Help on question of cross-tolerance

Posted By  CCF Neuro MD on October 09, 1997 at 15:07:02:

In Reply to: Help on question of cross-tolerance posted by Lee on July 23, 1997 at 02:16:59:

:
  I have been under chronic pain management for a number of years,
  disk and vertebral destruction from a serious high fall,
   including herniated disk in neck, 3 in mid thoracic area,
   2 in lumbar area, confirmed by MRI, and emg of right leg
   confirms radiculopathy of major nerves in right leg.
  I have periodic left arm symptoms from the disk in my neck.
  The medications which have worked for so long, I am now getting
   tolerant of, Mepregan Fortis (Demerol-Meperidine) and
   Darvocet N-100 ( proproxyphen) I would like to have
  recommendation of drugs to switch to for a couple of months,
   so tolerance level to those two drugs  goes back down.
  They are very effective for me and allow a fairly normal life.
  Not a "Drug Holiday" but another group or type of opioid
  temporarily, and one that will prevent any withdrawal symptoms .
  I am finding it difficult to research this on the Internet,
   and trying to help my Family Doctor with this,
  As I am no longer covered under the original insurance plan.
  I also take Soma (carisprodol), and when needed Phenergan for nausea,
   Zoloft for depression. Large doses of NSaids have destroyed my
   gastric system early on in treatment, and cannot tolerate any of
   them now. One suggestion has been Stadol Nasal Spray and Loracet ,
   though dose was not mentioned.  Various forms of morphine or
  synthetic morphine may serve the purpose, but I don't know if there
   is cross-tolerance? Thank you in Advance, I hope you can give a
   detailed technical reply. I have tried to learn all I can, and
   participate as much as possible in my treatment. I do exercise 3-4
   times a week at a physical therapy center sponsored by 'Senior Friends'
   in this area. Any more surgeries would most likely make a bad situation
   worse, so am doing my best to live with this, and lead as normal life
   as I can

[CF-Neuro-MD]

Dear Lee,
I can understand how this is a difficult situation when you require medications
to relieve chronic pain. The medications that you spoke of- Demerol, Darvoceta and Morphine are all similair in nature
and would therefore not be helpful to substitute morphine product for Demerol.  I know of doctors that work with chronic pain patients, there is a
Pain Center here at he Cleveland Clinic and the one that  may be helpful to you would be the Psychiatric pain clinic
as they are very knowledgeable about medications.  I know they use liquid
oxycodone because you can change the dose by small increments as needed and then supplement withan antidepressant that has pain relieving properties.  This may be an option for you.
Please consult your family doc about their opinion but sometimes this combination can be helpful ot eventually get patients off of the narcotic- very slowly!
Good Luck!