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Pain med dosage question

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Posted 4/14/2012 6:06 PM (GMT 0)
So my pain is weird. I keep a detailed medical journal and take 2 10/325 norcos as needed and 2 2.5/325 percocet at night. Somedays I can go without taking any pain meds for 8-10 hours and I'm fine. Other days I'm waiting til the 4th hour to take my next dose bc the pain is horrible. I started taking Prednisone and the pain meds about 3 months ago more regularly b/c of both dental and autoimmune problems.

Initially I was taking just 1-2 norco every 4-6 hours as needed and it seemed to bring my pain from a 8-9 on bad days to a 4-5. However, progressively it seemed to work for shorter periods of time, like after 3 hours I'd be really hurting again. I discussed this with my GP and he eventually prescribed me 2 2.5/325 percocet for night time. He did this b/c I couldn't sleep. I'd wake up nearly every 3 hours in pain and told him I'd like to try something extended release. He said to stick with the norco for now but I hate having to deal with the ups and downs of the pain, and I refuse to go back to how I was feeling before these meds. I couldn't see straight, get any school work done, keep a job, or go out with friends. After the meds my life went back to a somewhat normal one, as I'm a 31 year old male who doesn't smoke/drink/do drugs and eats healthy and exercises when I can. Also, I hate the idea of a short acting pill that contains a lot of tylenol. Before I was treated I just popped tylenol like candy which gave me some stomach problems.

So my question is what do I do? Do I insist on some other drug? Do I ask the oral surgeon or rheumy? Do I just deal with it? Because lately I'm finding myself taking more norco's and I don't like that at all. Either my condition is getting worse or my tolerance is going up. Either way I'm not sure how to manage my pain as when it's there it's all I can think about. I'm seeing a rheumy and oral surgeon very soon but I am almost at the end of my semester and am struggling to get my work done. The pain meds literally make the difference as to whether or not I can even focus on print. Maybe the rheum or oral surgeon will give me something different but I really like my GP and I like to have a steady doctor who knows me to help me until I get my surgery and establish a relationship with my rheumy.
Posted 4/14/2012 9:23 PM (GMT 0)
Hi Matt and welcome to chronic pain forum. In all honesty I don't see an oral surgeon rxing a along acting pain medication, that is just not within their realm of practice. Depending on what your medical condition is and what the rheummie is treating you for, he may be the one to prescribe the long acting. We are seeing since all of the changes that have taken place in the last couple of years for drs that prescribe narcotics, there are new rules and guidelines in place by the DEA, most GP's will not either. They do not want to be under the gun with the DEA showing up at their office for an audit, they are scared of the DEA. Something tells me you are not aware of all the changes that has taken place when it comes to drs rxing narcotics. It is very difficult finding drs willing to rx them. Most of us here at the forum are under the care of pain mgt drs as that is their specialty, treating pain. This may be something you need to consider.

Taking more medication that what is prescribed is going to cause you many problems, running out early, the dr will not give a refill because its too early, then they start looking at you like you are possibly abusing the meds, its just a bad scene to get into. I am not saying this is what you are doing, I am telling you this is how drs view this situation. Best thing to do is get in with the dr and let him know your pain is not being covered by your meds and see what he suggests.

Keep us posted on how you are doing. Take care....Susie
Posted 4/15/2012 2:05 AM (GMT 0)
Matt...I agree. The best thing to do right now is to go see one of your doctors....not the oral surgeon...and explain how you are feeling and simply ask for help.

One of the worst things to do is ask for specific meds or seem to demand a dose increase as this is often seen as drug seeking behavior. It is fine to bring up the subject of trying an extended release pain med or something general like that but don't walk in saying you want morphine or something like that.

If your rhemey or family doctor is unwilling to do anything then ask/insist on a referral to a pain specialist. Be sure that it is one that does prescribe medication as well as does procedures. Some will only do the latter and that is fine if that is all you need to see them for, but if they are going to be taking over your pain management you want a doctor who does it all.
Posted 4/16/2012 5:34 PM (GMT 0)
Thanks for the advice. I guess I just worry more about the stigma than my rights sometimes. I take extended release forms of other psychiatric drugs, therefore I guess I just prefer the idea of taking less pills per day. My GP told me the last time we talked he's just afraid he's going to get me hooked on pain killers. I told him that I've been on them before, am physically dependent on my antidepressants and prednisone, and have weaned off of other prescriptions in the past without a problem. I just want to get on with my life, as it seems I spend more time in the day trying to manage my pain than getting things done. My GP is a family friend of mine and I don't want to cause any suspicion, as he's the first doctor to legitimately address my issues. I'm used to the psych where, once you start a drug, you need to find the effective dosage, and then you work from there.

What should my expectations be pain wise? How much should I deal without calling him bc my current script is not doing it's job most of the time. I don't care what he puts me on, whether it be the same thing in xr, or anything else. I don't care and always tell them whatever he think will work. I told him that my main interest is in not having my pain come back in 2-3 hours sometimes, to be able to think straight, and to be able to sleep. I feel like since the medications now aren't working as well that it comes off as me wanting more rather than my body needing more to cope. It's just a touchy subject that I hate altogether, darn drug addicts screwing things up for everyone. I'm just trying to find a balance between being in less pain and not being in an awkward situation with a doctor I really like.
Posted 4/16/2012 7:36 PM (GMT 0)
I don't know how long its been since you last saw the GP or got a refill on your meds. If its been recent I sure would not make an appt. If its been a couple of weeks, then call and get an appt and just be honest with the dr and say the medication is not taking care of the pain and you are just miserable. Tell the dr you realize the pain medication will not take all of the pain away, but with the poor coverage that you currently have it is making life very hard and its even harder just to do daily activities. Ask the dr what he can do to help you.

You do need to try and get past some of your issues about taking pain medication. None of us want to be on meds but have no choice if we want any kind of a life. Another thing is try to get your attention off of the pain so that is not what you are constantly thinking about. Read a book, listen to some good music, work some puzzles, anything to get your mind off of it. I play online card games and even memory type games. I go outside and piddle around with my plants. I will go to a lawn center and hang onto a cart and walk around looking at stuff.

I am not going to try and kid you, its a real hard balancing act to pull off living with CP. Something I would not wish on my worst enemy. Take care.....Susie
Posted 4/16/2012 8:38 PM (GMT 0)
Do both Drs. (The GP and Oral Surgeon) know that you are getting prescriptions from both of them? It's important to have everyone on the same page...

Especially since you are taking two different short acting medications that include Acetaminophen which can take a toll on your liver.

I agree that the Oral Surgeon should not be the one to be continuing to prescribe any narcotics....That would be either the GP or a Rheumatologist that you say you are going to see...

When is the appt. with the Rheumy? Hopefully it is soon so that you can go over all your issues and have the appropriate tests....

The other thing as Stray mentioned is to use other modalities to be helping lower your pain levels....This is where those of us with chronic pain know that a narcotic alone is not the answer...As well as it's only meant to dull the pain...not take it away...

The key is taking the medicine exactly as prescribed....then you shouldn't have any type of issue with addiction. As well as not sharing with anyone that you take this kind of medicine.

But again...hopefully you can get some better answers to be on a plan to get better!

Keep us posted...
Posted 4/19/2012 8:36 PM (GMT 0)
Hi Matt
Just thought I'd put my 2 cents worth in. I agree with what the other have said. You may want to ask your doctor to give you straight oxycodone without it being mixed with tylenol. This is what I take. Percocet is usually oxycodone mixed with tylenol but you can get it without the tylenol or anything else added which makes it easier on your stomach, kidneys and liver. Good luck and keep us up to date. All the best.
Stingray
Posted 4/19/2012 11:34 PM (GMT 0)
First of all, I'm not getting scripts from both docs. Only from my GP. I don't think it's appropriate for me to ask both doctors for the same type of medication.

Anyways, scheduled my surgery for next friday and I'm hoping that its 100 percent of what's causing all of this pain. I think my GP is absent minded sometimes because I started on 2 10mg norco's, which I had previously taken when I had a kidney stone, then 2.5mg oxycodone/325apap, and now MS contin 30mg XR.

My main concern was addiction because of all of the stigma attached to pain relievers, however the reading I've done suggested that taking an extended release for chronic pain is much better than a short acting one. I've taken anti depressants before and always preferred the xr as it's not as much of a roller coaster. I'm a little scared to take the MS contin but, as of the last couple weeks, the norco isn't really even dulling the pain.

I'm excited for surgery and hoping that my pain will be like my girlfriends brothers who had the same surgery. He said he went from a 9/10 to a 1/10 after recovery. Thanks for all the advice, as I really appreciate it.
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