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Pain Med Question??

MsHumptyDumptyMMsHumptyDumpty Posts: 1,512
edited 06/11/2012 - 8:50 AM in Pain Management
I am on 75 mg of the fentanyl patch that I change every 48 hrs and Oxycodone 5 mg which I am allowed a max of 8 a day.

These pain meds have saved my life - at least my sanity ;)

However I have found right from the very beginning of using the oxy that after 6 pills through out the day that the last 1 or 2 pills ( which would be 7 and/or 8th ) does nothing for my pain. I have spread them out, I have tried full stomach, empty stomach, waiting to use them till my levels were quite high and using them before my levels got bad. Nope. Nothing.

My first doses do wonders for me, but the last 1 or 2 pills nothing??

Does anyone understand why?
L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.


  • That is not a very hig dose. Perhaps your pain just has gotten to bad that late in the day for that low dose to help.

    You know with pain meds you should take them before your pain gets really bad or they will not help. That is what I have read anyway.

    But what if your pain never eases any?? would be pointless to take them wouldn't it?? But that is what I have read.(take the meds before the pain gets really bad) Go figure.
    Sending a big hug
    Patsy W
  • Hi Pat :wave: so you think even 2 or 3 of the 5 mg is a low dose? I honestly don't know what meds are considered high doses - which is why I am asking this.

    I pretty much have myself on a schedule with my meds as I do the same thing day in and day out and most times know when I need to take the meds BEFORE the pain hits a high level.

    I am never without pain but the first 2 doses of the day controls it 75% I would say.

    I do try to take them before the pain is bad, but have waited at times for it to be bad for this last dose to see if it helps any more then - it does not.

    If I wait till pain is bad or take it as a preventive ( so to speak ) that last dose does zero for me.

    Is this common?
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
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  • Probably your pain is just more severe toward the end of the day and the meds aren't quite enough. But, honestly, the body does things when you take narcotics long-term. It adjusts, adapts, grows tolerant. Over time, the effectiveness wanes.

    Are you allowed to take them 2 at a time? Or just one at a time?

    Is your evening pain the same as your daytime pain? Or do you develop more nerve pain in the evening? Narcotics are notoriously ineffective for nerve pain.

    You might ask for something to add in the evening- a nerve pain med or a muscle relaxer. Also, if you're taking oxy without tylenol (probably not, though), ask your doctor about adding some tylenol or motrin. Remember that the best way to get complete pain control is to take advantage of multiple pain relief methods, as their effects can stack. But ask your doctor, as all of these things require knowledge of your medical history!
  • Thanks Happy :) No tylenol are in my meds. My pain is a bit worse by end of the day. How many I take makes no difference in it's effectiveness - regarding my night dose. I guess I am just really surprised that the last dose of the day does ZERO for me....when I am covered pretty well through the day, for which I am grateful for :)
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • Opioids are not ineffective in treating neuropathic pain. This mistaken belief was the result of a small group of flawed tests and has now been disproven (this fact is stressed again and again in the recent literature on pain management). Opioids generally work for all types of pain, but some are more responsive than others. There seems to be little doubt that opioids are less consistently effective for neuropathic pain than somatic pain, but they are at least as effective as other drug types for many patients. Often a blend of opioid plus anticonvulsant or antidepressant works better than either drug alone in treating pain caused by nerve injury.
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  • I'm new to the site but having been to over 40+ doctors over the past 17 years, I have lots of knowledge to share. I suffer from herniated discs in my neck & arthritis & degenerative disc disease, etc. I have a great neurologist now and use a pill called neurontin which tricks your brain so you feel no pain. You should look into trying this more than the pain pills but use it together with the pain pills that you take. I take 10 mg of oxycodone at a time, not 5 throughout the day like you. Percocet is also very good and effective. I also use the neurontin with topamax throughout the day and cut the topamax in half which you could also do with the pain pills if needed. At night around 7:30, I take limbatrol which the dr said was suppose to limber up my neck but ends up giving me a good nights sleep. I stop the other medication mid afternoon. The key is to find a good neurologist who knows about medication. I have never found muscle relaxers to do anything and over the counter pills never helped at all. If you have never been to physical therapy, that may also help you so you can learn how to live with all that is going on with you. One dr. ordered me a tens unit which I don't use now but until I found the right combination of medication to take, I did use it and it helped. Now I work everyday, I'm 57 and live totally pain free. Took me awhile to find what worked for me but I finally found it.
  • You are so fortunate to have found the right combination!!!
    I wish we all could be so lucky.
  • dilaurodilauro ConnecticutPosts: 13,434
    is so very important.
    first steps are to break down the various medications into the areas in which they are intended to help

    pain medications
    the opiate family (the hydrocxxx, oxyxxx, opanxxxx, etc)are based suited for dealing with moderate to severe pain. that pain comes from the discomfort after surgery, problems with your disc, etc. your physician is the best source to determine what pain medication you need and at what dosage. these medications are designed to 'dull' the feeling of pain.

    the classic problem associated with this is what diabetic and shingles patients deal with. the needles and pins they feel in extremities. sample medications in this family are lyrica and neurontin(gabapentin)
    these medications help with the nerve pain associated with many spinal problems. these medications work to change the way the body senses pain.

    muscle relaxers
    these range from creams to pills. they are used to treat muscle pain and muscle spasms. some of the medications include: flexeril, zanaflex, soma,

    when you have chronic pain, just using one of the above may not control and manage your pain. just upping the dosage is not the answer.

    its a combination of medications and other factors that help manage your situation.

    it took me almost two years working with my physiatrist before we came up with the 'mixture' of medications to help me. that along with my other treatments (see the blend is what you really need to control everything.

    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
  • Huggy said:
    Opioids are not ineffective in treating neuropathic pain. This mistaken belief was the result of a small group of flawed tests and has now been disproven (this fact is stressed again and again in the recent literature on pain management).
    While I disagree that the state of the literature is nearly that simple, I agree that my statement was too broad. I will restate it as "ineffective for some people" with the caveat that some opiate medications might be more effective than others for specific pain types, on a very individual basis (this knowledge based on both research and experience).

    As you said, for nerve pain the medication combinations are the gold standard- that was my main point. But I really commiserate with the OP because I am one of those for whom opiate medications do not do much for nerve pain, so no matter what there's always that pain that doesn't go away!

  • I noticed some saying the 75 mg of this patch is not a lot. Well as some might know i am considering the pain pump but after 7 years of nerve pain they wanted me to try this patch before we do the pump.All i can say is this patch has a lot of kick to it.

    This is the 1st time i used this patch and its the 50mc to use for 3 days before changing it. Its obvious we all react diferent to these medications because i had a bad flare up with my nerve damage yesterday and decided its time to give this patch a try.

    I put this patch on as the bears game started,In i few hours it was helping the nerve pain and i was happy. I felt like i just went to er and was shot up with all the good meds.

    Now here is my problem. My nerve pain finaly subsided enough where i can handle it and i am not too bad but this thing is making me very tierd, i can barely keep my eyes open, and i have that itchy feeling you get when you take methadone, or morphine, the feeling i never cared for in the 20 years that i have been on meds.

    I felt prety pain free i guess you might say, but the itching of my eyes and body was geting very enoying. I removed the patch after 8 hours before going to sleep for i was very concerned this keeps building up more in my body, even when i am at a good level already of not suffering, and the warning on the label says this patch can cause you to stop breathing.

    I put the patch after removing it back in its package of plastic just like it came out hoping i can use it again the next day, but noticed it wont stick again and i would hate to waste it after only 8 hour use.I know it says not to re use, but i cant see why it could not be re used if its preserved the right way.

    Even in the hospital after surgery they give you the pain medication as needed even with the morphine pump, so how is it they expect you to keep the patch on for 3 days if not needed that much?

    Does anyone use benadryl for the itch with the patch?
    And does anyone out there use this patch more then 1 time aplication? If yes what is used to make it stick to get all the benefits out of 1 patch? I am sure some have used it more then once especialy if it cost a person around 250 dollars without insurance to get this.

    Just to point out,75mg that was mentioned earlier in this post i am assuming was a mistake and they ment to say 75mc? Because there is a big diference. Mine is 50 mc and i can say its potent stuff in my opinion. I am waiting for a call back from my dr office at this moment to ask them questions, such as is there a lower dose of this patch posibly? Like a 25 mc for starters.

    Its posible if there is a 25mc it might not work but would be worth a shot for anyone using this for the 1st time. I know there has been people that have ended up in er with just the 50mc. Beter to be safe then sorry is what i always say.

    Anyone that has information on the questions i refered to in this post, please share. Thanks' Alex
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
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