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How much is to much expectation?

I started in Pain Management about 2 months ago after years of being looked at like I was a whiner or even less savory things. My current regimen is (1) 25mcg Duragesic every 72 hrs (1) 12mcg Duragesic every 72 hrs and (1) 5mg Oxycodone every 6 hrs for breakthrough pain. This is after 14 years of prescriptions of muscle relaxers, NSAIDs, other narcotics etc. I now suffer from peptic ulcer disease from long term use of NSAID therapy. With my current medications my pain levels are still at a 7-8 most days with it going through the roof if I am late with my breakthrough medication. Occasionally I get better times where I could all it is 6-7 but those are few and far between.

I guess my question is where should my expectations be? I know that I will never be pain free, but should I be getting more relief? I''m so afraid of telling my doctors my "real feelings" because I'm haunted by the memories of the way I've been treated though the years.
L1/L2 compression fractures due to MVA in 2000.
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1

Comments

  • at 37 mcg per hour of fentanyl, and the constant /around the clock use of breakthrough meds, i am not surprised that your pain levels are high....
    the fentanyl is supposed to be used for around the clock management of pain, and it should reduce your unmedicated pain levels by about 50%.......the use of breakthrough meds is never supposed to be used as a first line defense against increased pain levels. the use of otc remedies, ice, heating pads, hot showers, rest, topical rubs and creams, stretching and just plain rest, as well as the use of muscle relaxers etc if appropriate are all supposed to be used instead of reaching for the pill bottle as a means of relieving the pain. if there is not enough relief provided, then is when the judicial use of breakthrough pain medications are supposed to come in.
    using breakthrough medications with any regularity, whether it is once a day, or around the clock, only serves to increase the baseline amount of medications in your blood stream and winds up making the breakthrough medications completely useless and you are left with no means of managing additional pain spikes.
    https://www.spine-health.com/forum/pain/chronic-pain/chronic-pain-treatment-step-step
  • 50% is the goal of the majority of pain management programs. If you are saying that your pain levels medicated are constantly a 7-8 or higher, what are your levels without medication?
    The problem is that patients who claim consistently high levels of pain, especially at levels above a 8, can not functionally take care of themselves in most situations., let alone concentrate ....higher than 8-9 tends to have people heading toward the ER.
    Most people tend to overestimate their pain levels , and doctors frown on that.

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  • I was in an automobile accident that resulted in compressions fractures in my L1 & L2 vertebrae. The three surrounding discs are bulging according to my most recent MRI. I've been through countless doctors and physical therapy in the last 14 years finally being sent to Pain Management because my primary care doctor no longer could prescribe the type of medicines she felt I needed
    L1/L2 compression fractures due to MVA in 2000.
  • sandi said:
    50% is the goal of the majority of pain management programs. If you are saying that your pain levels medicated are constantly a 7-8 or higher, what are your levels without medication?
    The problem is that patients who claim consistently high levels of pain, especially at levels above a 8, can not functionally take care of themselves in most situations., let alone concentrate ....higher than 8-9 tends to have people heading toward the ER.
    Most people tend to overestimate their pain levels , and doctors frown on that.
    It had gotten to the point where I had no choice but to function at a pain level of 8+. I am a single parent of a toddler so regardless of how I felt I had to push through.
    L1/L2 compression fractures due to MVA in 2000.
  • Different figures I have heard as being the goal for pain reduction are 50-70% of your original pain. If you are 7-8, I would say that it is reasonable for you to expect more relief than you are getting. Have you spoken to your PM recently?
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  • My next appointment is on Wednesday. I'm actually afraid of telling the doctor I'm still in a lot of pain. I haven't had the best experiences dealing with medical professionals regarding my pain. Most of the time when the word pain gets spoken I see something in their eyes just go blank. My PM doctor is the first I haven't had that experience with and I'm very worried about seeing that look again as I am finally getting some relief.
    L1/L2 compression fractures due to MVA in 2000.
  • I have experienced the same as you with eyes glazing over at the mention of pain. It sounds like you PM is not like that, though. Given his chosen specialty I don't think he will respond negatively to complaints about pain. He would just have to be accustomed to hearing them.
  • There are many different options that the PM doctor can offer, other than just medications to treat your symptoms. I also have a spinal cord injury, times two, so while the whole idea of going to pain management is a bit different, treatment for chronic pain being done by your GP is not the best idea.........it is not their specialty and honestly , once pain has become chronic, you need to be seen by a different specialty, such as pain management.
    My PM is a physiatrist- physical medicine and rehabilitation with a sub specialty in spinal cord injury, and I simply adore mine......
    There are tons of different options available, to treat pain to bring it down to a more tolerable level, and not all of them include more pain medications, but a good pm will explore those options with you, and direct you to more therapies as you need them to get better control over the pain. It is not about eliminating pain , it is about learning to manage it........
    Read the link below my post for some ideas about how the steps work to getting treatment......it might help
  • I believe that I may have finally found a medication regimen that works for me. My PM doctor increased the Duragesic patches to 50mcg/48 hours and only using my TENS unit and Tylenol for breakthrough. It has worked! My pain level has reduced to a more manageable 5/6 on bad days and a 3/4 as a baseline for good days! Although it may not seem as so but I'm using less narcotic pain medicine now. It is a wonderful feeling!
    L1/L2 compression fractures due to MVA in 2000.
  • sandisandi Posts: 6,269
    edited 04/08/2014 - 4:10 AM
    That is wonderful news Jennie.....sometimes, the additions of "breakthrough " meds can be a problem, because someone who doesn't know better or new to pain management thinks that that is the "treatment" when there is more pain.......and it is, but only after you try every other option, to manage any pain spikes, and even then, they should only be used as a last resort, and only occassionally. If you use them "regularly" and that means even once a day, your body will quickly learn to expect that little boost of extra opiates.....and you will soon see that "increased pain levels" are now occurring more and more often and the baseline amount of pain that the long acting should handle is no longer handling it....so you increase it and it starts all over again.
    Chronic pain is always going to be there, so we have to learn to "live" with a certain level of it, and learn to cope, within that level......I am glad to read that things are better, your post reads much happier.....good luck
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