Meds not as effective anymore...suggestions?

Hello all! I hope life is treating you well and your pain levels are low. The time has come again for me to get your advice (cause your all so good at it). I have been on 30 mg morphine cr 3xday and vicoprofen 7/200 3xday as needed. I have also have a series of epidurals two months ago. I have been on these meds at the said dose for 2 years. I feel they are not cutting it anymore. When I wake in the morning I feel in pain and also like I am withdrawing a bit so I take my 30 mg morphine and I feel a bit better but not the way I used to. Because of this I have been taking my vicoprofen more. I used to take 2-3 day but now I need more but I never get early refills. I feel my body needs an adjustment. What do you think?? What should I ask my doc at my next PM appointment?? Any suggestions would be greatly appreciated. p.s. I live in fl so remember the pm docs down here are hesitant to do certain things. Thanks!

Hey Shaw,

It's been awhile, lol.... :)

I think you pretty much have figured out the answer.... you've built tolerance.... and you probably need a med change or increase.

My PM and I rotate my meds every 6 months to 1 year -- any longer than that on the same med for me - and it quits working. For instance, I rotate oxy IR and dilaudid as my BT meds... Oxy ER and Morphine as my extended release.

I know you've been several different meds before.... have you tried stronger meds as a BT? OR the doc could increase your morphine.

Also, my muscle relaxer is a big part of my pain relief. Does the zanaflex work for you? You could also try a new muscle relaxer and see how that helps you.

Good luck... and let us know what happens at the PM appointment :) --Tina

If its been 2 years since you've had a dosage adjustment your doc should have no issues either increasing the meds you already take or trying out some new ones. Docs are aware that tolerance is a part of taking anything long term, it really only becomes a problem when you try to claim "tolerance" after a short time or repeatedly or if you have a history of med abuse etc.

My doc told me she only really has a problem when she knows the patient isn't being honest. I live in FL too so I know how it is!

I think Shaw said he doesn't want to up his meds, as he worked hard to come down on them.... As one who has done the same -- I completely understand his desire to not want to increase the strengths.

That's why I recommended the med rotation...

:) --Tina

Tina, i read "meds not effective anymore". he has been jerked around so much it is disgusting. he has been stable on meds that were right for him until the fed gov comes in and places pressure on compliant patients and good doctors. med rotation is a great thing but when you are on the bottom rung of the dose ladder and although not adequate the meds are acceptable. i do not think i would want to switch again for 4th or 5th time and gamble on if you rotate to right drug. very admirable you rotate and strive to keep your dose low. this patient is in under treated un-controlled pain and now getting a few years behind him that way. if pain goes under treated permanent pathways will be burned in CNS and cardiovascular and endocrine systems will start to rust. i have followed his problems for a few years and no matter what doses of what he needs pain control. the object of pain management is not to see how low you can get yourself but how well you can control your pain within accepted parameters. to the result that you can live a bit of a normal life.

Nick (spinal soldier)....

First, I'm not sure why you are jumping at me over Shaw's situation?? I too have followed his situation on here for a long time and have tried to do nothing but help him over the years? If you read the beginning of this thread... he agreed w/ asking his doctor about rotating meds. So - not sure why you are trying to come at me, in his defense?

I'm very familiar w/ pain management, thank you. I never said that pain management was to get as low as you can get?? But, yes, I do think that chronic pain patients should stay on the lowest amount of meds needed to control one's pain.

Once again, if you reread - it was SHAW who stated that he didn't want to up his dose. He said: "I don't want to increase my meds as I actually decreased them over the past few years". All I was doing is saying that I understood that desire.

Your suggestion was for Shaw to DOUBLE his morphine.... Going to 60mg of morphine, 3x daily, isn't necessarily going to give him pain control either. I've had doctors do this to me before... where they just kept throwing higher and higher doses at me - until I was taking almost 600mg of morphine a day.... and STILL not having pain control.

I don't know how it's "admirable" that I rotate my meds and strive to keep them low?? I'm doing this because it is what works for me.... after years of having uncontrolled pain.

So.... as I said.... I understand having uncontrolled pain. I experienced that for a very long time until I learned that having your pain covered doesn't necessarily mean high doses of meds.

Once again.... not really sure why you chose me to address in your post...?? While we may share different viewpoints on what to recommend to Shaw, I think we both desire to see his pain controlled.

--Tina

Tina and I were both going on what Shaw wrote in his follow up post:

I think I might ask about rotating my meds like Tina said. I don't want to increase my meds as I actually decreased them over the past few years

 

Rotating meds works for a lot of folks with chronic pain so it's really up to each person...

I was quite taken aback SpinalSoldier with your suggestion that Shaw should double his Morphine dosage from his 90mg a day now all the way up to 180mg! As well as saying they should add in Dialudid taken 3 times a day. I don't know of anyone or any Dr. that would want to increase meds that much even if they chose to go up in dosages...To me, that would make someone's tolerance go through the roof too quickly. Just my opinion...

The whole point is that none of us are medical Drs. and just trying to help Shaw based on what he has written.

For me, I live with a 5-7 range with meds and all my other modalities. Since chronic pain is going to be a likely part of my life, I choose to pace myself with the meds and rotate for as long as I can or go up in small increments if needed.

I certainly hope you can work with your Dr. and get to a place with both medicinal and non-medicinal treatments that can have you at a good level with pain.

 

i believe we both want the best. i apologize because as of late many cases i know who are suffering are getting hurt by DEA putting the fear of loss of career on good doctors. i know or at least remember that shaw lives in FA. it is not easy there if you are a compliant patient and times past when he has had his meds changed was due to gov. intervention. after 3-5 years of that it will take a permanent toll. what scared me is what i know the fed gov is trying to put in place is kindof what you suggest but from having good intention were as they do not. also you say "what worked for me" MSER30mg bid w/hydrocodone/ibuprofen7.5/200 tid prn still in pain. FA limits you ability to rotate easily and he has tried other meds when he was d/c'ed from his prefered meds. i don't see another way?