Medication change

[mellie4]

I'm wondering if anyone knows anything about changing medications.  I seem to remember reading somewhere that if you switch your pain meds from time-to-time, it can help with tolerance.  For example, if you were on Vicodin, maybe after a long while on it you might give Percocet a try, or vice versa.  I had read some people do this fairly regularly, and I'm wondering if it's worth a try.

I'm going to try to talk to the pain clinic about this tomorrow.  Of course, I'm on such high doses, I'm not sure where we'd go with it, but I thought it might be worth a try.

Has anyone done this and found it works (or doesn't?)  I feel like I need to really aggressively deal with what's going on with me rather than just doing the same thing day after day and hoping something changes.  (Hmmm, isn't that the definition of insanity???)

Right now I'm on 30 mg. oxycontin three times a day plus 15 mg. of oxycodone up to 4 times a day as needed.  (Also other things, compounding cream, Cymbalta, Clonidine, and a few others.)  Any thoughts on what I could switch over to with causing me to go into withdrawals?  (Which is one of my greatest fears.)

[mellie4]

I don't want withdrawals.  If the patch isn't as strong as what I'm taking, I would hope she would give me something in addition to it that I could taper down from.  I have an absolute irrational fear of withdrawals.  

I'm anxious to see what they come up with.  I'm pretty much open to most things.  I've had every surgery and procedure they've suggested.  I just was afraid about the patch and/or methadone.  I still am, but I feel like I've learned a little more about the patch and I think it would be worth trying.

I wonder if anyone went on the patch and then for whatever reason changed to something else and how difficult it was to get off the patch.  One person told me not to go on it because I'd never get off it, but the NP told me that's not true, that you can get off it.

So anxiety-inducing all this thinking about pain meds and side effects and all that.

[jamlws]

I just wanted to add if you go from a weaker pain med to a stronger one then you won't have withdrawls, but I have read that you might have them if you go to the patch til your body gets use to it. I hope your appt goes good with your pain nurse and other drs. I hope they are able to come up with something to help you.
Jamie

[mellie4]

Did you find it just didn't work for pain after the second day, or did you get withdrawals as well (my biggest fear ... and somewhat obsessive with me.  Just can't help it.)

What are lortabs?  I'm not familiar with them at all.  Would you recommend taping them (What kind of tape do you use) before showering or waiting to see if I have a problem with it.

Where's the best spot to put the patch?

I just got an email from the NP at the pain clinic and she's going to see me Thursday morning.  She wants to wait until then because she'll be doing pain rounds on Wednesday with PT, OT, an anesthesiologist (who's done several procedures on me) and a psyiatrist (spelling).  She wants to see what they all can come up with.

I'm hoping they'll go with the patch, now that I've changed my thinking on it!  I'm also willing to go up a little on the oxycontin.  I take 40 mg. three times a day.  Not sure what the next dosage is.  (Or maybe I could stay with the 30 mg. four times a day.)  And maybe increase the BT med from 15 mg. oxycodone to 20 mg. oxycodone.

I really "feel" like I'm on the brink of finding something that will make the pain more tolerable.  I feel like if I could just get a little stretch of feeling a bit better for even a short time, it could maybe break this cycle.

[JadedSweetheart]

I went from 6-8 lortabs a day (doctor prescribed) to the doctor prescribing the patch.  I started out with 50 and went to 100 a about a month later.  It worked great at first except that it metabolized so quickly in my system that by day 3 I was crying in pain. I didn't have any BT meds for it.  It would work too well the first day, okay the second, and not at all the third.  I would have gone for a 48 hour dose, but my insurance wouldn't cover the patch.  The only negatives are that taking showers are tricky with them and at the time I used hot water therapy for pain relief all the time.  They can also come off and you have to tape them back on.  
I think it's definetly worth a try, though.

[mellie4]

I'll have to see if she's willing to try it.  When I talked to her late last week on the phone, she said she was hesitant to increase the pain meds I'm on now as I haven't been getting much benefit from the increased dosages.  But I sort of have this feeling I'm right on the cusp of finding the right fit to make things more manageable.  I just hope she's able to see me.  I'm guessing most pain clinics are pretty busy.  I know mine is as far as appointments and procedures.

[namnam46]

Mary,

I'm so glad that you are going to talk to your Dr. about the Patch. It really sounds like it would be a perfect match for you just as it was for me. There was a time where it was ONLY used for terminal Cancer patients but then the DEA realized that it would benefit many CP sufferers also and therefor I was able to benefit from their decision and I'm eternally grateful for that.

Tuck had to give up the Patch because she was allergic to the adhesive on it and couldn't overcome it. As far as I know I think that she really liked the pain relief that she was getting but she just broke out. I haven't had that problem at all.

PLEASE be sure and let me know what happens. I'm very anxious to know how it goes!!!..Sherry

[mellie4]

Sherry, I've been so determined to not do the patch for so long.  I think I had a certain image in my mind of what it's used for.  The only people I had ever known that used it before were people dying.  I never knew anyone that used it for CP.  I think it will be more than worth talking to the NP about switching over to it.  Has anyone tried it for a bit and then had to change to something else?  If so, how did that go?  I think that's one of the things I'm afraid of, trying it and then wanting to go back to something else and finding it difficult.

But after reading and learning more about it, I'm thinking it may be a better fit for me in a lot of ways.  I'm really hoping they can see me on Tuesday and I can get to talk about it.

JadedSweetheart, I have a ridiculous tolerance, too (in my own opinion.)  Considering how much medicine I currently take, I am able to function (mentally) pretty well.  Though I find even though I sound totally normal and reasonable, I often have NO recollection of conversations I've had.  I also tend to not follow through on things because I forget.

I am so very thankful that I've found this forum.  I've learned so much and realized that things could be far worse.  

[JadedSweetheart]

My current doctor originally prescribed 3 oxycodone a day with 1 Norco to take in the evening as oxycodone can cause insomnia.  By the third appointment I needed to up the oxycodone to 4 a day and take out the Norco because I seem to have a ridiculous tolerance, the oxycodone doesn't give me energy at all, if anything, it knocked me out when I first started taking it (so i cut it in half), anyway.
I've often wondered this myself.  I will tell you one thing my doctor tells all of his patients that I had never heard before.  He told us to take one day a week that we have nothing going on and plan on taking 1/2 our regular meds.  He said this will help to keep our tolerance down along with giving a few extras in case of emergencies.  Now I would never recommend doing that without talking to your doctor, but it's something to talk to your doctor about.  I've found it definetly helps keep my tolerance down.

[namnam46]

Mary I'm so sorry about the EARLY post. You guys are the beneficiaries of my youngest Granddaughters FIRST post on MH .... LOL

I went to get her a snack and when I came back in she VERY gleefully announced that SHE had HELPED NamNam help a Nice Lady!!! (She is 9 years old and has Autism.)

OK back to what I was saying:

1. I DESPERATELY needed the Pain Control as I could hardly walk. I was so stooped over from the pain and hadn't been able to stand straight for approx. 5 years or so.

2.I didn't want to have to take ANY MORE pills than was ABSOLUTELY necessary as I ALREADY take 15 to 16 pills a day for things such as Heart, Blood Pressure, Blocked Arteries, etc.

3. The EASE of not having to worry about keeping track of when I took my Long-Acting Pain Pill AS WELL AS my BT meds.

For me it was a WIN, WIN situation. I've been on it since January and it is Phenomenal for me as far as Pain Control.

It is, I've heard anywhere from, 80 to 100 times stronger than Morphine. The Patches come in varying strengths from the 12mcg, 25mcg, 50 mcg, 75 mcg and 100 mcg. You can go to many strengths in between by combining the 12 mcg with ANY of these different dosages of the Patch. i.e. 12 + 25= 37mcg, etc. The Dr. can also combine any of the other Patches with the 100 patch and continue to give you higher dosages of the med.

You need to talk with your NP and decide what is best for YOU. It's ultimately You and Your Dr.'s decision, NO ONE ELSE.

I wish you the VERY BEST of luck and please keep us posted as to what you decide and the outcome of whatever your decision is - whether it is switching your other meds around or trying the patch. Whatever it is I hope and Pray that you get the relief that you so desperately need AND deserve!!!

Good Luck....Sherry

[namnam46]

OK Miss Mary - about the Fentanyl Patch (like you asked in your PM) I truly think that you would be an EXCELLENT candidate for it. They start you out on a relative low dosage and the only thing that you would notice possibly at the start is a little drowsiness. I'm sure that since your NP mentioned it to you that he/she feels as though you would benefit from it. The NICE thing about the patch is that it gives you a CONTINUOUS amount of medicine into your system instead of having UPS and DOWNS all the time as you do with the pills. A lot of people have to change their patches every 48 hours and I am one of those. That is because I metabolize my medications faster than some people. My PM Dr. told me this information when I came in for my 2nd PM appointment and mentioned that it seemed as if my pain came back on the 3rd day and I had to take ALL of my BT meds that day and they didn't help much. So when we changed it to every 48 hours (down from the every 72 hours) it was PERFECT!!

I don't need as many of my BT meds as most people. My whole reasoning behind the Patch is:

1. I DESPERATELY needed pain control as I could hardly even walk. ;;;

[mellie4]

I sort of used Vicodin as an example.  I was on that many years ago and it worked a bit initially but it also made me itch unbelievably.  I haven't taken it since.  I experienced the start of withdrawals once when my prescription came late in the mail by a couple of days.  I only had about a bit more than 24 hours without my meds but I never, ever want to experience it again.  I found it brutal.  I'm sure the pain clinic will know what to do about that, though.

I don't know if my pain clinic has limits on dosages.  I'm on 40 mg. now.  (I may have mistyped in other posts and put 30.)  Maybe they could add in taking it one more time as I only take it 3 times a day.

I haven't changed narcotic medications yet; just increased the dosages (and added the oxycontin.)  We initially picked that as the long-acting one as I did get some relief from the oxycontin.

This is such a guessing game.  Everyone is so different.  They're also talking about trying to get me in for another stellate ganglion block as the last one did give me a good result, even though it was only for a couple of days.

[RunningMom]

You may be a good canidate for the fentynal pain patch.  I've heard so many people have good pain management with them.  I don't know if you would go through withdrawals.  I've have not experience withdrawals yet, so I don't know what it is like.

I haven't had a med switch yet.  They've only increased my doses, which is hard for my body to adjust as I'm so sensitive to medications.  Pain medicine makes me feel so ill, but it does help take the edge off of the pain.

Our pain clinic only allows 40mgs of oxycontin up to three or four times a day.  I haven't discussed what we are going to do next once I reach the max for the clinic.  I personally wouldn't want to switch to something lower to vicoden due to the medicine not lasting any longer then an hour.  

Good luck at your appointment tomorrow.  :)