Breakthrough pain med question...

I'm on the Oxycontin sustained release med 2x a day and have been trying to find a break through med that works for me.  With the sustained release med, the constant pain is better controlled but the pain flairs multiple times most days and my doc prescribed my break through pain for no more than 2 a day.  He said I shouldn't really need those but my pain flairs at least 3 times a day and more when I'm super active (especially right now because I'm moving).

This is my first time with long acting pain meds.  I am so great full to not be in pain 24/7 but I'd like to get the flairs better under control.  Are the long acting meds supposed to help with the flairs too??  That's what the break through meds are for, right?  Any advise, experience, etc would be nice.

[Tuckamore]

Hi Lee,

I am sorry to hear you are having trouble with pain control. I've found that physicians look at pain management differently.

I spend most of the year in FL where my new PMP believes that with a large enough dose of a long acting opiate you will not need more then one dose of a break through medication per day IF that. I've not heard this theory before I entered his practice. My PCP/PMP in my home state disagrees with that theory. I am lucky as the FL PMP agrees to follow what my home state physician has prescribed to a degree.

Personally I think you need break through meds even after you are on long acting medications... obviously less then what you required before adding long acting meds to your pain management regime. From what I read here I think most Chronic Pain patients are on break through meds, 2 or 4 times per day. It depends on the amount of pain you experience, which meds are prescribed and how well your body responds to them.

My FL PMP said if he prescribed more then one, or on occasional two break through meds per day he would be red flagged by the state. This may be the case with your physician. It seems obvious to me that your pain is not adequately controlled.... rather that means you require a higher dose of the long acting med or more break through meds.

I encourage you to discuss this with your PMP. Hopefully he will offer you a solution. I also hope that our members that are on both types of pain medications will respond and offer their opinions and insights

Please let us know how you are doing and what your PMP has to offer. I'll look forward to your updates.

Good Luck,
~Tuck

[lee73010]

Tuck,

Thanks for the info!  Florida just passed the new "pill mill" laws which has made a lot of changes for doctors in regards to prescribing narcotics and the doctors are very hesitant and scared right now because the law is so new and docs aren't quite sure how to navigate.  One doctor I was seeing would only prescribe one medication at a time.  

Through trial and error, I'm finding that a long acting med with enough breakthrough pills to cover 4 flairs a day should work for me.  I see my doc this afternoon so hopefully things will work out.  The other problem is that when my doc finally put me on a long acting med, he changed my OxyIR Rx from 30mg q6h to 15mg q8hr.  The 15mg don't work for my pain, even with the long acting med on board.

I'll let you know what happens at the appt.

:)

[cornishrex13]

have you ever tried Lyrica? Its not in the same category as Oxycontin but can be a great help to some. it helps me allot with my intestinal nerve damage. I also needed something for break through pain. My pain clinic Dr. explained that there are many different pain receptors and people usually will need more then one drug no matter if it is a higher dose. Some people get allot of weight gain on this med. I gained 8lbs. but without Lyrica with my Oxycontin I would be in allot more pain. It doesn't hurt to ask,and finding the right pain meds. for each person can be trial and error till you find just the right mix. I hope things go well on your move..........cornishrex

[lee73010]

Yeah....I was on Lyrica for a little while a few years ago.  I don't recall why I stopped.  I do know of Lyrica's positive effects in pain management.  Hmm....this is something to think about.

[cornishrex13]

If you can go back to your Dr. and see why he stopped it. It is commonly used for diabetic neuopathy , but its use is much broader then that. I am not diabetic and without this med.(and I am on 50mg tid) My main pain med Oxycontin doesn't work as well because of the different pain receptors involved. But some people can't take this med. because they get a unwanted side effect. So check and see why it was stopped. there are others that are similar like Cymbalta is also used for pain in addition with narcotics and is known to help pain. This one did not help me but Lyrica helped allot, we are all so different. Look on the (Irretractable Pain Syndrome ) web site. it gives a list of meds and there catagories from the studies of chronic pain patients and lots of great info. the family needs to know about chronic pain patients.....Let me know what you think of the web site and good luck.    Dawn (PS I know cymbalta is thought of as depression med. but it can also help some peoples pain even when it isn't related to depression if used in conjunction with other pain meds.  The above web site is very helpful................Dawn cornishrex

[Tuckamore]

You're correct. I've have made long comments on this board about the new laws in FL brought about by the numerous "Pill Mills" that use to exist.

I'll be interested to hear how your appt goes. You can't truly blame the physicians that are afraid of losing their hard earning license and career. However, as always it is the honest patients that suffer.

Good Luck!