on and because it is relentless, it seems to be more draining. At least it was for me.
    As far as the percocet goes, it may very well be that you have become tolerant to it......and waiting for the pain to get high, then taking the med, isn't really all that useful simply because by that point, it is more difficult to control
    What might help if I may is suggest it, is that if the percocet is not lasting as long as it once did, why not try cutting the tablet in half and taking one half a tablet every ( whatever your dosing schedule is- take 1/2 tablet half way through your dosing schedule). for example if you are supposed to take one tablet every 6 hours, try taking 1/2 tablet every 3 and see if that helps more.....
  • I appreciate the input. I've read the spoon theory, my spoons are limited. It just makes it more difficult when there are multiple problems.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • LC84LLC84 Posts: 599
    edited 04/07/2014 - 4:42 AM
    I think I will try that and see how it goes. I appreciate your advice.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • I know, I really do. It's horrible when you reach a 'still point', you want something to change, anything! So you can start to move forward & hopefully away from the bloody pain! Are you working on any 'alternatives' while you're waiting, or is that not your thing? Have you tried aromatherapy, visualization, heat & slow stretches..really feeling your body & trying to distance your mind? I know you've got my husbands terrible muscle problem..that's as bad as sciatica, I understand your pain. If you can just get that moving again, even in a little way it will take so much nerve pain away & at least you'll know what you're left with.

    Sorry, I know I'm combining a number of threads here but it's all so connected. ;-)
    Osteoarthritis & DDD.
  • It's still the same amount of percocet just taken a little differently but sometimes it does help. I hope it does in your case.:-)
  • LC84LLC84 Posts: 599
    edited 04/07/2014 - 6:40 AM
    I'm also dealing with nerve pain from damaged and other irritated nerves according to my surgeon. I've tried stretches, the last time I did a hamstring stretch my leg went numb, I've tried deep message of my left buttocks and sometimes it makes the spasms/radiating pain worse (could be coincidence I suppose). I walk, even though it hurts. I don't know if I'm doing more harm then good. I use my heating pad a lot. I've made it through this pain so far without going crazy. I do different things to divert my attention away from the pain. So yes, I'm not one that can just do nothing while I wait.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • LC84LLC84 Posts: 599
    edited 04/07/2014 - 5:59 AM
    Sandi-I hope so too!
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • Have you tried aqua therapy at all? Just the warm water alone might help your muscles feel better. Doing exercises in the water was wonderful for me. I hated having to get out of the pool.

    Keith
    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • LC84LLC84 Posts: 599
    edited 04/07/2014 - 4:22 PM
    No I haven't. I don't have access to a pool at the moment. I just worry about setting of a back pain flare by going from no pressure on my back while in the pool, to added pressure when I get out. The last time I was in a pool, once I got out I felt the added weight, then the back pain took me down to the ground. Could have been a coincidence but it's not a pleasant memory. That's also when my nerve pain started again. I'm sure I will get back in at some point. I have soaked in a hot bath to help relax the muscles.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • thoracic spine painthoracic spine pain Posts: 566
    edited 04/07/2014 - 12:36 PM
    When my pain meds started not working for the twelve hours they are supposed to, I took them earlier, after 8 hours, so I would have 16 hours relief until I went to sleep. I do have sleepers that work. That helped me get through the day. The only problem is that you wake up in the morning with pain and withdrawal symptoms, but as soon as I took the morning med - about 45 - 60 minutes later the pain and withdrawal symptoms go.

    It was much better than being in pain for four hours during the day. Lying down with a hot water bottle in tears and pain while waiting to take the next pain med. I did that for a couple of years until I worked out I could sleep during the night so didn't need them when I was asleep. I don't want to increase the meds. I've had this for a long time now so had to work out a strategy where I could function during the day and this worked.

    It's a way I don't have to increase my meds as now my body is so tolerant to them. I have been able to cut down daily 40mgs of the meds. As everyone said once the pain hits really badly it's too late - no matter how many meds you take they don't seem to work, better to take them as soon as the really bad pain sets in.

    I learnt this from this site - I didn't realise - even though I knew that the meds weren't as effective when I had the pain for hours before taking anything.
  • LC84LLC84 Posts: 599
    edited 04/07/2014 - 2:31 PM
    I appreciate the advice. I don't always sleep through the night. Sometimes I do, but it's common for me to be up every couple of hours or so. I usually plan my meds to take them before I go to sleep so I can at least try and be well rested. Unfortunately that's not always the case. I haven't asked about any sleep aids, but I really don't want to take on any additional meds until I get through the transition from Lyrica to Neurontin.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • The fact that your pain has worsened lately and now your meds aren't helping as much sounds more like tolerance than you not needing the med anymore. I'm in the same situation. My pain got worse and my med is making only a very small difference now. Maybe you could ask your doc about a long-acting med. I have heard they are better for chronic pain because one does not build a tolerance as easily. Don't ask me how that works.
  • LC84LLC84 Posts: 599
    edited 04/07/2014 - 4:26 PM
    I currently get my pain meds from my PCP but I'm in the process of finding the right PM Doc. I have a really good relationship with my PCP. I have an appointment this week and planned on discussing options including what I should be taking in the meantime for proper pain control. My pain has worsened since my last visit so I'll see what he recommends.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • So my PCP thinks I should continue the Percocet at this point until I find the right PM that may to want to adjust what I'm taking. I suppose the little bit of relief I can get from it is better than nothing. He also started Celebrex to see if that may help with inflammation since other NSAIDS I have tried ( Meloxicam and ibuprofen) haven't really helped. I'm hoping the increase in Gabapentin will help more than anything. The Valium really helps with my spasms but my Surgeon seems apprehensive to continue it long term. Skelaxin didn't help in the past so he may decide to try something else. I'm still figuring out the right mix of meds to provide me the most relief.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • dilaurodilauro ConnecticutPosts: 10,045
    Many doctors are not going to want to prescribe Valium for a long time. It can be very addicting. There are so many good muscle relaxers out in the market. Some of them ,

    • - Flexeril - Knocked me out and felt I was drunk the following day
      - Soma - Works well, can be addicting
      - Zanaflex - Very good, but at times I could be half a zombie
      - Baclofen - Very effective, dosage can be played with. (my choice, also what I am taking now)
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • The Valium has helped with the spams without making me feel zombie like or strange which is why I like it. I understand why he wouldn't want to continue it long term. It's unfortunate that it can be addicting because it helps me with no side effects. Maybe another one will be just as effective. I appreciate the information, it's very helpful.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • My surgeon wants me to try Flexeril- Since everyone is different I hope I don't have the same symptoms you did.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • I've been taking Tizanidine for about 4 years without any problems but I think I might be getting a little tolerant. ;-(
    Osteoarthritis & DDD.
  • & have not had any side effects. I've had a prescption for eons, but don't take it on a regular basis. I have usually taken it when I've had a migraine, because my shoulders & neck get so tight. I've taken it a few times for my back when the pain has been unbearable, on top of 800 mg of Motrin. My pain meds are limited to 2 Norco which doesn't cut it at all on a really bad day. Does it help? Not much, but I'll take any little bit I can get, because the alternative is the ER, & we all know how useless that is,
    We can't always control the cards we are dealt in life, but we can control how we play the hand
  • I've always been told to take my muscle relaxants consistently because they work better when the medication has built-up in our systems. Maybe someone with more medical knowledge can answer...

    I get far better pain control with both muscle relaxants & narcotics. Either alone doesn't help as much.
    Osteoarthritis & DDD.
  • I've always taken mine together on a consistent basis. I don't know if taking it consistently makes a difference depending on what kind you're taking or not. The dosing on my new muscle relaxant is 3x daily whereas the Valium I could take 4x daily. I just hope the Flexiril is as effective as the Valium. And I'm sooooo happy to finally be done with the Lyrica and start the next Gabepentin increase today ( fingers crossed). QUESTION- should I turn in my remaining Lyrica when I see the PM doc? He originally prescribed it and I have a bunch left.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • I usually do because I've got little kids & don't like meds hanging around. I also read an article that convinced me not to flush them down the loo! You know you're never going to take them again...

    When it comes to narcotics I always take the old ones in when I change. My doc never told me to but I think it creates a better impression & the nurse keeps a log so both ours bums are covered if he's ever investigated or anything.
    Osteoarthritis & DDD.
  • I'm so pleased for you! Lyrica made me feel terrible too. I hope things go really well with the Gabapentin. It made me feel a little tired & spacey but that passed in a couple of weeks. ;-)

    I've never taken Valium. Is Flexiril another name for Cyclobenzaprin? I found that very effective but more soporific than Tizanidine. We're all different though..
    Osteoarthritis & DDD.
  • I've been on Percocet for 2.5 years and am currently taking 10-325 3 times a day and it isn't really working for more than a couple of hours. By the time bedtime rolls around I've had my limit for the day. I take something for arthritis, but it isn't much help. I go back to PM tomorrow and had an MRI taken last week so I'll see what he says. My no-fault case is just about out of $$, so I'll have to go through my personal medical for anything else they want to try on me.
    Diagnosis: Thoracic facet syndrome & cervical and thoracic radiculopathy from car accident trauma.
  • Yes Flexeril is another name for Cyclobenzaprine. Hopefully it won't knock me out. My goal is to get to a level of functioning not vice versa :) Valium never made me drowsy, it just did it's job by reducing the spasms. I will take the Lyrica in since I have no use for it and don't feel comfortable disposing of them. I have 7 year old twins but thankfully my family has rallied to help me take care of them while I get through this bump in the road. They are old enough to understand and take it easy around me, and they aren't allowed in my room unsupervised where my meds are kept.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • LC84LLC84 Posts: 599
    edited 04/10/2014 - 5:51 AM
    I've adjusted my Percocet to take before bedtime. Getting through the night is more important for me then getting through the day. But I'm able to take it easy throughout the day so I'm not sure if that's your case or not. I hope you get some answers from your MRI, I know it can be tough financially to keep up with everything, especially for those out of work. I'm so ready to back to work it's driving me crazy!!!! It's possible you have built somewhat of a tolerance being on it that long. Maybe you need some med adjustments including the one for your arthritis? Might be something to mention to your Dr.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • So I started the Flexeril yesterday and it made me feel awful. It was partially my fault. Dosing said 1/2-1 tab 3x daily. I had trouble cutting them in half so I took 1 pill 2x yesterday and it was horrible. I finally was able to cut them in half so last night before bed and this morning I only took 1/2 tab. I'm still not happy with the way it makes me feel ( dizzy and nauseous mostly). I've taken it with food to help with nausea but the effects are still unpleasant. I may be calling my Surgeon's office today :(
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
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