Need Help with Stronger Pain Medicine

[Suda]

Dear Group:

I have been taking 6 10/325 vicodin now for the last 4-5 years.  Now it's as if I am taking nothing at all as it does not control my escalating pain.  

I know that vicodin is not the best for chronic pain and I have built up such a tolerance that I may as well be taking plain tylenol.

Does anyone out there living in chronic pain have any suggestions as to what type of stronger pain medicine I should be requesting from my physician.  

He has suggested some very strong pain medicines for me to try, yet I am terrified that if I do go to a much stronger, yet more approriate long-lasting pain medicine that there will come a day when that doesn't work for me either and then what shall I do?

Any help from you, the true experts with this problem would be greatly appreciated.

Thanking you in advance,

Suda

[Suda]

Dear Ones,

This has been the most helpful, not to mention hopeful discussions I have had about these problems with you two and all the other considerate people who have so kindly, and comfortingly given me great advice.

I love the idea of sweetly and diplomatically asking dear Nurse Molly if she has any great insight into pain management that I have been previously ill informed about.

Though I so doubt that this would shut her up, it sounds like the perfect way to converse with her about her unbeknownst to me great expertise in pain management.

So, as I've mentioned before, yet it's still bears to be repeated again and again!  Thank You!  Thank You! and Oh yes!  Thank you again and again.

I will research some of these meds you all have kindly informed me about and have a list to discuss with my physcian.  Though he is a Primary Care Physcian he is a great one and he listens to me and doesn't negate what I discuss with him as so very many doctors tend to do, no matter what they specialize in.

So, wish me luck!  I shall let all you caring people know just how it goes both with my discussion with my physician about stronger/longer lasting pain meds, as well as dear disengenuous Nurse Molly.

Big Hug and Great Thanks,

Suda

[BOK2Bjan]

I agree that the long acting drugs are the way to go.  The reason they are used is that when you take so many short acting opiates, there is a chance that you can take them at two short an interval, or your pain can "get away from you".  It is very hard to relieve pain once you're experiencing it.  It is easier to have it not get bad in the first place.  Having a more steady release of medicine in your blood stream helps manage the pain more efficiently and helps prevent roller coaster pain.  There is also less of a tendency for abuse for those who might have that tendency.

As for a less than compassionate nurse, may I suggest the following.  After a rude remark such as "you take how many!!!???", you might ask "oh, nurse, ___, I wasn't aware you had chronic pain management experience.  Perhaps you have information on the most recent protocol for its management?  Do you know the conversion tables for changing from one opiate to another?  I'd love to hear your suggestions.  I'm currently following Dr. ___'s well thought out advice, but if you disagree, perhaps you could talk with him about it or suggest an alternative".  This kind of tactic can do wonders to let them realize they're speaking out of turn.  It must not be sarcastic or hurtful, however, just tactful sincere dialogue.  Turning our caregivers against us isn't always a good idea - sometimes - but not always.  If you like the doctor, you don't want to give him personnel trouble.  He won't appreciate it.  Let him know though, if your nice guy approach doesn't work.  I sure wish you well.  It's so hard to be put down by those who are supposed to help us.

These are just ideas - don't try this at home! lol only in professional medical establishments, where first aid is available!!

Jan

[sacvic50]

When you are asking about the longer stronger drugs.. ask about Avinza.  I have tried most of the "long big dogs"  ie: ms contin, oxycontin of assorted strengths, fentanyl patch from 50 to 150 msg.. and the Avinza has worked the best for me.  I have taken it in doses from 220 mgs per day.. when I was riddled with an extremely painful staph infection, and now I am down to only 120 mgs a day.  The Avinza is a 24 hour time release morphine base drug.  It can be prescribed where you take the entire dose in the am and stays in your system at full strength for 12 hours, and then it back off a little and last a full 24 hours.. but a little less strong the last 12.  Some people split their doses up and take one pill every 12 hours.  It just goes to preference and what works best for you.  I'd rather take them both in the morning so that while I am up and functioning the most I have the maximum amount circulating through me.  I hate wasting pain meds while I am sleeping, unless I can't sleep because I) am in too much pain.  But mostly I think that is what Ambien is for...
Fentanyl didn't work very well for me.  MS contin is okay, I was totally un impressed with Oxycontin.  But I do find that the instant release Oxycodone's (like percocet/percodan) work better for me than hydracodones do. (vicodin).

Good Luck with your quest, and don't let the (*^&%) nurse get you down.

Vickey

[Suda]

Again, I thank you all so very, very much for your outstanding support.

I have actually asked my doctor when he came into the exam room "Why, Oh Why, does Nurse Molly hate me!!!??"  

"What did I ever do to her?  Oh, wait, I get it, Nurse Molly just knows I'm a total malingerer!"

My doctor told me that if Nurse Molly had 1/16th of intelligence that I had then he would give her the raise she keeps asking for.

As you all agreed, it is so very difficult to take these strong meds and have everyone think that "well, if they'd just suck it up and stop whining then they wouldn't needs these strong pain medicines.

So, thanks to all of you I shall go into my next appointment and let my physician prescribe the stronger pain medicines that he has previously suggested, but I will still request that I get my vicodin refilled exactly as before because I know that they do and anything new may not work as we hope.

Therefore, I shall accept the stronger prescription for daily consumption and have my regular time honored vicodin just in case it all goes to hell in a hand basket.

Again, Thank You!  Thank You!  Thank You!

Wish me luck and I shall be reporting back to all you very thoughtful people after my doctors appointment next week.

Big Hug,

Suda

[Tuckamore]

I disagree that PCP are less knowable about pain. In WI it is the PCP that prescribes for and follows their CP patients, not a PMP. My PCP is one of the the most understanding and compassionate physician I have ever met with a great understanding of CP.

The PMP that I saw some years ago was a, well I can't say it here but if I say disgrace to the PM community that might cover how he treated me and many of his other patients. I know that not all PMP are like the one I saw. In WI the PMP does not follow nor prescribe for CP patients.

However PCP's today are generally very knowledgeable about chronic pain. In WI they must be because they treat us. If they are not or feel that the situation is beyond their expertise the good ones send that patient out to someone that is more knowledgeable or able to treat them more effectively.

If you have a rude nurse and the physician practices in a clinic report the nurse to the Clinic Manager. The physician has to work with this nurse all day and often will not confront her/him. The Clinic or Nurse Manager is over the clinic nurses and will address any patient/staff issues. Indeed once I had a complaint about a physician and it was the Clinic Manager that handled it and actually reported my complaint to the Director of the Board of Physicians. That Clinic Manager was a NP (Nurse Practitioner). The physican received a written reprimand that went on his permanent record and was required to send us a letter of apology. But that's another story for another day.
Peace, Tuck

[nuredshuz]

just a quick thought on the rude nurse... if you are going to a PCP those ppl are way less knowledgeable about cronic pain... may I  suggest you go to a pain management doctor... they will help you get a good solution to your pain problems and they are way more understanding and knowledgeable about pateints who are on pain management medication... I am on a long acting hydrocodone... it is made at a local compounding pharmacy... it is working for me and I have had to have the mg increased a few times since going there... tolerance AND worsening conditions make that an unpleasant reality of taking opiate medications... best to you!!

[sandee1818]

Oh I definitely know what you mean when it comes to the nurse who thinks she knows it all and treats you badly. I would strongly advise you to tell your doctor how she is treating you after all he will never know unless you tell him.
I had the same problem a few years back and I told her frankly it was none of her business and that the doctor knows what he is doing being he did go to school for half of his life!
DO NOT let her treat you in this manner! Tell her that you resent that she treats you this way behind the docs back and that you have discussed it with the doctor. Of course do this before hand. Tell him that she really makes you feel badly for having to take medications and that she really has no right to do so and it offends you greatly.
We have so many people that judge us we do not need the nurse who thinks she knows it all making things worse!
The next time you see your doc please discuss this with him! He will not know and therefore can't take care of the situation if you do not clue him in on what she does behind his back!
The nurse I had trouble with was gone when I went back the next month!

[Suda]

Thank you all so very much for responding to my query so fast.  I will going to my physician's office for my appointment next week and will discuss his much stronger pain control suggestions with a bit more acceptance thanks to all of you.

I simply thought that I was just building up a huge tolerance, but then after reading your suggestions it makes much more sense that my pain has sadly, but surely escalated.

So, wish me luck and I will let you all know what transpires at the doctor's appointment.

I don't know if any of you have this problem, but my doctor absolutely understands that I live with chronic pain each and every day.

My problem is the freakin nurse!  It's so obvious that this woman thinks I'm an absolute malingerer.  You'd hope that people in the medical profession would be much more educated about these things and yet this Nurse is totally horrid to me.  Oh, she's charming when the doctor is around, yet when it is just the two of us in the exam room all I ever hear from her is "You take how many a day!!!!????".  Now mind you, I have been on this same amount for 4-5 years as I'd explained earlier and yet this Nurse acts totally shocked when I give her my list of the refills I need to be written up.

What's up with that?  Again, is it only me, or have any of you out there encountered such a non-caring nurse who works for a very caring doctor?

Thanks again to all of you!!!  It helps me so very much to know that I am not totally insane, nor absolutely alone in this situation.

Big Hug,


Suda

[ChronicPain1]

It all depends on what your body responds to. For example I used Fentanyl, and while supposedly one of the strongest, it did nothing for me.

However MS Contin/Morphine Sulfate works wonders for me. Tolerance is an unfortunate reality if you take something long enough, so a long acting medication (Extended Release or ER) may be your best bet.

Ask the doctor about ER meds.

[Tuckamore]

Thanks for understanding my post so well.I am glad I was able to help you. With the additional information you provided it does sound as if your condition is deteriorating.

Unfortunately I was not able to tolerate any of the long acting opiates that we prescribed for me.

When the pain becomes so severe that I cannot walk I add diazepam to my med list. Of course I do other things such as my massage chair, jacuzzi, heating pad and other similar things. When the pain is very severe nothing really helps except the diazepam but it makes me feel better to think I am doing something to ease my pain.

I hope you will share your progress with us. I will be interested to learn what works for you. Thanks again, Tuck

[sandee1818]

Tuck is right and I agree as does my doctor. When pain medication quit working as well as they used to your condition has most likely worsened. I do think tolerance does play a part but mainly it is your condition getting worse than it was initially.
You may do better on a long acting medication and use the hydrocodone for break thru as needed. I was switched to a long acting med and it worked well for me. I do take a break thru med as needed too.
No medication will get rid of all the pain but it will give you some relief so you can function and have a better quality of life.

[Suda]

Dear Tuckamore,

I never thought about the fact that the reason the vicodin wasn't working so well anymore may have absolutely nothing to do with a build up in tolerance to this med.

But your reply helped me very much because from your comment about how our physical conditions may be deteriorating, and therefore, it is not the medicines fault, but our own bodies as this chronic pain has escalated.

For the past few years I have noticed a great increase in my pain and an even greater decrease in my body being able to function as well as it used to function.  Therefore, I must look at this logically whether I want to do so or not, and realize the my physical condition has greatly deteriorated.

So, I do suppose I must discuss this with my physician and maybe together we can agree on a stronger and longer acting pain medication that will cover at least the most excruciating of the pain.

Do you take long-acting meds?  And, if so, have they helped with the abatement of a major part of your pain?

Thank you so much for responding to my query.

Suda

[Tuckamore]

Hi Suda,

I take the same amount of the same medication that you do. They still work but my condition has deteriorated and the pain has escalated. I am one of the ppl that believe that a condition worsens rather than you develop a huge tolerance. Don't get me wrong I do beleive we develop some tolerance but I think it is not significant. If I don't take the Vicodin the pain is not even close to tolerable. That's one of the reasons I know they are still effective.  

My PCP attempted to move me to the "Big Dogs" about a year ago. She prescribed me several and I tolerated none of them very well. And yes I gave them all a few months except the two that produced an immediate allergic reaction.

If you have been on the Vicodin for five years I would not be overly concerned that the next step will find you needed yet a stronger medication or even an increase any time soon. You have stayed at your current dose for four or five years you should be ok with the next increase for some time.

Everyone responds to opiates differently. I think I say that every day. You may find that a small dose of MS Contin (slow release/long acting morphine) will help you greatly along with Vicodin for break through pain. It is not a synthetic drug. I think that would be a pretty safe next step but that is obviously a personal opinion.

Discuss this in detail with your prescribing physician. Mine was very willing to spend time with me during the selection process. She explained the pros and cons of all the opiates as considered them. We made the decisions together. I really think that is the best way to approach an opiate change. Your physician knows you and your system best. We can only speculate and give you are personal experiences and opinions.

Others will post with their opinions and suggestions. Please let us know what you and your physician decide and how effective it is for you. We will look forward to your updates. Best of luck and take care, Tuck