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

Need opinions from long term opiate users

badback85bbadback85 Posts: 15
edited 06/21/2014 - 5:21 PM in Pain Medications
Ok, a quick history. I am 35 years old had bone cancer in left arm as a child (9yrs old) and then had a car wreck at age 16 going 120 mph. I totally messed up my entire spine basically. Went through physical therapy, chiropractic therapy, and was on low levels of pain medication, muscle relaxants, and anti inflammatory medications for two years. I went to the chiropractor 3-4 days out of the week for that two year span until my insurance ran out.

After my insurance ran out I basically just lived with the pain as best as I could and would randomly go to an out patient hospital when couldn't stand the pain and would get a steroid shot and 30 day supply of random medications. I couldn't afford to purchase insurance since I had cancer when I was a child and used over a million dollars worth of coverage. Up until I got married and was covered under my wife's policy all my previous records were used from when I was 16 years old and didn't really know how bad of shape my spine had progressed.

At age 30 I had my first MRI in 14 years of my T section and neck that revealed 5 levels of disc damage in the T section with impingements at all 5 occurrences. I was prescribed lortab 10/500 6 times daily for about a year along with soma. It never really reduced my pain in the T section below a level 7 or so on good days and asked my PC/family practitioner if he could change my medicine. He wanted to cover his back by sending me to a neurologist/spine specialist just to make sure I couldn't have a procedure done instead of increasing my medicine. He didn't think surgery would be a good idea but wanted me to check.

I went to the specialist and he didn't advise surgery since it would be so invasive and would require an extremely long recovery (I am self employed as well). So he added 20mg of oxycontin 2 times daily to my lortab and agreed to let my family doctor continue to treat me. I was worried about the oxycontin since it has been such a touchy subject with abuse. I was surprised that I couldn't even tell that I was taking it after the first week or so and told my family doctor that I was still in horrible pain so he explained to me that he wanted to use as low of a dose of the oxycontin as possible since I'm still young and would eventually build a tolerance to it (this is where I am now confused 3 years later, will get to that). So he switched my dose to 40mg 2 times daily.

I could tell a difference between the 20mg and 40mg doses mainly in the first half of the day. It seemed like the lortab didn't help as much after 2-3pm so he tried switching my short acting medicine to Percocet 7.5mg 6 times daily. For some reason it didn't work as well as the lortab so I went back to the lortab and just dealt with the pain as best as I could. He moved out of state and I switched to his partner and she too explained to me that I needed to stay on the lowest dose of oxycontin as I could manage since I would eventually build a tolerance to it. I truly thought she was the best doctor I had ever seen and took great notes to keep up with my treatments/symptoms. About three months before she was going to quit she put on my prescription that I could take 3 40mg tablets daily as needed and wrote my prescriptions for 65 tablets per month way on the really bad days I could take an extra dose without worrying about running out early once I started seeing her partner when she left.

So I have been seeing her partner for about a year now and he is a good doctor but feel like he treats pain completely different than any other doctor I've ever seen. When he read the notes about how I was prescribed 3 tablets daily as needed and I explained that I didn't want to up the dose he asked if I would try methadone (my wife is a doctor and knew he prescribed it so warned me not to take it if he suggested switching). I just told him that even though I am not getting great pain relief I'd like to just keep things how they are. He was fine with that and I have just continued to deal with the pain like I have most of my life.

Then two months ago my pharmacy finally ran out of the lortab 10/500 and switched me to Norco like everyone else has had to do. I could tell the first day that they didn't work as well as the lortab even though they are supposedly the same formula except lower Tylenol. I thought maybe my body just needed to get used to the switch whatever little difference there is would eventually work out.

Well after 45 days of trying to deal with the non effectiveness of the Norco I had to go get a new ct scan of my t section and neck just to make sure I didn't have new or progressive damage which was causing this issue. My neck had been hurting worse than normal since January of this year and both my doctor and wife figured it was related to my extensive t section injuries. But, the radiologist said I now have nerve damage and disc problems in some sections of my neck (the spine specialist told me that I had degenerative disc disease as well as the injuries so figure my lower back has the same issues that are now present in my newest scan of my neck).

My Dr was not in town when I had the new scan so had to wait a few days to get in but when I did get in I told him about how the Norco was not working at all and that I had a scan that showed new damage to my neck. The first thing I told him was all the medicine I had tried and what worked/didn't work. I asked if could replace the Norco with Percocet even though when i tried the 7.5mg it didnt work a couple of years ago and he said sure. Then he asked about the oxycontin and if I wanted to try 60mg twice daily or just go up to three 40mg every day instead of as needed. I told him I didn't want to increase the mg and he said "why?" I said because I didn't want to build a tolerance to it now way can have relief 10 years down the road if needed to increase later.

This is where he confused me and I didn't even really understand what he was doing until after the appointment. He said well oxycontin isn't like that. You won't build a tolerance to the pain relieving effects of it that it will always work according to all the studies. So I just went with it and said I'd rather have 3 40mg tablets daily than two 60mg way it would be in my system longer (I know it's supposed to work for 12 hrs but I've always felt like after 6-7 hours my breakthrough meds become less effective).

So, I was under the impression he was going to write my new prescriptions as 40mg oxycontin 3 times daily and 10/325mg Percocet 6 times daily. I thanked him and didn't even think twice about what all we discussed until I looked down and saw the Percocet was written for 7.5/325 3 times daily. I knew this was just a mistake on his part and hit the wrong box in the CPU when was filling it out. I waited for him to come out of a patients room and showed it to him and his response was yea that's what I meant to write. I raised your oxycontin to 3 times every day instead of when needed and Percocet is stronger than Norco. My immediate response was that's only half the number of tablets I've been taking for years and the 7.5mg didn't work the last time I tried it. I could tell he was frustrated with my questioning him even though he said well I'll write it for the 6 times this month and go from there. This made me feel like I was trying to manipulate him and am now confused about why he has kept me on 40mg oxycontin since I've told him it works but just enough to get me by that the pain is still at a 7-8 with it along with the previous lortab 10/500 6 times a day.

It just really bothers and confuses me how this past visit went and am curious if any of you that have similar medications have been told either of the theories? I know that there is no way I could even come close to getting by with 3 breakthrough tablets per day with the 40mg oxycontin tablets. I take one as soon as i wake up and am in pain within 2-3 hours every day. So taking 3 by lunch is a given. And, from what I've read I'm considered to be on a low dose for one that has atleast 8 bad discs and all with impingements. My guess is that my lower back has progressed just like my neck if the sensations I'm feeling are telling.

Any feedback would be greatly appreciated. And just for completeness I am taking nerve medication as well and have tried many different medications that supposed to target nerve pain. I haven't found one that "works" yet but do continue to take what I can tolerate as some that I've tried have had adverse side affects, mainly drunk feeling and loopiness.


  • You probably are not going to like what I am about to say, but I will say it anyway.... First, you are using the breakthrough medications all wrong........they are not meant to be taken on a regular basis. Your extended release medications are also known as baseline pain medications. The regular amount of pain that you endure, all day, every day is supposed to be covered by the extended release medications.....not the use of extended release and your breakthrough pain medications. All you are doing is raising your tolerance levels by using the breakthrough medications regularly.

    Oxycontin is notorious for doing exactly what you are describing......not lasting the 12 hour dosing schedule that it was marketed as...it is also known to become less effective and cause a feeling of withdrawal suddenly when the blood plasma levels drop....usually an hour or so before you are due for your next dose. It is those very reasons that I and many others have stopped using Oxycontin as our baseline medication.
    There are many other options for pain management aside from Oxycontin, and it does take some time to find the right combination of medications that work for you. That being said, opiates are not great at managing neuropathic pain. There are many other medications that offer far more in the way of relief than opiates will when it comes to managing nerve related pain. Yes, there are side effects with the use of any medication, but those side effects significantly diminish once your body becomes acclimated to the medication. And these type of medications need to be titrated to effect, meaning that you adjust the dosage until the patient gets relief, without unmanageable side effects. I would strongly suggest that you give them another try and at least one month and one or two dosage adjustments before calling them quit.

    Nerve impingement in what levels of the thoracic spine? While pinched nerves are painful, there are treatments you can do to ease that pain, injections, radio frequency ablation can be done even in the thoracic spine. Spinal cord stimulation, and of course, thoracic surgery if the condition in your thoracic area is such that surgery, despite it's complexity can be done with the right surgeon. Have you consulted with a specialized thoracic surgeon at a major teaching hospital? They deal with trauma induced injury all of the time and are usually the top in their field...It is worth consulting with one or two to see what options there are......

    You are in your 30's and a finding of degenerative disc disease is common at your age. ALL of us will have some findings of DDD in our spines if we are over the age of 21 or so. It is simply a loss of hydration to the discs that occurs naturally as we get older. This does not mean that there is anything wrong with your neck. It is an anatomical finding that is included on all MRI reports if the patient has some drying of the discs.

  • sandisandi Posts: 6,343
    edited 06/21/2014 - 5:21 PM
    What other medications are you currently taking and what doses? What other things are you doing to manage the pain beside taking opiates?
    What other therapies have you tried, and when was the last time?
    What else do you do to manage the pain, aside from relying on the medications?
  • badback85bbadback85 Posts: 15
    edited 06/21/2014 - 7:47 PM
    Thanks for the response! So in your opinion my first two doctors handled the dosages backwards for the intended purposes of each medicine.

    T1 through T8 are all protruding with flattening of the cord, paracentral deformalities of the cord, thecal sac, hemagiomas, and focal marrow signal abnormalities.

    I don't know what some of these terms mean and some were used in multiple different explanations of each disc protrusion. All I know is that I originally had extensive tissue damage as well as the disc problems. Now I assume muscle problems are directly related to the disc injuries. I have a twisted pelvis/lower spine and mild scoliosis but no new MRI of lower back. It gives problems but doesn't constantly hurt like neck and back.

    I understand DDD is very very common and doesn't even mean pain will be associated with it unless there are impingements or other issues that go along with it. My recent scan of my neck has impingements but don't have a copy so can't say what numbers.

    The spine surgeon I saw was highly recommended but don't think was a thoracic specialists. He did day that there were was not enough localization (I believe that's the word he used) for injections to be fully effective. It was too many places is how I understood it. He advised that I didn't have surgery until the day came that I woke up and couldn't walk or move an extremity. I do catch myself not lifting a leg when walking quite often and end up dragging it momentarily. Both of my hands have numbness as well.

    I would have to ask my wife which nerve medications I've taken but there have been a couple which I gave ample time to work and a few that I literally couldn't take more than a couple of days. I drive daily for work and also transport my children. I believe it was gralise and another that don't remember the name that caused the drunk feeling.

    I definitely don't have a preference to any medication since none I have taken truly provide ample relief. They all have just "helped" deal with it but that's absolutely it!

  • I take soma at night only as it makes me sleepy and have done chiropractic sessions but find they are too expensive and addictive since there are many places that can be adjusted with my body. I'm also taking Fetzima for nerve pain that shoots down my left arm that had cancer but I haven't been on it long. No nasty side effects so far though so who knows.

    I have an acupuncture session scheduled on Monday for my first session.
  • EMS GuyEEMS Guy Posts: 920
    edited 06/22/2014 - 2:45 AM
    I had the same problem with Oxycontin wearing off too soon. My doc switched me to Opana (Oxymorphone) which works much better. What I like about it is there is no dizzy effects or anything after I take it. The pain is controlled much better with it. I don't get a full 12 hours out of it, but I also don't have withdrawal symptoms right away either. I do have 10mg IR Opana to take when the ER stops working. This is the first medication that really works (in conjunction with cortisone shots).

    Be real careful about asking for specific drugs! Some doctors will write you off thinking your a seeker. It's good though that the docs you have now know you from your past doctor.

    Best of luck!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • sandisandi Posts: 6,343
    edited 06/22/2014 - 4:58 AM
    I am including a link to our Spine Health glossary. It contains the words you have listed in your MRI, so it can help you understand what the actual terms are and what they mean. If you go to the top of our page, you will see a search box. Or you can look under http://www.spine-health.com/conditions at the top of the page, and you will see a list of the various conditions that can effect your spine.

    Here are a few thoracic links to get you started.


    As far as your pain medications go, usually patients are started with immediate release or short acting pain medications at some point. If the doctors determine that they may need to be on medications longer, they transition the patient to long acting or extended release medications but there seems to be some gap in explaining how to use the short acting medications in combination with the extended release meds and patients wind up doing what you did.......using the long acting but taking the breakthrough or immediate release meds on a regular basis. There are two issues with doing this, the first, is that all it does it raise the patients tolerance and rather quickly.........the extended release medications should replace the amount of immediate release medications you were using prior to the switch....which means that instead of taking immediate release every say 4-6 hours, you are now taking one tablet of extended every 8 or 12 hours depending on the particular medication and dosing instructions..... the second problem is that when the person is really having a nasty flare up of pain, there is nothing to take to help ease it.....because your body has become acclimated to having the immediate release medication on top of the extended release so using the short acting accomplishes nothing in the way of pain relief. Make sense? I don't know why doctors just assume that we understand that when we add a long acting medication that using the short acting on a regular basis isn't what we should be doing, but they do assume it and patients are often left wondering why they aren't getting good pain control....well this is why.
    The use of breakthrough meds should only be used when all other methods of trying to ease the pain have failed........that means, ice, heat, stretching, topical muscle creams and rubs, heat patches or heating pads,warm showers, rest.......if none of those ease the pain, then is when you try to use the short acting medication only if necessary.
    Is it difficult at first to try to ease the pain this way, when there is a bottle of meds sitting next to you? Yes, at first it is, and your body may not be happy that you are giving it less in the way of medication at first, because it has become accustomed to having that extra 6 or so norco/vicoden or whatever medication you are using for pain a day......so the best way to get back on track is instead of taking a whole one, try a half tablet instead for when you normally would have taken a breakthrough medication......you are going to have to use some self discipline in the first two or three days of this, because your body is used to getting that additional medication......when you have stabilized, usually about 3 days, then take that half and reduce it in half, so now you are taking one quarter of a tablet of norco instead....again for another three days or so, then you have two choices, eliminate the quarter tab, or only take one quarter tab every other time period- for example if you were taking it every 4 hours, then try to make it to 6 between taking quarter tab doses.....then extend the 6 hours to 8 hours, then 12 and then once a day or off completely. Try to stay away from taking any norco for a few days. You will see that when you do have instances of flares up of pain, you will find that the norco works again, and you can get away with taking far less of it than you were previously.
    All of that being said, you may want to discuss with your doctor trying a different medication for your extended release......of all of the pain medications that I have taken over the years, I have found that Opana is by far the most consistent in maintaining a steady blood plasma level- and haven't experienced the sudden onset of drop off with it. I know that Keith has but by and large, those of us who have used it have found good pain control, and not needing dosing adjustments nearly as often as with other medications. I am not suggesting that opana is the right medication for you, it may not be, but the problems you are having with oxycontin are only going to continue, resulting in exactly what you are experiencing so far.
    The KEY with using extended release medications is getting to the correct total daily dosage that reduces your pain levels unmedicated by 50%......that is considered good pain treatment. Once you find that dosage for the extended release medications , you will find that your overall usage of both types of medications stabilizes and even reduces. The use of neuropathic pain medications is another percentage of managing the pain. Lyrica, gabapentin, topamax, cymbalta, and other medications in those classes are wonderful for the management of neuropathic pain. Yes, the side effects are part and parcel of any medication but again, those usually disappear once your body acclimates to the medication. And again, the key to success with those is sticking with the medication to find the right dose, while not letting the side effects overwhelm you. It does take time to get to the right dose, so you have to stick with it, unless there are true allergic reactions. When you mentioned feeling drunk I am guessing that it was Lyrica that you tried. Were you started at a low dose, then tapered up slowly? Muscle relaxers are only good when you use them consistently. They are not meant to be taken on as needed basis. They aren't meant to be sleeping pills, they have to be taken as directed in order for you to see the benefits of them. Then the use of other methods to ease the pain, swimming, excercise, strengthening, walking, ice, heat, massage, TENS, heat patches, rest, yoga/pilates or whatever works for you is the other part. Believe it or not, most of us learn to live with a certain level of pain, and learn to work around it.....That is part of the journey of having chronic pain, is learning to live with our new normal and learn how best to keep that pain from flaring up as much as possible while still living our lives as best we can.
  • badback85bbadback85 Posts: 15
    edited 06/22/2014 - 5:28 AM
    Thanks for the input. Maybe I can explain to him that he is trying to treat me in a different way than his previous partners and that will clear up the confusion going on between the two of us. I had never read anything about oxycontin specific usages until this incidence. I was under the impression he was wrong but maybe he's correct. He just didn't understand that the oxycontin by itself wasn't prescribed correctly since it was just used to increase the effectiveness of my breakthrough meds in my case which will not work like he tried to use it. I've told him I'm open to try anything just like I've told every other doctor I've seen but they seem to use morphine, oxycontin, and the patch exclusively from what I can tell.
  • badback85bbadback85 Posts: 15
    edited 06/22/2014 - 5:39 AM
    Gralise was the one that I couldn't tolerate at all. I took the lowest dose with drunk sensations lasting for 24 hours both days. I don't remember the other one.

    And thanks for the information! It does make sense now that I'm researching it.
  • sandisandi Posts: 6,343
    edited 06/22/2014 - 5:42 AM
    It appears that one of you misunderstood how the use of extended release medications is supposed to be used. ER medications are not ever used to increase the effectiveness of short acting ( SA) medications. It is exactly the opposite......ER medications are used to treat baseline levels of pain...and the dosage is usually increased to a level of reduction of 50% of unmedicated pain levels.....the other types of medications/treatments are used to treat the other 50%....physical therapy, TENS, excercising, neuropathic pain medications, over the counter creams, ointments, rubs, heat patches, stretches, and muscle relaxers. It is the combination of all of those things, that reduces that other 50% as much as possible.. The SA meds are used to treat significant spikes in pain, occassionally...
    Read the Do's and Don'ts of Pain Management and the What to expect threads that I linked earlier......they might help , and it might help to print them and bring them with you to the next appointment and talk to the doctor about this.
    There are other medications besides Opana, morphine, dilaudid, Nucynta , Tramadol, fentanyl, bupe patches, and others out there so there are many other options to try to get better overall pain control
  • badback85bbadback85 Posts: 15
    edited 06/22/2014 - 11:10 AM
    Yes I'm sure a Thoracic specialist would have different opinions than a general spine specialist but the degree of the procedure will still be very invasive and put me out of commission for a really really long time with an infant, 2 year old, 7 year old, and self run business. Not only that but my injuries above and below pretty much cover 70% of my spine so they would need surgery too from what I've been told. Once the t section is addressed the other discs will need attention sooner than if didn't correct the others. This is just an opinion from a family physician that has experience in many fields so could be exaggerated a little but probably some basic reasoning behind his theory.

    I've tried pretty much every pain medicine listed in this thread except the Fent patch and opana. I've used many muscle relaxants as well and they "all" make me tired so have stuck with the one that affects me the least and only use it after I'm done driving for the day unless I absolutely need to take it. Muscle spasms are a real stubborn ordeal that are present 24/7; although, some are worse than others. My past chemo treatments caused muscle cramps/spasms and they have been part of my life since I was 9. The ones that debilitate you and literally cause your entire body to contort are impossible to manage. I just have to sweat them out until they go away. They are normally located on my shoulder blades or below them. Sometimes they wrap around my body around the rib cage but I've never found anything that decreases their intensities or their unwarned accurances. I have had a tens unit but never received noticed any relief from it. I have a cream that my pharmacist made for my neck that will gradually relax the muscles enough to allow me to adjust my neck but it has anti inflamitory ingredients in it so don't really like the idea of using it 4-5 times a day even though I have done so quite frequently. I'm really hoping this acupuncture session will provide good results. I'm terrified of needles and could pass out from blood draws. Maybe keeping my eyes closed and trying to meditate will put me in a good place during the session.

    I have been searching for the answer about oxycontin and other extended release medications resilience to tolerance like my doctor told me during my last appointment but can't find any trials or studies that support what he said his research has shown. I just don't see how one can build a tolerance to hydrocodone or oxycodone in the lortab and Percocet forms but not build one to the long lasting forms of the medication. Any sources or links to read about this?
  • medical fact.......there are methods to attempt to manage tolerance, but that is generally changing opiates peroidically to help manage tolerance, or what is called a medication holiday, usually a few months in attempts to reset the receptors, which doesn't work all that well , especially if the same medication is restarted at a later point.
    As far as the muscle relaxers go, again, like with any other medication, used to treat pain or any other medical condition, there are side effects.The drowsiness that often accompanies the use of muscle relaxers quickly disappears in a week or so. As I stated in the Do's and don'ts thread, you need to stick with the medication long enough to get past the side effects.
    There are two areas when adding or changing medications, one is working through the side effects to see where you end up, usually those side effects, diminish or disappear completely within a week or two......the second is allowing enough time and at least one dosage increase to reach the desired level of relief....sometimes, it takes more than one dosage adjustment to reach that magic dose.
    While family practioner's are versed in various conditions and systems of the body, they are not the best equipped to determine whether or not you need surgery, nor what type of surgery you may need.
    Thoracic spine surgery is a very specialized field, and until you consult with the proper surgeon, you have no idea what surgery , if any you would need or even if surgery is an option.
    If there is in fact nerve damage involved, the longer you wait, the less likely for a good outcome and you can risk permanent damage to the spinal cord or paralysis. It won't hurt to find out what options there are for treatment, other than just medical management.
    You are only in your mid 30's now, so what happens in 10 years, when the medication amounts reach a level that no doctor is willing to write for, or your condition has deteriorated to the point that no surgery will be offered that might have alleviated the symptoms if done earlier? It is something that all of us need to consider, is the risk of avoiding surgery worth the potential price to be paid later?
    Until you know for sure that you have issues in other areas of the spine, you are guessing at the potential need for surgery. There are many of us who have issues at all three levels of the spine, myself included, not all of them require surgery at this point, but if that need should arise, we all have to make decisions based on what is found.
    I think that your concern about working is valid, however, trying to mask the symptoms with the use of medications may not be the best solution, and leave you in far worse shape down the road.
  • So he is wrong with the part of what the other doctors told me about staying as low as possible on the extended release way there will be room for increasing the dose down the road. My previous two doctors told me that but used breakthrough meds to keep the dose low. My current doctor says that isn't true and that they will never lose effectiveness and that's why he would rather increase the oxycontin and lower the breakthrough (which from the replies on here is correct way to treat with the medicine) but he is wrong in thinking the tolerance will never come into play?

    Yes I've seen one surgeon (spine specialist not thoracic) but is highly regarded among his peers that said to wait on surgery. I know a second opinion could be totally different but could also be the same. There is another surgeon in Nashville that I could see if there aren't any Thoracic surgeons near me. Will have to ask my wife if she refers to any thoracic surgeons. She is a family medicine doctor and partner of my doctor and uses oxycontin on patients in a more similar way to my previous doctors for purposes of tolerance build up. She disagrees with my doctors thoughts on that too.

    I know you think that just because I say a medicine makes me have certain side effects that I haven't given it time. That is not the case with some of them, mainly the muscle relaxers. I've been on soma for at least 10 years ( regularly for past 4 years) and to this day it still makes me drowsy.

    There are indeed other injuries in both my neck and lower back but my lower back hasn't been scanned/MRI since the original injuries accured but they are there just not to the point of chronic pain (just flare ups). The neck was scanned recently and reported worsening of nerve disease.
  • And just to make things clear, when I say the relaxants make me tired I don't mean like a body buzz or really heavy eyelids just relaxed and somewhat tired. I have never drank and drove and know that I could after only a couple of beers but I'm just extra cautious in every day living so choose to wait until wont have to drive before taking a medicine that does change my bodily functioning in a tired way.
  • roadiezrroadiez Posts: 5
    edited 06/23/2014 - 4:26 AM
    I know that more & more doctors are opening up to alternative medical treatments. Hopefully you will find even a 10% relief. That alone would be a +. If it is sustainable then that is even better.

    I have been on Lortab for 6+years & recently was moved to Morphine ER for the last 2 months. Now I am going to Percocet due to the side effects of the Morphine. I am also taking Gabapentin,Flexeril, Topamax. I am looking at at least 1 or 2 more surgeries in the very near future due to a hardware failure.

    I am not sure what is in store for me. But just as you am worried about the building up of tolerances. I have heard of many horror stories from others about being cut off basically from their meds. A lot of PM Dr's are so scared now of losing their DEA Lic. With states preaching so much about Rx drug OD. They(doctors) are just running scared in so many instances.

    Again I do hope that the acupuncture helps some for you.
    I do see that you are close to Nashville. Have you tried going to EDITED to see if there are any experienced Thoracic Surgeons?

    Post edited by Sandi- Please see the forum rules at the link below for more information.
    You agree not to post specific physician names or health care facilities , devices or product names on Spine-Health.com.


    5.10 You agree not to post specific physician names or health care facilities names on Spine-Health.com.
    Surgeries: 4/13 anterior channel vertebrectomy with strut graft C4-7 followed by ACDF C4-7
    Posterior cervical disc fusion C4-T1 with instrumentation and right bone iliac crest

    Now Broken screws & fail fusion at the T1 level all other level fused
  • sandisandi Posts: 6,343
    edited 06/23/2014 - 4:39 AM
    He has it backwards.......the extended release medications are meant to be used to manage your day to day pain levels and the dosage needs to be adjusted to do that......not eliminate the pain but reduce it to a manageable level. Then the use of breakthrough meds may be added, but how you use them is important as we discussed earlier.
    For minor increases in pain, using ice, heat, heat patches, topical creams , ointments, taking a break from whatever you were doing that led to the increased pain, whatever works to ease it before it spirals into a true flare, is what you need to do. You have to learn to incorporate and change how you do things, to take more frequent breaks, to get out of the car if driving causes the pain to escalate....stop, get out and walk around for a few minutes, during long drives, stretch, get some regular excercise, whatever it takes, swimming....
    If those things don't work, or have failed and you are having a significant flare up of pain levels increase, don't wait until it is out of control, but try half of a tablet of your breakthrough meds to see if it is going to help.....if it does, great, if not, wait a half hour or so and then take the other half only if absolutely necessary.
    Remember the discussion earlier about using breakthrough meds properly.....
    Soma is an old muscle relaxer that is not commonly used anymore, because of concerns about addiction and abuse of it....being on it 10 years is a long time, so it might be worth considering that changing to another similar type of muscle relaxer that you can take during the day, that doesn't make you drowsy or sleepy might be worth trying. As I said before, all medications have side effects and most of them will disappear when taking with regularity.
    Going to see another spine surgeon who is not a Thoracic spine surgeon is going to result in your being told the same thing, that the surgery is too complex.....you need to go to a large medical facility near you or nearby, to consult with a thoracic surgeon. There are several facilities near Nashville that might be worth looking into. You may even be able to search on their websites for a surgeon since most major hospitals list their doctors on the website, along with their medical specialities. Or you can call and ask for a referral.
  • Yes the entire procedure described to me (ribs, lung, other organs) was basically insane to even think about. Then on top of that what if there were problems or it didn't relief the majority of the pain? Just way too far out there for me. I went through too many procedures as a child and it has affected me to this day. Walking into a hospital (other than my wife's office which took a few years to acclimate) brings such anxiety to me that I am a wreck. Bone marrow harvest, collapsed lung inflation, marrow draws, infection that literally killed me one time, multiple surgeries all at the age of 9 just did a number to me. I freak out with any test or any type of medical atmosphere.

    A dramatically less evasive procedure atleast proves there are newer more advanced options.
  • Well acupuncture therapist was rather impressed with my back. Gave the spill about how could reduce pain and release tension throughout back before had me lay on the bed. Once she started the session she couldn't stop talking about my muscles and their tightness.

    Who knows if it will provide any help but will continue with a few sessions just to see. It wasn't bad other than having to lay flat on stomach. That was a little uncomfortable and the worse part of it. I could only feel a couple of the needles penetrate the skin, none on my back/neck just ears and behind knees were only places that felt.

    I don't feel any different afterwards that I can tell and have a weird scent from the oil lingering around me.

  • josbornejjosborne Posts: 86
    edited 06/26/2014 - 7:46 AM
    @badback, in regards to muscle relaxers, have you tried skelaxin? its a mild muscle relaxer, im also insanely sensitive to them and its the only one I have found that doesnt make me tired at all, I can still drive, take care of my kids, etc. I would mention it to your dr. Its a little pricy, with my insurance I think it was like $15 for 60/tabs, without insurance I believe it was around $250 but its worth it to stay awake lol
    (12.24.13) L2-L3 Laminectomy, Discectomy and Coflex insertion. DX'ed with Ankylosing Spondylitis on 5/13/14
  • peacelovehopeppeacelovehope Posts: 10
    edited 06/27/2014 - 6:47 AM
    Do you fill out a form when you see the doctor detailing your pain, what works (heat, cold, exercise, rest, etc) , what makes it worse/better, & what % of pain relief you get from your meds? The location of your pain, etc? I have a excellent Dr who keeps a file of this. It helps him keep track of what is & isn't working. For instance, what percentage of relief do you get from your meds? My Dr explained to me the goal was not to be pain free, but to have a better quality of life, or SOME quality of life for some people. It sounds like you've been in a lot of pain for a long time, but you are still able to function? What percentage does your meds increase your functioning? Is another question my Dr asks. Like everyone else in PM, I take a long acting medication, then something for "breakthrough" pain (I just call it pain) for the times when either your long acting medication isn't working as well, or you are having more pain than usual ( for me it's bad day, usually overextending myself ). Breakthough meds are prescribed at least several times a day to take as needed. They don't increase your tolerance any faster than any other opiod medication, and it's a given that you take as little as possible. Generally, if warm baths, topical creams, etc decrease your pain significantly, or you haven't tried PT, TENS, etc you probably don't need opiates at all. It's assumed taking opiates to decrease your pain is a last resort.
    I would be concerned about the amount of Tylenol you've consumed over the years, has your Dr addressed that or have you been tested? That amount of Tylenol can do irreversible damage to the liver.
    My experience has been that my tolerance is affected by taking the same thing for ER & IR, because you're taking the same med in different forms. The trick is finding the combination that works for you. I took Opana Er & IR, until they changed the formula it gave me horrendous stomach problems (I think they fixed that, because people were passing the pill intact), I've never reacted well to oxy ER, but haven't taken it since 2000, then 30 mg of MS CONTIN 3x a day with 15 mg oxycodone 4x a day for breakthrough pain, & I was on that for yrs. Most people do better on other things, so everyone metabolizes & tolerates different meds very differently. After some years on the same meds, you build a tolerance & need to change meds. Last month I switched to fentanyl simply because I've been on morphine for so many years. Also, I like to cut back on my BT meds occasionally so they don't lose their effectiveness, which they will after 3 yrs!
    If you have neurological pain, I would strongly suggest finding 1 that works for you. I personally find no matter what opiate med I take that it doesn't work without my neurontin, gabapentin. It used to make me loopy, but I adjusted to it. I know you said you drive your children, so I guess you would need to find a way around that situation. Not all of them may have that effect, I've never tried another because gabapentin works well for me. I got loopy at first, but if I had started at a lower dose & increased more slowly, I wouldn't have ( my psych dr who prescribed it isn't that great ). So I just didn't take it or took less if I planned to drive.
    I'm of the opinion your 3rd Dr wanted to cut back on your BT meds because perhaps he didn't want the responsibility, most new Dr/patient relationships are like that, even though he was familiar with you & your case, the relationship is new. It's possible he was concerned about the Tylenol.
    Sorry if I rambled, sleep deprivation makes me do that! 2 babies 4 & 2yr old is throwing a fit quitting the bottle & waking up all night, I need to be on a child forum since I can't post my question here, lol.
    Whatever the case, I wish you luck J
  • If tolerance was/is your major concern, if you are willing to cut back on your BT meds & live with a certain amount of pain, which is mostly mental and I think you've already proved that you can, I wouldn't worry about it. People go indefinitely in PM. I've been in PM since 2000 in 1 form or another, and 30 mg morphine 3x a day plus 15 mg BT meds 4x a day is a reasonably low dose. Studies have shown that the pleasure part of the brain does not get stimulated when opiates take the edge off of a chronic pain patient, that's why they/we become dependent but not addicted. If a pain patient has unrealistic goals of being pain free, then he/she will have trouble. 95% of people who become addicted to opiates first used them recreationally, so if you're honest with yourself, the chances are pretty low.
  • After a lumbar fusion and all the pain that followed, I researched and found the Butrans patch, which changed my life. Together with Tramadol for IR, I am active again. It might be worth you looking into.
Sign In or Register to comment.