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Life after BuTrans patches

jack_in_dallasjjack_in_dallas Posts: 1
edited 10/06/2014 - 6:42 PM in Pain Medications
Hello. My first post on this forum. My history: I broke my back while riding a Honda Trail 70 motorcycle in 1971, but was not diagnosed until 1997. I had blocked the pain for so long, but ultimately just could not deal with it another day, so I visited a local doctor in Irving, TX. As he entered the room after viewing my XRays, he said "So when did you break your back?" I could not recall specific info, but the motorcycle accident MUST have been the culprit.
In November 1997 I received lumbar fusion @ L4-L5-S1 with hip bone graft, which provided great relief for a few years. Then I began to experience pain that has never relented. After exhausting efforts with many "spine doctors" in the DFW area, I was abruptly CUT-OFF from all pain meds by a spine doctor, and when I called his office to ask "Why can I not refill my Tramadol?", I was advised to visit a pain management doctor.
My first Pain Management (PM) doctor treated me very well for about one year, but then we experienced three successive REFILL issues, which all happened on weekends, causing me to withdraw from my pain meds three months in a row. When I complained, I was told that "we do the best we can do", but that wasn't a satisfying response, so I found a new PM doctor.
I very much like this doctor, and would like to remain his patient.
At first he simply refilled my current (at that time) prescriptions. Since then I have tried many pain med combinations, none of which were fantastic, but then one day he suggested BuTrans patches. It took several days to get used to the BuTrans patches, but I had excellent relief for years.
While using BuTrans, I suffered a brain-stem stroke. I was told that the stroke occurred due to a unique combination: elevated Blood Pressure, and a cluster of blood vessels clogged near my left brain stem. I was advised that I must keep my Blood Pressure tightly controlled - or else. After recovering for several months at home, the first time I was allowed to drive, I was hit from behind on I35E-North by a drunk driver speeding in excess of 100mph. I am still feeling effects of that crash - more back pain, plus shoulder blade pain and neck pain, but most notably "Diffuse Axonal Injury", a MEMORY issue, but that's another topic for another forum.
My degree of chronic pain has subsequently elevated. My BuTrans patch prescription was increased to 20mcg, and was working well. Somewhere along the way I started taking Vicoprofen for breakthrough pain. I am 100% certain that I have become totally dependent on opiod painkillers. Recently I have been waking up during the night experiencing sickening levels of pain in my back - both lower (from fusion and hip graft and nerve issues), and upper back pain (from the car accident). So I scheduled an appointment with my PM doctor. He advised me that the BuTrans patches have probably run their course with me, and that I need to switch to another pain medication. He prescribed Oxycodone 10mg five times per day (50mg per day). When I got home, I removed the BuTrans patch, and took an Oxycodone pill. I felt nothing. I continued to take the Oxy pills as described for several days, but saw no relief. In fact, as the BuTrans slowly exited my system, the pain became more intense each day. There is no way that I can function with that level of pain. I read where BuTrans may actually interfere with other opiods effectiveness, so I gave this process a few more days - no relief after one week removed from BuTrans. So I increased my intake of Oxycodone by taking two 10mg pills five times per day (that's ten 10mg pills or 100mg per day). Finally I had some relief, Like clockwork, at the 3 hours 30 minute point, the pain would begin to creep through , so I took 2 more Oxycodone pills. My final self-evaluation: I need 20mg Oxy every 4 hours, which is 10 pills per day - 100mg per day - exactly twice what my PM doctor had originally prescribed.
Now that you have my highlights, here is why I am writing: I have an appointment for this Wednesday morning to discuss my relief from the new Oxycodone prescription. Because I experimented with the dosage, I do not have enough meds to make it until Wednesday morning at my newly-discovered rate of 10 pills per day. I suspect that my doctor will not appreciate my experimentation with the dosage. Should I simply tell him the truth, and trust that he will understand and prescribe Oxy 20mg five times per day? Or should I say that the current medication is simply not working, and that I need to try a different medication?
Since the car accident I suffer with memory loss. I do not recall being in this situation before. At my new rate (20mg each 4 hours) I do not have enough Oxycodone pills remaining to last until Wednesday, and today I am absolutely miserable with pain. Should I call the doctor's office in the morning and request to see the doctor ASAP? And, don't forget that since I am hurting badly, my blood pressure is sky-high right now from elevated pain, plus STRESS from worrying about what to do.
I have been repeatedly warned by my cardiologist and neurologist that I must manage my Blood Pressure, or I could suffer a second stroke - which is usually FATAL. Right now I am scared, hurting, praying for a good ending to this predicament. Thank you! I would appreciate your input.
Jack in Dallas

- Lumbar Fusion L4-L5-S1
- Brain-Stem Stroke survivor
- Survived hi-speed collision involving Drunk Driver

Chronic Pain - Must keep BP under tight control due to HIGH Stroke risk


  • LizLiz Posts: 7,832

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • sandisandi Posts: 6,343
    edited 10/07/2014 - 4:04 AM
    to increase your medications without clearing it with your doctor FIRST. There are no excuses that are acceptable for doing what you did. I know that it isn't what you want to hear but it is what you need to hear.
    If you are experiencing increased pain that is not managed by the current dosage, your responsibility to yourself and to your doctor, is to contact them for direction about what else you can do to manage the pain you are having.
    Patients are not permitted to increase their dosages to whatever amounts they feel they need........that's what you pay the doctor for. Doubling your dose could have been fatal. Self medicating for any reason is grounds for dismissal.
    What are you going to do when /if the doctor wants a urine test for compliance and you have no oxycodone in your system and you are out of medications? He will dismiss you, and then you will have NO medications, and it will be unlikely that any pm doctor will be willing to take you on as a patient.
    No doctor is going to be willing to keep a patient who self medicates on his own, and risks both his life, and his doctors livelihood by doing what you did. You have been in pain management long enough to be aware that doing what you did is never an option.
    As for lying to the doctor, I wouldn't suggest doing that. Your best option is to tell the doctor exactly what you did, and hope that he is willing to work with you.

  • KelizrmKKelizrm Posts: 5
    edited 11/01/2014 - 2:22 PM
    Jack, I have done that also. I told my doc what I did and why and said I need this dose. I said if my pain decreases I wont take as much. Luckily, they trusted me and gave me the dose I asked for. I have been with this pain doc for 12 years and they know I am not a med-seeker. As for running out...luckily I had a friend whose dad gets the same med but rarely uses it and I borrowed from him with his permission. Yes, that is illegal...but...I didnt steal it, it was the same dose as my rx, so no harm no foul.
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