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Pain Meds
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Pain Meds

Been on 5mg/325mg oxycodone for 5years w/contract for torn maniscus,intervertebral disk syndrome/degenative arthritis and rotor cuff tear.  I recently had emer operation for perforated ulcer and been out of work since march 2012.  Surgeon changed my pain meds to hydromorphone 4mg which actually worked and was prescribed them every 3 hours.  Didn't only work for operation but also for the other injuries I have had, but within 2 weeks needed to start doubling up (8mg) on them.  Approx three weeks ago I went back on my normal pain meds take 2 per every 8 hrs for pain.  Prior to the oper. I also was prescribed 800 mg ibupro for work but can't take these or any aspirin ever again.  My pain management doctor discontinued these and put me on tylenol apap 350 mg twice a day while at work and these don't help at all for the pain (pain level always 7-8).  Also the oxy 2 which are 10 mg per 8 hrs seems not working either, easing pain as a breakthrough but im still in pain and now have been taking 3 sometimes 4, but all that aspirin is bothering me seeing that tylenol can damage the liver (no fix other then transplant for damaged liver).  I have never asked for increases or changes through PM and I have a appointment 2morrow and I need 2 know is it a legitamate request to ask for something without apap for the pain, more or less asked for something either by change or stay the same or increase for breakthru pain with small amount APAP and also ask for a extended release pain med no APAP to last me 24 hours.  I don't want to go through any other operation due to meds and my pain tolerence is high and after 5 years I can say im dependant upon the pain meds.  Just asking if anyone out there can share some info.
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317787_tn?1373214989
Hi I am really sorry to hear about the problems you are having.  There are pain meds that do not have aspirin, Tylenol or ibuprofen in them.  I see that the doctor did put you on hydromorphone, does that have anything with it?  For me the only thing that works is motrin as it is a antiflammatory.
There is another thing you could try, they are called lidoderm patches.  originally made for people who had nerve pain from shingles.  Now, people use for pain like strains, sprains, tennis elbow, etc.  It numbs the area so  you do not feel the pain.  You could try asking for that to supplement the pain meds.  Just a suggestion, I am not a doctor just a fellow patient :)
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Avatar_m_tn
hydromophone has nothing except a systhetic morphine, the only thing is that my body/system has built a tolerence towards them as well as the oxycodone.  I am worried more bout the aspirin/tylenol.  I am very reluctant to take any more meds with any type nasaids/tylenol/buffers and the patch and the the extended relief(no fillers) probably wont get it either seeing that I work for a zero tolerance employee.   Regardless, if I get hurt at place of employment, i would still come up positive for percs, ther in my system, maybe not that day but the concentration levels are high in my system that they would be detected.  And espeacilly working round machinery.  Like I said, I see my PM Doctor 2morrow and will explain this again but keeping employed is a big goal in this practitioners philsophy.  They are sometimes in certain cases to just say 100% dissabled and unemployable but thats like tooth and nail.  they dont like doing this and to change jobs is probably impossible as they are cutting and reducing the workforce within the entire federal government.   Just a terrible situation
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1331804_tn?1336870958
Hi Steve and welcome to the pain management community!

I am a little confused.  It sounds like you are saying two things: 1, that you want to get on a pain medication that is extended release and take a short acting medication for breakthrough pain that doesn't include combination OTC meds like aspirin, tylenol, or ibuprofen, and 2, that you are concerned about getting hurt at work and testing positive for narcotics.  These two things work against each other.  If you are concerned that you won't be able to function at work on stronger pain medications and then getting tested and let go because of impairment around heavy machinary, it seems that a short acting opioid medication without the tylenol is a good route to take.  The dilaudid (aka hydromorphone) would be a good med to try or oxycodone IR.

However, you state you have a tolerance to opioid medications, and that tolerance could keep you from feeling impaired such that your risk of reprimand is low.  In this case, there is a long acting medication on the market called Exalgo, it is hydromorphone in extended release form.  One pill lasts 24 hours.  

So there seems to be two directions you can take.  Let us know what you decide and how your pain management appointment goes!

femmy  :)
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Avatar_m_tn
Yes and no, My first concern is getting off any pain med which has aspirin/tylenol/ibuprofen in it.  That is the utmost concern and after seeing my PM doctor, he has now prescribed me 4mg hydromorphone 3 x a day and to see how it goes.  This is the same medication I was prescribed for my operation but was taken 4mg every 4 hours, it dosn't last and yes, i have a high tolerance for pain meds and thats why I looked also into the er, you know take at 5pm and don't take again till next day. My PM Doctor will not give me a IR and a ER at the same time, and as far as work goes, Even if im tested the next day without taken pain meds that same day I will come up positive which Im really not concerned 2 much because I have a prescription.  You know, for the past 3 years my visits to the PMs have always been positive, but this last one was horrible.  I was rushed and I was asked to make a decision on what I wanted to be prescribed, like Im a doctor and know all about those pain meds out their.  I felt like I was on a assembly line and they kept the patients flowing in and out as quickly as possible, it was horrible, couldn't even get a questioned answered as I wasn't important enough.  Now Ive been thinking about this alot, looked up alot of information on the web and Im leaning towards asking to go back to the same Meds I had instead of changing to the hydromorphone as this change takes effect the 1st day back to work.  The original meds did work and why change something thats not broken.  
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1331804_tn?1336870958
Hi Steve,

Thanks for clarifying, this is making more sense to me now.

What medication were you on that had either tylenol, aspirin, or ibuprofen in it?  Hydrocodone, the medication in vicodin, lortab, norco does not come without tylenol, aspirin or ibuprofen.  They are developing an extended release hydrocodone medication called Zohydro, but it is isn't scheduled to hit the consumer market until 2013.  They are in the final stage of clinical trials.  

Medical research studies have shown that the most efficacious way to treat chronic pain is through administration of a long-acting medication with a short-acting medication for breakthrough pain.  I would be absolutely miserable without my breakthrough pain medications as I get the worst pain spikes sometimes.  It is really frustrating when a doctor no longer listens to the patient nor addresses his/her concerns and implements a "one size fits all" prescribing practice.  I totally feel your frustrations about this!

Have you considered recording your pain levels in a pain diary and bringing that into your appointment?  That could help him understand more about how your pain behaves on a day to day basis.  

An extended release medication can provide better coverage of your pain than short-acting medications alone but it is important that he works with you to titrate the medication to therapeutic levels; otherwise, you could end up in worse pain with the extended release medication than with the short-acting medication.  

Breakthrough pain meds are very useful during the extended release medication titration period as they are used by the patient to cover spikes in pain.  The amount needed tells the doctor whether or not a titration is needed and by how much.  This phase is repeated until breakthrough pain medications are typically only needed 1-2 times per day.

My only suggestion to you is consider another pain management doctor.  There are many others out there that believe both long-acting and short-acting opioids are needed for optimal coverage of chronic pain.  

I am glad that at least something he prescribed was effective for your pain, and hence, that is the other option...reverting back to what worked before and not rocking the boat.

femmy
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Avatar_m_tn
The ibuprofen 800mg was by itself to take while I was at work, and the pain meds only had tylenol which wer 5mg/325mg oxycodone.  I was tested frquently on my tylenol/liver levels and they are fine.  I was only concerned about any aspirin/APAP/ ect ect because what I have gone through with my current surgery.  But, your right, dont want to rock the boat and seeing I have manage this long with the current pain meds, why really switch now to another.  More confused and I will go see my PM Doc this coming week and try to move back on my contract and leave everything as is for now, and see how it goes.  Just to let you know, Im not really dealing with a pain management doctor, as my user name says Im with the Veterans administration doctors, you now 50 years old, VA, Veteran,  IE steve50vavet
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