Pain, Meds, and Work

Hi All,

I've been struggling with my new medication regimen. about 2 months ago, my PM told me to increase my hydrocodone use to 20-30mg per day, rather than move on to a stronger time-release med (currently, Ultram ER 300mg).

I've been finding that daily use makes me feel crummy. I'm o.k. for the first 10mg, but as the day moves on, and I take more, I get headaches (even with 3-4 liters of water) and just don't have the energy I used to. So, I've tried various strategies -- taking lower doses more often, taking a large dose in the morning then waiting a long time until I take another, etc..

Overall, I feel like I am negotiating between cognitive side effects on the one hand, and sufficient pain relief so that I can work on the other.... and so far, I haven't found the balance.

Although Hydrocodone in the past (where I would take it just a few times a week) was activating, that just is no longer the case. It doesn't make me as groggy as some other opioids, but it does now seem to erode my ability to concentrate. Over the next six months, I have a book to finish, two papers to write, a conference to organize, and a new book series to get started (as general editor). But most days lately, I can barely get 2 hours of work done!

Today, I'm going for a new MRI and will be seeing the ortho on Monday. Maybe he'll have a good plan of action. Otherwise, I think I'll have to tell my PM that the hydrocodone doses aren't suitable, given my cognitive needs.

I understand what you're going through. I take 30mg of oxycontin and 60mg oxycodone daily and it really affects my ability to think, write, read, play guitar...just about anything. And I still deal with pain that gets pretty unbearable at times. If you want to adjust your hydrocodone down I applaud you for that. It's a trade-off though between functioning well and having more pain. As long as you are dealing with the pain without having very high levels of it, I would think that would be okay. If you do deal with very high levels of pain that can be draining and very stressful on your body, to the point where you are doing more damage, it would be advisable to find some other source of pain relief. I can't possibly recommend that you not go down on your meds, I just hope that you may find some kind of non-narcotic pain/muscle relaxer or other med, massage, PT, etc that might help you deal with additional pain. Best of luck to you and I hope you are able to succeed in all of your efforts.

Thanks for the comments.

From roughly 2008-2011, when I was taking Ultram ER daily and hydrocodone 2-4x per week, I had a good balance between meds, pain, and work. But as they both have become less effective, the latter shorter in duration, and my pain has gotten worse, I'm without a viable formula.

Oxycodone remains the best for pain, and if I take just 5mg, I still can work. But if I were to move to it vs. hydrocodone, or even oxycontin vs ultram (assuming my PM agrees), I suspect that I'll be dealing with the same issue once again.

Maybe the ortho will have some treatment ideas on Monday.