pain medication questions

Hi there, I've been reading posts on medhelp for months but this is my first post. I have a question about pain medication. A little background, I have a some disc disorders (herniated, bulging, degenerative) as well as a lot of nerve damage in my back. (I also have fibromyalgia but I use different, non-narcotic medications and treatments for that.) Anyway, I see a neurologist/pain management doctor regularly and a chiropractor occasionally. I'm doing all the treatments I can including physical therapy, nerve burning, injections, exercise, and medications. I take a muscle relaxer for spasms as well as naprosyn and norco for pain.

Because I'm still in significant pain and have been on norco for a while, my doctor wants to change my prescription and have me try percocet. He thinks it may help more and that I have probably built a bit of a tolerance to the norco. So next week he'll switch me from 4-5 norco 10/325 daily to 4-5 percocet 10/325 daily.

My question is, has anyone ever switched between norco/vicodin and percocet before? Which worked better for you? Did you feel the switch helped with your pain? I know medications work different for everyone, I just would like to get some opinions. I'm nervous about the switch, I've never taken percocet before. I know it's suppose to be 1.5 times stronger than norco, but I know some people feel norco relieves their pain better. If  I feel that way, my doctor should switch me back right? I also am nervous about how percocet will make me feel, I'm a mom and I work, I can't be feeling "high" all day. We've discussed other stronger and longer lasting medications before but I turned them down, I'm afraid of how they'll make me feel, and I fear addiction potential of stronger meds. I have a cousin who's a recovering heroin addict and I never want to go through what he's been through, I've read some of these stronger meds are up to twice as addictive as heroin so I'm not willing to take that risk.

Anyway, if anyone has used both norco/vicodin and percocet I'd really appreciate your experiences and feedback. I also wouldn't mind hearing your experiences with other meds and treatments for back pain, I'm pretty sick of being in pain all the time, as I'm sure many of you are, so any info would help! Thank-you for reading, sorry it was so long. Thanks for any responses.

[Hillsy69]

Oh, I also use hydrotherapy like swimming and water aerobics at my gym and we're buying a hot tub/Jacuzzi/spa/whatever you wanna call it lol

[rtjrevie]

Hello, I have been waiting for someone with more experience to respond to your post (I would be interested to know the answer too!) but since no one has yet, I will tell you what I have experienced. I too have DDD, arthritis and bulges/protrusions in my lower back, also question a possible fibro diagnosis but not official yet. Anyhow, I have been dealing with constant back pain for 3yrs and occasional for 5yrs +. I have tried PT (in it again), multiple injections, exercises, chiro, etc but nothing really seems to work. Currently on Vicodin, Neurontin, and Cymbalta.
Ok...where I am going with this is last March I had a hysterectomy. I had fibroids and endo, and my pain management DO thought perhaps my uterus was causing secondary pain to my back. I was put on Oxycodone-acetaminophen (Percocet) after my surgery. I really thought, WOW this has helped the back pain...until I went off the Oxy. I now know that the oxys were taking care of the back pain. It was the first time in years that I can honestly say I was "pain free." As far as a "high" feeling, I did not get that any worse than I did when I started the Vicodin (and I am sensitive to meds) although it did make me feel good and gave me energy (guessing because I had no pain for the first time in many years) as far as becoming "addicted," I don't have the answer to that,  I would say perhaps "dependent to alleviate the pain" I know this can be a difficult choice. I fear the same thing, and thats why I haven't gone back to the oxycodone. I too am a mom, and have a job that I can not be fuzzy for. I guess you have to weigh your options. I would try the Percocet for awhile and see how it affects you. Yes, if it does not work, your pain management doctor should be more than willing to switch you back. Sorry this is so long, I hope I was able to answer some of your questions, or atleast offer some support. Good luck, and keep us posted!
P.S.-Have you noticed a difference in your pain from hydrotherapy or swimming? Just wondering, thinking about giving it a try but worried it may cause more pain. Thanks.

[femmy29]

Hi and welcome to the community!  

I have been dealing with chronic back pain due to degenerative lumbar interverbral disc disease with lumbar radiculopathy as well as due to myofascial pain syndrome and extensive nerve damage in my thoracic spine (mid back) for over 12 years.  Over the years, I have been through chiropractic, physical therapy, massage therapy, accupunture, 5 epidural steroid injections, and of course a long list of medications.  I started with just ibuprofen until it ate a hole in my stomach (ulcer).  Added a muscle relaxer called flexeril which helped a little for a little bit.  Then was put on valium which helped me regain my sleep back but was still in pain throughout the day as I only used it at night.  Then I was put on my first real pain killer, Tramadol.  That truly gave me my life back but it began to fizzle out and after 3 years it was barely working at all.  My doctor then added in Vicodin, which contains the same narcotic pain medication as Norco just with more tylenol.  That worked for about a year at which time I started my first long term med, morphine sulfate ER along with Percocet for breakthrough pain.  For some reason, when I tried percocet alone without the morphine, it didn't work as well.  It could be because I was on 1/2 the dose they plan to switch you to but the percocet did help significantly when combined with the morphine for treatment of breakthrough pain.  I needed both a titration in strength for both the morphine and percocet and my pain was still more than I could handle but it was much more controlled than it was in the beginning.  Switched insurances this year and had to find a new doctor and it was the best thing that has ever happened to me.  My new doctor put me on Opana ER, 30 mg twice a day along with percocet for breakthrough pain.  I only now need 2-3 percocets per day versus the 7-8 I was taking while on the morphine sulfate ER and my pain is gone for most of the day; it has been so surreal for me to not have to constantly battle pain every day, all day.

Percocet is quite a bit stronger than the norco you take (more than 1.5 times as strong).  Norco is about 60% the strength of morphine and percocet is 1.5 to 2 times stronger than morphine.  The Opana (oxymorphone) I take is 2 times stronger than percocet.  However, despite this revelation that percocet is more than 1.5 times the strength of norco, it is not too strong of a leap for you.  Many people are prescribed percocet who don't take opioids on a regular basis for things such as dental procedures or post surgery pain.
  
Less than 1% of chronic pain patients get addicted to their pain medication.  If you haven't felt the urge to take more norco for mental reasons, then you are at an extremely low risk of becoming addicted to pain medication.  Addiction and dependancy are two separate things.  Most chronic pain patients are dependant on their opioid medication such that if the medication is abruptly stopped, withdrawal symptoms would occur...the same symptoms happen to an addict as well.  Difference is chronic pain patients in withdrawal don't crave their medications psychologically for the "high", they simply don't feel well.  Many chronic pain patients don't realize their symptoms were even caused by stopping their medications abruptly because they are not addicted to them.  You are probably already dependant on the norco if you have been taking it for at least 6 months or more.  This is okay.  There are many other medications that have no addictive properties that cause withdrawal symptoms such as blood pressure meds (blood pressure spikes when the med is abruptly stopped), anti-depressants (mood swings and headaches occur when the medication is abruptly stopped).

It would be in your best interest to explore a long acting pain medication as it provides a steady stream of pain medication across a 12 hour period versus the roller coaster effect produced by short acting opioid medications.  Short acting opioid medications are typically used for breakthrough pain or acute pain (pain that is expected to last for less than 3 months).  Breakthrough pain is pain that spikes after taking a long acting opioid pain medication.  With the right dose of long acting opioid pain medication, you could possibly only need 2 pills per day of the long acting opioid medication and no norco or percocet for breakthrough pain.  I take 10 mg of percocet in the morning 3 hours before taking the Opana ER for breakthrough pain.  Occassionally, I need 5 mg of percocet in the evening around 5 pm but most days I make it through the entire day pain free without needing percocet.  It is considered optimal dosing when a patient only needs breakthrough pain meds 2 or 3 times a day.  

I am also a mother and I work as an engineer.  I continue to get great reviews of my performance despite me needing strong opioid pain medication.  I actually can concentrate more now on the medication as I am not thinking about pain every minute of the day.  As long as your doctor starts you out on a low dose of long acting opioid medication and titrates up slowly as needed, you shouldn't feel "out of it".  Most pain patients do not get "high" off of pain medication as they are not using the large amounts required to get "high".  People who abuse opioid medications take 5 times the dose I take everyday (many times more than that) to release the euphoria of the medication.  Long-acting opioid medications have to be tampered with to release the euphoria.  Drug addicts snort or inject the long acting opioid to defeat the time release mechanism as when taken properly, they don't get you "high".  There are chronic pain patients that need to take a large amount of pain medication to control their pain but their doctor slowly titrated them up to that dose such that no type of "high" was experienced or is experienced.  Hopefully that makes sense.  

I also take several adjuvant medications: an anti-depressant (changes the way the brain perceives pain and thus provides pain relief), valium, flexeril, and gabapentin (an anti-convulsant that helps a lot with nerve pain).  None of these alone provide enough pain relief but combined together with my opioid medications, they provide substantial pain relief.  These medications along with excercise and self-accupressure provide a comprehensive pain management program. I encourage you to continue your water aerobics even after your pain is controlled as it is good to strengthen the core muscles so they can better support your back.

I do hope that the percocet helps with your pain; however, I think the best approach is to start a long acting opioid medication so that you don't have to worry about pain and pain medication all day.

I do not use the term narcotic as it refers to drugs of abuse and includes illicit drugs.  Narcotic is a term that the DEA regularly uses but it is not the true term for pain medications that contain a substance from the poppy plant.  Opioid is the proper term to refer to medications such as norco, vicodin, percocet, morphine, opana, etc.  

Lastly, I encourage you to visit our "Pain Management Community" Forum on MedHelp.  There are a lot more discussions about pain medications for management of chronic pain.  I think you find a lot of support there also.

femmy

[rtjrevie]

Wow, thank you for the response. I know I am not the one who started this message, but your reply has helped me so much!! If you don't mind me asking what are your symptoms of Myofacial pain syndrome? When I went to the rheumotologist (it was my first time) she mentioned that she things I may be having this? I was just having aches and pains everywhere, I had trouble explaining it. Now it has improved some, but I continue to have a lot of achiness/burning in both wrist-hands and occasional achiness in knees and feet. My main pain is in lower back though.She did not feel it was Lupus/RA/etc, but did find out that my VIt D was severly low, now they are focusing on trying to get that replaced to see if that helps (no so far). ANyhow, I just wanted to say thanks for all the info!! I appreciate it!

[femmy29]

You are very welcome, I'm glad I could help!  And, I think you provided a lot a great info as well for the original poster!  It is great to have two moms testify how much pain management has helped them.  :)

Myofascial pain syndrome is a fancy term for severe muscular pain.  The pain originates from several active triggerpoints embedded deep in the muscular tissue.  When the triggerpoints are activated, they send pain signals to various places in the body.  An active triggerpoint within the muscular tissue of the gluts can send pain signals to the right or left leg.  Where the active triggerpoint is, is usually not where the severe pain stems from.  However, when deep pressure is applied to the triggerpoint it can hurt but many including myself think that it hurts in a good way.  

You can locate triggerpoints by feeling where the tissue in the back appears to tighten and feel thick (or in other words, where thick bands of muscle tissue can be felt)...this is usually where people say they feel a knot in their back.  Accupressure is great at loosening these thick bands of muscle tissue and thereby reducing pain.  Typically, accupressure has to be repeated frequently at first as the tissue surrounding the trigger point tends to knot back up quickly but over time the therapy begins to "stick" for longer periods of time requiring less accupressure sessions.  

I do self-accupressure by using a Theracane.  If you google "theracane", a lot of great information will pop up.  I posted a couple of links below that you may find helpful.  The first one can help you locate the triggerpoints that may be responsible for the pains in your hands and wrists.  The second one is a .pdf file of the Theracane manual for proper use of the green candy cane shaped object for self-accupressure.  I received my theracane through physical therapy about 10 years ago; however, there are several sites on the web that offer theracanes for purchase and should come up when you do the google search if you are interested in purchasing one after reading more about it.  

http://www.triggerpoints.net/
http://www.theracane.com/TCmanual_English.pdf

Low levels of vitamin D have been shown to precipitate pain and also play a role in inducing depression so I think it is good that your doctor is working to elevate your vitamin D levels.  You can also further increase your vitamin D levels by getting a little more sunshine each day.  I hope over time your pain levels decrease from increased vitamin D levels and perhaps self-accupressure.

femmy :)

[rtjrevie]

Once again, thanks for the info! It is almost scary how many of the trigger points I have, but very very interesting, it helps explain a lot.  I know exactly what you mean when you say "hurts in a good way." Right now I am going to Physical Therapy again, basically the therapist is spending 30 minutes rubbing my butt. It is a little weird, but the deep massage feels good. It hurts pretty bad, get tears in my eyes sometimes but it is a "good hurt." It is so hard to explain, but I know exactly what you mean!!! So if you have these "trigger points" does a muscle relaxer help with the pain at all?  I have not tried one of these yet. Or is there anything else used to treat it? I am kind of at a loss right now. My pain managment NP was hoping that the Cymbalta and PT would help me enough to gradually get off the hydrocodone (and so was I) but the Cymbalta seemed to work for a short period now it has tapered off. I am having quite a bit of discomfort all over. I am a nurse and don't want to be getting on too strong of pain meds, but on the flip side don't know how long I can handle this pain either. It starts to affect all aspects of your life. Anyhow sorry to babble so much, I have been up since 3am with no one to chat with!! lol.....;Thanks!

[Shrooms]

I have c5/6 and c6/7 disc problems.  The first is buldging 3.5 mm into my cord and 6/7 is herniated.  I have ALOT of pain in the left side.  Starting at thumb and going all the way to my spine.  The doc said this is due to compression of the nerve.  I started on hydrocodon 5-325 and flexiril.  The hydro gave me some relief and the flexiril did little.  After 3 days of pain I went back to doc's office.  He switched me to Oxycodone-Acetaminophen 5-325 which is a little stronger than the hydrocodon.  He also took me off of the flexiril.  It works GREAT.  After I take the Oxy I can feel the pain melt away in about 25min after I take it.  I am having surgery tomarrow.  Disc replacement.  Both of them.  Both my parents have had this done with great success.  I dont know which state you guys are from but if you live in one that it is legal I suggest getting some marijuana.  It does help with the pain.  Coupled with the pain meds it helps like you wouldn't beleive.  It not only helps the Oxy work it also lets me sleep and gives me my appitite back.  When I take the Oxys and dont smoke I really dont eat.  Which is bad for my energy and healing.  Pot is not for everyone but I function better and have to take less narcotics.  To tell you the truth I get more messed up, light headed, dizzy, foggy, when I just take the Oxy.  Because I have to take more Oxys for the pain if I dont smoke. Since pot is non-addictive and the Oxys are I feel better smoking than taking pills.  If you want to know more about your state and the laws pertaining to pot visit NORML.ORG.  It has alot of information. Good luck to all.   I will repost to tell you guys how the surgery tomarrow goes.  

[femmy29]

Hi rtjrevie,

The gluts can actually be the location that has many active triggerpoints that cause pain in our legs, back, and hips.  Those butt massages are the best LOL!!  :)

I take a muscle relaxer called Flexeril.  I have been on it for 7 years.  It has kept my back from "locking up", it can become so tight and inflammed the even the smallest movement send me moaning in pain.  I think it has lost some of effectiveness but not all because if I don't take it, I feel my back locking up again.  I just don't think it is very effective against the muscle spasms anymore but it still serves a purpose.  Muscle relaxers work by telling the brain to relax the muscles versus directly penetrating the knots in your back.  I have found a muscle relaxer helpful for stretching and using the theracane.  The flexeril has relaxed the muscles in the back enough to reduce some of the pain felt from deep massage and stretching so it may be something to look into and perhaps try.

As for the cymbalta, you could ask your doctor if an increase in dose may help with you pain.  

@Shrooms:  LOVE your post!!! :) I live in CO and have a MMJ license.  I know what you are talking about when you say the MMJ helps augment the pain relief from the opioid medication.  MMJ is definitely a potent pain killer.  I haven't smoked or eaten a brownie in awhile cause I started a brand new strong opioid medication and I have been dealing with a basketful of side effects from that which seem to be subsiding now.  I know there are no dangerous interactions between MMJ and opioids as a board certified physician that recommended MMJ therapy for me stated that is was safe to mix the two.  A little goes a long way!  MMJ is a great muscle relaxer and anti-inflammatory and relieves pain by binding to our cannabinoid receptors similar to how opioids bind to our opioid receptors to relieve pain.  I wish you the very best in surgery, please update us when you are able.  

femmy

[rtjrevie]

Hi femmy,
Yes, the butt massages are wonderful...hahaha....pathetic that I am paying so much for PT to rub my rear, but hey it helps!! lol.
I am on 60mg of Cymbalta, it is not clinically proven to help with a higher dose for pain (I believe I read that??) When I first started it, I thought "wow" this is going to really help, I was told the affect would only get better...nope. I go to my pain management doctor today, just can't stand it anymore. I am not really sure what is going on. I ache all over, my gluts/low back/si joints and ishial tuberosities (sp?) are very sore again, but my wrist and hands (bilaterally) are terribly achy, and burn it is all day with no relief.  For me, it is hard to admit that I am in pain. I was taught that you should "be tough." It is funny how I would tell my patients a completly different thing than what I would tell myself? It has just affected every aspect of my life. ANyhow, my question to you is as an engineer how do you feel the percocet affects you compared to the tramadol or Vicodin? I have taken it in the past, but I did not work on it??? I believe I can work as long as I have a "clear head" which I wonder if that is even possible? I hide the pain quite well, but I need to sit down with my superviser and talk about this. I will not jepordize my job.
So this MMJ? I don't know much about how this works, but find it interesting. (not legal here) So you saying you have a "license" is that to take it? Is it pretty regulated? How do you get it? I was just watching the news and it showed that in California they have it dispensed in a machine that is similar to a soda machine/ATM. Lol. Working in home health and hospice I really wish they would legalize it here. It is amazing how many hospice patients take it within their home and how much it helps. I honestly think the affects are so much better than a lot of the other meds. Anyhow....have a great day everyone
]
Tammie

[Hillsy69]

I'm so glad I posted this, so much great info! I'm also on other meds to help, an antidepressant and klonopin for the anxiety, depression, and sleep problems that come with fibro and chronic pain. Hydrotherapy seems to help while I'm doing it,but not much after, kinda like how physical therapy has been lately. Thanks everyone who commented. I will update when I see my dr

[Hillsy69]

Rtj, in Michigan you get your mmj card from a dr and there are places you can go buy it (you can grow it too) but NO ONE without a card is even allowed in the door of these shops. Some dr's are for it and some aren't, my mom has M.S. she's eligible but doesn't want it, I don't think she realizes it's a lot different than the stuff the kids do on the street (from what I've heard from other pain patients anyway, I've never tried mmj). Hope that somewhat answers your question.

[Shrooms]

Thank you to all the people out there wishing me well.  My surgery went very well and I only spent one night in the hospital.  My nerve pain in my arm is almost gone.  The doc said I did better than most.  I was surprized that they prescribed me valium.  I asked about this and they said it is a very good muscle relaxer.  They said it was the best.  If you wish to know more about the MMJ I urge you all to go to NORML.ORG.  It has alot of facts and news.  I hope and pray for all of you to get better and find the relief you deserve.  Sry about the misspellings and stuff I am in recovery at home and these drugs do a number on my mind.  

[femmy29]

To All:

So much great discussions to respond to!  I am not online much during the week as I work really long hours such that there is only 2 or 3 hours before hitting the hay to eat and spend time with my little buddy.  :)

@Shrooms:  So glad your surgery went well and that you are at home recovering.  Thanks for the link to the NORML website.  There is a lot of great information there.  When my massage therapist told me about the valium being a great muscle relaxer I was shocked at first too because all I remember growing up is my step mom and her bipolar disorder and the valium she had to take just to calm down as she would just start flying around the house and talking at 70 mph.  I didn't understand how or why that little pill she took made everything slow down but now I do lol!

@Hillsy69 & Tammie:  That is how the MMJ law is regulated in CO too.  There are so many other options than just smoking it.  You can vaporize it which bypasses the carcinogens produced by burning it.  I purchase MMJ at a dispensary, there are hundreds of them in CO.  The edibles they have are great too and they are as potent as smoking or vaporizing.  The brownies are the best but they also make cookies, muffins, candy, chews, and soft drinks.  The secret to the baked goods is CannaButter!  They sell just the CannaButter too so that you can go home and bake whatever you like!  It comes in sticks just like regular butter but the butter is green instead!! LOL  I haven't seen any vending machines here yet but that doesn't mean they don't exist as it sounds so convenient!  The wait in line can be kinda long as they only let one person back at a time.  But recently I noticed that my dispensary is now allowing MMJ patients to preorder online for pickup so I have to try that out.  Marijuana off the street is nothing compared to MMJ.  There are so many different strains to choose from versus just whatever the drug dealer has lol!  There are 3 types of MMJ: Indica (dark purple/green MMJ flowers, great for pain, anxiety, sleep, and inflammation), Sativa (light green buds, great anti-depressant, motivational strain), and then there are Hybrids that are buds spliced with a little of both and they come with different levels of Indica/Sativa mix so that you can get the best of both worlds!  :)  The dosing is tricky if you don't want to get stoned out of your mind.  With the brownies, I cut them in 8ths and I eat one little piece and then you wait for about an hour for it to work (this is the drawback of the edibles, with smoking, it instantly works).  If you eat the whole brownie...you will be sorry and they are soooo good that it is hard to eat just a small piece!  One brownie lasts me about a week sometimes a little longer.  My mother during her battle with cancer (she lost and I miss her very much) also smoked marijuana at home (it wasn't legal in CO at the time) and it was amazing to see how much it put life back into her.  She became so happy and motivated and most importantly could eat as she would go days without eating as the chemo made her lose her appetite.  Those buds are on this Earth for reason!  She did try Marinol (synthetic THC made by a pharmaceutical company and its intent is to mimic the effects of marijuana) but my mother said it didn't even compare to the real stuff.

@Tammie:  My managers know what I take for pain and they have noticed that the quality of my products has improved since starting the medications.  Before pain medications, I would make so many mistakes at work because I couldn't concentrate and my patience was thin because I was in so much pain.  I have been on opioid medications for about 6 years now and still employed despite the recession so I think as long as you perform just as well or better, your managers won't have a concern.  But I think you are doing the right thing by talking to them about your pain to understand more of how they feel about pain medications in the workplace.  I would also look at the policies that govern the corporation as a whole as well to make sure they match up with your supervisor's statements.  At first on most any opioid medication, there is a tendency to feel a little loopy at first but the adjustment period is so short that within 2-3 weeks that effect is gone as it is very temporary.  Even when I do have loopy moments, I am still able to function well at work.  I can't say that is the same for everyone.  The vicodin and the percocet make me more loopy when I haven't eaten anything; however, I get better pain relief when I haven't eaten so I have learned to just deal with the loopiness as it only lasts for about an hour or so and then I eat a small snack.  So if the loopiness bothers you at work, just take it with a couple of crackers or a FiberOne Chewy Bar (my fav!) and you'll feel better.  The extended release meds like OxyContin (the new formula is all ER and doesn't produce as much euphoria as the old formula), MS Contin, Opana ER, are very transparent even at higher doses such that I don't feel any loopiness at all from the Opana ER, it just takes away the pain.  I rarely (if ever) have to take a percocet at work now because the extended release med works so well for my pain now.  The problem with Vicodin and Percocet is that it is all released in the body at once (Instant Release) and that can cause a loopy feeling in a lot of people as the medicine peaks quicker but after it peaks it quickly begins to dissipate from the body and the pain returns.  The extended release meds are controlled release such that the medicine peaks much slower and stays there all day.  Most doctors prefer the extended release meds because they are less prone to addiction as they release very little euphoria which sometimes accompanies the loopiness from medications like percocet and vicodin.  So if the loopiness concerns you, an extended release opioid medication may be the way to go.

It sounds like you are dealing with a lot of pain that could be better controlled.  The low back pain that radiates downward is the worst for me as the pain switches from very sore (like you said) to an intense burning sensation (the burning is very aggravating).  A lot of the anti-depressant medications like Cymbalta are only effective up to a certain dose.  I am maxed out on my anti-depressant as well.  What dose of Neurontin are you taking?  I am on 1200 mg per day.  The max dose goes up to 3600 mg per day so there may be some leverage there.  I was taught growing up to be tough too and for so many years I pushed through the pain and did things to make it worse.  After doing that so many times, I became the exact opposite...I was afraid to do anything that could bring more pain so much that I almost stopped living completely.  I knew I needed help from pain management at that point.  So I think we can only tough it out for so long.  Pain is supposed to be temporary not a lifelong condition so at some point a chronic pain patient needs management of the pain before it eats them up alive.  I never knew that given the right medications and doses I would be in little to no pain for most of each day.  So I know there is the right combo and dosing for all of us to live as best of a life that we can.

femmy    

[CoconutHulaQueen]

Hillsy - Norco is just a brand name for HYDROCODONE, as is Vicodin, Lortab, and few others.
ALL contain APAP's (Aspirin/Paracetemol) *OR* NSAID's (Ibuprofen) , this 2nd # After "/" is the amount in Mg. of the "APAP"

-->First # Before the "/" is Strength in Mg. of the '[Hydro] Pain Med:
5/550 or 7.5/325 "Norco" means

(5 Mg Hydorcodone + 550 Mg APAP or 7.5mg Hydro + 325mg APAP))

PERCOCETTE/PERCODAN is OXYCODONE (with Tylenolol/Aspirin respectively speaking).


OXYCODONE is Considerably STRONGER than HYDROCODONE: about 55% (This is an EDUCATED ESTIMATE, and Rounded Up
BASICALLY,:

{7.5} of 'Norco" = 5 mg. of "Percocette'.(well, from 6.7 to 7.5 depend. on generic, etc)
So, Currently 4 tabs or 40 mg of HydroCodone = 26.6 mg of OxyCodone.

So You are going up in use to a Stronger Drug... increase btwn 55-65% due to variables you will see on the 'equanalgesics" or Opiate Conversion sites (see below link)

Have you thought about an ER Drug? If you are Still Lucky enough that Vicodins or Percs ALONE can Ease Your Pain, You are VERY Fortunate...

MS Continus ER is a Great painkiller, Morphine Sulfate is NOT as Strong as Oxycodone.
100MG of MS Cont. ER is = 60mg. of Oxy(OP)

In Turn, i saw someone suggested OPANA and This drug is  Twice as strong at Least than Oxycodone,. so You DON"T NEED even a 5mg. of SUCH Strong, HIGHLY addiction drug - is Hydromorphone (NOT a comb of Hydrocodone and Morphine, btw); but i would HOLD OFF on Opana, Fentanyl... you get yourself stuck with Complesx Time release systems that MAY NOT RELEASE ANY MED WHEN YOU ARE IN PAIN; is has its OWN Agenda on release of pain meds... BBBBBad Idea.


You can use one of several "equalanagesic" sites which CONVERT diff meds, including All the OPIATES, including Equivalents of Ext. Rel. To INS. REL. and vica-versa...

"http://www.globalrph.com/index.htm"

This is to the homepage, hit the Tab for "Calculator" and you can Select the two drugs you want to compare, is Clear and like money-converter site.

These are the sites the Chemists (Pharmacists) use - and speaking of, USE YOUR LOCAL CHEMIST!!
They should Already Know you if you have CP, and they have your history right there as well as **Knowing what EVERY Other dr. in town is Writing for Same or Similar Level of CHRONIC PAIN, another BONUS!!!

YOUR LOCAL CHEMIST if You go IN And ask Nicely When is a "Good Time"  and ask if YOU CAN BORROW THEIR BRAIN to help you with Understanding the Conversions, that you DID Research First (but DO THE RESEARCH YOURSELF FIRST!!) and,
but is the MATH or ER to IR CONVERTING...is Boggling your mind and HELP! ; D
at Least 99% of the time, they WILL  TAKE the TIME 2 HELP YOU and, MORE TIME than Prob your PAIN SPEC, as he/she Most likely has a Patient scheduled every 15 MIINS,  ANY Changes, throw them off schedule. Even if it to Lower or Change to MORE EFFECTIVE MED for YOUR PAIN...CHANGES take TIME (researching, Math, Finding New Replacement... ARGH!! TIME!)

as well as being informed of New drugs or New format (like the Fent Lollipops; well - when they were New, i heard about them thru the Chemist, my Dr. had NO IDEA and had to go ONLINE right Then as this was Indeed News to Him...), they know all the Crazy changes in Availability/Recall of All the Pain meds;  and / or what strengths of ALL the meds Are Available, and They are Up on New meds; what might be say, a diff group of 'anti-nausea' or 'stomach' meds.. one to ask Dr. to change for since your Pharm. rec'd it!  They will Also tell you if Comparitively You ARE in correct ranges on all your meds.

IF YOU RESPECT THEIR *TIME* AND VERBALLY LET THEM KNOW THIS, AND THE TECHS TOO... They will RETURN THE RESPECT and NEVER TREAT YOU BADLY or make You feel "uncomf. when they ring up your px's as sometimes happens to the 1 of 20 Real CP patients they've seen that day, lol... I have had my local Pharmacist call ME BACK on a Friday Evening to answer my question of tapering off of Fentanyl (the worst Opiate due to Deep, Prolonged Depressions), on
What the Correct range of in MILIGRAMS (mg's) of an IR med would Equal 25 MICROGRAMS (mcg's), and on a 3-day Very Complicated release matrix;
He Actually DID this for Me! Called me back SAME Day, s/thing a DR. WOULD NEVER DO.
***********************************
Back to Topic of MEDS not Resources...

Another thing you need to watch is if you are taking Naproxen or Other Anti-Inflamms,
You MUST make sure your dr. Keeps the APAP level to its LOWEST with the IR meds.., which at XX/325 (/325=325MG of APAP, IS the Lowest, but still...),
you CANNOT take *Safely* More than 2-3 GRAMS per day of NSAID's!!!!!
if you take Naproxen 500mg. 2/day, that is 1 GRAM. the /325x6 tablets /day = almost TWO GRAMS of APAP.. so NO "Alleive" (OTC Lower Dosed NAPROXEN!!!); ibuporfen, etc. as your KIDNEY's and LIVER are going TOXIC.
My doc says, "NO~! of COURSE is NOT hurting your Kidneys' but then tells me on the very WORST of PAIN DAYS, i may NOT TAKE a 3rd NAPROXEN tablet... so...


I have been on a Progression over past 12 years+ of Degenerative Cervical neck, with spurs.. Since moving to a Constant WARM CLIMATE, i have for First time since the Orig injury had MRI;s showing HUGE SLOWDOWN of Growth (weather, DIET of so MANY Fruits!!!????) and as well, have NOT needed for First time to UP Any of my [Pain] Meds COINCIDENTALLY,  SINCE ARRIVING almost THREE YEARS ago, when i CUT them Down to what i Used to call my "Summer meds".

Sorry for Such a LONG post, but i See So much INCORRECT info... and  if people are doing ANYTHING BUT swallowing ONE pill as px'd, it SKEWS INFO for us Dorks who just Swallow the Pills 3x/day and Hopes for the best....

Good Luck... buy some Milk Thistle, Your Kidney's will Thank You;;;

[gilbertmatt]

Thanks for all of the input. I've gotta start researching pain meds for an inevitable surgery haha...

[femmy29]

Excuse me, but all the information that I provided above is accurate.  I would love for you to highlight specific information in my posts that you feel is inaccurate and let us talk about the reasons why you believe it is inaccurate.  I provided the same strength comparison information that you reiterated in your post.  And, I did not promote for them to switch to Opana ER (i.e., oxymorphone) - instead I stated that was simply what I was taking for my pain.  I said a switch from Vicodin to Percocet is not too far of a leap.  A switch from Vicodin to Opana ER is contradicted as the patient is not considered opioid tolerant enough yet.  It can be done under close supervision but the Opana ER dose should be around 5 mg not 30 mg.  And, "Percocette" is actually spelled Percocet.  

I did not get into maximum tylenol dosages in any of my posts but here are the rules:
Max tylenol amount in a single dose should not exceed 1,000 mg, this equates to 3 Norco 5/325 tablets or 3 Percocet 5/325 tablets, for example.  The 2nd number after the "/" is the amount of acetaminophen (we call tylenol acetaminophen on US mainland not paracetamol).  The maximum safe amount of tylenol over a 24 hour period is 4,000 mg.  It is recommended that the dosing of tylenol over 24 hours not exceed 2,600 mg when used long term.

No one is talking about just popping pills on this thread.  Instead there was a intelligent conversation of the different types of medications that help with chronic pain (not just opioid medications), which should be combined with regular stretching, excercise, accupunture, accupressure, massage, and even a change a eating habits for a comprehensive pain management plan.

I do not believe in black balling certain opioid medications like Fentanyl or Opana ER.  Everyone is different and there are patients out there that do require Fentanyl or Opana ER.  Not everyone responds well to Morphine as there are people that lack the ability to metabolize morphine (and codiene for that matter).

The term opiate refers to the the three opiates of the poppy plant: Codiene, Morphine, and Thebaine (Codeine and Morphine are considered pure opioid agonists).  The term "opioid" is all inclusive of the opiates (just defined) as well as synthetic and semi synthetic opioid agonists like hydrocodone/oxycodone/hydromorphone/oxymorphone, and mixed opioid antagonist/agonist like Buprenephrine contained in Suboxone, Subutex and the Butrans patch.  

Lastly, no one on US mainland consults with a Chemist but rather, consults are done with the patient's local pharmacist.

femmy

[wcontrerasd]

I've been going through something similar for a couple of years. When I did my research, I found out that FDA had not approved double disk replacement. Is that the surgery you had done? Have they finally approved it? What hospital did your surgery? Any doctor you may recommend?