This is my first post but as many of you have noticed, I have been around answering questions for quite awhile now.
My question is has anyone switched from Morphine Sulfate ER to the newly formulated Oxycontin OP? If yes, could you tell me if you experienced better pain relief after switching?
Reason I am asking:
I had a doctors appointment today to say goodbye to my PCP that has been treating my chronic pain for over 5 years now. My employer is no longer offering the only insurance he accepts so I am forced to a different doctor via a different insurance provider. We finished open enrollment at work already but I won't get my insurance cards until mid December and I won't be able to search for a new provider until January.
My PCP gave me three referrals today and I told him that the current pain meds are working but I consistently have breakthrough pain 3 times a day requiring me to take percocet 3x a day along with the Morphine Sulfate ER. I told him that I was hoping to not have breakthrough pain EVERY single day. I also told him that part of the reason is due to the fact that the Morphine ER doesn't last 12 hours, but instead starts fizzling out after 6 hours and it is completely gone after 8 hours. I also said that, despite this, I am still getting pretty good pain control as the Percocet almost always covers the pain that the Morphine ER leaves behind. Here is what he told me:
He said that since I am switching insurances in a month, he doesn't want to make any changes to my meds. But he encouraged me to ask about Oxycontin under the new insurance provider. The insurance provider my current PCP works for doesn't offer Oxycontin as he says, it is a very addictive medication (despite it is simply the oxycodone in the Percocet just in extended release form) but he believes it will control my pain much better. He said my new insurance carrier covers Oxycontin.
I silently disagreed with the addictive statement he made regarding Oxycontin as Percocet is the same thing only in immediate release form and I am taking that and it is covered. I think as long as you take it the proper way and as prescribed the addiction risk is low.
He agreed to fill all of my prescriptions through the month of January only. I was hoping I would get at least refills through March at the latest to give me time to get things set up with another doctor. I am very hopeful that these referrals will work out for me such that I won't have to jump through a whole bunch of hoops before I can get my prescriptions filled. I have heard the withdrawals are horrendous and I bet the withdrawal from the Morphine and Percocet will make the Tramadol withdrawal I went through look like a picnic on the beach. I don't want to end up there. As there means I won't be able to work until after the withdrawal is over. I'm very apprehensive right now.
Lastly, I have read a lot about the Oxycontin OP not being as potent as the old formula such that a lot of folks have experienced increased pain after switching from the old Oxycontin to the new Oxycontin OP. But I am wondering if the Oxycontin OP will still be better than the morphine. I am hoping someone has gone through this switch and can tell me if their pain got better or worse. Otherwise, I guess I won't know until I get to that road.
Any responses at all will be very much appreciated. Thanks so much!
Just wanted to offer a bit of help/suggestions even though I haven't been on the new formula of Oxycontin...I do know some friends who are on this and they actually get great relief from it. So even though there have been some people who have made complaints...try not to let that enter into your giving it a true and fair trial if the new Dr. happens to switch you. Our brains can be very powerful in this matter and if we believe something will turn out negatively...it seems to happen that way...LOL
Are you only on the MSContin twice a day right now? And I don't know if we are allowed to say dosage or mg on here or not...
My regimen is that I take MSContin 30mg at 5am....and another 30mg at 5pm...
However...I also have MSContin 15mg that I am allowed to add in (up to two) at any time during the day if needed. So I could add it in the am dosage....or most times...I stagger it and take a dose at 10am and then 2pm....
This gives me the flexibility as I didn't want to be locked into 90mg a day if I didn't need it.
I also take OxyIR 5mg...as needed as my breakthrough medication. I am allowed up to 8 a day if needed...The reason I am not on the 10mg or 15 or 30mg of the Roxicodone is that I am uninsured...so the 240 tablets of the generic OxyIRmg are the cheapest but offer the same amount of mg for breakthrough in a 24 hour period if needed.
As well as I was having stomach issues with the acetaminophen and didn't want to keep having this in every pill for breakthrough as I used to take Percocet...This way...I can add in a Tylenol or even an Advil if needed.
That is also why I switched from Oxycontin (old version) to the MSContin....the generic is very inexpensive.
The reason I bring up the costs is that let's say for some reason you don't find a new PM Dr. to prescribe until March...Then your old Dr. can prescribe you things that you can self pay if needed.
For all my meds...which are the 60 MSContin 30mg, 60 MSContin 15mg, 240 of the OxyIR mg....(as well as 60 Flexeril and 30 Ambien...)...ALL generic....is $130 for the month...
So for your prescription it would be less than a $100 if you had to pay cash for a few months....
Just going worse case scenario as I like to do this to prepare...
Also...the reason why your Dr. now can't provide you with prescriptions by hand until March (right now) is that new laws are they have to actually see you every 3 months minimum to prescribe...So...if needed you can go back and see him and get another 2 months if you aren't set up with someone.
This would keep you from having to withdrawal off of the medication...I think if you contact him this week and discuss the 'worse case' and ask if he will do this if you haven't found someone...this should help put you at ease....Being with him for 5 years I'm sure he will want to help.
Now...with the new Dr....he may want to up the mg of the MSContin....or change you to 3 times a day (if you aren't doing this now)....So he may try this instead of switching to the OC first...
I personally get really good coverage with the MSContin...and I have deliberately stayed really low on my daily mgs as I will be on meds for years to come.
This is why I also use a muscle relaxer...I thankfully don't have nerve pain but that is also very helpful for many. And then the usual things you've seen me post about daily exercise, acupuncture, injections, massage, aqua therapy, stretching, TENS unit, eating all Organic (this helped with the inflammation greatly!)...Counseling....etc.
I'm sure as you know...the opiates are just one small piece of the puzzle to help with my overall pain level...I stay at a 5-7 range on the pain scale depending on the day...And that is using everything..
Again..I could go lower with higher dosages of medicine...but I don't want to...I want to keep my tolerance as low as possible.
Lastly...I hope that you can find a PM Dr. as the law is going in effect next year that anyone who is not a PM Dr. will need extra certifications and training to treat chronic pain or prescribe narcotics..So many PCP's or Internists are stopping this and referring to PM's.
Sorry for rambling...I hope that some of the suggestions or thoughts can help..and feel free to ask anything else if I was confusing...LOL...
I happen to also be friends with my PM Dr. outside of our appts. these last years... so without going against the HIPAA, he explains what it is like on his end. He is such a caring Dr. whom all his patients adore. I have learned so much about chronic pain and treatments from him.
Thank you so much for your heart felt thoughtful response! It is so much appreciated and is great to hear that you have friends that get good pain control on the newly formulated oxycontin. That puts my mind at ease a lot!
My daily medications are as follows:
2 1/2 percocet tablets between 7 and 8 am (12.5 mg/812.5 mg - oxycodone/acetaminophen) with 10 mg Flexeril, multivitamin, and blood pressure medications, amlodipine and atenolol
600 mg of Gabapentin between 9 and 10 am
30 mg generic MS Contin at 10am
5 mg percocet, 10 mg Flexeril at noon with chewable Caltrate calcium tablet
2 mg Valium at 2 pm
5 to 10 mg percocet at 4 pm w/ 10 mg Flexeril and chewable Caltrate calcium tablet
600 mg of Gabapentin at 6 pm
30 mg generic MS Contin at bedtime w/ 1 mg Valium and 45 mg of Remeron
Each of my medications costs a $10 copay for a 30 day supply. The same with the new insurance as well but there is also a mail order pharmacy that provides a 90 day supply for a $25 copay.
So as you can see there is a lot of percocet wrapped within my daily dosing schedule that I wish I could take occassionally but the pain increases with such severity that I can't take it anymore. I try other modalties first like stretching, mild exercise, self accupressure which sometimes works long enough to prolong taking a percocet such that sometimes I end up taking 5 mg less per day. I used to take the MS Contin between 7 and 8 am, but I found that I am in so much pain in the afternoon, which is too early to call it a day and lay down. Plus I have found that the percocet works much better for my morning pain and gives the MS Contin an added boost when I take it at 10 am.
I have tried a tens unit 10 years ago when I was in physical therapy but it was only used during the sessions. I wasn't able to take it home and try it there. I have been curious about it lately and looked into purchasing it once but I hate buying things online so I have yet to find a store that carries them.
I do wish to keep my tolerance as low as possible as I am effectively delaying surgery and I want to continue to be able to do that. My hope is that if I get all of my breakthrough meds included into a long acting medicine that I will be able to continue at that level for a longer amount of time and slowly add in breakthrough meds as needed until they equate to another long acting med titration.
This new insurance is quite expensive and I will be taking a huge paycut because it is cheaper than losing 40% of my salary going on long term disability! LOL
I put $2500 into a healthcare spending account which equates to my out of pocket costs for medications and 4 injections next year. So, I can self pay with my HSA until I find a doctor.
I've noticed lately that my doctor has had me come in a lot more often for like random blood pressure checks. I am sure that has to do with the laws changing as you said.
I am trying to be as optimistic as possible and I keep telling myself that I will find a doctor that will honor my medications. I think the referrals really helped boost my confidence as now doctors can know me through their collegue that they went to medical school with. So I am hoping that when I say the magic name, doors will instantly pop open for me. LOL
I am also concerned about the withdrawals because of my high blood pressure. It is so well controlled now and I am on very low doses of blood pressure medication. So I know the morphine is doing some of the work too. I worry that the withdrawals will cause me to have a heart attack or stroke. I have been thinking of going back in to talk to him one more time as we did cover a lot at this past appointment but it is only 20 mins so there wasn't any time left for any extra discussion. My blood pressure at this last appointment was 120/70 and it has been consistently at this level for 6 months. Because of this, I would like to stay on the morphine. And as you stated the oxycontin is very expensive as there isn't a generic on the market yet. I will need to check what category it is in, in my new insurance's formulary.
I do hope my doctor will continue to vouch for me if any of the doctors I am inquiring about want to know additional information about me from him. He always tells that he knows I am not abusing the medications and that I have been a really good patient. I think it is great that you have a friendship with your PM doctor.
I am trying to plan as much as I can. I have researched different places and i know the first place I want to go to as they have the family practice, PM, physiatry, anesthesiology, and their own out patient pharmacy all in one hospital. I have budgeted my HSA based on their cost of care. They have received really good reviews so I am hoping things go well there. If not, it is onto to the physicians that my current PM referred me to.
Lastly, it sounds like your pain management program has you very well covered. You have a lot of extra leverage with your pain medications if needed for flare up days. It really sounded like the kind of flexibility I would like in pain management in the future.
Thanks so much again for all of the great tips and advice. It has been so helpful to me.
It is always frightening when you are forced to change physicians. The stress of the unknown can be over whelming. My heart goes out to you.
How effective one medication is for an individual is not a predictor of how effective it will be for another. Our systems are all a bit different and how our specific system utilizes a specific drug varies. Additionally other required medications often go into this process rather they may or may not be in the opiate family.
That's a good part of why you'll hear one person claim a certain opiate is so effective in controlling their pain yet another person will find the same opiate very ineffective. So no one can really tell you how effective this newly formulated Oxycontin will be for you. Pain Management is truly a trial and error process.
All opiates can be "addictive" however most physicians that are educated in pain management understand that true Chronic Pain suffers rarely become "addicts." Trusted studies from respected researchers reveal that l any where from less then 7% to less then 4% of Chronic Pain patients ever become addicts. However it is true that our bodies all become Dependant. As I am sure you are aware there is a huge difference between Addiction and Dependency.
Be aware that you should be able to make an appointment with a new physician before you obtain your "official" card.... as long as your initial paperwork has been signed and the process has begun. Your HR Representative can provide you with the information you will require. I don't know of a good reason why you can't search for a new provider until mid January. Indeed you should be able to make those appointment very soon if not now for an appointment in January. You have the right to medical care as soon as the new insurance becomes effective... with no lapse in medical care.
Prescription laws change a bit from state to state. In most states only a PMP will prescribe long term opiates.... in other states it remains the responsibility of your PCP to prescribe to their Chronic Pain patients. How often you are required to physically see a Physician also varies from state to state. I don't know of a federal law that says otherwise but that doesn't mean there isn't a new one coming down the pipes. So if anyone has a link to that information I would be grateful for it. We all learn from one another.
I do agree with your physician on any changes at this time in your medications. Changes will require follow up and possible tweaking to get it right. If he cannot do so it's best to let another physician make the changes.
I would get right on that search for a new physician. I would not wait till January. Good luck to you. I hope the change is seamless and that you will be more then satisfied with your new provider. Sometimes changing providers can be a blessing in disguise. I hope that will be true for you.
Thank you so much for your response! Even with the referrals that I received, I am still somewhat worried about the transition. I truly hope that this transition will be a blessing in disguise.
I have discovered a great pain management clinic in a hospital setting that has physiatrists which I believe would be at the forefront of managing my medications along with anesthesiologists to perform the injections and they have a pharmacy on site that I can use to conveniently get my prescriptions filled every month. The new insurance is more expensive than the old insurance and I have had to set aside a lot of additional money from my paycheck to be able to afford the same treatments I am getting currently. My current insurance is HMO and the new one is PPO.
One thing I do like is there are no referrals required to see a specialist. It took a referral from my PCP to the Neurosurgeon and then another referral from the Neurosurgeon to the pain clinic to receive epidural injections. And the first round only got as far as the Neurosurgeon and I had to start all over again. When I finally got back to the Neurosurgeon a second time and 5 years later, she told me, "So you are back and still in pain?". Duh! LOL So yes I am optimistic that this switch will be good for me.
Once my med cards come in the mail next week, I plan to make a appointment at the facility I just mentioned. I did get 2 referrals to physicians that reside there but my doctor said they are internist. Is there anything an internist can do for my chronic pain?
I am planning to see a brand new physician in the back pain clinic first before I start looking for the referred doctors. The other referral was to a physician in family practice and that could also be another place that I can get good care but I would still have to go someone else for the injections.
I agree with you that the effectiveness of a particular medication varies from patient to patient. I have just heard an enormous amount of gripes from patients over the web that are very dissatisfied with the new oxycontin but I am hopeful that it will work for me or a higher dose of morphine will help such that I won't need to take break through meds on schedule every day.
You are absolutely right that all opiates are addictive. With extended release morphine; however, I don't get the rush of euphoria that the percocets produce but I know there are people out there that mutilate the morphine pills and inject them or do other harsh things to release the euphoria. I am always focused on how well the medicines are relieving my pain. I notice the brief moment of euphoria but I am more focused on how much my pain levels have decreased.
You are also very correct that a very small amount of chronic pain patients get addicted to their meds. I have even read on the "Pain Topics" website that the addiction rate amongst chronic pain patients is as low as 1-2%.
I have never taken more of my medicine than prescribed and I have always taken it the correct way (orally) and if I still have pain, it ***** but I just deal with it in other ways until I can take more medicine. I am truly hoping my compliance will open the doors for better treatment of my pain.
I will keep you updated on my journey. I hope that I can find a good doctor in January. If not, that is when things are going to get rocky. I appreciate your support Tuck. It means a lot! Thanks so much!
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