New PCP wants to switch around my meds

Hi PJ and welcome to HW.

Sorry you have to switch NPs. The lortab is a short acting Med and all the other meds for pain mentioned are Long acting. Due to changes in regulations and all the controversy over narcotics Drs prefer their chronic patients to be on LA meds.

Same kind of controversy has caused them to switch from Soma to something with less addictive tendency. Ambien again has gotten some bad raps in the media.

As for which of those choices will best serve you, its a trial and error process..you will find many here on all of those and although one person does great on morphine someone else can't use it at all.

All 3 have great potential, it just comes down to individual choice.

Same holds true for muscle relaxers.

I know that's not much help but its just the way it seems to work.

Welcome.My Pain Management Doctor won't write Soma.Every Doctor has at least one line in the sand,maybe more,of Drugs that they will not prescribe.My regular Doctor took my 30 Somas a month from me years ago.Hard to figure out.He's definitely willing to prescribe you strong extended release pain meds.

Good luck,
Rick

Soma and Ambien together is deadly. I take Soma but only at night as it knocks me out, would def not need Ambien on top of Soma, may never wake up. Flexeril and Rybaxin MR's don't work for me.

Your regiment is close to mine- Exalgo 8MM x 1 daily (24 hour pain pill), Perc 10/325 x 2 daily, Nucynta 200MG ER's x 2 daily, Soma 250MG x 3 daily (Night time only). I've had one neck surgery and another coming for C3, C4 and C7 next.

I won't take Oxycontin or Methadone.

I agree with LexiRae. I have been on pain meds for 19 years with zero break in care. 18 years of that has been on OxyContin ER and oxycodone IR. I am on other meds too, but those are my 2 consistent ones. Once you get regulated on an extended release dose, it is such a relief to not have to fight the roller coaster of pain. It may not relieve all of the pain, but at least it becomes consistent pain. And once your pain is a little more predictable, it is easier to plan some day to day things. The oxycodone works for breakthrough pain, or for days you want to have increased activity.

Addiction and physical dependence are completely different. As is increased tolerance to narcotics and addiction. They are not interdependent. Just because you have increased tolerance to narcotics and your body is dependent upon them, does not automatically mean you are addicted. Addiction is a separate illness.

As patients, it is up to us to remind doctors of this fact. As long as we demonstrate responsible behavior with our meds, it is alright for us to question and educate our doctors on topics that are scientifically proven. Just like with all things medical; technology, information, treatments, etc. are always changing. As chronic pain sufferers, we are well versed on our individual conditions and how our bodies react. Unlike doctors, who have to keep track of 100s of patients and their illnesses. Any good healthcare provider will truly listen to what their patient is telling them. It's one thing to ask for tons of narcotics and appear "dishonest" with the need for pain meds.

Probably just like most of the individuals here, I have proven to be a good pain patient. If my doctor focused on old fashion myths and stereotyped me as a possible addict, I would find another doctor and fast.

We must be vigilant, fearless and assertive when it comes to our health, comfort and quality of life. Never accept anything less then what you think is best for you!!!

I've never been on Methadone, I would not take it because of how addicting it can become. I know, most pain meds are addicting but methadone seems to be harder to kick. I don't even think my PM even prescribes this to anyone I know there.

As mentioned, ANY pain med can be abused if taken the wrong way or used for the wrong reasons.

I'm a little taken aback that you are so attached to the Percocet saying that you "understand why people crush it" as the intent is to just have steady pain relief throughout the day and not "feeling" the high or "rush" of this by taking short acting meds. So maybe I am misunderstanding your comments.

Most Drs. would be very concerned by a patient who says they want Percocet but refuse to take Oxycontin.

Obviously you are making these choices with your Dr.....Just sharing my thoughts on what you wrote in your posts.

To the OP pjune....as others have written, PLEASE be careful of the Ambien and Soma as well as Vicodin added in...All these meds can be sedating and affect the respiratory system.

I had to switch around my meds years ago when they stopped producing the generic for Oxycontin. I moved to generic MSContin as it's very inexpensive. I had some fatigue and a bit of a headache the first few weeks but then they went away and I've been on this for many years now at the same dosage.

My PM believes in starting low and tirating up as needed. If we had followed the typical "conversion" chart I would be on double the MSContin! But I went from 120mg of Oxycontin to 75mg to 90mg a day of the Morphine and haven't had to go up in dosage in more than 4 years now.

There are also plenty of other muscle relaxers from which to choose so hope you will find one that works.

The biggest key to remember is that medication is just one small piece of the puzzle in our overall pain management and should be taking our pain down by maybe 50%.....We have to make sure we are using other modalities to help as well.

Also, you may want to find a really good Board Certified Neurosurgeon and see whether or not surgery is something that may be beneficial to you as staying on strong pain meds long term if you haven't even had one surgery yet is not something most Drs. are going to recommend as it's just "masking" the pain.

Keep us posted...

Post Edited (Snowbunny21) : 8/8/2013 4:17:27 PM (GMT-6)

I think it just threw a few of us off by your statement below in bold in one of your posts...

 

But the way the pill releases is the most important thing. I don't crush pills, break pills, etc. but there is a reason people do this.

 

People abuse both the short and long acting versions of Oxycodone....I only use short acting meds for "breakthrough" pain as yes, most people who  have chronic pain prefer to be on long acting medication to prevent chasing the clock and pain all day and having a slow and steady release of medication for pain relief.

Either way, hopefully the surgery you end up having ends up helping you tremendously:) The good news is that many surgeries are successful!!

 

I don't think anyone is offended and it's not about any particular med in general or who takes what.

I just hate the misinformation perpetuated by the media and other sources. Oxycontin is often singled out and picked on as being somehow "worse" than the other meds in its class. The same with Methadone.

jpjr50, I understand your points quite well.

1) some drugs are more chemically addictive and so call for greater caution. I'm not sure if that is particularly the case with methadone or not, but my PM does not prescribe Soma for precisely this reason. As he put it: it acts significantly on "the pleasure center of the brain". While that may be the case for many opioids too (I presume), it certainly is a reason to defer to other meds if possible.

2) Don't feel put off by someone attacking "But the way the pill releases is the most important thing. I don't crush pills, break pills, etc. but there is a reason people do this. I've been taking the same meds for a few years and don't like to switch as I know what works for me best" -- I feel bad that it got twisted into impugning you. Your point I take to be quite clear -- obviously some people do this and this is why the FDA has introduced REMS, even to the detriment of legitimate CP patients.

3) Your point regarding not wanting to take Oxycontin, though willing to take oxycodone makes sense. While a constant dose of an opioid can help manage pain better than short acting meds, the constant dose also leads to cellular changes that don't necessarily happen with more erratic dosing. For example, I was taking oxycontin 10mg x2 for close to a year. As a result, every morning I woke up in withdrawal, feeling terrible until about 20 minutes after my first pill. However, for the past 3 or so months, I've been taking more or less 20mg of oxycodone for BT, don't have the terrible feeling in the morning any longer, and can more thoroughly regulate my opioid intake in relation to my pain levels.... now and then going a day without any, or at least on better days, maybe only needing one 7.5mg BT dose.

In relation to the OP, the above I think is relevant -- there are pros and cons for time-release meds.

Pros: They definitely can help if your pain is always present and thus need relief around the clock; they'll do better keeping your pain down while you sleep (so you don't have to wake up and take a BT dose).

Cons: the constant levels in your body will tend to have a more profound effect on your body, down-regulating receptions in particular; in most cases, they cost far more (both an issue for individual finances and a social issue as it reinforces some of the less ethical patenting strategies of pharma); they may not net enough benefit to justify the above -- i.e. even with the time-release, how many BT doses do we still end up taking?

In my case, when on 20mg of oxycontin, I was probably taking about 15mg of BT daily. Now, I'm averaging 20mg. So, my net opioid use has gone DOWN from 35mg to 20mg daily. Of course, we're all different -- we have different pain etiologies, different reactions to various meds, etc.. But I do suspect that time-release OPIOIDS are far less beneficial than they are made out to be.

Please let's not run this thread off on another tangent. I'm going to post some thoughts in a new thread.

Thanks,
Tina

PJ The biggest thing to remember is we are all very different in our expectations of what we're looking for in our pain relief.

Many people like the gush of instant relief they feel with short acting meds, many of us would rather have the more steady even relief that LA meds give and still others like the relief of multiple days dosing as the patch gives.

After more then a decade as many of us have Ive pretty much covered the board with the exception of Demerol and diluadid. I got tired of chasing the pain, watching the clock, never leaving my house without making sure I had enough SA meds on me if I didn't get back in 4 hours or so.. hated being connected to a pill bottle and ended up after trying oxy-c, and sleeping all day on methadone .. Im one of the ones whom my Dr allows me to take that 40-60 mgs however it best serves me. He also is a no B/T Med believer. Thinks if your LA dose and meds correct they're not needed.

I dose one time every 24 hrs and the composition of this Med allows it to work that way. I've had some problems, had to adjust the Med here and there and it has a black box warning for heart issues on higher dosing. Is it more addictive? No, is it anymore dangerous? No. As long as you can and do use your meds as ordered and responsibly. It's been a good Med for me. I can leave and if I don't get back until tomorrow? Im not in w/d nor a great deal of pain. Im positive the 4 hr percocet only folks can claim the same.

This is why its a personal choice and one you and your Dr need to discuss. Although I would feel much better for you if a Dr was prescribing any of these to you instead of a NP. I also know some just have no choices and take what they can get.

I didn't go into any of this in my first reply as I said we all are very different in our choices for various reasons. I will say we've seen many here lately that can't pay for brand oxy-c and their insurance wont. Generic options are not available at last check. If you don't have insurance or have Medicaid in many states that wont pay for narcotics for CP then many of these LA meds are not going to be options narrowing your choices. Methadone is also dirt cheap compared to many of the others and for that alone some have to use it.



It's gotten a bad rap from deaths associated from non-opiate tolerant abusers or those who mix it with benzodiazepines when it clearly warns not to.

JP they now have a new formula of Oxy that they claim cannot be tampered with like the original formula. I am thinking it was a couple of years ago when the big media blitz hit over the abuse of this drug, maybe even a bit longer. I do know in some states it is getting nearly impossible to get a script filled.

The important thing for June is this is a new dr she is dealing with. Until she gets to know the dr and the dr gets to know her she may well be at this drs mercy until they get to know each other. It is never good to go in to a dr demanding a certain medication. Of course she can & should tell the new dr that she is getting good relief with the medication she was taking with the prior dr.. Bottom line is the dr is going to do what she see's fit, at least if she tries something new & it does not work she has a bit of leverage with the dr......Susie