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    Pain Medication Equivalents and Length of relief expected from dosage
    DaisyDiane posted:
    I recently had to be taken off of methadone after 15 years of 40 mgs daily due to a head-on car collision and post surgery back and leg pain. The prolonged use effected my heart beat and was advised to stop the medication immediately. The new pain clinic I am goin to due to a recent move has had me slowly coming off of the methadone and is now changing me over to ms contin 15mg 1 tablet every 12 hrs. This is not taking care of my pain at all. I am a caregiver for may father who is bedridden and suffering with a wound from a recent great right right toe amputation and now has a mersa infection in the wound that I am supposed to clean and redress 2 x daily. I am unable to stand to clean the wound let alone change his briefs, cook and feed the both of us etc. I need serious help here what should this new Dr really be giving me? My old Dr. would never of allowed me to suffer like this being aware of my responsibilities!
    Kelly_30 responded:
    Hi Daisy,

    I am also on 15 mg of MS Contin every 12 hours. And it was not sufficient in relieving my pain alone. I take 3 doses of either percocet or vicodin for breakthrough pain. The short acting and long acting combo makes my pain manageable.

    There are some folks that take MS Contin every 8 hours versus every 12 hours.

    Living one day at a time.
    DaisyDiane replied to Kelly_30's response:
    Thanks for the info Kelly. Why are you not just able to take more of the ms contin? I being a caregiver have no medical insurance and no medicare or medicaid and am self pay. The cost of additional meds is extremely costly. In addition I am leary of taking anything with tylenol in it do to the damage to my liver over prolonged use, as I know this is going to be a life time problem for me.
    annette030 responded:
    With your back and leg pain, you might not be the right person to be doing those things for your dad, even though you want to. Your own injuries may preclude you from being his caregiver.

    To find out, I would ask the doctor to send a home health care Occupational Therapist to your dad's home to see how you can do things easier. I was an RN in home health care for awhile and the OTs were great. They could break things down and teach folks to do them in such a way as to not cause further harm. Or ask your dad's doctor to get home health more involved in his care and the housekeeping.

    For instance, you said you are "unable to stand to clean the wound", why stand up? Nurses do things like that sitting when possible. This is just one thing you might learn how to do differently so as to cause you less pain.

    That aside, and back to your pain meds. The starting out dose of a new pain med, when switching over from a different one, should be started very low, then adjusted upwards to cover the pain appropriately. There is only a partial cross tolerance, so if you switch over to too high a dose, you could die of an overdose, then where would your dad be? When I changed my drug dose or switched to a new medicine, I expected to see my doctor in person more often, once it was adjusted properly, I went back to less frequent appts.

    My doctor and I went by my total daily dose of MS Contin (generic) per 24 hours. Sometimes I took it every 8 hours, sometimes I took it every 12 hours. She was happy to just double the total daily dose, but I wanted to increase it only by 50%. I wanted to then adjust the number of hours apart the doses were. She let me do it my way, after I explained it to her. Eight hours, twelve hours, both worked fine for me.

    Talk to your new doctor, but please do not compare him to his face with your old doctor. That is like comparing the new wife to the dead one, no one is ever happy with that comparison.

    Take care, Annette
    annette030 replied to DaisyDiane's response:
    I took generic Norco as a breakthrough med for many years, and my doctor just checked my liver enzymes regularly, they were always normal. I did not take any other tylenol containing products. Now I opt to use a breakthrough med without tylenol because it is cheaper.

    Although some doctors would just give you more MS Contin and no breakthrough meds, that would not be the standard of care in most places. The medical research shows that using a long acting opiate with a short acting one for breakthrough pain seems to give the best pain relief, and the fewest side effects.

    What other meds do you take? There may be other kinds of drugs that you could get through a special program that would decrease your opiates which are sometimes not covered. Have you checked through needy to see if you might be able to get any help with RX drugs?

    Take care, Annette
    Kelly_30 replied to DaisyDiane's response:
    Hi Daisy,

    I also have a lifelong sentence with chronic pain. I am a little weary about the tylenol as well. If your liver is healthy, you can take 1,000 mg in one dose and up to 4,000 mg of tylenol per day. I currently take up to 3,000 mg a day as I take two 5/500 vicodin tabs 3x a day for breakthrough pain. I get regular liver panels done to ensure my liver is still okay.

    I haven't requested any changes to the MS Contin because I just started MS Contin 3 weeks ago and want to give the new regimen at least a month before making any addjustments. I also had some nasty side effects when first starting MS Contin so I have been reluctant to up the dose. However, many people still have breakthrough pain even when addjustments are made to MS Contin, Fentanyl, Methadone, or Oxycontin. I have been trying to decide on vicodin or percocet for breakthrough pain. I think the vicodin works better at covering the breakthrough pain for a longer period of time. However, the percocet has a much lower dose of tylenol in it (325 mg) and I like that but it seems to help more than the vicodin for pain in the short term. There are other short acting opioids that can be used in combination with MS Contin such as roxicodone, Morphine IR, and I believe there are more like these that contain no tylenol. You can talk with your physican about the desire to have a breakthrough medication without the tylenol.

    If the cost of additional meds are a concern, perhaps a modification of your dose of MS Contin alone may provide enough relief. But keep in mind that your purchase of a short acting breakthrough med may last longer than a month or two as you are taking them as needed versus on a schedule.

    Living one day at a time.
    annette030 replied to Kelly_30's response:
    Hydrocodone/APAP comes with just 325 mg. of tylenol also, both as Norco and in generic form. I used the generic for many years with this level of tylenol in it. Discuss it with your doctor.\

    Another suggestion is to try taking a long acting drug like generic MS Contin just at night so you sleep clear through the night, then use short acting meds in the day time. I did that at first. Just sleeping for a full 7-8 hours made a huge difference in my life.

    Check the prices though, often a larger quantity of pills is not that much more than a smaller quantity of the same pills.

    Take care, Annette

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