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.