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Thread: Long Acting Pain Meds; Lesser of the Evils

  1. #71
    Senior Member ~Lin's Avatar
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    morphine is in a patch? Hmmm! I'm on extended release morphine and dilaudid. Medicaid wouldn't cover the extended release dilaudid though, and since the morphine works I wouldn't have basis to debate if they refused morphine patches. Though I have super sensitive skin so maybe I need to give up my dream of a patch lol. I just take so many damn pills a day. My body tries to reject the I say, because they'll come back up and I have to re-swallow them. Or maybe that's just related to my GI and refux issues...
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

  2. #72
    Has anyone tried Fentanyl in the Duragesic transdermal patch(100mcg)? I use them and they are expensive even with the part D medicare. They are the only thing that brings me any comfort when the pain is severe but the 3 day patch really only lasts 2 days and then their effectiveness is greatly reduced. Otherwise I take up to 20mg of methadone four times a day. On really bad days nothing helps even when taking both Fentanyl and methadone, especially last winter with the weather changing drastically and the temps bouncing up and down 20 or more degrees. My neurologist has tried talking me into using morphine with the Baclofen in my intrathecal pump. The Baclofen costs $1700 just for the medicine (10mg), and the whole refill process is about $2000. With paying the 20% of medicare this adds up quick! As far as stool softener I use Probiotic Complex from Swanson vitamins and stay hydrated. Probiotics are also very good for the immune system. Honestly, we all should be on a high potency multi-vitamin with minerals and vitamin D because today's foods and diets we are very nutrient deficient. Be sure to check with your doctors first before taking vitamins because they do have an effect on some meds.
    Last edited by keiten06; 06-16-2012 at 12:06 AM.
    1 Corinthians 13:13

  3. #73
    Hey Avic! Tina is my name, from years of signing paper work, I sign everything, T for short. Charlotte is what I named my Arachnoid Cyst. But, you can call me either!

    Thank you for your admiration but I do would any Mother does and try to do it with a smile! I raised my daughter, for the most part, single handed, the teen boys are stepsons as are the adult daughter and son. It was a big culture shock for me 9 years ago!

    My daughter has suffered mental illness, (present on her Father's, Mother's and Father's side - wham!), for 20 years. She functions at a high level; I didn't give her a choice. I was blessed, and able to provide her with great treatment. Wow, if you want to see humans jacked around by the system... anyway, I can talk her world, her illness, and her meds, which makes my injury and meds lower on my list of priorities. Hence a portion of my ignorance - the teenage boys live with us every other week during the school year and live here most of the summer, hence the remainder of my ignorance. If that's not enough reasons for my stupidity, add 1 dog with toddler requirements, 3 gorgeous Granddaughter's, and my husband's very recent battle against cancer. My world is on a spin cycle and doesn't stop for pain and surprise medication changes!!! LOL

    I ditched the Methadone, stopped it as of yesterday morning. The breathing trouble increased, as did the strong spasms in my right leg, nausea, and dizziness to the point of vertigo, insomnia, and rapid heart rate continued. Add to that, tightness and pain in my chest on either side of my throat, followed by rapid heart beat, more dizziness, and headache. I don't get headaches as a rule.

    Contacted the Dr. this morning and he agreed, I should stop the Methadone. Despite my protest, he said, he would have to try me on another "long acting" pain medication, they required it. He mumbled one, but I was in orbit, (required???), and the drug name didn't register. He rushed me through for an appointment next week.

    In the meantime, I have spoken with our State Health Dept., the DEA Diversion Dept., and my Health Insurance/Drug Rx Dept., and non of them require my Dr. to continue trying or have me on "long acting" pain medication or any other medications.

    I also spoke with my Neurosurgeon's, Nurse Practitioner, for over an hour, regarding the situation. She told me there is no such requirement made on doctors. Additionally, she said, long acting PM's should only be tried as a last resort, especially considering my breathing suppression and injury level. Lastly, when my NS sent me to my Neuro, he had recommended, short acting, Oxycodone because it's the closest to Hydrocodone with respect to molecular structure and I would probably tolerate it well. His PM goal for me was to move laterally and eliminate acetaminophen. BAATTA BOOM!!!

    Now, to get this through to my Neuro. who may possibly be suffering from Alzheimer's or sumppin... LOL

    Everything about my injury goes up and down, pain, sensation, weakness, all of it. It depends on my movements. Aside from the injury, arachnoid cyst, and adhesion's, there's a deformation, (bend), and compression to my cord. I might lose sensation in my hip, for example, and have it come back in the same day. My pain eases if I sit still but once I move around the party's over. The spasticity has increased as the adhesion's have. I never know from moment to moment what is going to work or hurt. LOL

    In any case, thank you again, for all the information. I appreciate it and have spent a good bit of the day pouring over it.

    You're an Angel!

    T & Charlotte



    Quote Originally Posted by avictoria View Post
    Charlotte (or do you prefer T?)

    You have my unending admiration-dealing with pain, disability, teens and a daughter with schizoaffective disorder. Wow.

    I hope this pain management plan works out well for you and am glad you're being cautious. If you have to ditch the methadone I wonder if they might look at extended release morphine or buprenorphine. My lay opinion is that if you have to ditch the methadone, do it sooner rather than later, before you become physically dependent on it because it is said to be very, very difficult to discontinue w/out miserable withdrawal. If you all decide to stop the methadone make sure the doc switches you to something at an equivalent dose and dosing schedule to cover you.


    Most opiates get metabolized pretty quickly; that's why they devised extended-release delivery so that hopefully you maintain a fairly steady serum level of opiate. Oxycontin, fentanyl patches and extended-release morphine are examples.

    Methadone and buprenorphine in contrast last much longer in your system simply by 'sticking' to opiate receptors. I know some pain docs are starting to use buprenorphine. I have no idea how well it works, expense, DEA regulations etc with bupe. It might be an option.


    This company has just asked for FDA approval for tylenol-free extended release hydrocodone. http://www.zogenix.com/index.php/products/zx002/ It might be expensive though and the extended release formulation a PITA as is the 'new' Oxycontin.

    Do your pain levels go up and down a lot? You might get decent relief from taking a short-acting medication in smaller quantities but at more frequent intervals.

    I'm just tossing ideas out there & hope they're useful. Has anyone here used buprenorphine for pain management?


    All the best!!!!
    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  4. #74

    Update: Meth-be-gone!

    First let me thank everyone for all of your great knowledge and/or advice in this thread. Avic, I credit for for possibly saving my life.

    By Friday, I was confused and struggling to breath. My husband told me to call the Dr. about the side effects and not to take the 5mg a.m. dose of Methadone. I did not want to talk to the Dr. and had decided to just take it and go along with the Dr.'s "long acting" program. Before I took it, I logged in here and had a PM from Avic containing the Methadone warnings she later posted in the Pain Forum. After reading the article, I snapped too enough to discontinue the Methadone. I really wasn't thinking straight, had been in tears for 2 days, and at the time was thinking, I'd rather die from the pills than listen to my Dr.'s BS! Scary, huh? Side effects.

    The breathing problems and chest pain continued to get worse Friday. l noticed my lips were pale, but thought it was funny, (really, haha funny). That night I got up from bed with my hips on fire and unable to breath. My lips were blueish looking and I still thought it was haha, funny but was scared to go to sleep. So, I kept myself awake bopping around CC. Apparently, Methadone makes me cyber chatty! I also went for a drive at 3:45 am. I was out of my mind but did NOT feel high just very ready or not, here I come; but still in need of oxygen.

    I finally went to sleep Saturday afternoon and slept until Sunday morning. During my semi coma, my husband checked on me several times. His words seemed to come out in slow motion and he says all I could do was stare at him. He said sometimes I was very irritable. Since I never sleep through the day, everyone was scared.

    I've lost more weight, and have my first ever pressure sore. Until yesterday, I had crushing chest pain and spasticity throughout my chest and ribs. Today, I'm feeling more myself!

    I saw my Doctor this morning and he was very kind and apologetic for the ordeal I had been through, (he had forced me to go through). He Rx'ed the original, Hydrocodone, 7.5/500, max 6 a day, and said he'd get a letter from the Medical Board. My husband asked if they were the party "requiring me to take a long acting pain meds, and my Dr. stated they were. Seriously? I haven't checked this out, yet. Anyway, my Dr. said, and I quote, that's ok, now I can tell "them" we've tried them, (long acting PM). O-M-G -- please, let me take a bow to "them", I'm honored to have risked my life to appease "them"!!!

    When I see my NS's, NP next MRI, I'm going to request a letter stating the risk of medications that suppress breathing with respect to my injury level and have it placed in ALL of my medical records.

    Now that I have made "them" happy, I'm hoping I'll bounce back quickly and return to a smoother sail!

    Thank you all again for your help, support and advise (and for reading my lengthy posts) throughout my last dilemma de jour, I may have croaked without you!

    Sincerely,
    T
    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

  5. #75
    Tina

    OMG I am glad you're ok. What a terrifying ordeal. The MD that's rx'ing for your pain sounds kinda goofy. Why in the heck doesn't he just rx you plain oxycodone, no dye, no acetominophen at the equivalent dose to the hydrocodone you're taking??
    I think certain hydrocodone/NSAID formulations are listed as schedule III by the DEA but methadone is scheduled II along with oxycodone, fentanyl etc so if your doc is trying to stay with schedule III medications it doesn't make sense that he'd rx methadone.

    You're taking a pretty low amount of hydrocodone...jeeze they use methadone to treat addicts that are tolerant to incredibly high levels of opiates. Commonsense tells one that methadone is very potent.

    There is/was a theory in pain management that long-acting opiates are less prone to abuse. Well the whole 'hillbilly heroin' Oxycontin debacle should have refuted that theory.
    When I was first rx'd Oxycontin after my shoulder was injured in a car accident the PM nurse told me to chew the tablets so they'd work faster. Thankfully I read the prescribing info before taking it.
    The excellent MD I now have simply rx's a low dose of plain old 5mg oxycodone tablets. Yes they're short acting but they work great for fluctuating pain levels and they don't build up in your systen after the pain relief wears off (methadone is notorious for that). Also, when I have a 'good spell' where the pain is low I simply taper down and off. I hate the fuzzy head and depression.
    Your experience was awful! I am so glad I found all that info on methadone and sent it to you and posted it. It scared me to death.
    very best! keep nagging your doctor!

  6. #76
    Quote Originally Posted by avictoria View Post
    Tina

    OMG I am glad you're ok. What a terrifying ordeal. The MD that's rx'ing for your pain sounds kinda goofy. Why in the heck doesn't he just rx you plain oxycodone, no dye, no acetominophen at the equivalent dose to the hydrocodone you're taking??
    I think certain hydrocodone/NSAID formulations are listed as schedule III by the DEA but methadone is scheduled II along with oxycodone, fentanyl etc so if your doc is trying to stay with schedule III medications it doesn't make sense that he'd rx methadone.

    You're taking a pretty low amount of hydrocodone...jeeze they use methadone to treat addicts that are tolerant to incredibly high levels of opiates. Commonsense tells one that methadone is very potent.

    There is/was a theory in pain management that long-acting opiates are less prone to abuse. Well the whole 'hillbilly heroin' Oxycontin debacle should have refuted that theory.
    When I was first rx'd Oxycontin after my shoulder was injured in a car accident the PM nurse told me to chew the tablets so they'd work faster. Thankfully I read the prescribing info before taking it.
    The excellent MD I now have simply rx's a low dose of plain old 5mg oxycodone tablets. Yes they're short acting but they work great for fluctuating pain levels and they don't build up in your systen after the pain relief wears off (methadone is notorious for that). Also, when I have a 'good spell' where the pain is low I simply taper down and off. I hate the fuzzy head and depression.
    Your experience was awful! I am so glad I found all that info on methadone and sent it to you and posted it. It scared me to death.
    very best! keep nagging your doctor!
    Aictoia, honestly, I'm a little concerned about my Neuro. His behavior the last few visits have been odd. I think it's trying his best to get through the red tape until he retires.

    I didn't mention trying Oxycodone today. Too chicken until I regain the lost weight. 101 this morning - at 5 foot 10 inches, ugg! I'm hoping the Hydro will come out without the acetaminophen soon. We have this in common; don't need it don't take it. I'm so freaking blessed that my pain and body allows that, still!!!

    The PC I was going to was worse than my Neuro. They told me, a bac and morphine pump or no oral meds, per regulations. LOL Although they changed their tune when I had my NS's office contact them, I didn't go back. The way it works here, you cannot make an appointment to consult/interview the PM Dr. They request your records and decide if they will treat you. You also can not be seen by a new PC if you have been turned down by, or are currently in a PC. My husband dropped in, unannounced on every PC in my area, including the corp hospitals that have jumped the gravy train, and found all of them cheesy and lacking professionalism. None would give him general information! It's a no win for the patient, and a run on gov money for the PC's with notta complaining about it. Twilight zonish, if you ask me!

    I just can't wrap my mind around what PM has become. More than ever WE have to keep our eyes open and stay proactive about our health. Thank you again for helping me do that, Avicangel! AND, thank you for posting the information for everyone to read. You're the deal!!!

    Incomplete, SCI, T1-T8, w/ Arachnoid Cyst. Bilateral shoulder surgeries, 2 on the left, 3 on the right, right forearm surgery for a crushed radial nerve.

    "We can always choose to perceive things differently. We can focus on what's wrong in our life, or we can focus on what's right."
    — Marianne Williamson

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