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Is it possible Morphine might not work for me?
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Is it possible Morphine might not work for me?

My dr recently changed my pain medication for my lower back pain from percocet to morphine b/c he wanted me taking less tylenol, as it causes liver damage. I do NOT feel pain relief from the morphine. I'm taking twice what he prescribed me just to feel relief. I was NOT expecting this!!!
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441382_tn?1329196690
Some people don't metabolize morphine well and they get no relief from it.  You might be one of those people.  If you were getting adequate relief from the percocet, I don't know why he switched you to morphine to get away from tylenol, all he had to do was give you pure oxycodone in the immediate release form.  It comes in dosages as low as 5mg, it's not like oxycontin, which is the time-release version.  If I were you I would ask him about it.  There is no point to taking something that isn't giving you any relief.

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1855076_tn?1337118903
I agree with Ghilly.  Morphine did not give me good relief and it also caused me terrible headaches.  And the oxycontin is also a good option if you're at higher doses of the oxycodone; it also doesn't have the Tylenol in it.

There's a lot of choices for pain relief but everyone is different.  What works for one won't work for another.  I would say be careful about taking any increase in your dose without talking with your doctor.  So many people find themselves discharged from their doctor and then have no one and nothing for their pain control.  If something isn't working well, call and ask about a switch or an increase; just don't do it without the doctor knowing.
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Avatar_f_tn
First I would caution you greatly to not be doubling the prescription on your own. This can cause you to be released from your Dr. and have a record of abusing your medications which then could lead to not having any Dr. want to treat you.

You need to call and speak with your Dr. and let him know it's not controlling the pain at the same level.

You say you changed 'recently'.....when was the switch?

All good Dr.s when switching to a different medication will start with a lower dosage based on bioavailibily rates of a conversion.

Many times it takes a month or so for the Dr. and you to figure out the right conversion to get the same pain reduction.

Keep in mind with chronic pain...not acute...the goal is to have the medication be only ONE way to help reduce the pain. Using injections, acupuncture, massage, aqua therapy, a muscle relaxer if needed, a nerve medication if needed, biofeedback, counseling to help deal with chronic pain, even a depression medication, eating well and exercise are also very important.

So...it's imperative to NOT take more than prescribed and contact your Dr. and let him decide what to do from here.

I switched from Oxycontin to Morphine years ago because of cost. It took a few months to get to the right levels.

I do all of the things I listed above every day/week/month. It's not about trying them once...it's about combining all the tools a Dr. has to help reduce the pain.

I live with a 5-7 on the pain scale each day as I will have to live forever with my pain and I want to keep my tolerance as low as possible.

I do wish you luck.

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Avatar_f_tn
Thanks for the replies everyone!!! All the info was helpful!!! I called my dr and he had me come in and changed me from Opana to something new called Nucynta. It still doesn't help as much as the percocet did so i'll be calling him again Monday. Or, maybe I just need to give this one some more time.
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Avatar_f_tn
Most Dr.s want their patients to at least give a new medicine a month to see how it works.

*Unless there is any sort of dangerous allergic reaction which you obviously would stop immediately. (See information that comes from the Pharmacy with your medicine)

There are regular side effects to almost every medication...some nausea...fatigue...dry mouth...constipation....Most of these will go away or lessen with time.

The main thing is to NOT double or change the Dr.s prescription like you did with the Opana. You can possibly overdose, die, or have the things I listed before which is to get flagged by your Dr. for abuse.

So...I hope that you will give this medicine a proper amount of time. Another red flag for a Dr. is if you only take a medicine for a few days and say it's not working and want to switch.

As I wrote before...each new medicine needs to be tirated up in dosage by the Dr. They always start with the lowest dosage...

Good luck.
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1331804_tn?1336870958
Hi Amber,

I am on morphine and I noticed that you have already switched from the opana (which is oxymorphone not morphine, very different chemical makeup between the two).  I agree with Weathergirl's comments that the doctor always starts on the lowest dose and titrates up.  I had to have the morphine titrated up once.  I tried the lowest dose for about a month and called prior to my next refill to tell him it wasn't working so that I could try a stronger dose with my next refill.

You may need a short acting opioid in conjunction with the opana or nucynta.  I still have pain after taking the long acting morphine and I take percocet for the pain that breaks through a couple of times per day.  Given that it happens regularly, I could probably use another titration of the morphine but I haven't bothered since my pain is covered after taking the percocet.  

If you are concerned about the tylenol, you could take pure oxycodone IR as JayBay recommended or some other immediate release opioid formulation.  It took awhile for the pain relief to become more constant after starting morphine as it does take some time to build up in your system.  But as others mentioned, you may not metabolize morphine well and in that case you will not reach that steady state of pain relief.  But Opana isn't morphine so I don't think you have actually tried true morphine.  You could ask your physician about it but keep in mind you may want to try it for at least a month or through at least one titration to see if it worth sticking with it as Weathergirl recommended.

The Nucynta is often known as "Tramadol on Steroids".  Not sure if you have taken Tramadol before or not.  The generic name for Nucynta is Tapentadol and it binds to opioid receptors in the brain and spinal cord quite a bit stronger than Tramadol does but both Tramadol and Tapentadol (Nucynta) increase serotonin levels in the brain just like an anti-depressant which changes the perception the brain has on pain and thus reduces pain in this manner.  Many have said that it doesn't help with their pain very well.  There was however one lady that was also on Fentanyl in conjunction with Nucynta and said that it works great...believably so in this case.  

I really hope you can find a medicine that helps with your pain.  I hope to get away from the percocet in the future myself because of the tylenol.  Johnson and Johnson recently changed the dosing instruction again, instructing patients to take less of the OTC tylenol and less often which tells me they still don't know what the safe maximum dosage really is as there must still be people having liver problems who are taking close to 4,000 mg per day maximum.  I got away from the vicodin because I would be nearing that max dosage, and that was too close for comfort so I understand you and your doctor's concerns.

Please keep us posted on how you are doing.  You may want to try adjuvant medications as Weathergirl discussed like a muscle relaxer, anti-convulsant.  I have found that opioid medications give me 30% pain relief on average and I have to get other 70% by doing other things.

PS: if your doctor wants you to try methadone you absolutely DO NOT want to double the dose of the medicine.  It takes a long time to build up in your system and the double dose may not start working for a couple of days and collide with your normal dose and cause you to overdose.  Methadone requires a very slow and cautious titration because of its extremely long half life.  Many have attested that it is a very powerful pain reliever but I was too afraid to try it when my doctor recommended it.

femmy
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Avatar_f_tn
The Nucynta seems to help more than Opana did. But, i've noticed today (I started Nucynta 3 days ago) that my joints hurt horribly. It hurts for my knees to bend, my whole neck and shoulder area are so tender to even touch, my wrists are sore to bend. I'm not sure if this is a side effect of the Nucynta or something else going on, but very ironic to me. Uggghhhhhh.
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1331804_tn?1336870958
Hi Amber,

I am very sorry to hear that you are in so much pain today.  If the pain becomes intolerable, be sure to tell your doctor asap as it may be a side effect from the medication, especially if you don't normally experience that type of joint pain.

In the meantime, be sure to keep a journal where you record your pain levels throughout the day and if you did something significant to make the pain levels rise,  be sure to note that as well and also how often you do that task on a regular basis.  Be sure to bring it in to your next appointment to share with your physician.  

I think there are a couple of different dosing levels with the Nucynta if you think it may work better at a stronger dose.  Keep in mind the Nucynta has a ceiling so after about 2 dose changes, I higher dose won't equal more pain relief, just make you sick.  After that point, you may need to switch over to a pure opioid agonist such as oxycodone, morphine, or fentanyl to name a few.

I hope the joint pain goes away soon.  Take care.

femmy
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Avatar_f_tn
Hi Femmy!! Thanks for the info :) The body pain is less today but is still there. I did notice i am feeling more irritable. I'm going to call my dr to let him know and see if he thinks that'll go away once my body's used to the Nucynta or not. I'm feeling very easily aggravated and bothered, which is not like me. I don't like this trial & error stuff, but the medicine IS helping the back pain which is wonderful.
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1331804_tn?1336870958
Hi Amber,

I am glad that you are feeling better today!!  

The feelings of aggravation may be from the anti-depressant property of the medication.  I am not sure if you have taken SSRI anti-depressants before but some people are very sensitive to the effects and it can have an opposite effect on them.

I think it is a great idea to let your physician know about this phenomenon that you are experiencing.  These types of sensations rarely go away as everyone's brain is wired differently and certain types of anti-depressants don't play well with how some brains are wired.

If you aren't extremely aggravated to where you feel you have no control, you may be able to deal with the effect the anti-depressant portion of the medication has on you and you may get used to the change such that it won't be as noticeable over time.  But then again, there are many other medicines that may be a better fit for you.  

Keep us updated on how you are doing.  I am so glad that you are feeling better today!  :)

femmy
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Avatar_f_tn
Well, the weird side effects went away. I called the dr and the nurse called back saying the side effects should go away within a week of starting the Nucynta, and they did. Well, now i've been on it for close to 3 weeks and i'm feeling more pain. I called the dr and pushed my follow up appointment closer b/c i can't handle this throbbing/achy feeling in my back for another week. It's like the Nucynta did help a little but now it's not helping so much. I still feel like I get better benefit from percocet. I completely understand that the dr doesn't want to keep me on that b/c of the possible liver damage from the tylenol, so maybe there's something else similar to it without all the tylenol? I'll find out Thursday. I did have another MRI yesterday and am very curious to see what it shows. Thanks for your thoughts and info!!
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1331804_tn?1336870958
Hi Amber,

That's terrible that the nucynta stopped working as well for you as it did initially.  I have never tried nucynta so I can't offer any additional insight in that area.

How many percocet were you taking per day? If you were taking close to 12 pills then I could see your doctor's concerns about liver damage.  But if you were taking 1/2 that, then most likely, you would be okay going back to the percocet as you would be no where near the max pharmaceutical dose.  

To put your mind at ease, you could start requesting regular liver panel tests to monitor your liver functions.  Elevated levels of ALT can sometimes be linked back to acetaminophen.  I just had another liver panel test recently and everything turned out okay.  I take between 5-6 percocet per day.

Please let us know if your MRI shows anything new as it could mean that you have more pain versus the nucynta's effectiveness being reduced.  In this case, simply switching to a stronger pain medicine should reduce your pain levels.

femmy
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Avatar_f_tn
Hi Femmy!!! I was taking 4-5 percoct a day. So, not the max for sure. I go back next week and am going to see about getting off the Nucynta. I'm noticing after being on it for a little over 6 weeks that i'm a lot more tired/fatigued than I used to be and it probably has something to do with the Nucynta. And i'm going to discuss getting the percocet back b/c it definitely helps. Unfortunately, the MRI did not show anything new. I was hoping it would so maybe i'd have an explanation for the back pain, but it looks the same it did 1 1/2 years ago - just mild osteoarthritis.
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1331804_tn?1336870958
Hi Amber!

I hope you had a Merry Christmas and are doing well.  

I am having similar problems with the morphine that I am taking.  It is very sedating.  I have actually researched the different opioid formulations and the opiates (i.e., morphine, codeine, thebaine) they are derived from.  And I found that the oxycodone that is in Percocet is derived from the opiate thebaine which possesses stimulant properties, which is why it makes so many people more alert and awake than drowsy and sleepy.  The dose of Percocet that you were taking is well below 4,000 mg a day and in fact is even well below the tentative new maximum dose of 2,600 mg per day.  Additionally, the FDA is considering a maximum one time dose of 650 mg versus 1,000 mg.  If the Percocet is appearing the most effective, then I would definitely express that to your physician next week.

I have a doctor's appointment on Jan 3rd with a brand new "prospective" physician.  I am losing my current insurance that my current doctor only accepts at the end of the year so I am forced to find a new physician that accepts my new health insurance.  There is a lot of paperwork to get together for the appointment but just based on what they sent me to fill out, it is definitely a real pain management facility that does injections, medications, and surgery (as a last resort) versus just injections.  So I am hopeful that my new doctor and I can reach common ground regarding my current medications.  My current physician has agreed to prescribe my morphine only through January but I am hopeful that this new doctor will adopt my current treatment plan.  I am considering switching from morphine to oxycontin due to the sedation from the morphine.

Did they do an MRI of your entire spine (cervical, thoracic, lumbar)? If not, I would get the other regions scanned as there could be something in another spine region that a different region of your spine is compensating for.  I started out having a lot thoracic spinal pain; however, the majority of the damage was in my lumbar spine.  And then as you would expect, I started to experience severe pain in my lower back.  Mostly, because my Sunday chore routine was snagging the "thin string" that was holding my lower back together and one Sunday that "string" broke and the worst pain wave came over me.  I was bedridden for two days and when I was finally able to get out of bed and do things, I tried to get back into the Sunday chore routine and the pain was horrible!  So now I can only do one thing at a time, which is hard because I enjoyed the gratification from an immaculate house whipped up in one day!

I'm glad you are actively working with your physician to find the most effective treatment for your pain.  I appreciate your update and please let me know how your appointment goes next week.

femmy  :)
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Avatar_f_tn
Hi Femmy! How did your appt with your new dr go Tuesday? I hope it went well. I went today and thankfully my dr. put me back on Percocet. So, i get 5 mg 3 times a day. I asked if it was every 6 hours like he had prescribed previously and he said no, only every 8 hours b/c he didn't want me taking too much tylenol. Him and that darn tylenol. But, we discussed the other meds and that i felt more relief from the percocet so he gave me that. Also, he prescribed me Baclofen. My back always hurts the worse when I wake up in the morning. Baclofen is a muscle relaxer but he said it also has pain reliever in it so it's a little different than most muscle relaxers. I'm supposed to start off just taking 1 at night before bed and after a week if i notice it's helping I can also take it during the day if i feel the need to. So, here goes another month of trying something new, lol. He said we won't discuss any injections for now and was going to also prescribe me something else but said he'd wait a month to let my body get used to being back on the percocet and Baclofen.
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1331804_tn?1336870958
Hi Amber,

I am glad that your doctor switched you back to Percocet as that is what has helped the most with your chronic pain.  My appointment on Tuesday went so-so.  I went to see a Spine Orthepedic Specialist and they told me that they don't manage medications there and rather rely on the primary care physician to manage pain medicines.  They did give me a prescription for Voltaren Gel which has helped get rid of the residual pain left behind from my other medications.  Have you tried Voltaren Gel?  It is an anti-inflammatory gel that you rub directly where the pain is.  It is easier on your body than the oral NSAIDs as it doesn't irritate the stomach.  They want me to use that while they work on obtaining the MRI films from my previous insurance.  They said that eventually they will start me back up on injections both epidurals and trigger point injections (which I haven't tried yet but have been interested in) but they want to give my bones and joints a break as I have already had 5 epidural steroid injections.  He also ordered physical therapy (3rd round!) and I will go for four weeks and at the end I will get a TENS unit for home use!  I went to PT yesterday and got some stretching excercises to do twice a day at home that I haven't done yet but I need to get going on those!  

So today I had an appointment with a primary care physician that went very well!  He swapped out the morphine sulfate ER that I was taking for Opana ER.  The dose of the Opana ER includes my doses of breakthrough meds that I was taking so it looks like I will only need to take 2 pills a day of pain medication.  I am taking my first dose tomorrow morning.  I will let you know how it works out for me.  My PCP was also VERY worried about my tylenol intake from the percocet.  He said 2,000 mg was the soft limit and I was bumping up against that.  He did; however, refill my percocet but I don't think I will need it given how strong the Opana will be.  Your dose of percocet is very safe so you shouldn't worry about the tylenol intake.

That's great that he prescribed the Baclofen for you!  I haven't tried it but I have heard of it.  I am also on a muscle relaxer called Flexeril.  I hope the Baclofen is helping the back pain you have in morning.  My back pain is the WORST in the morning too so you are not alone.  Also, let me know what other medicine he gives you next month.  I know trying out something new can be scary as I am very scared to try the Opana as it is 60 mg more of morphine equivalent a day.  I am on so much pain medicine and wish my pain could be controlled at a lower dose but unfortunately that a unachievable dream.  I just have to focus on my goals in life to be more active and less focus on pain every day and I think this year is going to be a good year towards achieving those goals.  I hope the goals that you have for this year are obtained as well.  Keep working with your physician and you both will come to the optimal solution for your pain.  

Please keep me posted.  :)

femmy
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Avatar_m_tn
I have had acute leg pain for 9 years Lumbar fusion L4 and L5, Stints for circulation to my legs.I am now in pain management and have tried Norco . Opana long acting morphine which seemed to work for a while but now my pain returns, it's relentless nothing helps. I see my Dr. in 10 days and hope I can get some relief, any suggestions please. I'm sure there are those out there that know what a nightmare this is,
.
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1331804_tn?1336870958
Hi myndset,

Welcome to the Pain Management Community!  You have come to the right place.  :)

If you click on "Post a Question" at the top of Pain Management Community Forum page you can post your question as a new thread.  Doing this may help you get more answers to your questions.

That being said, if you would provide more information on what medications you have tried and the dosages, others can recommend either changes to your dosing and/or changes in medication type.  However, please bring our suggestions to your doctor for approval first.  Don't ever change your meds on your own (I know you probably know this).  

Your pain sounds like it is chronic not acute as it has been going on for 9 years.  Acute pain is pain that lasts less than 3 months.  It sounds like you are dealing with chronic pain that spawned from a lumbar fusion.  I too have chronic pain in my lumbar spine due to degenerative disc disease with radiculopathy but I haven't gone under knife for disc repair yet.  I just started new meds this past week and the transition has been nothing less than rough.  I was switched from morphine to Opana (which is oxymorphone).  Morphine and oxymorphone are totally different opioids.  They aren't interrelated in any way.  Oxymorphone is extremely potent and is 3 times as strong morphine when taken orally.  I would like to know what your dose was of the oxymorphone was when you were taking it (or are you still taking Opana/oxymorphone?).  I am on Opana ER, 30 mg every 12 hours with Percocet for breakthrough pain (a couple of weeks ago I was taking morphine sulfate ER, 30 mg every 12 hours w/ percocet for BT).  At first the Opana didn't seem like it was working (at all) but I discovered it takes 3-4 days to reach full strength in the body.  As of today it is working fairly well.  How long have you been taking Opana?  

Norco is on the opposite end from oxymorphone in terms of strength; hence, it is rather weak.  I was on vicodin a couple of years ago (contains same opioid as norco just different strength in tylenol) and it didn't work well for my pain.  I also experience a similar type of pain to what you are dealing with and I know how debilitating it can be.  It is very hard to reduce the pain in the legs due to nerve problems in the lower spine.  Have you tried any medications with oxycodone in it? such as percocet, roxicodone, oxycodone IR, oxycontin?  Until I started the Opana, I found oxycodone to work superiorly for my pain.  Anti-convulsants are superior medications for nerve pain.  Have you tried an anti-convulsant such as Neurontin or Lyrica? If so, what are/were your dosages?

I hope your doctor's appointment goes well and please start a new post with the information requested.  This will ensure that you will receive assistance from members other than just me.  

femmy
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Avatar_f_tn
Hey Femmy!! I'm glad you're liking the Opana, that's great! I tried that for a month but my dr only prescribed my 5 mgs. That did NOTHING at all for me. So, i went back today. I told him the Baclofen 10 mg wasn't helping at all, can't even tell when I've taken it. So he upped that to 20 mg at bedtime. And he put me on Celebrex. He thinks the pain is stemming from my SI Joint and said he was very upset he didn't think previously. He was kind of basing where my pain is coming from on the MRI and that wasn't helping us at all. So, i started Celebrex at 600 mgs today, then i'll be on 400 mgs/day. He said it can take a few days to start to feel relief from it. If i don't get relief from it then i'll have an SI injection done.  He also refilled my percocet, just 5 mgs. He's a stickler for putting patients on low doses, but that's okay. I completely understand why he would do that.  So, i'm anxious to see how this Celebrex works. Hoepfully it works wonderfully for me!!! I was in the car for about 6 1/2 hours 8 days ago and i started hurting a lot more after that. So, road trips are a NO NO for me...which isn't good b/c we're driving 9 hours to Disney World in May, lol. Just sedate me already!! ha ha ha!!
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Avatar_f_tn
Hi Myndset. First of all, I'd like to say I hope you can get some relief from this pain ASAP! I know it's a long, treacherous road. I definitely don't have all the expertise Femmy does, but i wanted to say that my friend has been on Morphine for a while for her back and it stopped having the same effect. So, she was recently put on the pain patch. I'm not sure what it's called but know she was started on 25 mg patch and changes it every 2 days. So, that may be something to check into since the Morphine's not helping as much anymore.
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1331804_tn?1336870958
Hi Amber,

It is great to hear an update from you!  It sounds like you are still making great progress in pain management in terms of finding out what works and what doesn't.  Muscle relaxers at low doses typically don't work well for those of us with chronic pain so I hope that the increase in Baclofen at bedtime will help more with your pain during sleep time as well as some during the day time as well.

5 mg of Opana is a pretty low dose, it is equivalent to about 10 mg of oxycodone which is double the amount you are taking within the percocet.  The reason why the higher oxycodone equivalent dose from 5 mg of Opana isn't working is probably due to the additional analgesic effect you are getting from the tylenol within the percocet.  This is the reason why my physician stated that it would be best for me to stay on percocet versus switching over to a breakthrough med that is pure opioid.  I would think that if you started the extended release form of Opana along with staying with the percocet for breakthrough pain, you would have better coverage of your pain.  Your doctor needs to quit being such a stickler!  

I have been on 60 mg of Opana ER for almost a month now (30 mg in the morning and 30 mg at bedtime).  The pain relief is still surreal to me.  I have a very small amount of breakthrough pain now that happens about 3 hours before my morning dose and so I take 2 percocet for that pain and pain breaks through only sometimes in the evenings around 5pm and for that I take 1 percocet.  So at the most I am taking 3 percocets a day but most days I take only 2 percocets.  That is a big change from the 7-8 percocets a day that I was up to.  The Opana extended release really lasts for 12 hours and sometimes longer than that which is nothing short from amazing!  The extended release morphine I was on would work for maybe 8 hours but most days it would wear off after 6 hours as my pain would spike sharply and stay there.  With the Opana, I get a little break through pain but it quickly dissipates almost as quickly as it came!!  So I don't have a chance to really think about if I need to take a percocet or not.

I am glad that your physician is looking into other causes to your pain.  You will have to give me an update on how the celebrex is working for you.  I sure hope you are feeling less pain today.  I plan to explore the possibility of an underlying issue with my SI joint as well as I researched it and I have all of the symptoms associated with it.  Just like in your case, the doctors have always treated my pain based on my MRIs.  Granted some of my pain is probably coming from the damage on the MRI but I doubt now that all of the pain is associated with the disc problems in my low back.  If you do end up getting an SI joint injection, I would love to hear your results from that.  

Road trips kill my back as well, I don't do them anymore LOL!  I hope that you have someone to share the driving with when you all go to disney world.  That sure sounds like a lot of fun!  I have yet to see disney world.  I have been to disney land but I heard disney world is so much better!  After long road trips like the one we took about 10 years ago from Colorado to California and then within California all the way south to San Diego and all the way north to San Francisco my back was screaming!!!  My husband had to pour a bucket of ice on a towel that was on my back every night.  I usually can't stand the cold but those times they were welcomed and it did reduce the pain quite a bit.  The drive was so well worth it though once my pain decreased and I was able to get out and enjoy the scenary, especially the beach.  I wasn't on any opioid medication or a muscle relaxer at that time, just good old ibuprofen...and ice lol!  I think you will be fine on your road trip, just be sure to take the percocet right at the beginning of the pain.  Once the pain is full blown, it is harder for the medication to get the pain under control and many times it ends up not working as well.  

Keep in touch as always.

femmy  :)
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Avatar_m_tn
I know this is an older post, but I just wanted to let you know that it helped me out.  This month (less than a few days ago) I switched from Oxycontin to Morphine due to my new insurance will not pay for non-generic drugs.  First day I started by around lunch, so I had a mix of medicines  in my system.  The next morning I woke up around 4am and was in the worst pain I had experienced in years.  I have gaven it a few days to get into my system, but that has not worked.  I am going to call my doctors office first thing in the morning to see if she can adjust it, so I can continue to work and have as normal of a life as i can with chronic pain.

DarleneEllis
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