redhill
Banned. Flames, offending others
Reged: 06/02/03
Posts: 278
Loc: Hell on Earth, for now
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OK clear enough I guess.
I think my arthritis symptoms and lower back pain are both getting worse.
Since getting prescribed OxyContin 20mg tid, the pain has increased. NO - not because of this med, I mean in spite of it. My pain was about to escalate, I expected, and now it is.
So what's the best course? Shall I ask my doctor for breakthrough meds now? Are BT meds the usual course of action with long-acting meds or is that totally at the doc's discretion? Sometimes I definitely feel I could use a BT med.
Tonight I thought I'd use IBU 800mg for BT pain, but that is not doing a think. Only thing I can think of that will work is taking and extra OC, and we all know I'm not supposed to do that! But hey, it was the weekend, and I did, a few times, and it helped. what am I supposed to do - suffer?
This is really painful - even for me, and I'm a notorious crybaby. Incidentally, before all my pain problems existed, and there was no such state for me as being undermedicated, I had a high pain threshold. That just disappeared bit by bit as the pain got worse, and the treatments became less effective.
Thank GOD at least now I have a doctor who prescribes Long acting meds.
Hallelujah!
Red
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fred_s
Member
Reged: 11/18/03
Posts: 185
Loc: SE USA
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Hello, Red.....
If I were in your shoes I'd discuss the situation immediately with your doctor. He might prescribe a higher potency OC. They should be able to knock out the pain at some level, just taking extra pills shouldn't have to be the only answer.
Best wishes
Fred S
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"One Lives But Once In This World"
- Johann Wolfgang von Goethe
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PAIDFO
Member
Reged: 02/01/03
Posts: 152
Loc: southeast
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I'd speak with the Dr,you don't wanna run out early,withdrawls from what you are taking can be ugly,Good Luck...P
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"The difference between Ordinary and Extraordinary is the Little Extra"
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trixxie
Member
Reged: 05/23/03
Posts: 133
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Red, I went through the exact same thing. I went to her, and said that my LA acting med was not working all the time, and could I have something for break through? She asked what works for me. We have been put down for so long to even think of asking for pain medication that when we find someone that is compassionate to our needs, its hard to ask. How many times have you been told that "that should be taking care of your pain"? I know I have, and those tapes replay in my mind when I say some med is not working as well as "they" believe it should. Sorry for the ramble, but I have been there.
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The truth shall set you free!
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pickles
Journeyman
Reged: 11/09/03
Posts: 55
Loc: Indiana
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Hello Redhill,
I'm curious as to how long you have been taking the OC20's? As with anything,you will need to give this sufficient time to build in your system.I'm sure your doctor will tell you the same thing.Also,were BT meds on your mind before getting or during your newest form of therapy? Some people have posted on here about getting breakthrough meds with there OC's.Your pain should be decreased drastically with the 20's,unless you just want to be totally numb? If your a man you probably know one of the first things to go numb
I probably speak for the majority on this board,when i say: Be very thankful and consider yourself lucky to be treated with Sched 2's.There should be nothing to breakthrough the barrier the Oxy has on your pain.
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keystone
Veteran
Reged: 09/05/02
Posts: 587
Loc: Arizona, USA
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I wouls suggest beaking your OC20's into 4ths. This would give you, basically percocet (no APAP) 5MG each instant release. That would work great for beakthrough pain.
Just my observation.
KS
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The greatest trick the devil ever pulled was to convince the world he never existed.
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14stones
Board Addict
Reged: 06/18/03
Posts: 336
Loc: On the beach in California
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I agree with most red, everything I have read makes me think that ocs are simply too dangerous to mess around with. I would talk to my doc and get it fixed as soon as possible.
Gods speed.
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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It's the lowest dose offered for that pain med. After giving it at least a week for the full effect, I'd call the doctor. NEVER take extra pain meds without ADVANCE permission from your doctor. If you are ever subjected to a pill count (what would you do if your doctor called tomorrow morning and said "if you don't bring your bottle of OxyContin in for a pill count within 24 hours, we will not be prescribing in the future"?) you will LOSE that compassionate physician. That was a huge point made by my PMD...NEVER take extra pills, call first or risk loss of prescription. I'm not saying you don't have pain justifying the extra dose or two...just that I would NEVER risk it. Also, you WILL be short at the end of the month unless you make it up from another day's dose. I guarantee no doctor will prescribe early.
I don't mean to sound judgmental or harsh. Only that I know you struggled a long time to find a compassionate doctor. I'd hate to see you lose it for that moment of instant gratification. Granted, your pain could be a 10 that day, but no matter how bad it is, NO doctor would put up with that behavior. Just CALL first! For your own protection. I DO feel for you. My pain has been extremely bad lately and I would love to have the latitude to take an extra pill. I FINALLY made an unscheduled appointment (I normally go in every 3 months) to have it re-evaluated. I told my doctor I felt like a whiner and that he might see my visit as "drug seeking." He laughed and explained to me the behaviors the pain clinic views as "abuse"--including using up your pills before the end of the prescription period. I am not perfect---it's just that I am paranoid of losing my great doctor and so am especially careful not to violate the rules in ANY way. If my pain is that bad, I either tolerate it or call for an appointment.
So, PLEASE call for an appointment to avoid any problems you might run into by misusing the prescription. Doctors view taking an extra pill as abuse. OK, OK, I'll quit beating this dead horse! I really am just concerned for you--especially since you JUST RECENTLY got this doctor and this drug!!!
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Never underestimate the predictability of stupidity.
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redhill
Banned. Flames, offending others
Reged: 06/02/03
Posts: 278
Loc: Hell on Earth, for now
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You know, you are totally right.
I already left the doc a message to say that I was interested in BT medication, due to pain crashing through. I thought it was a normal thing to have with LA meds, so I thought no harm of it.
Another poster was also correct in suggesting I shoud allow a little more time to have the Oxycodone reach a certain level in the bloodstream.
We do have just one little complication here. My liver! Just got word this morning - just before I was going to call him over my pain - that my liver is showing abnormal values.
Last time I just showed some elevated enzymes, this time around, several flags went up, and the doctor scheduled an ulrasound for me this week.
I suspect the combination of being rather overweight, and having taken APAP and IBU in all kinds of forms for over a year has taken a significant toll on all my organs. Best if kept off the board OTC meds. See that's what I'm taking for BT's right now, and I honestly think a low-dose (but pure) opiate is simply safer
So it is with that in mind that I want clean opiates for all pain for a while. I've vowed to stay the heck away from all NSAIDS and APAP, as well as alcohol.
It's just that, once in, I speculated that it could be beneficial to approach this the way they do in Europe - geared to stamping out pain - giving relatively high doses of medicine, and relying on the patient's reports of pain, rather than going the conservative route, starting small, and adding an extra fraction until the right dose has been reached. The latter method is one that takes longer, and leaves the now treated patient in pain for a while longer. I take it that the honours system and trust are not being experimented with here. Mostly it's a system based upon mistrust of the patient.
A mistrust that's almost a self-fulfilling prophecy, because if you begin by undertreating, the patient may feel she has no alternative but to supplemement or borrow from hsm/herself once in a while. That's natural, but it's also...non-compliance. Welcome to the 21st century. Welcome to the drugwar, because you just got drawn into it, because you took an extra oxy/vidodine/dilaudid or whatever, when your pain was out of control and you once again could not reach your doctor.
Oh we all know the millions of possible scenarios. As if anything in our society, as if anything this day and age reflects a measure of personal freedom, discretion, dignity, or trust.
Anyway, I was just being impatient. Don't want to be numb or asleep, just out of pain, but if I want to be numbed, hey, that should be between me and the doc, and if it helps my pain, and it doesn't hurt me or anyone else, I think it SHOULD be MY business!
My pain is already much less, most days, but only in the last two days new (extra) pain has surfaced. The overall result is that I am moving around and going out, where normally I'd stay in bed or on the couch sulking! So the LA meds are doing what I want them to do.
So I am definitely one of those who actually benefits from effective medication.
But you are right, those who suggested waiting it out.
And I am definitely scared of having my pills counted now. I did use some. I mean, didn't it HAVE to begin when the weekend did? I am screwed already eh? Just over that discretion/own judgement thingie.
Life is tough! Maybe I will call the doc to change my mind as to the pain meds. Again, I just though BT meds were a normal part of pain management. Why do a halfassed job, when we're on a roll and prescribing the good meds? Why not do a full job and make sure the therapy is working?
Because this is not a game of trust, and not a game of outsmarting the doctor or anything. It's a matter of working with him. I mean, if he asks if I am out of pain on these meds, should I say "NO??" Because if I did that, if I pretended to be out of pain so as not to cause a hassle, so as not to look too eager for pain meds, well, then I'd be sabotaging myself, and I'd be acting as if I can't trust my doctor. And I'd be in pain.
This isn't about games...period. I need to titrate, not settle, now that I have good, consistent care. I have to be vocal, speak up, if I want this therapy to work. Can you imagine if I hobbled along on 20mg for a year, never fully satisfied with the pain control, losing out of living, when there's a possibility that 40 mgs bid might have done the trick? These different dosages exist!
I'm 6'2" - 300 lbs (losing weight is HARD - but I try) with quite a tolerance to begin with, so one might just be able to imagine that 20mg tid can be a little on the low side, for me, especially in light of escalating pain and three years off and on on pain meds.
Thanks for hearing me all!
Red
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joyous
Newbie
Reged: 01/16/04
Posts: 48
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Red,
I completely understand. I am on the same med, but have hydro and soma for breakthrough pain and sometimes THAT's not even enough. I agree with the previous posters about being honest with your doctor. From what I understand, it is quite normal to have breakthrough meds. BUT, just a warning about breaking them. I tried it once, when nothing would touch my pain and all it did was add a horrible stomach ache to the mix and I'm ususally not sensitive to any meds. DEFINITELY talk to your doctor. Don't be afraid to call and leave a message if you don't have an appointment scheduled. If he/she put you on a long acting pain med, one can assume the goal is for you to be out of pain, BUT your doctor won't know unless you tell him/her. PM me if you have any questions or need any advice.
Good Luck and let's get that pain under control.
Best,
Joy   
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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Hey Red-
I don't think any of us expects you to just suffer--especially me (God knows we have all done that enough in our lives!)
When I started at the pain clinic, it was EXPECTED that the starting dose wouldn't be sufficient for me and I was scheduled to come in every 2 weeks for the first month, then once a month for 2 months and now every 3 months. These appointments were specifically for dose titration and finding (for me) the lowest dose that allows me to do the most I can without SEVERE or MODERATELY severe pain. I personally can't deal with the nods or being tired all time. I have 2 kids and am a single/divorced mom. Perhaps once the kids are out of the house in a few years I will want the kind of pain control that may have more side-effects and less pain. Right now, it isn't feasible. In fact, I just woke up and my pain level is 7...but I just breathe through it, keep busy, and know that I just took my pain pills and within an hour I will feel a bit better. But that is MY choice for MY pain regimen. If you want to deal with the side-effects (or don't find the side-effects unpleasant) then I certainly don't blame you for it.
Obviously, your doc is being cautious and starting you at the lowest dose available for that med. I think you are well within your rights (and their expectation) to call and let the doctor know you aren't getting adequate relief. I would expect them to either add another 20mg dose to your schedule (qid) or up you to 40mgs tid before considering adding breakthrough meds. I always just waited for my appointments to let the doc know and suffered mightily through the 2 weeks or a month until it was my SCHEDULED time to see him again. It was my own paranoia that wouldn't allow me to call early because I didn't want to be seen as a drug seeker or act in ANY way I though might possibly lead some to believe I was. It IS sad that we can't feel comfortable just calling the doctor when we hurt like we can if we have some other medical issue that doesn't involve the prescribing of narcotics. But I see my doctor--and each and every nurse, nurse practicioner and employee who works there--as especially compassionate and DECENT. I have never been treated in this positive way by my providers--for ANY reason--and I don't want ANYTHING to ruin it!
Anyway, hang in there. I feel for you.
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Never underestimate the predictability of stupidity.
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redhill
Banned. Flames, offending others
Reged: 06/02/03
Posts: 278
Loc: Hell on Earth, for now
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OK - here's the result of some ruminations...
1) all of you - wonderful replies and posts. The support, as well as the quality of the posts is overwhelming, and I appreciate every bit of advice.
2) I am still convinced I should be titrated. I am not trying to be a drug seeker. I just want the doctor to be able to make mental notes as to my status, rather than assume he happened to get the dosage right on the very first try.
3) I thought BT meds were the standard, though not always prescribed from the very beginning. BTW I certainly don't want to batter the pain to death! I think I'd be happy to try adding 2 5mg OxyIr to see if that catches the worst pain.
4) i must avoid any OTC med - simply must. They have doen a number on my liver, and my kidneys are already compromised a little (genetic).
5) I don't want to medicate to the point of near-OD, and I also think what I am currently on is a little on the low side. I think there is a happy compromise somewhere!
Red
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LumbarSpasm
Silent Chaos
Reged: 05/07/02
Posts: 1538
Loc: USA
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There are OC 10's. Just an FYI.
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LumbarSpasm
Or just a pain in the butt?!
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pickles
Journeyman
Reged: 11/09/03
Posts: 55
Loc: Indiana
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Yes Lumbar,
You are very correct,i believe the 10mg OC's were created for initial dosing and titrating.
Redhill,there is a good chance you will be given the dosage of 30mg tid on your next visit.Also,Nightshade made a very good point,the hardest thing is over(finding a compassionate doctor),now you must take it slow,and play by the rules so-to-speak,and wait until your scheduled visits to request more relief.
Finally,for your own benefit,i would log everything.A documented journal of your day-to-day pain pattern will impress your doctor and show him your concern for your well-being and your willingness to work with him on titration.
Hang in there friend!!
P.S. Are you fully educated on Fentynl(Duragesic)?
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redhill
Banned. Flames, offending others
Reged: 06/02/03
Posts: 278
Loc: Hell on Earth, for now
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Quote:
Yes Lumbar,
You are very correct,i believe the 10mg OC's were created for initial dosing and titrating.
Redhill,there is a good chance you will be given the dosage of 30mg tid on your next visit.
Unfortunately no. My doctor thought he was going to maintain me on the same dose that the old clinic had me on, just in OC form, rather than as Roxicodone.
He told me today that he wanted to back out of prescribing me anything, to find a pain specialist. He was once again uncomfortable. Why, all of a sudden is beyond me. But I do know that life is now not only very hard, but also unfair, and basically, a nightmare.
Quote:
Also,Nightshade made a very good point,the hardest thing is over(finding a compassionate doctor)
It was over, then he had a change of heart just like that, and I am going to have to find a really compassionate doctor, not a backstabber who will prescribe once, then behind my back decide to back out.
This was the last insult, and it's almost surreal. You cannot imagine the horrible thoughts going through MY mind today. I am about to give up on everything. I don't know what to do or where to go now.
This was supposed to be a long-term relationship, not a single OxyContin pewscription. This drug is meant for the long haul, for those who are committed to pain treatment.
GRRRRR...
a disillusioned red..
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kittie74
Board Addict
Reged: 02/16/04
Posts: 310
Loc: Hollywood
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hey redhill...
sorry to hear that your doctor had a change of heart. it's rough out there. i'm in the same boat: trying to find someone locally to treat my pain. not easy. i spent all day in bed yesterday with an insanely painful migraine. and yes, when the pain gets that bad, you think you can't take it anymore. maybe you should just give up. but today, thank god, it was gone. and i felt good. my other pain, neck and lower back, is always there. but if i had migraine pain all the time? i couldn't live like that. but i love life, and am desperately trying to find relief.
so i guess in a long, round-about way, i am saying please don't give up. there has got to be someone out there who can give you proper treatment. i don't know you. but if someone came on here to post and say that you gave up, i would be very upset. does that sound crazy? being sad over a stranger? maybe? but you stand for all of us. we have to be here for each other.
keep trying and know that we're out here keeping our fingers crossed for you.
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Ocean
Member
Reged: 04/20/03
Posts: 137
Loc: Outside of New York City
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Red - I am really sorry to hear about the day you're having...
Did your Doctor say why he wasy releasing you from his care? It can't be prescribing because he seemed to have no problem with it last month and it sounded like it was a long-term plan...
What the heck happened? Do you think it was the appointment asking for B/T? He had to give you some kind of explanation, and if he didn't I would demand one....
Please hang in there... Just know, you're not alone... Every minute you're out there suffering, just know there are millions around the country suffering right along with you!
Maybe we should start a big commune where we all live together and support each other... Could you see it?
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Such a long, long time to be gone... And a short time to be there...
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LumbarSpasm
Silent Chaos
Reged: 05/07/02
Posts: 1538
Loc: USA
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Red I am sorry to hear your doctor had misgivings, second thoughts, whatever happened in his brain. It may be due to tolerance and your need for higher doses. He/she probably sees the DEA asking questions.
A good PM is hard to find but worth looking for. Your doc may feel quite uncomfortable prescribing more than he/she already has. OC really has a bad media rap and our government is busy scaring people - patients/doctors/family members.
Not to mention the attorney commercials...soliciting patients to sue. 
Good Luck!
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LumbarSpasm
Or just a pain in the butt?!
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PIGINPAIN
Journeyman
Reged: 06/10/04
Posts: 85
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First, I can seriously relate to lower back pain... I know I will catch a little flak from some for suggesting this, but... Are you sure that OC is for you?? There are some people, myself included, that oxycodone doesn't work on. I was post-op and pain was 10/10. The doc put me on percocet 10. I felt NOTHING from them even after four days of taking them.
Went back to the doc and got 1mg diluadid and it worked wonders. Then went to norco 10/325 and it worked wonders. I ran out of norco during second week and took two of the percocets again because I was hurting, nothing. I had filled the script at Rite aid so I took the pills to Walgreen's to verify they were actually percocet which they were.
I got a couple of percocets for a migraine about a year later in the ER and they did nothing either. My body can't process it for some reason.
The doc said that every person has a slightly different combination of opioid receptors sizes and this results in some drugs not working as well for people... There are many opiates out there, maybe seeing a pain doc who knows what he/she is doing is not such a bad idea.
Hope this helps a little.
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Sky_Queen
Fly Girl
Reged: 12/03/02
Posts: 1971
Loc: Texas
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Redhill - I posted this on your other thread, I can't tell what your location is from your bio - I wanted to mention Dr. Mildred Watson in Texas to you - I think she specializes in back pain and I hear well worth the trip to see her. Sorry you're having so much trouble. It just shouldn't be so hard to get adequate medical care, but unfortunately it is these days...
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redhill
Banned. Flames, offending others
Reged: 06/02/03
Posts: 278
Loc: Hell on Earth, for now
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Quote:
First, I can seriously relate to lower back pain... I know I will catch a little flak from some for suggesting this, but... Are you sure that OC is for you?? There are some people, myself included, that oxycodone doesn't work on. I was post-op and pain was 10/10. The doc put me on percocet 10. I felt NOTHING from them even after four days of taking them.
Went back to the doc and got 1mg diluadid and it worked wonders. Then went to norco 10/325 and it worked wonders. I ran out of norco during second week and took two of the percocets again because I was hurting, nothing. I had filled the script at Rite aid so I took the pills to Walgreen's to verify they were actually percocet which they were.
I got a couple of percocets for a migraine about a year later in the ER and they did nothing either. My body can't process it for some reason.
The doc said that every person has a slightly different combination of opioid receptors sizes and this results in some drugs not working as well for people... There are many opiates out there, maybe seeing a pain doc who knows what he/she is doing is not such a bad idea.
Hope this helps a little.
Hi Piginpain (I'm sure you're no pig!)
Your idea is a very intelligent one. Dilaudid actually has worked better for me in the past (I got it once as a BT med), but due to its reputation for being such a strong narcotic, it's even more of a holy grail to get prescribed than Oxycodone.
Cannot take Norco, cannot take anything that has Tylenol from now on. I have damaged my liver with Tylenol, and even the pain doctors now want me to stick with strictly narcotic medications, although they give me a hard time on that too - go figure, they are not really consistent.
But of all the meds, Oxycodone is actually one of the more effective ones for me, more so than MS Contin or the Duragesic patch.
In fact, the most worthless drug for me has consistently been Fentanyl.
But yep, Hydromorphone worked wonders, but I doubt I'll ever see that again unless brain matter is spraying from my eye sockets!
Which is not to say the pain is not bad.
Today has just been a constant struggle. And at the moment my BT med is Ibuprofen.
Thanks for your suggestion. Oxycodone just happens to be one of the more effective ones so far as I know.
I wonder when Palladone hits the market. Any idea?
Red
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