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PM visit -- new meds

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Posted 6/13/2012 5:41 PM (GMT 0)
Hi All,

As mentioned in an earlier post, I was very worried about today's PM visit.
After 5 years of Ultram ER and 7 years of tramadol, I didn't think it was helping any longer -- and the extra hydrocodone the PM prescribed last time was giving me bad headaches.


I told the intake nurse about the headaches and waited for quite a while until finally the PA came to see me. He said that he and the PM were going over my records and were discussing what would be the right strategy. They had in their notes that most other meds were not working out (Opana, Nucynta) and so wanted to see what I thought about methadone.

I indicated that I was worried it would make me too sleepy (as it had this effect on my father) and so we discussed all the others options. The PA, who I like alot, was very willing to discuss all the options with me, and we even discussed levorphanol, which they've never prescribed.

We settled on oxycontin and oxycodone for BT, since I've reacted well to oxycodone and given the pressure I'm under to get my work done, I didn't want to risk a med that will make me sleepy.
So, I am to begin with 20mg in 24hrs and if that isn't enough, move up to 40mg. For BT, they wrote the script for 5mg oxycodone, since I tend to break the 10mg into quarters (and take 3 = 7.5mg). To my amazement, the script was for 180 pills, so I can take a few a day if I need to.

I have to cross-taper over the next week and then I see the PM again in a month.

Also, I discussed the problems I was having getting more info from the orthopedic surgeon I saw and the PA said he would take care of it (I signed a medical release and they'll ask for a report, then refer me to a neurologist).

So, all in all, I am VERY VERY pleased. The oxycontin may or may not be the right choice, but I was allowed to voice my thoughts and we had a real discussion.
Posted 6/13/2012 5:44 PM (GMT 0)
Great! I'm glad you had a good appointment. Makes such a difference when we are heard...

I hope the new meds work for you... let us know.

:) --Tina
Posted 6/13/2012 8:57 PM (GMT 0)
You won't have to worry a thing about withdrawals as they are putting you on a very hefty dosage of Oxycodone per day. And moving from Ultram and Hydrocodone...it's a big jump in narcotic...

So in a 24 hour period they are allowing you to take up to 50mg a day or 70mg...But you can't compare mg for mg to the Ultram/Hydro as Oxycontin is much higher on the narcotic scale.

You should be in fantastic shape with reduction in pain...

The only thing will be if you have any symptoms related to going off the Ultam which should be tapered slowly due to possible risk of seizures....I personally didn't have any trouble switching but glad they are going to monitor you.
Posted 6/13/2012 9:16 PM (GMT 0)
Snowbunny,

In principle, I could go as high as 70mg, given the way the scripts were written. But the expectation is that the oxycodone IR lasts a LONG time.

My hope is that I'll be able to get by on just one 20mg oxycontin and be able to not use any BT meds most days. 3 years ago, I was taking a BT med about 3x per week, back when the Ultram was adequate. I'm hoping that I'll be in similar shape with the oxycontin. So, if all goes well, I'd like the oxycodone to last the better part of a year.

I must say, though, that I'm nervous about the switch and am second-guessing myself. For most of the day, my pain was between 2-3 -- a fairly good day. I also had a good day 2 days ago -- so I started to think that I'm overdoing it with the shift to oxycontin. But then I started to get dinner started, and the back pain flared. So, I took a meager 5mg of oxycodone and hopefully, that's it for today.

Tomorrow, I see the interventionist PM to discuss options. They set aside time for injections, but I think I'll delay since I don't want to conflate their benefit with the oxycontin -- which I'll either start after that appointment or wait until Friday.
Posted 6/13/2012 9:44 PM (GMT 0)
Sure...you want to be and stay on the absolute lowest dosage possible to prevent tolerance from happening too quickly and then having to keep move up on stronger and stronger meds...

I just meant that it is wonderful that your Dr. has stated up front that IF you need the larger dosage they are willing to tirate you up as needed:)

I have a lot of flexibility in my pain medication for good days and bad days...

I also have a muscle relaxer to use for that specific type of pain as a narcotic does not help..

It's the same thing with nerve pain when I used to have that....A narcotic does not help so nerve pain medication was needed...

I guess it's your choice and that of the PM...But even with my meds...I had/have injections when needed to help as that is specific medication of streroids when in a flare....Again...a narcotic doesn't do the same thing as steroids which are an anti-inflammatory...I didn't choose between the two, it was in addition to.

Just like there is PT, exercise, acupuncture, massage, TENS unit, etc...I use any and all modalities to help with my pain and keep my narcotic usage to the bare minimum.
Posted 6/13/2012 11:55 PM (GMT 0)
if you actually had a doctor volunteer to do a trial of Levorphanol and it is available in your area i would give it a shot, for sure if they titrate the dose to effective level over time. long acting, kicks in fast, potent like dilaudid or oxymorphone, has action with other receptors ex: norepineprine-reuptake inhibitor and a NMDA receptor antagonist which can reduce tolerance to morphine and other opioids. if the Oxycontin with OxyIR is not to your liking go for it but maybe keep something familiar for breakthrough pain. good luck
Posted 6/13/2012 11:57 PM (GMT 0)
if you have sedation at a pain relieving dose talk to your doctor about a stimulant like Dexedrine Spansules or Provigil.
Posted 6/14/2012 12:17 AM (GMT 0)
Thanks Snowbunny21 -- I suppose getting such a large quantity of meds shows that the PM trusts me -- which is something I hadn't been feeling lately.

Spinal Solider, I spoke with the PM in the past about Provigil, and he was hesitant. He said he prescribes them in some cases, but I was actually suggesting it as an option so I could focus on writing, despite the pain. If needed, I'll bring it up again.

However, I have a heart condition and so I need to be very careful with stimulants, including caffeine. It can cause tachycardia if I drink more than a cup. I also can't use ginseng at all.

I have as some other options for improving concentration: Picamilon and Idebenone (the latter is a fat soluble version of Co-Q10). I'll likely wait a few weeks before anything new, however, so I have a clear sense of what I'll be like replacing the Ultram with Oxycontin.

I have 6 months left before my book is due, with 6 out of 7 chapters written (approx. 250pages so far). I hope to finish editing by mid-July and then finish the final chapter in August/Sept. I also have a conference I'm hosting in Sept, and then its on to a few invited papers and a book series I'll be managing. Ultimately, my goal is to make sure I'm able to focus on these and future projects.
Posted 6/14/2012 4:17 PM (GMT 0)
you are very well informed, not many people know about the nootropics like the Picamillon sp?, i think that is a form of GABA and nicotinic acid but i do not know in the USA if it is available. it is good you are careful about your heart, from what i have been told by a pain doc is dextroamphetamine or modafinil at most raise the blood pressure by 5 points on top and bottom unless you are super sensitive. i like the way you and your doc work as a team in managing your pain, keep up the great work!
Posted 6/14/2012 8:24 PM (GMT 0)
I actually bought the Picamilon (and Idebenone) from Amazon -- I didn't shop around too much for prices, but theirs did compare favorably with the few other sites I looked at (and I have Amazon prime -- so get free 2 day shipping).

But since I'm going to start the oxycontin tomorrow, I'll wait a while before moving on to any new supplements. I do expect the oxycontin to help with the pain, as oxycodone does. But I really need to make sure I can focus. I've been finding it very tedious to edit my manuscript and it is going FAR too slowly.
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