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Pain Medication Problems, Please Help

Chelsea87CChelsea87 Posts: 3
edited 06/11/2012 - 8:54 AM in Chronic Pain
I would first like to say hello, as I am a new member to this forum. I joined because, unfortunately, I can relate to the problems that so many of us are now facing. I am a 23 year old with L4-L5, L5-S1 disc herniations which pinch the nerves in my right leg, causing severe pain. I have slowly deteriorated over the past year and a half to where walking and sitting times are minimal, and I spend the majority of my time lying on the couch. I need to have surgery but my back problems are considered pre-existing conditions by my insurance company. Needless to say, my only option is to deal with the pain through medications. My doctor and I have tried many medications but I have come to the determination that more than one kind is needed. He currently has me on Dilaudid 4mg 4x and lorset 10/650 6x but the combination is not cutting it. I was thinking about Oxyxotin 40mg and the lorsets but I am really unsure...
If anyone has suggestions I would love to hear them because I am in great great need of some lasting relief.
Thank You


  • You have insurance though correct? So, why does it matter that your condition is pre-existing and why would that stop you from getting surgery? I can see it stopping you from getting different insurance, but that isn't your problem-your medications seem to be your biggest concern at this juncture.

    Patients don't normally dictate what medications a Dr should Rx, and you say that you are *unsure* of what would work, so it would be best to communicate your concerns to/with your Dr and let him/her decide what to Rx for you. Maybe whatever s/he tries next will be the ticket, but it's not only opiate/oid type medication that help the pain and esp. when nerve pain is concerned. Opiates are not good at all with relieving nerve pain and maybe you need another *type* thrown into the mix.
  • I completely agree with your comments and concerns. I just wanted suggestions from people who has been through my situation. On my last Dr. visit, he told me "there's nothing else I can do for you" which I don't think is good enough. The only way he'll try new medications is if I research them. And I completely agree with you on Lorsets, they scare me, and he's never even mentioned anything about my liver. I can't change doctors bc I can't afford the specialists. I am on Gabapentin for the nerve pain however.
    As far as the insurance, I was able to get it in January through the Obama plan but doing away with all preexisting conditions is not till like 2014. I have to wait 12 months for the insurance to cover surgery, which is the only option I have to regain any semblance of a life. I am on a waiting list at the medical university but nothing has come through.
    I can't work and I am just out of options and I'm scared to death and I don't know what to do. I can't last like this.

    Sorry for the multiple posts, couldn't figure out how to delete them.
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  • Sometimes pain management specialists work for people, sometimes it doesn't. If you haven't tried it, you could ask your primary for a referral?

    We feel your pain.

    4 level ACDF C4-C7 5-2-11, laminectomy & discectomy L4-L5 1/26/12, ALIF L4-5, L5-S1 12/10/12.
  • Oh I see. I don't know how the new insurance/program works. Is there any way that you can ask your PCP to refer you out to a new PMDr? Lorcets 10/650 are for acute pain, but not (generally) to be taken six times a day for any length of time as optimist mentioned-just entirely too much APAP on a daily basis. I don't understand why your Dr wouldn't switch you to Norco 10/325, or just do away with both of what you are taking and offer you something without APAP, such as oxycodone, if he insists on IR medication. It comes in different strengths and I manage my pain quite easily with it, along with other, non-opiate medications.
  • I have a very similar problem. Have you tried oxycodone? It's instant release, where as oxycontin is extended release. Have you tried nucynta, or fentanyl patch?

    Have you tried neurontin, or zonegran for nerve pain?

    My dad's doctor used to combine morphine and oxycodone along with neurontin.

    Hope everything works out for you


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  • Supposedly, with Obamacare "coming", pre-existing conditions will be "out the window". However, that doesn't mean that a specific surgeon has to sign up to "be in your plan"...Its going to be a tough call. Many people here have gone to teaching hospitals for their care for "discounts".

    I agree with Robin, none of us patients here are qualified to make recommendations about what medicine you should take, we can only tell you what we have tried that's helped. And, to maintain the best relationship with your pain management doctor (or prescribing doctor), I don't suggest tell him or her..."I think I should be on XYZ, at this dose". Instead, better to keep a list of everything you have done & tried, from medications to lying down, to heat or cold (a pain journal)...and tell him/her what helps & what hasn't. Be specific about where your pain levels are at when you took Lortab #4 or Dilaudid #3, and what it did to your pain. Most pain doctors prefer to manage chronic pain with longer acting meds than dilaudid and lortabs, those are more "break through" or "emergency meds"; but they have little tables that do dosage calculations & conversions to make sure they safely convert from short acting to long acting pain medicine. Many of us here have also been helped by usin combinations of a variety of meds including nerve pain medicine such as anti-seizure meds (neurontin, Lyrica), anti-depressants that work on pain (amitriptyline, Cymbalta), muscle relaxers, and opioid & non-opioid pain medicine.

    Having said that I don't feel I should tell you what to take, I am strongly concerned about taking 6 of the Lortabs with 650 acetaminophen each- if I am correctly repeating you on that. That's 3900 mg of Tylenol (acetominophen) a day - that's just about overdose range!! Four grams (4000) is usually considered potentially lethal, it can destroy your liver! I believe the FDA recently "lowered" what they consider safe "daily" amounts of acetaminophen to be to the 2,000-2,800 range depending on your size and liver function; I thought that was why so many pain meds have "325mg" in them, instead of 500mg or 650mg. Please ask your doctor immediately if you really should be taking that much acetaminophen a day.
  • I really appreciate everyone's input. I have taken most of the medications mentioned but I haven't found the right combination yet. The Gabapentin is generic for Neurontin and I take 800mg 4x a day. I think I am leaning toward either the fentanyl or oxycotin for a time released effect with a 15mg oxycodone for breakthrough pain. Is the oxycodone a 4-6 hour relief medication?
    Again, thanks for all of the opinions. I really enjoy this forum bc in my situation, as well as others' here, its nice to know we're not alone.
  • There are other nerve meds that can be tried if the gabapentine is not working for you. You can also look at Lyrica,cymbalta and there are some others. I would with out a doubt be looking for a new doctor. Any doctor whom tells a patient to go find out what drug they should take, has something wrong with them. Your doctor has gone to school for that training and he/she should know the right medications to keep working with you on. As the other poster said you are getting to much for your liver and if a doctor doesn't know that, I would run and run fast from them. It is not like any of these medications members are suggesting are any secret either.

    The other thing have you tried any injections? If so and what type? Injections can target the nerve and give you more relief, say with a block. I have the same issues as you do and get a injection every 3 months and love the relief I get, even if it is short term and not a fix.
  • On the question of Oxycontin ER release, its usually prescribed to take twice a day, or at the most three times a day. Its supposed to last 8-12 hours, but your mileage may vary. Some docs would rather do twice a day, and give you more "room" in breakthrough medication, and I'm pretty sure that's where most pain docs "start" with ER medicines, and only increase to three times a day if your going through too much breakthrough meds.

    There are other long-acting opioids, for example MSContin ER (morphine ER) in the generic is very cheap, although there are branded morphines that supposedly last even longer (Kadian, Avinza). There is also an entirely different category of long-acting opioids, Opana, and you already mentioned the fentanyl patch, I believe there is also an extended release dilaudid now (Exalgo - ?sp.).

    Sometimes a short course of oral steroids (Medrol dose pack) helps if you can't get in for an epidural injection or limited by insurance constraints on procedures.

    Since it looks like you haven't been on any long-acting meds at all, I wouldn't "leap frog" to fentanyl, but try morphine ER or Oxycontin ER instead. Again, I agree with everyone above if you can get into a pain management doctor that really is the way to go. These meds are just too complex IMHO to be optimally managed without the experience of someone who prescribes them all day. Tolerance can happen when you are on these medications long-term; you always want to leave "something stronger" in your back-pocket so to speak.
  • This thread may be moved to the Pain Meds Forum- but I will add my $0.2 :D I never asked my PM for specfic medication- just if I was having side effects. He.she knows that I have serious problems that will need a surgical intervention eventually.

    I take the Oxycontin CR 40 mgs (extended)as well as Oxcodone 5 mg (for bt pain) as well as a mucle relaxer. I used to take a nerve med but had to stop. Thinking bout going back on it.

    I am fairly well controlled with the CR meds. My PM upped me to 3 x a day (2 was not quite enough). She said since they reformulated the meds (anti crushing formula) that it doesn't seem to release like it used to.I also have 2 10mg Oxycontin CR to take on bad days as I see fit. The BT Oxycodone is 5 mg to use as I see fit- I get 3 of theses. I take Robaxin 4x a day as well. Might need to change as I am now almost alaws in spasms again.... Not sure if it is the meds or me doing more activity.

    I wanted to tell you about Embeda. It is a long acting morphine and was the first med my PM put me on. It worked very well at a low dose, but I am allergic to it so I had to stop it. I liked the zanaflex but it was bad with my nerve pain med. It was good for night time but too strong during the day. I just broke the 4 mg tablets in half while I was taking it for the day time antispasmatic. I may go back on that soon. I have taken flexerile primarily for about 4 years until about 6 months ago. I like valum as well but my PM has never givem me any.

    Have you had any of the steroid injections or selective nerve root blocks. They had short acting effects for me but sometimes a few days is better than nothing. If I could afford it I would have another couple right now to calm things down a bit and I hate the side effects of Steroids.

    Good luck,

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