Gunshot and in severe pain

Hello,
I am new here and need help. Here is a
bit about my injury:

I had a burglar break into my home in San Francisco
where I was nearly done with my BA in International Business
I was shot with a .357 magnum in my left humorous.
The bullet shattered (literally, no bone larger then 1cm)
7 inches of my humorous and tore apart my radial nerve.
This happened in the spring of 2010. I have been
on high doses of pain meds ever since. I have had 2
nerve grafts in the last year. The most recent was November .

I am having a lot of trouble with my tolerance increasing
quickly. I am only 28 and the docs say I will be on meds for
at least a couple more years.
I have great doctors. My ortho is one of the best in the world,
literally! My pain management doctors are great to. There are 5 doctors
that I rotate thru so I get different opinions and to be sure I'm not abusing any meds.

Here is what I'm taking:
150mcg/h fentanyl transdermal changed every 3 days
Gabapentin 1800 mg per day (this is a great med)
Oxycodone up to 180 mg per day (30mg each tab)
Tizanadine (xanaflex) 24mg per day (8mg per dose)
Xanax 2mg per day
Lunesta 2mg at bedtime (but it does nothing, I still wake up at least 4 times a night in pain)

My docs are ok with increasing fentanyl but I'm not. The 150 is the lowest dose I've been on since being shot and it's a level that gives me some type of life. I function and remember things much better at this dose. I research everyday to try and find a new med or combination of meds I haven't tried, but much luck.
I see my doc again on Tuesday 3/26/13 and I'm hoping to get ideas here on how to lower my tolerance or switch meds?

I want to try switching to a higher dose of IR morphine for breakthrough pain so I can leave my fent stable or even lower it.
Obviously I only want to switch one med at a time and with the pain I am in I think that oxy to morphine may work.
I am only 28 and in great shape. Though I have radial nerve palsy and not much use of my left arm, I try to stay active.
Up until now I have been able to switch meds and be fine just rotating thru every opiate known to man;-) (that's legal and Rx). But since they did the nerve graft in November I haven't been able to get back ahead of the pain. It's really starting to get depressing, knowing that the best way to help is to increase the fentanyl which will slow me down again.

Any advice on going from oxy to morphine will be appreciated. I've been on morphine before and just read a study from a university in England that proved a high dose of morphine mixed with gabapentin had the best results in helping patients with chronic nerve pain.

Sorry for writing a book, but how can I get solid advice without giving you the facts.

Hope everyone is having a great weekend!

Cheers!
B

IMHO you will be better off finding the right long acting pain medication(s) at the right dose and reducing your reliance on breakthrough medications.

Hello B, I generally type initials for longer usernames but when I typed yours it came out to BS,maybe as we know you better,dint think on your 1st post I should.Lol

Welcome to the forum for chronic pain. Sounds as if you literally almost lost your arm!!! Sorry for having to deal with something so tragic and horrifying as being shot.

I'm in agreement was Jim here as that as longtime CPers It appears that the majority find their quality of life and the lower average pain levels with getting your base med correct and titrating your rescue med to make a.better fit.

The higher uses of rescue med seems to the culprit in causing tolerance issues to build faster.

I'm of the rare few who uses only my base med now and otc meds and other modalities to keep pain at its lowest.After years of going med to med and increasing and decreasing I found a Neuro who believes that if your base med is adequate you can do with little or no b/t meds as long as you are open and dedicated to try other options.

It works for me and doesn't for others. That's the point we can advise but in the end we each are different in our situations and what helps.

Have you been on a 48hours fent change or did you just increase dosage at the 72 hours?

I also have seriously disturbing reactions to many opiates and ended up with a methadone and lyrica combo that has been my gift from the heavens. I know others who can't take it but several members who do like it as well as I.

Maybe if you give us a run down on what you have used we will see something jump out as one you have not tried.

Good luck and again welcome to the forum.

Vickie