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About three months ago I had a discectomy and decompression on my lower back from an injury I had in 2009. I had been in constant pain for over four years. Since surgery I have been prescribed 8 Percocet 7.5/325mg daily for pain. The surgery did not help, if anything it got worse. I just began pain management last week and the doctor put me on Opana ER 5mg - one daily with two 10mg Oxycodone HCL for break-thru pain. The second week he says to take two Opana ER 5mg every 12 hours and one 10mg Oxycodone HCL for break-thru. Since I started it has been the worst pain I have been in for a very long time. I have fallen several times because of leg weakness and have trouble doing everything, even walking around the house. I fell down the steps to the basement last Friday and my wife called the nurse because I was in extreme pain and this guy didn't even care to call back. His nurse called us on Saturday on her own behalf and sided with me and could not justify this doctor's plan. She said she would talk to him but I said don't bother because I am leaving. My attitude has become worse and worse. I have three year old twins that are my absolute life and since I began pain management they don't even have the same Daddy and I feel like giving up. I have done some research and it seems like this is a LOW LOW dose all around of any relief, especially for someone who has taken Percocet everyday for years. From what I can tell this doctor cut my relief by about 60% and what I though was going to be a new beginning for me has turned into nothing but me withdrawing from everything and everyone in my life. I am considering switching doctors because not being able to do anything physical cannot be healthy and to me it seems I am being under treated in a big way. Am I right? Any opinions would be so appreciated.


  • sandisandi Posts: 6,343
    edited 06/30/2014 - 12:34 PM
    when converting a patient from an immediate release medication to an extended release medication, which is also a different type of opiate for there to be a reduction for cross tolerance in dosage. What your doctor did was considered a good safe practice. He started you at a low dose to make sure that you weren't going to have any negative reaction to the new medication, and started you on the lowest dose, and considering that you are a new patient to him, and new to this medication. He also increased the dosage of the oxycodone to 10 mg per tablet, to cover the loss of the percocet strength, while tapering you onto and over to the Opana. Then he allowed for your body to adjust before increasing the dosage of the extended release medication, while lowering the amount of breakthrough dosage, which is also exactly what he should have done. He also, in a weeks' time, raised the dosage of Opana to a dose that should have covered what you were previously taking of percocet/oxycodone.
    I don't see how you think that you were lowered in amount of opiates some 60%, when he increased your overall opiate dosage total intake per day.
    I'm sorry that you aren't happy with what he did, but what he did was exactly what he and any other pm doctor should have done in the same situation. Patients aren't given straight conversions, because a new medication should be introduced at the lowest dose to make sure that there aren't negative reactions and it may act differently than the old medication so a reduction for cross tolerance is perfectly normal.
    It takes time to get to the correct dosage for any one on pain medications, and finding the right combination, in the right dosage is time consuming and takes patience and work on the part of the doctor and the patient.

  • What Sandi says is my docs approach. When I experience tolerance I change to a different medication because I can take a lower dose of a different narcotic with the same or slightly better results. This is part of the European Union & English guidelines for narcotic therapy. It makes a lot more sense to me than ever escalating strengths of the same medication. I recently changed to Opana ER & my doctor started me on the lowest dose 5mg tablets. My breakthrough medication was increased though but my doc knows me & my reactions very well.

    You're new to both of those narcotics. I think your doctor was just adopting the safe, standard approach. I know what it feels like to go month after month titrating to an effective dose of meds. It's incredibly hard & frustrating sometimes but it really is the safest way to do it. Your liver will be grateful to have a break from all of that Tylenol. ER meds do feel very different from IR meds, because you don't feel them working it takes a while to get used to them. Are you not getting any relief from the Oxycodone?

    I've got little kids too. I know how incredibly hard it can be. Chronic pain has brought isolation & depression for me too. It's a constant struggle but only have to look at my children to remind myself why I fight so hard. I'd try to bring my next appointment forward, maybe your doc will titrate you a little faster but I think you need to be discussing your leg weakness. That's very worrying & sounds too physical to be improved by pain meds. I know you're still recovering from surgery but this new symptom is very concerning & needs attention. Lack of mobility & falls could seriously jeopardize your recovery, please focus on that.
    Osteoarthritis & DDD.
  • Okay, let me make sure I am looking at this correctly because i was certain he lowered my total dose of opiates. I was taking 8 7.5/325 percocets that my neurosurgeon was prescribing which is 60mg daily. I have read that an Opana 5mg is equal to 10mg of oxycodone roughly, is that not right? if so that would be 30mg daily right now from 60mg. Am I off on that?
  • I meant to respond to the comment from EnglishGirl as well. What you are saying makes sense. I have been on Percocet daily for probably at least 7 years now, not 8 a day but at least 3 or 4. The 8 a day started after my surgery bc the pain unfortunately was magnified after I finally had surgery. I have just been so used to taking a pill when I need one to feel okay which I don't feel bad for because its what I had to do. And much of that seemed to center around who I needed to be for my kids. I am kind of a 'mr. mom' . I always have been. I make them breakfast, get them dressed and take them to school and pick them up every day. They wear you out and when I began the ER and only had two break thrus I felt defeated. I'm struggling with this and I knew I would. I don't yet understand exactly how the ER works, is it just as good when you get it started?

    The weakness in my legs I believe is nerve damage and I have lost a great deal of muscle mass from my back injury. I lost a lot of weight bc I couldn't sit for a whole meal and eating is just one thing I withdrew from overtime. I had the pain for four years before I had surgery so this has taken its toll on my body and is probably why I have some permanent nerve damage.

    And yes the oxycodone helps but I only have 2 a day and next week he is bumping me from one opana to two a day and giving me only one oxycodone. I have been halfing the oxy and taking it 4 times a day to spread it out in smaller quantities. I would rather have a smaller dose 4 times a day than a larger dose 2 times a day. but one a day is going to be a challenge. In my opinion this is not the healthiest approach as I get used to the Opana bc I think it is unnecessarily making this more difficult for me. But I still have a more is better attitude about the whole thing. This ordeal has affected me and my family so much and has put us in a lot of debt bc my career has suffered. I always hear people saying have you tried massage therapy, resting on a heating pad and ice, yoga, swimming, etc. ? That sounds great and all but am I the only one that doesn't have the time to do that stuff? I'm slammed at 5:30 am with two kids and it's non stop the rest of the day just trying to get the bills payed. I have been forced into a give me that pill so I can do my job mentality but I am trying to convert into a more healthy day at the spa mentality. I will get there.....hopefully in this lifetime, after my kid's graduate
  • And I didn't mean to seem so harsh about the pm doctor in my first post. Pain is like a brick wall but what is worse is the mortgage is still due no matter how much pain you are in. If the pain is under treated and is defeating you and causing you to not be able to take care of things it is a vicious cycle and devastating things can happen if you shut down. I have come very close but I have never given up. Its hard to be always healthy in mind, body, and spirit when you are pushed against a wall. From my point of view, I love my wife and kids more than anything and they need their Daddy up and running. I have nothing to hide and thats why I told my doc up front, I want to be aggressive, I want this burden lightened, I want to take control of my life and in my opinion, we are a not off to the best start. But hey, thats just me. I'm sure everyone at the spa would disagree
  • I have been having to take from 5-10mg of Percocet on a daily basis as needed for my neck and back. I found that different pharmacies use different companies to formulate their drugs. For instance I was taking the 7.5mg of Percocet from Vons and it didn't feel like I was taking anything, so I changed and took my script to Costco and their manufacture was different and it worked. So Im wondering if that might help you, change pharmacies to get a different manufacturer of the Opana.
  • from one opiate to another. Different opiate types target different receptors in the brain. One opiate you may be on more milligrams per day, but it is may not be as effective as another, which is more potent and hits different receptors. It is not the milligrams that you need to be concerned about, but rather how the medication works overall.
    Don't believe everything you read on various forums out there, alot of it pertains to misuse and abuse.
    Your doctor did in fact, convert you properly, and he is titrating you properly.
    You are still in the titration phase of introducing a new medication. As with introducing any new medication in the world of pain management, it is and should be done slowly and increased as side effects are tolerated, and a reduction of 50% of unmedicated pain is reached......that reduction of 50% is obtained through a variety of treatments, injections, physical therapy, using ice and heat, rest, TENS, and topical creams or ointments, as well as other medications for neuropathic pain.
    The use of pain medications should be one SMALL part of an arsenal of treatment for your pain, not the sole basis, nor the biggest part of your pain toolbox.
    Did you read any of the links I posted above? In particular the section that discusses the differences between immediate release medications and extended release medications in the Step by Step Guide ?

    Getting aggressive with treatment is fine, there are lots of other options to treat your pain, and using those options aggressively is not a bad idea, however, the use of medications should be kept at the lowest possible ,effective dose. And that takes a bit of time on your part, and patience, and time on your doctors part as well. Remember, you also have to come off these medications at some point as well.

  • There are differences and simillarities in the two types of pain medications. The extended release medications are far superior to providing steady , ongoing pain control. The purpose of the extended release medications is to manage the normal, baseline pain you endure every day......with the very occassional use of a breakthrough medication only when absolutely necessary.

    Extended release medications:
    Long/smoother delivery of medication - meaning that instead of having to take another pill every 4-6 hours, you only have to take it once every 12 hours. However, it also means that you don't "feel" the medication "kick" in, as you do with the use of immediate versions of a medication.
    Steady blood plasma level- this means that the medication achieves a steady dose state through out the hours of dosing........you don't get the up and down effect of the immediate release.
    Consistent pain control- smoother, more effective pain control

    Immediate release medications:
    Shorter duration of action- most of the dose is released into the blood stream within a half hour to one hour post ingestion
    Highs and lows - the medication is felt when it kicks in and the patient is left feeling as if the medication has suddenly stopped "working
    Becomes less effective for less time - which is typically referred to as tolerance issues.
    Does not provide steady blood plasma levels

    There are a couple of things that you said that are concerning........that you took the meds to be what you need to be for the kids, and that all you had to do was reach for the pill bottle.......those , are considered red flags. Pain medications are not meant nor should they ever be used to give you energy or to be what you need to be for anyone. You had surgery 3 months ago, and you are not supposed to be doing certain things at this point.....you are barely out of the acute phase of recovery.
    Taking medications for any other purpose other than to provide pain relief is a red flag. Taking medications to "get through the day" is another red flag. You need to change that mentality in order to get back to your normal activities. The use of medications to allow you to do things that you shouldn't be doing at this stage of your recovery is going to put your recovery/surgical outcome at risk.
    There are medications used to treat neuropathic pain, that might be a good option, Lyrica, gabapentin, cymbalta, amitryptaline, and others. All of which are good at easing neuropathic pain. Nerve damage can take months to recover from, but you can and will experience improvement as time passes.
    Physical therapy, and using ice, heat, yoga, TENS and other options are all for your benefit. They will help you more than you can understand, and many find them more helpful than relying on pain medications to push through.
  • JDRobinson. My kids are 7 & 4. My 4 year old is a little tornado! Please believe me when I say I know EXACTLY how you feel. I don't have a support system. It's just me & my husband. Relocating from England is a decision that I often question but it's been done. This is our situation & I have to deal with it. Do you have family close by? I'm of the character that I find it very hard to ask for help & not being 'Super Mum' 24/7 haunts me. We made the choice to wait to have kids until we were older. I chose to be a stay at home Mum thinking that I could direct all of my energy into giving my kids the most fantastic life I could dream of. It's incredibly hard when you watch your fantasies crumble away.

    I can't be that sort of parent. All we can do is our best & if a day goes horribly wrong we need to wake-up the next morning & try again. I've gone from being fit, healthy & dynamic too a hobbling cripple in 7 years. If I could turn back time I would take better care of myself, being Mary Poppins has made my situation worse. I know it's hard to hear but sometimes we need to concentrate on our own health & recovery to be a better parent in the long run. I've returned home after numerous procedures & found myself holding toddlers on a agonized hip, making dinner with tears streaming down my cheeks. I've rushed recovery 'for the sake of my kids'...Duh! Going to the park when I should of been recuperating has only hurt my kids in the long run.

    I'm not a 'spa Mum'. My family is my life. I thought that popping pills was the best way to get through the day & it did work for a while. 'Mummy hurts too much to do that' was never in my vocabulary. 'wait 1/2 hour' (for the meds to kick in) was my approach. Problem is, the meds stop working well enough. The pain after any activity rocketed & in the end there was no quantity of pills to keep me going. I've been on HUGE doses & variety of meds, I promise you it won't work! My kids know all about stretches & airomatherapy, they've decorated & named my hot water bottle. I've worked hard to come-up with activities & games that keep us entertained without breaking my back.

    Don't worry about being hard on your doc. I directed all of my anger & frustration at mine for years! If he was compassionate, hobbled a mile in my shoes, he'd give me an endless supply of narcotics & deliver them to my door so I wouldn't have to get child care to make appointments!

    Good therapists will teach you how to do things at home. I can't do the 3 appointments a week thing. There's a lot of help out there. Your doc is trying to do the right thing for you. Chronic Pain is a marathon, not a sprint. Your lifestyle isn't sustainable. It took me a very long time to accept my situation & work with it rather than fighting every step of the way. Feel free to vent. It does help. I still hit the brick wall at times. This life is bloody hard. ;-)
    Osteoarthritis & DDD.
  • had my first surgery......and I did the same thing, tried to push through, why should the kids suffer when it is me and my stupid back that is causing the problem? You aren't doing them any favors by medicating to do things you shouldn't be doing......you have gone through all of this so far, to get better long term........not to have to medicate to get through a few minutes of time with them. Do you think that they don't notice that you are in pain? That you are taking pills in order to do things with them? They do...........I assure you they do, and they notice the difference in your behavior and interactions with them as well.
    I finally realized that I needed to talk to them, about how difficult things were for me, especially post op , and they were told that the medications were to help keep my pain levels in check, but I never used them to do things that I wasn't supposed to be doing......I enlisted my kids help, at age appropriate levels to help each other, and me at times, and they did the things that I couldn't do, reach into a lower cabinet, get pots and pans out for dinner, etc, and we played at tables that I could sit at, and created new games and activities that we could all enjoy. On those days when the pain was spiraling, we watched movies and made popcorn and laughed together......
    You will recover much faster by doing what you are supposed to be doing as far as your recovery goes, and the long term outlook will be much better .
  • I must have been misleading. When I wake up I can barely move because I am hurting so much. I don't take a pill so I can do this and that, etc. I take a pill because of pain which enables me to do semi important things like make them breakfast, get them dressed, and take them to school. This isn't possible unless I take medication. Tomorrow I will try staying in bed and letting my three year olds cook their own breakfast, run around the house naked, and maybe they can learn to walk to school...the exercise will do them some good.
  • The last time I tried talking to my son about my back surgery and how it really hurts Daddy, he yanked up my shirt and said, I wanna see your boo boo Dad, EWE thats a scary boo boo Daddy, and jumped off his bed right onto my back. But I will make an effort to have a sit down with my twins and explain to them that daddy needs help with all the daily chores. If you have ever had 3 year olds that means your workload just doubled
  • I was attempting to help you, and I've had 4 kids, so I am well aware of how three year olds can be.
  • I know how you feel. I use breakthrough meds to do special things sometimes & I used to be exactly like you. I'm sorry we're offending you but the truth is, in the current climate in this country you will not be able to find a PM who will allow you the quantity of instant release meds you would need to carry on like this. I'm honestly trying to help. So much with chronic pain is about acceptance & getting your head in the right place to function. I still have to remind my 7 year old not to run into me & jump on me..my 4 year old is a tornado! I know! You've got 2 little ones but mine are only a little older. You're in a bloody hard situation but it's not impossible. You don't have a lot of choice as I see it. I've wasted anger, frustration & tears for years. I'm just trying to save you a little. I'm sorry. I know!
    Osteoarthritis & DDD.
  • Instant release meds only last for a few hours. Once you're on the correct dose of ER you should find mornings a little easier. I still stiffen up overnight but I don't wake in withdrawl (which makes you feel bad & MORE pain) anymore. ER meds should make your pain relief smoother. Your doctor hasn't taken your pain meds away, he's just changed the way your body gets them. Please remember the suggestion of nerve & muscle meds..they can make a huge difference. Narcotics are only good for mechanical pain.
    Osteoarthritis & DDD.
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