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Posted 12/27/2011 3:30 AM (GMT 0)
I see my PM on Friday and plan on talking with him about rotating away from Ultram ER for a while.

Recently, I took a bit of an BT med holiday (as I discussed in a previous post). Aside from a 5mg dose of hydrocodone to deal with diarrhea (presumably from withdrawal), I went a week without taking anything but my Ultram.

When I returned to my BT meds, maybe a bit of an improvement, but I doubt such a short break will have any long-term benefit.

So, I think my remaining option is to change my daily time-release medication. Options would be (a) to supplement the Ultram with a small dose of another time-release, or (b) move on to a stronger opioid. I'm leaning towards (b), with the hope that 3-6 months away from tramadol will help restore its potency.

Assuming I go with (b), I think my only options are Opana ER or Oxycontin. Dilaudid doesn't work for me, so I assume its ER won't either and I've tried Kadian (morphine), but it makes me too groggy.

I've probably asked this before, as I've been struggling with the problem of the Ultram ER being inadequate for a year, but does anyone have other ideas for medications than those listed above?

I wish a hydrocodone ER was on the market, but alas, not yet (though another poster included an article about a product close to FDA filing).

Thanks.
Posted 12/27/2011 4:13 AM (GMT 0)
Many Prayers and well wishes on your appointment, I don't know enough about the
stronger pain medicines to give you any advise there, but if your current medicines
are not working good for you, definitely let your PM doctor know...I sincerely hope things
go good for you on Friday...keep us posted on that...
Posted 12/27/2011 4:41 AM (GMT 0)
Hi Cogito,

We've not got Opana here, but I've been on both Oxycontin and Jurnista (which is a 24-hr ER version of Dilaudid). I know the Jurnista did almost nothing for me, and what effect it did have lasted barely 10-12 hours. I've done well enough with Oxycontin, but I take it in combination with Topamax and Mobic as a lot of my pain is nerve related.

Another thought is Targin, which is another ER oxycodone prep, but is combined with naloxone. Naloxone is the drug they usually give to reverse opiate overdose, but when taken orally the theory is that it can only act on the GI tract - thereby counteracting a lot of the side effects that opiates (esp. the stronger ones) have on the gut - slow stomach, constipation, etc. I'll be totally honest and say it wasn't a good one for me - my body doesn't believe in playing by the rules, and I was feeling like I was heading into full-blown withdrawal after 48 hours on Targin instead of Oxycontin, but my PM had never heard of it happening before.

All the best with your appointment :)

Laura
Posted 12/27/2011 5:36 PM (GMT 0)
Thanks for the support.

Last night I was looking into Opana ER and saw that some generics were recently approved. I'm curious about the price (10 or 15mg doses). Does anyone here know? The brand is roughly $650 for a 90 day supply.
Posted 12/27/2011 6:42 PM (GMT 0)
I'm kinda in the same place as you, Cogito.

I'm on Tramadol right now, which hasn't been helping me much at all. It sort of helps with my arthritic type aches and pains...but so does Motrin. What I need is relief from my 'actual'/main pain, which is due to the herniated disk I have. So far I have tried Tramadol and Hydrocodone. The Hydrococodne was a rather low dose and did zip for me at all. The Tramadol still doesn't help much...I really can't deal with this same level of pain forever, so I hope i find something that helps.

I'm not sure what to recommend for you Cogito, since I am asking the same questions right now...but I hope you find something that helps you soon! If you do, you should let us know, I'd like that info myself! :P
Posted 12/30/2011 8:13 PM (GMT 0)
I saw my PM today and discussed with him my concern about using BT meds too often and their having less effect.

I put together a spreadsheet of my monthly use and annual averages from the past few years, which shows about a 30% increase in total pills and # of days per month year over year. To me, that made it clear that I need a stronger time-release medication.

But to my surprise, he didn't want to change my daily time-release medication and instead suggested that I use my BT medications more liberally. Even though I am moving towards using BT daily and sometimes 2x in a day, he said he doesn't want to change my time-release med until I'm at a point where I need BT meds at least 3x a day.


I also told him about my recent opioid holiday, hoping to find a way to lower tolerance, but he didn't have anything to say other than to just go ahead and take a pill and a half or two pills at a time.

Perhaps I should have pressed the issue more, but from what he said, I think he regards the increase in tolerance as inevitable -- nothing really can be done about it, and so doses simply need to be increased as tolerance builds.

So I asked for another script of hydrocodone. I usually only need a new script every 6 to 9 months, but to follow his advice, I figure I'll need more on hand. Thus for now, I'll just take as needed rather than often bearing the pain for the sake of keeping my use within my self-imposed quotas.
Posted 12/30/2011 8:56 PM (GMT 0)
cogito,
Sorry that the doctor wasn't open to changing the time-release medication. My PM doc is the same, and is okay with me taking my BT meds as often as 4 times a day. His reasoning is that as tolerance builds, if you change to a new medication too quickly, I will end up with tolerance to every drug available. Seeing as my issues are life long, building a tolerance to everything quickly is not a goal I am striving for. Tramadol is something I am no longer able to take along with my antidepressants because of serotonin syndrome. It did provide some relief for me and was the med I began treatment on.
I hope that you get the pain relief you need without feeling too badly about the number of pills you are taking.

Its also good that you have a relationship with your doctor that you can talk about your issues in this way. That is a great thing!
Mindy
Posted 12/30/2011 9:45 PM (GMT 0)
Mindy, you make a good point about changing meds too soon. The PM didn't put it that way, but it may have been part of his reasoning.

Thanks.
Posted 1/2/2012 4:22 PM (GMT 0)
Hi Cognito. Wow---a spreadsheet! You're really organized. I'm sorry your doctor didn't want to change your medication. I do understand his reasoning though. I hope that you get relief with your new dosing schedule.
Posted 1/2/2012 5:33 PM (GMT 0)
Flower,

For nearly three years now, I've kept a one-page calendar beside my BT meds. Whenever I take one, I mark it off. That way, I can keep track of how many and how often. I entered the data into a spreadsheet before my recent appointment. As you might imagine, I'm somewhat fastidious with other things too.

I am finding it hard to get my mind around the idea of taking BT meds more often, when I've been so fixated on cutting down my use. I was hoping to find some time-release meds effective enough that I would only need BT meds on a few bad days per week. Instead, my PM is encouraging me to use them more liberally -- and given my typical pain pattern, that would roughly double what I've been using.

For example, following his advice over the past few days, I took 2 BT meds on Friday, 3 on Saturday and 2 yesterday. Normally, I would have likely done 1,2,1 or even 1,2, then 0 -- since I've tended to withhold use even when in pain after a few days of taking meds. On the day that I took three, my back was killing me and I gave in to my third dose after spending an hour or more in bed rotating ice then heat.

Over the past few years, a 90 pill script of hydrocodone would last 6-9 months, an a 60 pill script of oxycodone would last a year. Following my PM's recommendations, I'm looking at 90 hydros every three months. But I still plan on limiting my oxy use to just the worst days... so maybe 5 per month still.
Posted 1/2/2012 9:52 PM (GMT 0)
Cogito....My doctor was exactly the opposite she upped my time released when I started needing more than 2BT a day, she would prefer if I never use the BT. I have to say once she upped my time release I have not needed any BT. That is what is frustrating..one doc says this and the other says that. I have to say I have never found much relief with my BT meds.


Take care, Amy
Posted 1/3/2012 2:20 AM (GMT 0)
Amy,

Your doctor is following what I understand to be the norm... and I remain baffled.

But one more point that came to mind is since I very rarely wake up at night in pain, I can do o.k. most days with 20mg of hydrocodone, spaced out into 5mg or 10mg doses. Serum levels wouldn't be as stable as if I were taking 5mg Opana ER every 12hrs, but perhaps for me, the latter is overkill if I don't need anything from roughly 11pm-9am.

Nevertheless, there's the question of a "feast or famine" cycle for my opioid receptors and what consequence that might have.
Posted 1/3/2012 5:40 PM (GMT 0)
Cogito, one thing I have learned about pain medication and CP over a 20 yr span is taking a BT when needed and not sit and have a inward battle with myself over taking a pain pill. I now have a pump, however, I am still rx'd BT meds because even with a pump you still have pain and always will. For years I use to sit and worry about how many I took even though I only took it as prescribed. My pain was never under control with me doing that battle and trying not to take one. I was only hurting myself doing things that way. Once I made with peace with taking medication life was better in the pain dept. I have days now I take BT meds and days I don't. One thing I will no longer do is let my pain get too far out of control because its too hard getting it back down. My PM dr is in total agreement that I only take the BT meds when I feel I need it. I also had to learn how to listen to my body in this process.

I know you have issues with worrying about tolerance issues and such, but that is just one of those things in the long list of what CP patients have to deal with. I hope you can find some real relief. Take care.
Posted 1/4/2012 6:31 PM (GMT 0)
Thanks Straydog. "Inward battle" does capture what I am doing most days, never knowing whether I should take something or wait to see if the pain gets even worse, etc..

I still can't really give in and take something unless the pain is way over the edge. Most of the time, as the pain lingers around a 3 and begins to hint at getting worse, I fall into my chronic deliberations and, if I do take something, second-guessing.

I'm trying to adjust to my PM's recommendations, but I think it will take a while -- as I still will have in my mind how many I've taken, how many days in a row, and if the count is too high, just spend more time in bed.
Posted 1/6/2012 5:50 AM (GMT 0)
Look into adjuvants perhaps? I know my pain medication wasn't helping taking the edge off enough to sleep, just enough reduction of pain to go to the store and other errands(although not what I would want to do as I am still in pain). Anyhow my doctor added gabapentin and that does help some but, as stated in another thread, gives me a not so ideal slight cloudiness thought-wise. Then I went back to my old diclofenac since the Over The Counter NSAIDs weren't doing anything for the pain, then oddly enough when I took my nausea medication(promethazine) I noticed that all four together(reduced dose of gabapentin) allowed me to sleep a whole 7-8 hours which as of lately I would call amazing. I am going back to my doctor soon and am going to mention this and see if orphenadrine(which is actually meant as an adjuvant) might be a better choice as I am not comfortable taking my promethazine more than maybe 4times a week at maximum and that is only if I really need it(by that I mean the risk of antihistamine habituation is outweighed by severe nausea since if I took it everytime I felt like I was going to throw up then I'd be taking it 15-20days out of the month). Also cyclobenzaprine was prescribed to me a few years back and that allowed me to get sleep, although that was when I was taking the diclofenac and wearing Lidoderm patches so I wouldn't say by itself it is as helpful as some other medications might be but of course everyone is a snowflake and will be effected differently by any given treatment. Hope that wasn't too long and I hope that maybe I planted a seed thought that may lead to something more solid.
Hope I helped and hope you feel the best you can!
Posted 1/6/2012 4:14 PM (GMT 0)
Thank You Valley.

Fortunately, sleep isn't much of a problem for me. Thought I can't lie on my right side, I can sleep fine on my stomach or left (or back for a bit). Rarely do I miss sleep because of pain (though pain meds keep me awake).

I have, though, contemplated trying dxm with BT meds, but haven't yet had the nerve.
Posted 1/7/2012 12:43 AM (GMT 0)
I'm not sure what you mean exactly by "dxm" but whatever you do I hope you do so with your doctor knowing because if you were to have an interaction of any sort and hadn't talked to them first you will most likely regret it. Definitely take anything I say as mere suggestion though and do what you see fit since only you know exactly how you feel. Best of luck! Hope things look up for you and hope to hear some good news in the future!
Posted 1/15/2012 6:39 AM (GMT 0)
Cogito,

I know I'm chiming in late, but I suspect what is going on with you is similar to what is going on with me. Basically I think docs who have patients who by chronic pain standards are "not that bad" (as in, manage their pain with fewer meds than many) are hesitant to become to aggressive with the opioids for those patients. And somehow in their minds tramodol as an ER med is "different" than switching to oxycontin. IDK, I think some docs just view the switch to Oxycontin as a big step. I also know some docs are worried about opioid-induced hyperalgesia, although I"m not sure that's more likely with an ER me than a IR med.

My doc has also advised me to use the BT meds more liberally when I need to, and now that I'm not worried that she won't prescribe enough for me, I have. It has made a HUGE difference in my quality of life. Basically allowed me to work full days at the office, even during a flare up. Didn't come home and break down in tears every night from the pain.

I think you need to give up a little of the mental struggle you are having over the BT meds. Honestly, BT meds are not much different from taking an ER med, other than the dosing. Plus this may give you some time to wait for ER hydrocodone to come on the market, which would be a nice plus.
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