Pain Management Community

You are doing what you need to do by making an appointment so you can talk to him. He should be interested in helping you get out of pain if not then you need a second opinion. I know it is difficult to find a good doc so if he is helping you stick with him. He just might want to put you on something like Fentanyl that is a very effective long acting opioid.
I sure hope that your doctor can help you.
Take good care,

You are doing exactly what you are supposed to do. The only suggestion I have is to ask him whether you should deal with this with him by phone or by appt. in person. Every doctor has their own preference.

I prefer to deal with all things in person at an appt. I feel I get more focused and better care this way. I know what kind of multitasking goes on while the doctor is on the phone!!! My doctor keeps several appts open for emergencies or urgent propblems for just this reason, I can always get in to see her within a day or so, usually the same day I call in.

Take care, Annette

Hi mamalol,

Your story sounds very similar to mines. I had great pain relief with one pain medicine (tramadol) for about 5 years. I have had several appointments resulting in a few titrations to where I now have an effective level of analgesia.

It sounds to me that it may be time to transition to a long acting opioid as primary with norco or percocet for breakthrough pain. I am taking morphine extended release with percocet 10/650 for breakthrough pain and this combo works well for me.

Short acting opioids tend to work fairly well for opioid naiive patients until tolerance becomes an issue. Once tolerance builds up, it begins a nasty cycle of up and down pain levels throughout the day versus the more continuous relief initially received for several years on a short acting opioid. This problem can be fixed through adding a long acting opioid.

Fentanyl, might be quite a leap and should be reserved until the required opioid tolerance has been attained and more extensive pain relief is needed. The build up of the required tolerance for fentanyl is achieved through the transition to a long acting opioid with an initial dose equivalent to slightly higher than total amount of percocet you are taking per day. That initial dose is then increased as needed for analgesia over time. At some point, the amount of opioid medicine one takes will be at an equivalent level of dosing from the fentanyl patch. Starting off on Fentanyl 25 mcg/hr, given your current opioid dosing would potentially pose a risk of respiratory depression because you are not opioid tolerant enough yet.

If you don't mind me asking, how many 10/325 percocet doses are you prescribed per day? The answer to this question helps understand your current level of analgesia better in order to provide additional advice.

Kelly

I also am on two different opioids....

The more you stress function and what your life entails and how pain limits you usually the more you will get from your doctor.

I also use everything else I possibly can....a fantastic craniosacral hands on manual physical therapist (only about 5% of PTs really help with most chronic intractable pain)...

Also use ice packs, heat, stretching, exercise, rest/activity/rest only doing one activity a day, do things I love (pet cat, sing, ballroom dancing, sewing/creating) for distraction....

The more you show your doctor you aren't just wanting pills the better. Perhaps a muscle relaxant, anti depressant, anti convulsant, etc. used in conjunction with the opioids might help depending on your situation..... Some physicians encourage careful use of additional OTC pain meds like aspirin, acetemonophin, aleve/advil types, etc. being careful by taking liver tests and watching any reflux/stomach issues.

Good luck!

I also feel like I contact my doctor quite a bit due to the fact that I either have adverse reactions to meds or they don't work very well. I'm thinking about asking for medicine without Tylenol in it. My liver enzymes were slightly elevated due to so much Tylenol. Seems like there should be a way to get prescriptions that don't come diluted with Tylenol. I'm going tomorrow to see my pain doctor (again!) and ask him about it. There are also long acting pain meds I that I know are available but my doctor only prescribes the short acting kind so far.

I do not call and speak to my doctor on the phone, I call and make an appt. and go see her in person. That way she gets paid for her visit, as she should, so why should I feel guilty? That's her job. I also feel I get much better medical care than I would over the phone.

It is a reasonable medical problem, it takes time and adjustments to manage chronic pain. I used to see my doctor much more often than I do now, I will again when my meds need changing.

Aside from feeling like a bother, it might be time for you to go on a long acting opiate on a set schedule, with Norco or oxycodone IR as a break through med. Long acting meds often work better as you keep pain at bay for most of the day. You don't get the relief ups and downs that you get with short acting meds.

Take care, Annette

Hydrocodone comes with tylenol. As far as I know it is the only short acting opiate left in common usage that is not available without tylenol.

Some short acting opiates that spring immediately to mind and are available without tylenol are codeine, oxycodone IR, morphine IR, and Dilaudid.

Talk to your doctor about this.

Take care, Annette

I've been on all the pain meds mentioned in this post and because of a fear of addiction (family history) I've not used any for more than a month before asking for something else and explaining why. I've had a trial for an occipital nerve implant that has promised to work miracles for post concussion trauma and even cluster headaches. However the insurance company
(dirty words to me) are claiming that it's investigational or experimental, hence a first round refusal. Right now the only thing good for long term pain relief is daily exercise, stretching, diet, and pardon the language, 50mcg fentanyl patches changed every 72 hours or just a little more. I'm more afraid of the tylenol effect on my liver than the long acting opiate. I'm 62 and I've been in this situation for 15 years and 5 years ago my liver enzymes started to elevate. I don't partake of alcohol and the combination of OTC pain meds with aspirin and tylenol was all the medicos could attribute the elevation to. So now it's Anacin and fentanyl and hope that somebody will find something that will work. I'm sorry for your pain and advise you to trust your doc and be honest with her/him. You know better than anyone the extent of your pain and whether it's real and what works and what don't.

I have had 2 back surgeries I also have DDD and arthritis in my spine and my SI jiont it unstable which causes unbearable pain. I have been on norco 10/325 1 tablet every 6 hours for about 3 1/2 years.It is no longer working for me either. My doctor really doesn"t want to increase the dose.And I don"t want to go anything stronger because my boss said if they put me on anything stronger I would not be able to work,I really don:t want to stop working and I can't afford to stop because I carry the health Insurrance on my family.Any ideas what I should do????

scurlock77

Hi,
I have been in chronic pain for over 20 years. It forced me out of a job I loved and onto Medicare. I have been treated by a "Pain Clinic" for over 6 years. They take a realistic view of your pain problem and are truly believe that one doesn't have to live with life altering pain. My suggestion: Dump your doctor. The only thing he is doing for you is making you more and more dependent on drugs that are not helping. You need a time release narcotic such as Oxycontin (a wonderful drug, but not perfect). There are many time release narcotic drugs on the market. Your doctor is afraid that he is exposing his license to revocation. FIND A PAIN CLINIC. Your doctor is not helping you. Also, find out the difference between dependence and addiction. Should you decide, there are very effective drugs out there that will get you off of any narcotics without having withdrawal problems.

I hope this helps. I have been there and done all of it. Demand satisfaction. You shouldn't put up with a miserable life. Remember, in our stupid society, medicine is for PROFIT, not your well being.

There are other codones without Tylenol and I had found that Vicroprofen works better that the hydrocodone. I am only on Tramadol for many illnesses and have had 15 surgeries in 2 and a half years for kidney stones and knee surgery. In West Virginia it is hard to get a doc to prescribe ant narcotics due to tons of pill heads in the state!

I too have had a long trip trying to find what medication(s) work for me. It does get frustrating but try to stick with it. I did switch doctors after about 2 years because they were so over zealous that they literally wanted to know every time I basically bumped my toe...seriously.

The new one finally put me on Morphine Extended Release along with Morphine Sulphate Immediate Release for break through pain. And, while I don't like to be on these type of meds, they work! The only other thing that worked for me, about 6 months at a time, was the radio-frequency procedure. But, it costs more money since it is a surgical procedure. I just had to think about what we could afford. Been out of work for about 2 years so had to stick with meds for now.

Hope you find a good mix (doctor and medications).

P.S. Annette I sure would like to know who/where your doctor is!.

I am so glad I read your post. I have compression fractures in T3, T4, and T6 vertebrae. I've done PT, steriod shots, and heat. I was initially taking Vicoden which makes the pain bareable but now when I ask for more, I feel like a criminal. I don't need it every day or even every week but sometimes I need it everyday for a couple of weeks.

I don't have much pain as long as I do nothing but that's the problem. I like to do all kinds of things. I'm a baker and decorating a wedding cake or birthday cake sends me into at least two days of pain. When I invite my children and cook a big meal, I get the same pain for a couple of days. I have two grandchildren that I love playing with but am afraid to pick up. Anything I do other than sit at my desk or in my recliner at home is painful. I'm really limited in what I do unless I want to hurt.

I have an appointment today to talk with my doctor about my pain and armed with your suggestion, I feel like I'll be able to convince her to provide me ongoing treatment for my back pain. I have occasionally had prescriptions but used them sparingly for fear I would not get more. That's just sad. I want my busy life back.

Usually percocet is used for what the doctors call "breakthrough" pain. What you should ask your Doctor about is a long acting or time release pain medicine like OxyContin. You would then take this once in the morning and once in the evening. You first have to decide what level will be adequate enough to cover the pain. So you will be tinkering around with medication levels until you get it right. Now the downside to this medication is that it is what I call a plateau drug. Eventually the level of medication you are taking will no longer be able to keep pain in remission so you have to increase the dosage. The other thing is the addictive quality of the medication. I was on this medication because of knee replacement surgery on both knees that left me with more pain then I have ever experienced. The problem with the medication besides what I listed is its impact on you as a person and the life you can lead. I asked to be taken off the medication and that process took 3 months. It is frustrating because there is no adequate pain medicine that is not a narcotic. Please no one say Tramadol, that is like taking baby aspirin. I wish you luck on this journey and what you decide to do.