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Posted 10/17/2010 5:12 AM (GMT 0)

I am thinking that this topic has already been discussed & covered quite a FEW times but I couldn't find a thread for it.

 

As with each and every one of you, I currently take a LOT of medications. Morphine 15 mg (1am, 1pm, 2 at bedtime), Lyrica 150 mg 3x a day, Paxil 10mg 2X a day, Valium 5mg 2X a day, & Vicodin10-660 1 every 6 hours or 2 if needed.

 

My newest concern is that I am building up a tolerance to the Vicodin. I am just NOT getting the same relief from it as I used to. I know there really isn't many other pain medications that are stronger than the Vicodin. I want to be able to take it and still somewhat function during the day because I currently am in graduate school.

 

I am already going to talk to my doctor about trying a pain pump so I can take less oral medication & maybe get more relief that way.

 

I was just wondering if anyone has tried any other types of medications that provide similar relief as the Vicodin does for me. It does not tear up my stomach. I have been on Percocet, Norco, Nucynta (BAD BAD reaction...hallucinations, blurred vision), Darvocet, and Ultram (which gave me SEVERE hallucinations).

 

Just trying to get as much information as possible from my fellow warriors in pain.

 

~Black Satin Phoenix~

Posted 10/17/2010 10:51 AM (GMT 0)
Well, a pain pump would be a HUGE jump from where you are...a VERY huge jump. There are a lot of medications between what you're taking and a pain pump. In my opinion (in regards to pain management) you're not on a high dose at all.

There is oxycodone without tylenol for breakthrough and there's Norco, which has less Tylenol than what you're taking now (10/325). There's dilaudid. The morphine that you take (I think) is the lowest dose that they make in long-acting form.

So, if you don't feel like your pain is under control, you have many options in regards to medications because I really think you're on the low end dose-wise. I'm sure that others will chime in here.

Hugs,

Flower
Posted 10/17/2010 6:24 PM (GMT 0)
Thanks Flower :-)

Appreciate the information!

Norco really doesn't work all that well for me, tears up at my stomach like nothing else. The doc thought it would be that way on the Vicodin. He & I STILL can't figure it out! LoL. I will see what he thinks about upping the morphine or trying something stronger like dilaudid. I was on that once in the hospital and that is one of the best I have felt in quite some time. So we'll see.

Just wanted to know more of my options before I took a step forward with the pump. With being on Worker's Comp, I am just going to TALK to my doctor about it because it takes literally FOREVER & a day for them to approve anything. So possibly by the time I will need it, if that day comes, it will already be in the works of being approved so I won't have to wait so dang long!

Thanks again Flower!

~Black Satin Phoenix~
Posted 10/17/2010 6:49 PM (GMT 0)
Hello BSP!

I have to agree with Flower123 as well, and feel that the pain pumps should be a last resort, and even then should be approached with caution.

We have a few members here on the Pumps, and maybe they will comment on this with their knowledge.

I must say that you're doing well to have a PCD working so closely with you on the meds, as many in this country are experiencing difficulty getting proper treatment.

We wish you luck, and hope you report back your findings to the members here.

SE wink
Posted 10/17/2010 6:55 PM (GMT 0)
Hi BSP,
There are lots of other options besides the ones you've tried.

The ACPA describes different treatments for pain, including medications:
www.theacpa.org/uploads/ACPA%20Consumer%20Guide%202010%20062110.pdf

But I have to wonder what other non-pharmacological treatments the doc has tried, as well as whether he's done drug holidays with you. My current PM does them & I haven't upped my meds in 7 years. Some people even say that after the holiday their prior dose works extra well for a while. Definitely not something to try on a school week, but Thanksgiving or winter break can work well. It sure sounds like you are on a LOT of acetaminophen. Having lost a lot of relatives to liver damage -- 2 non-drinkers who got it from regular Tylenol use -- I would worry about nearly 8000 mg of acetaminophen a day. I guess a pain pump would be better than that, but there are so many other options that don't involve surgery. Hope you can find something that works for you.

take care,
frances
Posted 10/17/2010 7:14 PM (GMT 0)
Yes, that is a lot of tylenol and the dr really needs to be careful of this. The pump meds would not necessarily be a huge jump most likely you would be on less, thats the beauty of the pump. Plus the liver is bypassed. I cannot remember but how well is the Morphine covering your pain? I can understand the need to keep things on the low end because you are in school too. It stinks when we start becoming tolerant to our meds. I know Frances mentioned the drug holiday, which would be great if your RSD was in remission, but thats not quite the case so I do not think a drug holiday would be something you would be interested in. Perhaps your dr can come up with something different for BT pain. Its a pain finding something that will work, its all trial & error. Do you have an appt scheduled with your dr soon? Let us know how it works out for you.

I don't think some of the other members are aware you and I have been talking about the pump in another thread, lol.

Take care.
Posted 10/18/2010 2:32 AM (GMT 0)
Just to clarify, drug holiday is not for when you are in less pain. If you are in less pain, you should lower your dose for as long as you are in less pain. Usually I go on the drug holidays when my pain is at it's absolute peak & I am nearing the point where I would be hospitalized for the pain. It is a living hell for a week or two -- usually I am nearly totally incapacitated. That's why I say not to do it while at school & to plan on having it totally destroy your vacation.
The only real point of it is that I started on meds in my mid 20's & am now in my 30's. I have a heck of a long way to go, god willing, living on pain meds and after seeing 8 of my relatives die from cirrhosis, I need to be as careful as possible. Even if I were given a pain pump, which I really don't want & hopefully now won't need to consider, I would still be put on 1-2x/year drug holidays b/c though the amount going to the liver is much less than with most oral meds, some is still processed by the liver for most pump meds and it seems that people with pumps need more increases than people on oral meds [though in fairness, there is less overall impact on everything but the spinal joint from spinal anesthesia vs. oral so it takes many more increases to get to the point of it equaling out].

Just so complicated. Anyways, my only point was that drug holidays are not for when your pain is less. It would be nice if it worked out that way (& I'm going to try to start being proactive & scheduling one when my pain is less so hopefully later in the year it won't be so dreadful), but the point is to take it when your pain is getting worse to hopefully "reset" your tolerance, making the same dose have a greater impact (when you need it most).
Posted 10/18/2010 4:54 AM (GMT 0)
Thank you Screaming Eagle!

You are definitely right about one thing. SO many people have been struggling to find a good doctor to help them even get started on the right path to healing. I have been one of those individuals. Took me almost 5 years to find a doctor who is willing to work WITH me & play trial and error with medications to see what works best.

I will for sure keep you updated. Thanks for your kind words :-)

~Black Satin Phoenix~
Posted 10/18/2010 5:08 AM (GMT 0)
Frances,

I have never heard of "drug holiday's" before. Now that I sit back and think about it, it seems like a very common sense, great idea. I could only imagine how HARD it would be without your meds for a week or two. I was on NO medication for over a year. Surprisingly. It was a mind over matter type deal. I totally BLOCKED out the pain so that I could function. No it wasn't healthy but I had to do it with the life circumstances I was handed at the time.

I already have acid refulx and had that under control for awhile. With the constant switching of medications lately, it has irritated that. My doctor is surprised with the dosage of Vicodin I am on because of the high amount of acetaminophen content. He put me on Norco & Percocet, which irritated my stomach MORE! My body is weird! I want to find something that will decrease the pain so I do NOT have to take more medications.

I am in graduate school online. It is a VERY extensive program. Classes are 6 weeks long (15 wks of a normal University semester crammed into 6) and it is very stressful to say the least. Classes are back to back with NO breaks in between, even for holidays. I just recently found out that I can take "medical leaves" from classes if need be, which I am GRATEFUL to find out that its a possibility. That is why I wanted to talk to my doctor about all possible options ahead of time so I can plan accordingly & NOT be penalized in obtaining my degree.

I saved the link you provided to look over at another time. I love learning all I can so that I know EXACTLY what my options are.

I had an epidural cathetar from one of my previous pain management doctors that ended badly to say the least. He put me on Fentanyl (sp?) and I before that point, that was THE hardest drug I had EVER taken. To him there was no other choice of medications & every time I brought up the subject, I was shot down. The pump started to leak & doctors had to remove it. They feared I had menengitis. So I am scared to receive another one but the pumps I have been looking at are a LOT safer & more advanced than the one I had with more options of medications.

You're right. It is a toss up. BEYOND complicated.

Thank you SO very much for the information & your concerns! I very much appreciate it.

Take care.

~Black Satin Phoenix~
Posted 10/18/2010 5:13 AM (GMT 0)
Straydog,

I am on Morphine (15mg) 1 tablet am, 1 tablet pm, & 2 at bedtime. I am becoming tolerant to this medication as well, unfortunately. I used to be able to tell when the morphine kicked in but now, nothing. It's kind of like me taking a sugar pill.

I have an appointment on the 27th of this month. Yes it is over a week and a half away. This appointment is when I am scheduled to receive round 2 of the trigger point injections as well.

Will for sure keep you posted.

Hope you are feeling better yourself!

~Black Satin Phoenix~
Posted 10/18/2010 4:22 PM (GMT 0)
BSP-
They do have fentanyl available in patches. 12.5mcg/hr or 25mcg/hr are usually the starting dose, but they can go way up from there. I am allergic to the adhesive and on top of that I can't have them on in the shower without OD'ing, but that's not common so maybe it would work for you. For a number of years I was on oral fentanyl (Actiq) and that helped. They are designed to be used for breakthrough pain, but I used a little bit at a time so that it was more similar to the patches. It did help & I was able to work full time & take a couple graduate classes while on it. I feel for you with the overload of classes. I'm looking for a permanent teaching assignment right now & need to complete my 6 endorsement classes by next August so I needed to find something that would work very well, without totally blurring my thought process.
Everyone is different but personally I've found that Methadone works way better than anything else I've been on (if you get a pump, they can put Methadone in the pump too). After a couple weeks of adjusting to it (my pain got worse for a while & I needed extra bt meds for a bit), I am now better than I've been in 10 years. So there is hope. I am studying Mandarin & haven't had any issues so far so I'm not really worried about grad school.

Good luck. Hope you find something that works for you.

peace,
frances
Posted 10/18/2010 5:53 PM (GMT 0)
Wow, I sure hope your getting bloodwork done to check your liver
with that amount of tyelnol...Good luck with your appointment.
I sure hope this doctor will do good with getting you the meds you need
for the medicine pump...I'd rather it was called medicine pump..
((((((((((((((((((((((((((((((((((((((((BSP)))))))))))))))))))))))))))))))))))))))))
healing hugz
Posted 10/18/2010 6:28 PM (GMT 0)
You know I SHOULD be getting blood work done to ensure my liver is ok with all that Tylenol in my system. But I have been on it since March of this year and not ONCE has that occured. Guess it is yet ANOTHER topic I need to discuss with my doctor.

I put in a call to him today, so HOPEFULLY he returns my phone call so I can talk to him about a couple options with the added soreness of the trigger points ALL the way through my leg AND lower back, as well as another option for medication because I of my tolerance to it.

I like medicine pump too. Pain pump kind of sounds like it's going to be causing MORE pain. And that's a NO NO! It technically is a medicine pump because that's it job! LoL.

Hope you are having a good day!

*HUGS*
Posted 10/18/2010 6:37 PM (GMT 0)
Frances,

I did NOT know there was an oral alternative to fentanyl. SO good to know! It makes perfect sense though because MOST medications come in numerous forms. Maybe mixed with different medications, I can take that (orally or in the patch form) it will work a lot better for me. Lately, since having the trigger point injections, I have been having a great deal of BT pain & quite frankly, don't like it. I think that may have to by my next step, other than dilaudid or methadone. I am a little scared to be put on Methadone. But if it is something that will significantly help with pain & let me accomplish the MANY things I want to in this life, I will give it a try. Did you have any bad side effects with it at first? Or does one's body easily adjust to it?

Wow! Your educational endeavors sound fascinating! And something to be very much proud of yourself for! A lot of the medications do blur your thought process significantly. With the switch of medications lately, I am finding that to be more and more true. IT's hard to concentrate on anything for too long before you sometimes feel like a total idiot. Some assignment I know would only normally take me an hour or so to do, take me all darn day sometimes! It's like SERIOUSLY! Ok. Enough. Ridiculous! Please work brain! PLEASE!!

I wish you the best of luck in searching for a teaching positiong & with the rest of your classes. 6 more to go is NOT bad at all. It just seems the closer you are to being done, the time does NOT go by fast enough!

Thank you for ALL of your helpful advice & suggestions! I REALLY do appreciate them!

~Black Satin Phoenix~
Posted 10/19/2010 2:19 AM (GMT 0)
BSP yes Methadone can be a very good cheap pain reliever. It is a drug that is for long term use only. I was tried on it but could not tolerate it and I was glad in many ways. It is a last resort type of drug as far as I am concerned. There are lots of other drugs out there for pain. It has the half life that you have to deal with. It is a drug that has to be taken exactly as prescribed and you cannot ever decide oh, I will take just one more to see if it will work better, thats how many have overdosed on it. One of our members here is on Methadone and has been for a long time. She has tried 2 different times to get off of Methadone to change to something different and has not been able to do it. Methadone does not always work well with lots of other meds some of them are your nerve meds like Lyrica and Cymbalta. You really have to do your homework on it. We have talked about it before here so you may want to do a quick search on it. The Actiq is a highly addictive medication and one of our mods was put on it and she had no clue about it. She ended up changing drs and he probably saved her life she says. Not only that but it is about $2,000 a month and I doubt WC would pay for it and it is real bad about causing tooth decay. I don't know about Methadone being used in a pump, have not heard of that before. I know only certain meds can be used in them not just any drug. As far as tolerance issues being more with a pump it is no different than with orals I would lean towards less because your medication is in a concentrated form not diluted with other stuff like oral meds. In the beginning with a pump they always start a patient at the lowest dose and slowly titrate the dose. Also, high doses are not used in pumps, instead they will change you to a different medication. High doses can lead to problems with the pump itself. So much of this is all trial and error to say the least, lol. Hope you get to feeling better.
Posted 10/19/2010 3:48 AM (GMT 0)
There is Actiq & Fentora (there's oral Dilaudid too for that matter). As Susie describes, they are rapid acting & last for only about 4 hours at a time. You cannot take more than 4 doses per day regardless of what dose you are on. The patch (Duragesic) is a bit better if you can tolerate it b/c you get more even dosing every hour. But people do say that sometimes it only lasts for 2 of the 3 days it is scheduled to be on so that can be tricky. The cavities are an issue. I've gotten a lot & that is a huge downside, but even my dentist doesn't fault me for choosing fillings over bedsores. Like Susie mentioned, the generic of the lowest dose of Actiq runs $1200/month for 120 doses. Fentora is name-brand only. It runs about the same. I don't know about WC, but even private insurers don't always cover them unless you are using them on-label (i.e., for cancer pain) so it's good to check with your insurer first. Duragesic patches are quite a bit cheaper & usually are covered.

Like every other drug out there, there are downsides to Methadone. It took me a while to build up to taking one whole dose per day. And now I'm working on 2. It really knocked me out at first -- severe dizziness & such. I was not too keen on it for a week or two. But now I love it. I can focus much better on Methadone than on the Actiq/Fentora. Dosing is much simpler & it's safer on the liver (neither fentanyl nor methadone cause probs with kidneys which was a major factor for me since I've had probs with them shutting down on one med & having more minor issues on others). I don't really imagine I will be off of pain meds ever so that's not such an issue. But there is always the trade off of choosing short-acting meds & having a shorter but acute withdrawal or choosing long-acting meds and having a much longer but less acute withdrawal. My PM is really good at managing both so I'm not terribly worried. Plus with switching back to teaching, I will have 8 weeks in the summer to deal with the drug holiday (usually I end up needing one in August, so we'll just move it up to July so I can be through it by the time school starts back again). Best of all it runs $20/month so regardless of whether it's covered or not it is manageable. Pete's been on it for a while & says it's worked well for him (I think his screen name is "Pete trips again").

But it's always tricky. There's not one thing that works for everyone & different people have different reactions. I imagine almost regardless of what you choose it will mean taking some kind of leave from school or at least asking for accommodations (as an undergrad they allowed me to skip more classes than what was usually allowed & as long as I still got decent grades on papers and tests I passed the class with no attendance penalty -- amazingly, the classes that I was allowed to miss I got all A's in b/c I was able to get treatments & then go back and listen to tapes/read notes/etc. rather than sitting through a class the best I could, running out to throw up from the pain at least once & using all my focus on trying not to scream or cry during the lecture). Not every school or teacher will allow that, but it might be worth asking about. I had one jerk of a teacher who refused -- in spite of a petition from the dean asking him to consider showing mercy -- but other than that all my other teachers were very understanding. I would definitely suggest taking whatever help you can while you're in school to get your meds straightened out b/c once you're in the workforce there is not likely to be too much understanding, esp. these days. There are all kinds of ways that schools can help you out (special assignments, testing arrangements, student helpers, scheduling accommodations, etc). Take advantage of them so that upon graduation you can hit the ground running & find a great job!

hope that helps!
frances
Posted 10/20/2010 6:02 AM (GMT 0)
Thank you straydog!

I will do a quick search on it to see what I can find.

I would never go on something like Methadone ONLY if it were a last resort. I just wanted to get some information to see how others have tolerated it & if it was any good with pain. Sounds like something I probably wouldn't want to be on. Most likely would be scared to death to try it. Like I said...a last resort.

Thanks again for your kind words & your advice. Much appreciated.

~Black Satin Phoenix~
Posted 10/20/2010 6:19 AM (GMT 0)
Frances,

After reading your post, I am not so scared about the Methadone. If I was able to tolerate it, being in grad school online, it may be easier to take the breaks I need & still be able to accomplish my work. I know the school I attend is VERY understanding & extremely accomodating, so I DEFINITELY am going to look into it. Because I have almost a 4.0 and I don't want to jeopardize that in ANY way. All I know is that I need to get on something that will work & something that will allow me to concentrate because lately I have NOT been able to do so with pain.

I am more concerned than EVER before about the amount of Vicodin I am on and my liver. I don't want to cause any more health issues than I already am experiencing if I can help it.

I just quickly looked up Fentora and Actiq. Fentora sounds more like something I would be able to tolerate and still somewhat function. I know with any other types of medications there is an adjustment period.

I have to be honest. I am scared. EXTREMELY scared. My pain is getting worse & I have no idea what to choose. A part of me REALLY wants to try the pain pump again. I know lower dosages are used to start off with, but being in a concentrated form may help me more than the oral type of medication. Duragesic patches sound like something I would be interested in as well. But as you stated they only last a few hours but the medicine is continually in your system...which I like the idea of...just as with the pump.

I can NOT quick my dream of obtaining my Master's degree again. When the injury first happened, I lost 2 jobs, my apartment, and my first chance of obtaining my Master's. I want to make sure I choose the right medication so that if and when I must take a leave from school that it's only a one time deal. But knowing this disease, probably not. You're right Frances. It IS tricky.

I want to thank you from the BOTTOM of my heart for your kind words of support & words of wisdom. They mean more to me than you will EVER know.

I hope school is going well for you & that you are having a good week so far.

*HEALING HUGS*

~Black Satin Phoenix~
Posted 10/20/2010 8:13 PM (GMT 0)
BS the best thing to do is set down and talk to your dr about your pain as you have here with us. Explain to him your fears of many meds because of not wanting anything to interfere with your schooling. I will caution you to be very careful throwing out names of pain meds to a dr, many times that can cause a red flag to go up and the next thing you know your very nice PM dr suddenly thinks you are an abuser and junkie. So tread very lightly here. Many a patients have been escorted out for this very thing so be very careful.

I think if you explain things well like you have here he should be able to come up with a plan on medications for you. Everyone is so different in how they metabolize and tolerate medicines it can be a hit or miss.

I had my pump refill this morning and another increase in my pump. I am still after all of these years on a very low dose for a pump and my dr knows this has been a fear with me. My prior PM dr that knew nothing about pumps or the meds had me on such a low dose then told me for 2 years no more increases that I was maxed out when I was far from being maxed out. Increases are given in such tiny amounts that it can take awhile to get there. But, one thing about it, during this time I am able to function, you have no highs or lows with a pump like you do with oral meds. She told me this morning it was her job to worry about me maxing out my pump and in all of the years she has been doing them she has never had one to max out, lol. She is right, from now on I am going to turn that over to her to deal with. Oh how I wish she had been taking care of me from the very beginning. But, I am so thankful to have her now that is for sure.

Saw my PCP yesterday and the cellulitis is back in my legs. We did a shot of Rocephine and I started on oral antibiotics. If those don't get it cleared up or improved in a week then I will do IV antibiotics. I was fussed at because of the swelling and tightness in my legs, I am suppose to wear compression hose, but there is no way to wear them in the heat in Tx. I don't mind wearing them when its cooler but not in heat. Now, back to elevating these legs. Hope you are feeling better.
Posted 10/20/2010 9:39 PM (GMT 0)
BSP,

 

Have you tried Opana?? I've heard some great stuff on it for pain releif on Opana. I've never tried it myself, but the people I know who take it, swear by it. It comes in a long acting form and a short acting form, so you could take the long acting one daily and the short acting one for breakthrough pain.

 

Actiq and fentora are great for breakthrough pain, but most insurance will NOT pay for it unless it's being used for cancer pain, and they're VERY expensive!! The fentanyl patches are great also for a choice in pain releif, but like other's have said, it has its downside, like only lasting 2 days instead of 3, ODing if you overheat....

Methadone is also great for pain releif, but that's one you must be very careful with, and must be started low and built up slowly, it has a bad reputation, but when used correctly, it is a great pain releiver, I used it for many years and it worked great.

But the morphine dose your taking does have ALOT of run for being raised, 15mg is the lowest dosage form, at one point I was taking 100mg three times a day, so your nowhere near being out of options for the morphine.

 

And you said you have taken Norco (hydrocodone 10/325) and had a reaction, but your okay with the 10/660 dose?? Or did I get something wrong there?? Cause I was thinking that maybe you just need to be switched to the 10/325 to help save your liver somewhat.

 

These are just a few ideas I have, I hope your doctor comes up with something more helpful, building a tolerence to pain medication is part of life when suffering with chronic pain. And thankfully more and more options are being invented all the time lately for pain control.

 

-kitty

Posted 10/21/2010 3:45 AM (GMT 0)
Wanted to mention also that there are pain psychologists & that might be an option to help you sort through some of the options your doctor gives you. I know when I was first starting on pain meds I was terrified -- had a roommate who went from a 3.9/4.0 Honors student with 2 semesters left to a college drop-out from getting addicted to Vicodin after breaking her arm. So sad. The pain psychologist took lots of time to explain all the factors that can make a medication more or less beneficial for one's particular situation. Your doctor needs to determine what meds are options for you, but assuming there are a few choices the pain psychologist can be a real godsend (plus they can recommend ways to manage the pain so that you can still function and/or so it doesn't get quite as severe). Your pain specialist should be able to refer you to someone if you ask.
Posted 10/22/2010 3:27 AM (GMT 0)
Straydog,

Trust me. I am not going to go into the doctor's office throwing all types of names of medications out there. I just want to do my research for me so I KNOW what is available & what my options are. My doctor knows I like staying ahead of my traetments and knowing how to better manage my pain because of my bad experience with the last doctor. He oftentimes asks me for suggestions about what he thinks we should do as a team & gives his advice & we go from there. So that is why I am gaining all this additional information.

I would LOVE not to have highs & lows with pain! That is why I am seriously considering the pump. I am learning to have patience with certain aspects of my life where I NEVER did before. One good thing about this nerve disorder. I really hope it continues to give you relief.

I am SO sorry to hear the cellulitis is back. I REALLY hope they shot & antibiotics help calm it down so you DONT have to go on IV antibiotics. Please take care of yourself. Keep those legs elevated. Pop in a movie now and again & relax.

Please keep up posted. You have me worried about you.

*BIG HEALING HUGS*
Posted 10/22/2010 3:34 AM (GMT 0)
Kitty,

I am SO glad to know I am NOT out of options with the morphine! Even though I take 60mg over the course of the entire day, it does provide a very small amount of relief. So maybe upping that dose & finding something that will work during the day will be just the ticket I need.

And you got the Vicodin/Norco situation correct! I took the Norco 10/325 & it ate my stomach something fierce! I couldn't keep ANYTHING down & my chest felt like it was on FIRE! But I can tolerate the Vicodin 10-660 with no problem what-so-ever. I know it doesn't make any sense. But that's what is occurring. I do NOT want to do any damage to my liver. I have ENOUGH health issues to worry about. I think my BIGGEST concern is wanting to find something that will help with pain that WON'T cause any damage & that I don't have a tolerance to. That is why I am trying to find as many options as I can so that I know what is available. I will NOT take Nucynta or Ultram! SEVERE seretonin syndrome & SEVERE hallucinations occurred. Scared me S**Tless. Thing were talking to me and popping out of the woodwork of the house that NEVER should.

Thanks SO much for your advice! It is BEYOND greatly appreciated!

~Black Satin Phoenix~
Posted 10/22/2010 3:38 AM (GMT 0)
Frances,

I have NEVER heard of pain psychologists before! WOW! YOu really DO learn something new everyday! I need to find other ways besides over the counter remedies & stretches to manage pain, along with my worsening depression, so I can function and feel like myself again. This is something I am SERIOUSLY going to look into.

I am sorry to hear about your friend. That is SUCH a shame when there is SO much potential & SO close to accomplishing her dreams. Some people think they can handle pain medication & injuries without any kind of help from anyone. My heart truly sinks for her as well.

Thank you SO very much Frances! It means a great deal to me all this wonderful & insightful advice!

~Black Satin Phoenix~
Posted 10/23/2010 6:54 PM (GMT 0)
Hi Black Satin,

As far as a medication with similiar potency to Vicodin 10 that builds a tolerance more slowly, there is a medication. You should talk to your doctor about Nucynta (Tapentadol). Nucynta comes in 50 to 100 mg tablets, but only about 1/3 of the tablet gets absorbed (which is why the dosing is higher), so a 50 mgs Nucynta is roughly = to 10/660 mgs of vicodin. In addition to being a full Mu agonist like vicodin, it also has a secondary mechanism of action, norephinedrine Rreuptake inhibition, which does 2 things. #1, it provides a second mechanism for reducing pain (as the NE/SE pathways are now considered part of pain relief) #2 it slows down the development of tolerance to the medication. Eventually you will build a tolerance even to Nucynta but at about 1/2 the rate, and its secondary action mechanism keeps that tolerance from taking as big of an effect.

Its worth a trial but just be aware that it does cause some side effects and that it is a schedule 2. If you use it for more than 90 days on round the clock dosing and decide to come off, expect some moderately severe withdraw (I tappered down to quick and it was definately in my top 10 most unfun events EVER, so tapper off SLOWLY ) that has both anti-depressant and narcotic withdraw symptoms (restless legs, hot flashes and cold sweats, emotionals out of whack, drop in energy). However, the withdraw period seems to be relatively short compared to some other medication. Most of the time I had little to no side effects and it does kick in significantly after 45 minutes to effectively kill the pain and improve your mood/socialiablity. The worst side effects were when I took 150 mgs for breakthrough pain, I had some not so nice hallucinations, which were tolerable after about the 3rd time, lol.
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