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Visiting new PM dr tomorrow

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Chronic Pain
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Posted 1/10/2010 11:41 PM (GMT 0)
Tomorrow I have an appointment with a pm dr that my orthopedic surgeon suggested I see for help. I have never been to a pm dr. My orthopedic doctor has been able to take care of some of my pain issues himself but agree's with me that with my worsening condition that this would be very benifical to me. I am currently taking hydrocodone and ultram for pain, but we both agree a long acting medication would help more. I will leave all of this up to the new dr to decide, but out of curiosity what are some of you guys taking for a long acting medication? I have heard pro's and con's of different medications, but it would be awesome to hear first hand from CP patients. Thanks a bunch, and wish me luck guys

Mike

Posted 1/11/2010 1:31 AM (GMT 0)
Hello Mike, and welcome to the CP forum! I'm not sure that the members will suggest a med for you, but I can tell that you are on the low side of meds that you are on. There are many meds on the market to help with pain, and they all take a different pathway to your brain. I will suggest that you stay on the low side of any dose that they suggest to you. The idea is not to be in La La land, but to give you something to make you more comfortable. I'm on Percocet's and they are the same as Oxycodone, and I also take Oxycontin as well, 30mg X2. Can you give us a little history of your condition please? Your age and how long you have had this problem might help us understand more about you. Keep checking in here, as it may take a while to get replies. Hang in there, and I hope all goes well for you.

Michael
Posted 1/11/2010 1:36 AM (GMT 0)
yeah im definitly going to see what the dr reccomends, I just wanted to see what everyone takes and how it helps them. I have NF which is a condition that can cause tumors to form in the affected area. I have a localized NF condition that affects my hip and knee. This is caused an errosion to my femur which has started to cause a large amount of pain. I have had this condition since I was 7 and have been operated on almost 20 times. The operations have made me deal with pain very well, but because of the degenerative affect of the disease its time for a new approach. Thank you for your input Michael.

Mike
Posted 1/11/2010 3:29 AM (GMT 0)
Hi Mevans,

I don't believe I have ever met you before and I would like to say welcome aboard to the land of CPer's. Boy, we do understand those words really well. Wow, 20 some surgeries due to your conditions!! I say you are a veteran of CP good grief. I am sure there is much many of us can learn from you for sure.

I do hope your appt goes well with the PM dr. If for some reason it doesn't for whatever reason, try not to get upset over it. Simply. request another referral from your PCP for another one. Keep in mind one size does not fit all with PM drs. Just be sure you like the dr well enough and trusting his judgment will build over time. This is a dr you will see quite frequently thats why its so important that he takes the time to listen to you and answer your questions. I would make a list of medications taken in the past and how they affected your pain, along with how your current meds are working for you. Make a list of questions that way you will not forget anything.

I have a pump and its been a very long time since I was on orals meds. There are others that should pop on here and share where they are at with their meds. Most of my meds were short lived and either they helped for a short time only or the side effects got me. We ran out of options with me that is why I have the pump. There is other threads on here that medications were discussed. One post was done by Catahoula just recently so you should be able to pull that one up and get lots of info.

Again, a belated welcome aboard and good luck at your drs appt.

Posted 1/11/2010 11:38 AM (GMT 0)

Hey, Mevan.  I think your otho is on the right track suggesting you see a PM doctor.  Hope he is a good match for you.

As far as extended release meds there are alot of different options out there to choose from.  Oxycontin is the same as oxycodone or percocet with no tylenol but is extended release.  There is no generic for this so can be quite expensive depending on your insurance.  There are also several morphine based ones too, such as Avinza or MS Contin. 

I'm sure your PM doctor will be able to work with you on the best pain treatment for you.  As you know everyone is different so what works for one person isn't going to work for another.  It can also take time to find the best mix for you.  It can also get frustrating until you find the best meds for your pain so try to be patient.

Not all meds have to be narcotic based either.  I use Neurontin which is non-narcotic for nerve pain and alot of people add Cymbalta, an anti-depressant which can help with pain.

Good Luck with your appt. and like I said be patient until you find the right doctor & meds for you!

Posted 1/11/2010 11:18 PM (GMT 0)
Update- I saw the new pm dr today. I really like him as he sat down and really wanted to try to understand why and where I have pain at. He has given me a variety of options and wants me to tell him what I feel would be the best way to start. He bas prescribed me oxycodone for bt pain, and because I do get a big benifit from tramadol as many people do not he has put me on 200mg ultram er. Its a 24 hr extended versus the 50 mg immediate I was on.

Now onto another question for you guys... Do any of you have any experience with a Spinal cord stimulator? Because of my condition, he has also thrown out that option. I have gone over a dvd as well as brochures. but I really would like to see if anyone has had this implant put in? Benifits/non ?

Thanks again guys.

Mike
Posted 1/12/2010 12:50 AM (GMT 0)
hello, Mevans27 First question: I am blessed in the fact I have a very good friend who is a rheumatologist who now does pain and arthritic pain mang.. Also prior to my own spine problems I have had pre-med classes relating to pharmacology and a couple simestors of pharmocology college. As far as long-acting meds their are two classes: "smoothy opiates" which ultramER is one; these are formulations that do not have an initial spike in the blood levels or have any immediate release properties: kadian, oramorph (brand only),methadone, opana ER, fentanyl patch. Long acting non-smoothy opiate meds have an initial spike in the blood level or somewhat of an immediate release effect: oxycontin, MScontin, avinza, or most generic formulations of sustained release morhine sulfate or oxycodone. A side note; people that do well with ulram are saying great things about nucynta although it is not long-acting you might want to talk to the PM Dr. about it.

Second question; because of your relatively low level of meds at this time, if it is contolling your pain I myself would hold off on any surgically implanted devices. I have no experience with one but it was brought up. I do know many people with them and I have heard mixed results.
Posted 1/12/2010 1:33 AM (GMT 0)
The pain levels are certainly still elevated, but better. I am at a lower level of meds and deal more with the pain due to my job. I am a full time chemist in which my attention is need constantly. I found with the higher levels of meds my focuss would decrease but my pain levels would be helped alot. I am trying to find a balance in which I can try to manage both. The oxycodone seems to work much better for the bt pain versus the hydrocodone, but of course we all know the differences. I have an alergy to morphine, so because ultram has a synthetic property that works similar to morphine may be the reason why it works better with me than a lot of people. I will definitly talking to him about the nucynta. Thank you for your input
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