My opioid tolerance never seems to decrease

After 2+ years of having no insurance, I finally went back through the process of getting into pain management. Since I'm new, I'll list my issues:

Thoracic Outlet Syndrome left shoulder

Patellofemoral disorder in both knees, left is worse due to failed lateral release surgery and no cartilege

Wrist pain resembling carpal tunnel in my left hand

Horrible lower back muscle pains/spasms

"Turf Toe" left foot big toe

Chronic headaches

Gastrointestinal issues

That's mostly everything, I think. Now onto the topic.

Pain Management diagnosed me (again) recently and sent recommendations to my Primary because their program is backed up by 9 months. My primary was reluctant until he saw their recommendation (I'm 27 and they always use my age against me).

I signed the contract and was given MSContin 15mg 3xDaily because I was on morphine for years before I lost my insurance. Unfortunately, it seems I'm already tolerant to the level.

People always say your tolerance is gone in weeks/months, but yet YEARS after last taking it, it barely works for me. My next appointment we'll be discussing the dose and I'll bring up that I may need 30mg, hopefully he's receptive to it.

Has anyone else had this problem where it seems like your tolerance is permanent?

Hi there....Welcome to the boards..

Tina gave some great suggestions and we will look forward to learning more about you..

As she mentioned....an opiate really doesn't do much at all for any type of muscle pain or nerve pain. So many of us also have these types of meds that we can take when needed to help.

The key with pain management is to not rely soley on opiates to bring down your pain level. This is what causes tolerance to develop so quickly in most people.

I haven't changed my dosage in close to 3 years...but that has been something that both my Dr. and I agree about because with chronic pain...this will be a life long journey and I want to keep my dosages as low as possible to have room to move all the upcoming years.

The other part of PM is having realistic expectations about pain levels..When someone has acute pain from an injury....of course they want/expect to be pain free down the road after surgery or treatment...

But those of us with chronic pain...getting and staying at a level 5 or so is what many Drs. shoot for. I live with a 5-7, depending on the activity level and day.

So...in addition to a nerve pain med and/or muscle relaxer that you can add to your treatment....

There are injections that Tina mentioned...have you done these for your wrist, shoulder or knees?

How about physical therapy for the TOC?

Are you on any medication to help with your gastro issues? I know that eating healthy and watching your diet is very important to helping with that as well.

For your other issues....there is also daily exercise (even just walking for 30-45 min. a day) Or if the Dr. is saying you can't do that...then aqua therapy is very helpful...

There is also using braces for the knee/wrist....

As well as acupuncture, massage, ice, heat, TENS unit, biofeedback, etc.

Also not smoking (if applicable) and eating well and maintaining a healthy weight is very important, especially with those with spine or knee problems to keep added pressure off.

And then many of us have actually gone to counseling/therapy to help with the emotional side of living with chronic pain. Sometimes people are diagnosed with having depression which is nothing to be ashamed of...it's very difficult adjusting to this new life. But with the counseling and even antidepressants...this can help with the pain as well as our mood. So that is something to look into as well.

By working with your Dr. and finding the best comprehensive plan...this can help you live a good and active life with chronic pain. By using every modality possible, including different medications....each one will put a tiny dent in the pain and add up to getting to a 5 or so.

Most Drs. will go slow on medication..especially opiates and tirate up as needed. My PM has always said to give each medication a month to see if it is working well and monitor or get rid of any side effects before we add something else or move up.

I've been in PM for 11 years and am on 75 to 90mg of Morphine a day. I have the choice as I am on both 30mg and 15mgs so depending on the day I can use less/more so I'm not tied to taking 90 each day when I don't need it.

Obviously we can't compare meds as we are all different and what works for one person may not for another.

It could be that you just need to add a low mg. breakthrough medication. I use OxyIr 5mg. My PM thinks that by using a different opiate for my BT med...it has a better effect and again, we can stay lower in the dosage. So, this may be something that you can discuss with your Dr.

I recommend keeping a pain journal so that you can write everything you do during the day, when you take your meds, what other things you do to help the pain, and what levels they are throughout the day and then talk with your Dr...

Glad you have found us but sad to see another person with chronic pain..

 

      Good afternoon Cave!

             Just wanted to pop in and say howdy to you! I also believe Tina, Snowy, and Matt have given you some very good advice...and I really have to agree, that a dose problem was more of what I thought of..more than a tolerance problem in your case.

       Take care, and enjoy the forum, and it's members!

        SE

Thank you for the responses!

I have been given Flexeril as well, but it does little more than make me groggy. I've never much liked muscle relaxers due to that and can really only take them at night time.

I've been given a TENS unit as well which is great, I'm using it on my lower back currently and I love it.

I have done injections in the past including epidurals. The PM Clinic basically said they were pointless to continue trying, and I agree. They never did much in the first place.

Physical Therapy helps, but I can't afford it more than once a week with my co-pays.

I was walking for 30mins to an hour a day until I hurt my back so badly I couldn't get out of bed for a couple of days. I've been afraid to start again as it hasn't stopped hurting in two weeks.

I quit smoking 3 months ago actually with the help of wellbutrin and have actually lost weight, which is the polar opposite of what would happen cold turkey.

My old PM Doctor gave me Oxycodone IR 5mg as well, I could bring it up to my primary. He did write in my notes for the last visit that we'll discuss the dose next appointment a month from now.

So I'm thinking he'll be open to listening to me. Currently I've already taken 2 of my 3 daily 15mg's and am still in pain. 30mg's worked the best in the past, so they should hopefully still work.

Cave,a lot of people have trouble like you with Flexeril making them sleepy or groggy. I couldn't handle it, it made me sick at my stomach. I have taken Robaxin and Zanaflex and did not get sleepy on them. I am currently on Baclofen and it works great without the sleepiness. If you are having back problems and TOS you can bet you are possibly suffering with muscle spasms and would probably benefit from a muscle relaxer. Getting rid of some of the spasms will help get rid of some of the pain. I would ask the dr id he has ay samples that you could try. Just a thought...Susie

Hi, just wanted to include the idea that nicotine leaching out of your bones after quitting smoking can decrease the efficiency of your meds. I know it can take a year or two before all the nicotine is really out of your system.

One thing that I didn't see mentioned is that morphine may not be the best pain medication for you to use. Morphine makes me vomit, and it does very, very little for me in the way of offering any type of pain relief, so it is not one of those meds that works well for me , at all.
It may be, given that you were on it previously , that it just doesn't work well now for you, and you may need to explore other options- oxycontin, nucynta, tramadol, hydromorphone, fentanyl, etc or a combination of them to see which may offer you the best pain relief.
Not all pain medications work as well for someone as another might.

15mg tid is low and w/o breakthrough meds it is very low but fighting tolerance is a pretty new thing in pain medicine. NMDA receptor antagonist are perscribed like Namenda the alzhimers med. but some of these have major side effects. the herb Ashwagandha has some NMDA antagonist properties and so does Magnesium. because you are young you have to go through to much waiting until your dose is titrated to effect, i went through it. before you go to the tolerance fighters i think you just need the right dose and it may take time but est. a trust and if they still won't help you maybe find a different MD,(easier said than done). the amino acid DL or D-Phenylalanine may help you because it blocks the enzyme that breaks our own endorphins down and possibly the morphine. one other area i would look as mentioned by straydog is the class of meds known as potentators. soma, baclofen, vistaril, phenergan, clonidine, tizanidine, certain anti-depressants like elavil, cymbalta, pamelor, GABA modulators like baclofen, klonopin, ativan, soma, lyrica, gabapentin, lamictal, ect. ect. i takes trial and error so that is when it is nice to have a doctor who will work with you, i am just now landing on a combo that helps me and i have been looking for 10 years. good document to read, "intractable pain patients guidebook for survival", by Forest Tennant MD. if they are not trying help you much i might print it out and bring it to the doc. that would show you are proactive about this and you noy asking for anything but what the standard of care is. best of luck to you, i know it will come out ok. NICK

Before this week it's been since July 2010 that I've been on the Morphine 30mg 3xDaily and I had Oxycodone 5mg as needed for breakthrough pain back then.

That's why I think I have a permanent tolerance, I can take 45mg and still have a significant level of pain after years of no pain medication.

We'll see what else he wants to try, I've tried Neurontin and things before.

Surgery for the various issues is a no-go, except for possibly the carpal tunnel.

The Thoracic Outlet they refuse to do surgery because of the risks involved. I already had knee surgery and that failed miserably. The only alternative is sawing through my bone below the knee and resetting it, and that required 6+ months out of commission, and I can't do that.

Physical Therapy helps in the short term, but with my new insurance the co-pays are too high for therapy 3x a week.

The opiates do help me at the right level, and once upon a time 15mg of Morphine was effective. So was 5mg of Oxycodone, but now they don't do much, hence why my tolerance seems permanent.

I'm not sure if any of it is nerve pain except my shoulder, but that's only part of the problem.

My knee is bone on bone with no cartilege. My shoulder is cutting off the nerves and blood flow to my left arm, my lower back is a muscle problem (doctor said it wasn't sciatica), toe is a muscle issue as well.

Like to say hi and welcome to HW and hate that you have to be here at the same time! Lots of great advice given on here! I only wonder if 1 reason your meds aren't working for you is that with all your symptoms is if your pain levels have gradually gotten higher over time? You've got alot going on. I'm definitely no authority but I feel bringing up a change in meds IMO is to tell the Dr. that your meds arent working for your pain level with honesty and maybe mention how this is affecting your life. I think they prefer that you are humble to their care and thats what they have studied hard for their proffesion. If you have a good Dr. they should make adjustments for you. I hope they do as you sound like you need the extra help.Straydog (Susie) may have a point about the spasms and relaxers. Im with you about those pills but they do help "that's if its what you are excperiencing" good luck"!!!