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Going to my PCP Wednesday..need to find a new pain med

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Posted 4/14/2013 9:56 PM (GMT 0)
Hello - I wanted to get some opinions from you all out there, who have been very experienced with Chronic Pain.  I have chronic pain from a muscle spasm in my left buttock.  It can really hurt!, believe it or not!

Anyway, my PCP understands this, and usually prescribes whatever pain medicine I need.  So far I've been through Hydrocodone 5 and 7.5 w like 500 MG Apap, Tramadol, up to 2 50 mg tablets twice a day, Percocet 10/325's one every 4 to 6 hours and Oxicontin 40 mg, up to 3 a day.

The problem is, both the percocet and Oxycontin and have a tendendy to make me sick.  Knowing that Vicodin doesn't work well for me any longer and Tramadol doesn't work well either, what other pain med could I suggest beside Percocet or Oxycontin, that might take care of the pain, but not make me sick.  Something that is different enough from Percocet, Oxycontin, Vicodin and Tramadol, that it might be effective for a while.

I actually have found a new muscle rehabilitation doctor who thinks he can help me with the buttock spasm, but I need some type of pain med to help me make it for a couple more months, as it is going to probably at least take a couple of months of rehabilitation under the guidance of this new muscle specialist, to beat this thing, and I need a good pain med in the meantime.

I don't know what to suggest to him, as it seems like I've been through, or can't take the most popular ones.  I may also request that he refer me to a chronic pain clinic.

Anyway, let me know what you all think about a new pain med that I might be able to take.

Thanks a lot, as always!

Posted 4/14/2013 10:43 PM (GMT 0)
Welcome iluvmy2dogs.

Sorry you are in pain.

Have you seen a physiatrist or orthopedic doctor? I'm not sure what a "muscle rehabilitation" doctor is. My rehab doc is an MD, a physiatrist - google it. Has anyone found the source of or the reason for your pain? Have you had EMG testing to see if you have nerve damage? Have you had a lumbar spine MRI to look for bulging or herniated discs or subluxation?

My pain (not necessarily yours) in that location (I have other pains elsewhere) is caused by a nerve being pinched in my spine. It seriously feels like it starts right in the buttocks, but it doesn't. Pain meds don't do much for it, but facet joint injections take away the pain. I used to get good results from epidural injections for pain from discs. The pain quit after they dried up, but it came back as other spine problems cropped up - an accident that led to arthritic changes. I'll be getting nerve ablation, which is just like the facet joint injections. These things are no big deal. They just sound scarey. Mine have given me relief right away.

It's also possible for you to have the nerve being pinched in between the branches of the piriformis muscle. You can test for this by sitting with your left ankle across your right thigh, then grabbing hold of the left knee and pulling it toward your chest until you feel the stretch in the muscle. See many videos and pictures online. You may have to do the exercise for a while to get results. I did this for several weeks. It didn't help me but didn't hurt either.

Best wishes. Let us know how you are getting along.
Posted 4/14/2013 10:58 PM (GMT 0)
I'm a bit confused at the doses you describe. You might just be on too much medication for your body to handle. At the very least you doubled, if not tripled your dose of oxycodone.

I might be wrong but from what you said, it sounds like you went from taking 40 to 60mgs of Oxycodone a day (in the form of Percocet) to taking up to 120mgs a day in the form of Oxycontin.

Generally Oxycontin is a 12 hour medication to start, and then it's changed to every 8 hours if needed as the patient becomes more tolerant etc.

So it might be just be too much too fast.

You could also ask your doc to script you an antinausea medication to help with feeling sick, if you don't want to switch meds.

OR you could switch to Morphine ER or Opana ER or Nucynta ER or the Fentanyl or Butrans patch. There's also Methadone but a lot of docs only use that as a last resort kind of thing.
Posted 4/14/2013 11:08 PM (GMT 0)
My new doctor ordered a lumbar spine MRI, so had that on Thursday. He told me he suspects some irritation of the L5 vertebra, based on the neurological exam he gave me. I don't know the results of that yet.

Yes I went from 40 mg a day of percocet to 120 mg of Oxycodone. It made me sick. Both actually have made me sick. I think I need to stay away from Oxycodone. I can take it for a short period of time, but not a long period of time. 40 mg or 120 mg, make me sick. I have some anti-nausea meds, but they don't help much. This is the 2nd anti-nausea med that he's tried and neither have worked. I had to miss most of last week at work (it is really hard to sit at a desk all day unless the pain meds are working), due to being nauseated, no doubt from the medication.

I'm only taking 4 percocets a day now, and still getting sick (we quite the Oxicontin about 4 to 6 weeks ago). I think I just need to get away from Oxycodone. Not to mention, that the change in pain pill will probalby help it work better, as percocets are not working nearly as well for me now as they used to.

I wish Tramadol still worked, as it had the least side effects for me.

Anyway, that's my story, I hope that straightens things out. I went from Vicodin to Tramadol to Percocet to Oxycontin, then pack to Percocet. But, am going to have to get away from Percocet, I think.

And, then hope that this "muscle" doctor (I think he's schooled as an orthopeadic doctor), can work miracles!

Please keep the suggestions coming. I want to help the doctor pick the right thing on Wednesday! Thanks!
Posted 4/15/2013 12:32 AM (GMT 0)
I'm really surprised at that dose jump. It's pretty big, especially if you were feeling sick off the 40mg amount. Anyway...

I gave you some med suggestions in my earlier post. You could try morphine next...its going to be a lot of trial and error. I went through a loooot of med changes and then fiddling with doses to get to a place where I had some relief with tolerable side effects.

Just explain what you've already tried, and ask the docs opinion on where to go next.

Do some research on the meds I listed in my other post and see what you think.
Posted 4/15/2013 1:22 AM (GMT 0)
Will do, thank you very much!
Posted 4/15/2013 5:09 AM (GMT 0)
The best way to go about trying new pain medications is to not go in and ask for a specific one. This often sends up a red flag with medical people and they may start to view you as a drug seeker. What you should do is explain to the doctor that your meds are not working for you and at time make you sick and ask what else you can try.

If your pain is from spasms a muscle relaxer in conjunction with a pain medication might help.
Posted 4/15/2013 12:40 PM (GMT 0)
Hi again luv.

I forgot to mention earlier that I have also had hip pain from bursitis. A simple injection in my hip bursa has helped when that has been the problem. My pain doc/physiatrist has injected, also my rheumatologist. Some PCPs will do some bursae, I don't know about the hip though.

You can get a copy of your MRI, both the disk and the report. Just ask where it was done, maybe medical records, maybe radiology dept. It should be free if you are going to take it to another doctor.

My orthopedic surgeon doesn't do anything with the spine, so he looks at local (in the hip) causes of hip pain. I recommend a pain doctor or anesthesiologist) or a rheumatologist.

I'm glad others are talking to you about meds. I can't take anything but tramadol on a regular basis. I get tolerant to opioids and muscle relaxants don't work except Flexeril which, with tramadol, gives me serotonin syndrome.
Posted 4/16/2013 11:34 PM (GMT 0)
After doing some research of the meds mentioned above, I think the best med for my would be Nucynta, as I really liked Tramadol, and it is supposed to be chemically similar, but stronger than Tramadol. Does anyone out there know if 100 mg of Nucynta is really stronger that 100 mg of Tramadol. It would have to act somewhat differently or be stronger, or it isn't going to help me, as my body has built up a tolerance to Tramadol. But, does anyone out there think it might work? They have a savings card on their website, so though it would normally be pretty expensive, it shouldn't cost more than $25 per script for me, with that savings card. I'd really like to try it if......my PCP prescribes it. I don't know what he'll think about, but if you guys think it is worth it, I'd like to suggest Nucyenta in about 100 mg doses, or perhaps even an ER version. Please let me know what you think. I see the doctor tomorrow afternoon.

Thanks!
Posted 4/16/2013 11:57 PM (GMT 0)
When I need a med change, I tell my doc "so and so is really not working anywhere near the way it used to a few months ago, is there anything else we can try?"

And then that opens up the topic for discussion and I mention any research I've done or articles I've read and then ask if she thinks that particular med would be helpful in my case.

It's really created a nice partnership between my doc and I and I feel like we work together to try and solve my dilemmas.

*strength" is kinda a relative term, but the two meds are different, so your tolerance to tramadol shouldn't matter, except when it comes to your overall tolerance of pain meds in general.

Tramadol is not a narcotic pain reliever, whereas Nucynta is, if that makes any difference to you.

I wouldn't suggest a specfic dose, I would let your doc decide where you should start, and whether you should be on the IR or ER version.

But there's no harm in discussing the research you've done, asking questions, and finding out if Nucynta could work for you.

Good luck and let us know how it goes!
Posted 4/17/2013 12:44 AM (GMT 0)
I'm not worried about the narcotic vs narcotic. I know that if this spasm was to suddenly get healed up, I could slowly wean myself off of a narcotic. I did it off of vicodin once. I really don't take them for the buzz. Really don't get a 'buzz' any more. I'm more concerned with pain relief.

You know though, since it is a narcotic, it always makes me feel bad to ask the doctor for it. I guess in my mind I kind of consider it dope, and I certainly don't want my doctor to think I'm a dopehead, because I am not. I'm just looking for pain relief, because when I get pain relief, I live a more normal life. Without it, I just lay in bed, can hardly work or do anything. So, I need pain relief something terrible. My new ortho gave me feldene for the immflamtion and had an MRI done of my lower spine. He thinks I might have irritation of the L5 vertebra. But, he seems to think he can help me with the spasms. He seems like one of the those doctors that takes on the tougher cases, so I'm hoping he can help me. But, even if he does help me, I need something beside percocet to help with the pain for a few months, then hopefully the doctor will have helped me - though I'm not holding my breath on that. My PCP has always been open to giving me pain medication. So, I will tell him that I think the percocet is giving me morning sickness and that I'd like to try something else (not to mention it isn't working as well as before), and see what he thinks of Nucyenta. We have a pretty good relationship when it comes to the medication, as he knows I'm in a lot of pain.

But, I always hate asking for new narcotic pain medication! If he doesn't prescribe it, or won't, I'll just have to have him refer me to a pain mgmt place, as I'm sure they would be open to prescribing it - especially knowing that Percocet & Oxycontin (which are essentially the same thing just different strengths), make me sick to my stomach and vicodin no longer works well, and neither does Tramadol - though I wish it did as I think it was the best pain reliever I took. It Took care of the pain with less side effects.

The only thing that concerns me with a narcotic is the side effects. But, I'm not concerned with getting addicted. I know I can come off of that - I really think I can.

Thanks for your help.
Posted 4/17/2013 3:51 AM (GMT 0)
No one here should be suggesting medications for anyone. We are not doctors here, just other patients with our own experiences on medications. The only person who should be suggesting or recommending treatment options is the doctor that you are paying to treat the problem. We don't know your medical history, other comorbid conditions, allergies, etc.
However, it may be that the tylenol is what is causing your stomach issues, coupled with a higher dosage than you should need for what you are describing as a muscle spasm. You would be far better off to try one of the many muscle relaxers out there to ease the spasms than taking opiates for that. While you work with the new doctor, to find a way to ease the muscle spasms permanently.
As far as the Nucynta goes, 100 mg dose is again rather high- and that dosage for any opiate should come from your provider. Opiates should always start at the lowest most effective dose if they are to be used, otherwise, all you are accomplishing is setting yourself up for big problems later when you do need to stop taking them.
Posted 4/17/2013 9:26 PM (GMT 0)
…just a quick note: I do take the 100mg IR of Nucynta…and yes that dose seems pretty high to me. It comes in both an IR and ER type. It is a powerful med, and is duel purpose, in that it is a narcotic, and also contains a nerve damage medication. My Dr has added Lyrica to the mix, and I have seen positive results with the combination.

Everyone is different of course, and your Dr will have to determine what is best for you. If you do have a good and longterm, and trusting relationship with your Dr, I see no reason not to inquire about different medications. My Dr usually ask what I think we might try as I have that kind of relationship with him. However, if you do not, then I would not push for a specific med. There are several of us here that have been on most all of the pain meds, and nerve damage medications, and at times have revisited going back to a particular medication with no problem.

I hope you find something that works for you!

SE
Posted 5/5/2013 1:17 AM (GMT 0)
Sorry it has been a while, but we did decide on 100 mg of ER Nucynta (SP?).

It does absolutely nothing for the pain, nothing.  I'm very disappointed.

I'm going to have to call him or go back and see if we can decide on something that will work better, and won't make me nauseated like Percocet or oxycontin.

Also, since I'm getting to the point where by body is getting somewhat immune to the narcotic pain pills, I have started to think about disability.  You know, for the last few years I've been able to go to work (I'm a computer tech), because the pain pills masked the pain.  But, now that they aren't doing that very well, it is getting harder and harder to work.

I called a SSN disability lawyer place, and they said you have to prove that you 100% can't work at anything.  And, also the fact that I've been able to work with the problem would go against my getting disability.

Does anyone out there have any idea how I should proceed with trying to get some sort of disability.  I'm just 4 1/2 years from being able to retire at 62, which would have been nice...I actually could retire around January of 2018, and I've been putting a  lot of money away for years, so I'm ready for retirement at 62.   But, I just don't know if I can make it 4.5 years with this pain.

Does anyone out there have any idea how I should proceed?  Should I procure some type of disability lawyer to see what is available for someone in my position.  Or does anyone know of any forums like this, for that type of thing, where I could talk to people who are, or have been in my situation, and could help point me in the right direction as to what to do in regards to my job.

As I said before, it is just getting soooooooo hard to sit there about 10 hours a day, on the pain of this muscle spasm in my left buttock.

By the way, since the last time I was on here, I found a new orthopeadic (sp?) doctor who thinks he can fix the problem.  But, after going through two weeks of very painful exercises with his therapists and so far, no results whatsoever, I can't help but think that, yes he's sees a lot wrong with my pelvic area, and thinks he sees what is causing the problem.  But, it occurred to me, is he seeing the cause of the spasm problem, or is he just seeing the results of 4 years of my having the problem.  Because I favor that side of my buttocks of course, because I'm in so much pain, and of course it is out of line because of that, and there are probably other problems too, caused by my favoring of this area, due to the pain.

So, I was very hopeful they were going to be able to help me, and each day I'm getting less and less hopeful.

Anyway, any responses that you all might give me would be very much appreciated!  I just don't know how best to proceed.  And, Wednesday marks my 4th anniversary of my first symptoms of this problem, and the day my life changed so drastically for the worse!

Gosh, chronic pain is an awful thing!

Posted 5/5/2013 3:19 PM (GMT 0)
Sorry the nucynta didn't work out for you. It's always going to be hit or miss with finding what works for us individually. I took oxycontin for years and always was bothered with nausea and finally took 12.5mgs of phenergan with every dose.

As for disability the lawyer is correct and you don't have much of a chance until you've not worked due to your pain atleast. 6 months. You then can apply and will likely do battle for a year or more.

The best thing for you to consider is an early retirement and if you can access the money you have saved make a frugal attempt to live on it until you can take early retirement from SS or been off work long enough to apply for disability and have some reasonable chance at winning.

I'm sure these are not the answers you were hoping for and they certainly are not the greatest ones to have to think about but such is our lives as chronic pain sufferers. Many of us were caught off guard in the prime of our lives,raising kids or starting a career whatever then blindsided with a life filled with struggles and issues.

No money or job and facing years of battles for SSD,pain relief by a culture who believes if your young all your seeking is drugs not answers.

There are not many of us here that haven't been faced with the issues at hand. We can sympathize and understand your dilemma but in the end you have to make the best choices for yourself to allow for the best quality of life you can have.
Posted 5/5/2013 8:39 PM (GMT 0)
If oxycodone works well for your pain I'd keep that and focus on controlling the sickness. You can use a couple of meds - cyclizine which is an antihistamine which works on the puking centre of your brain. The other option is metoclopramide which does a couple of things - it acts on neurotransmitters and also increases gastric motility which can help mitigate some of the constipating effects of that much oxycodone. There are other meds which your doctor may have more experience with and prefer so don't be surprised if a different med is recommended.

If of course you aren't getting adequate pain relief with that amount of oxycodone then you need to have a serious chat about more appropriate meds. Generally morphine is the gold standard for pain relief and if you haven't tried this, it's a good place to start. The conversion ratio for oxycodone and morphine is x1.5 - x2, i.e. 1mg of oxycodone = 1.5-2mg of morphine and a combination of slow release and instant release is quite normal to help reduce ups and downs. The ideal is to control the pain most of the time with slow release stuff and then have instant release for breakthrough pain.

Combining different opiates isn't proven to the beneficial. There was a study in rats showing synergistic effects when combining morphine and oxycodone but this didn't translate into human studies. There are different qualitative effects to different opiates / opioids and my personal preference is to stick to one at a time rather than mixing and matching as it's a potential recipe for overdose, requiring very careful calculations and monitoring, and is also more difficult to pin down which drug is causing an intolerable side effect. Obviously there are exceptions to this and your doctor will know these.
Posted 5/8/2013 7:36 PM (GMT 0)
I was going thru some PT to try to correct this spasming problem, but last Friday, the session left me hurting so badly, nothing I had would work, which included 40mg Oxycontin (just had a couple left) Finally after 4 or 5 days I'm feeling better, but have gotten to the point where Percocet (Oxycodone) 10s, really don't even work very well.
I'm hoping to work things out so that I can go to the Mayo Clinic some time in the future, but till then I have to hope that local doctors can find something for pain relief, as when I'm hurting with this thing, I'm just about useless. All I want to do is lay in bed, and how boring.
Anyway, going to my doctor on Monday, and am going to have to ask him for something else - but what should I ask for, or let him recommend, seeing that I'm now pretty much immune to Tramadol, Vicodin, Percocet, Nuceryn, and even Oxcontin doesn't work all that well.
Just wondering as I really don't know much about these things. It is funny, before this injury happened to me I didn't even know pain pills of this type existed. Boy, has it forced me to learn, unfortunately!
Plus, I'm going to suggest that he refer me to a pain clinic as they specialize in medicating people like me, he doesn't. I won't put it that way, I'll suggest it as an out for him, as I feel bad to keep asking for pain meds from him. He's been very good about it, but I just feel like we're getting in a little deep, and I may need these things the rest of my life, and at not quite 57...that could be quite a while.
I'm so depressed that I can't find an answer for a muscle spasm. But, when the pain relievers are making me feel better, my life is probably 80% improved. It's not what it was before, but not nearly as far off of what it was before as it is now that I'm laying here in pain.
Thanks for all your suggestions!
Posted 5/8/2013 7:55 PM (GMT 0)
Sorry the nucynta didnt work out for you and from the looks of it your about to run outta options. The only thing you haven't tried is morphine in some form and fentnyl and both of those would be better prescribed to effectiveness by a pain management dr.

I'm glad your going to ask for a referrel. The fact is as we say here time and again,its a combination deal,it takes a variety of methods together to get the lowest possible pain levels. Relying heavily and Wiley on narcotics rarely gives any of us adequate pain relief.

Another point is if none of the opiates are giving you adequate relief its possible the majority of your pain is nerve related and they just wont help all that great.
Posted 5/8/2013 8:31 PM (GMT 0)
Sorry to hear you are having a rough time..

I also didn't see you mention Methadone, Opana, or the Butrans patch....So these may be options but I am thinking that if you jumped up so quickly to 120mg of Oxycontin and you say none of them are working for you that opiates are not going to be the best treatment.

If the Lyrica that you list in your signature isn't helping then perhaps trying Neurontin or Cymbalta.

And then other muscle relaxers are Robaxin, Skelaxin, Baclofen, and Zanaflex if the Flexeril isn't doing much.

So, it just may take time to find the best combination of meds and modalities. The key is knowing that there usually isn't just one med/treatment that will do the trick.

I also am a believer that a Board Certified Pain Management Dr. is the most knowledgeable about treating chronic pain issues.

My PM Dr. and myself happen to think differently than the member Phileidiot in that I have much better pain relief when I have two different meds for my long acting and short acting. This way when I need a breakthrough med, it seems to work faster and stronger since it is a completely different med.


I know it's difficult, but lying in bed most of the day is actually going to make things worse for you as that only puts pressure on our nerves and then atrophies are muscles.

My own overall plan includes is exercise (1.4 mile walk daily), yoga/stretching daily, TENS unit, muscle relaxer when needed, Advil, massage, acupuncture, aqua therapy, PT (at home), biofeedback, counseling, ice, heat, steroids, injections, eating healthy, drinking lots of water, etc.

Every single thing I do helps take the pain down a tiny notch to get me to a 5-7 each day which is ok for me as I want to stay on the lowest amount of medications as possible. I actually just recalculated that I have been on the same strength of meds for over 5 years now!

I hope you can get that pain clinic appt. soon! Keep us posted...
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