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Avatar universal

Need advice please

I'm new to this site and I have never posted on a forum so please bear with me.....
I am having surgery for a torn tendon in my right arm next Friday.  Aside from having claustrophobia and panic attacks and my fear of hospitals, I am addicted to oxycodone.  I am prescribed 2 40 mg long acting and 30mg Of Oxy
Immediate release 4-6 hrs for break through pain.  Before the oxy I took vicodin 10 mg for ten years.  I had an intense back injury 15 years ago.  Have some permanent back injury, but the neurosurgeon I was referred to said i really NEEDED to have a couple metal plates infused in my back......I don't want the back surgery!  But I must have the tendon repair as my R arm hurts all the time and I'm losing range of motion......
Sorry about the lengthy dialog about myself, but wanted to give a little background info.  
My real concern now and question is that 1.  I'm suppose to fast after midnight,  my surgery is at 2:30pm how can I fast and NOT take my oxy 30 that I take for breakthrough pain...the 40mg long lasting would help if that was all I took, but it's not and I don't want to go into withdrawal prior to surgery?  2.   I had a recent episode in the emergency room and none of the pain shots they were giving me ie morphine and fentnal?  Gave any relief.  The ER DR said my "receptacles were full" because of taking the  oxycodone etc.  So if the ER couldnt relieve my pain, what happens if i have surgery?  Am i going to feel the operation and not be able to communicate that because of the anthesia?
What can they give me for pain that will work if my body is "used to" the oxycodone?
Again I'm sorry if this isn't the right place to be asking, or if I am being selfish/stupid about this.
I am scared to death of surgery even the minor one I am going to do, Maybe some day I'll do the back surgery, but for now if anyone has any advice about fasting when your addicted and what  to expect with additional pain?
Thank you so much
I am on disability   I have been procrastinating about the bacK
Surgery that I need to have because of
7 Responses
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547368 tn?1440541785
Each state is a bit different. In my home state PMP do not, yes that's correct, do not prescribe opiates on a long term basis. They are more of referral source, offering pain management suggestions and preforming treatments.  It is our PCPs that follow and manage their Chronic Pain patients. So Beauty (true beauty is never fading) you may not require a PMP. I don't in my home state.

However in many states it is only a PMP that prescribes and follows Chronic Pain patients. You do not provide a state. It can become confusing on this site regarding which physician manages what! :o)

This community is supportive and caring and I am glad that you have found us. While it is absolutely true that in most instances you may take required meds with a sip of water it's always best to consult your surgeon. Physicians/Surgeons differ in their opinion and practices. Multiple times Chronic Pain patients have been instructed to change doses or times prior to surgery. Again it's up to your Surgeon and that's where your should obtain pre-op instructions  

I hope you will be active in our community. I look forward to hearing from you again. We are great at support.... I hope you will take advantage of it.

Best of Luck,
~Tuck
Helpful - 0
Avatar universal
Opps....accidentally hit enter....in closing you all gave me such wonderful advice, I am humbled by your kindness.  I never talk to anyone about my situation because I feel weak and ashamed that I can't deal with this pain and I KNOW what the general population thinks about someone who takes pain medicine......sadly I used to be one of those people.....my injury made me "painfully aware" that not everyone who takes PM is an addict looking for an "high".  
I'm still scared about the surgery, but per your advice I will address this with my Dr.  It would just take too long to explain what I have already addressed with the ortho surgeon with the response that he could find me a PM Dr.  I have a PCP who put me on these meds, why would I need a PM Dr and how could I get that done before my surgery Friday?  Anyway, thanks again....my thoughts on your advice ....I need to talk to Dr before surgery, I need to recalculate my BT dosage vs long term dose.
I am so grateful that I found this forum and even more grateful for people like you guys who took the time to respond!!  If my other post shows up somewhere this post will be repetitive :). I'll let you know how it goes!
Helpful - 0
Avatar universal
I posted a response to "all" expressing my gratitude for the informative & kind words I received.... I don't see my post, did I do something wrong, or am I looking in the wrong place?
Just in case.....Mangel, Tuck, and Marycarmel. Thank you so much.  Mangel I wanted to let you know that regardless of what is "prescribed" I usually take 1 instead of 2 of the 40mg, but I usually take 3-4 of the 30 IMM oxy for BT pain
Helpful - 0
1855076 tn?1337115303
Before making any general comments, you definitely should talk to the surgeon about your medications before your surgery date.  I had similar concerns, and they did advise me to take some of my regular medications with a sip of water.  A couple of other meds they had me hold off on.  Because everyone is different and every situation or surgery is different, you have to always talk to your own doctors.

I had 9 surgeries on my hand and I also was on a lot of medications/narcotics for my pain.  It was different combinations for different surgeries.  At times I was on very high amounts of both long-acting meds and BT ones.  My pain management doctor was always able to keep my post-surgical pain under control.  For one of the surgeries, the medication that was prescribed did not work for me.  When the post-surgical medications wore off, it was like I was taking nothing.  I just called my PM doctor and they talked to me and then worked out a solution that worked for me.  There is no reason you should have to worry about this.

Whoever is going to be prescribing your post-surgical medications should be very clear on your history.  If this surgeon is not someone who is very familiar with your case, make sure you have the doctor that is prescribing know what's going on.  It's better to make sure you have all this worked out ahead of time so if there are any little bumps in the road, all you have to do is make a quick phone call rather than be scrambling when you're in pain.

It is surprising that the ER isn't always great at managing pain!  I found that out in the late summer when I got sick.  On top of being sick, I couldn't keep my pain medications down and went into withdrawal.  The ER just wasn't really comfortable giving narcotics.  After they conferred with my PM doctor, they gave me a little more but really I was still having some withdrawal symptoms.  I wound up being admitted.

Because it was a hospital different than where my PM doctors were, I wasn't kept as comfortable as I should have been.  If this were to happen to me again, I would try to go to the hospital where my PM doctors practice.

I agree with what Tuck said about involving your PMP to get them involved.  It's likely your surgeon will welcome that.  I know mine did.

Best of luck with your upcoming surgery.  Let us know how everything goes.
Helpful - 0
1814148 tn?1332485798
Having been a surgical nurse and also studying pain management extensively a surgeon would be highly unlikely to advise not taking regularly scheduled opioids. Otherwise a pain crisis can occur. It would be wise to hold off on any BT doses though. A skilled Anesthetist will be monitoring all of your vital signs until to are in the post anesthesia recovery unit.

Definitely have a discussion with your surgeon prior to surgery. You have questions that need answering and that in itself with decrease your anxiety.

Best wishes!
Helpful - 0
547368 tn?1440541785
Hello and Welcome to the Pain Management Forum.

I am sorry to hear about your Chronic Pain and the surgeries you are facing. My heart goes out to you!

DO NOT take any medications prior to surgery without consulting your Surgeon.  Due to the medications you will require for the surgical procedure they may want to limit the amount of opiates in your system. It's common for the Surgeon to request that you not take those last few doses before surgery. So please call and confirm. Do not listen to anyone but  your medical providers regarding pre-op instructions. They should have discuss this all with your prior to your surgical date.  Someone did not do their job!

I do agree that what occurred in ER was very unfortunate and very unnecessary. The ER Physician apparently was not skilled or educated in Pain Management in Chronic Pain patients. Although we are more difficult to manage in an emergency situation there are alternatives.

You may want your PMP involved in any up-coming surgery..... at least to the degree of a consult with the surgeon. Together they can manage your pain and you will be comfortable.

Best of Luck to You... and Please let us know how you are doing.

Take Care,
~Tuck
Helpful - 0
1814148 tn?1332485798
Sorry to hear that you need to have surgery.  I can understand why you fear the hospitals when you are not given the proper information and pain control. Not all doctors understand pain management. It is in fact a special area of medicine and you are likely to get better answers from people in recovery. It would be normal to fear the unknown so I hope these answers help..

Fasting is regarded as all unneccessary food and drink. You should take all you routine medications with a small sip of water. You would want to avoid anything that could cause increased bleeding like: Plavix, fish oil, aspirin, coumadin...some of these should be stopped 2-3 days prior. So take your long acting pain meds.

Chances are during your last experience in ER, they were not giving enough morphine. Fentanyl is a poor choice because it doesn't last long. You have a tolerance to opioids, NOT full receptors. Opioids are unique because there is no "ceiling" for the doses. Meaning that the doses are based on the person's specific tolerance. All other medications have a ceiling or therapeutic blood level. When the recommended dose is exceeded the person risks overdose and toxicity.

So prior to surgery be sure to tell the surgeon the amount of opiates you take in a 24 hour period. He can give you IV morphine based on a conversion chart. There is no such thing as a nurse saying "I can't give you anymore pain relief". She CAN by calling a doctor and getting an order. Your pain is what you say it is and that should never be an arguement. You are your best advocate. So you reply, "my receptors are NOT full, I just have a higher tolerance level for opioids than the average person because I take Oxycodone daily for chronic pain. Tell the doctor your fears and ask him about his plan to manage your pain, given your tolerance.

I hope this helps to open a dialogue with doctors and nurses who provide your care. Well wishes and a speedy recover to you!

A note about your chronic pain:The general rule of thumb is that a BT dose should be 10% of the total long acting dose. So if you are taking 80mg on long acting, the BT should be 8-10 mgs. 30mg is overkill. I feel it is this error in prescribing that set people up for addiction. How many 30mg BT are you taking in a 24 hour period? The best thing to do would be to recalculate your long acting. Add up the total 24hr dose and divide by 2. Then take 10% of the total for BT dosing every 4-6 hrs.



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