Pain getting worse, tolerance going up?

Hella again everyone. I am very worried about my pain because it has been getting worse the past month. I have not been doing anything to make it hurt so bad except take care of my son. He has gotten bigger so maybe that is why my arms are hurting, the weight I am carrying all day is starting to give me sharp nerve pains. I am already taking the maximum dose of norco. I take 12 a day and I have yet to see a pain management clinic bcause the dr is out for 3 weeks for her vacay. I am scared to go tell my dr that I am in so much pain because I am already taking 12 norco. He knows I have chronic pain and he knows I have been taking this meds for a long time but I feel like a failure or like I bother him when I go or that he thinks I only come to see him for drugs, which I don't. I don't know what to do. I know that my pain is unbearable and I am going to have to see him soon anyways I cant keep going in pain but I need some encouragement. Does anyone else get this? Is it perhaps my tolerance building from the drug? I haven't had my tolerance go up in a year so maybe it has gone up? Please share soemthing so I can maybe build up the courage to go because I feel like I am wrong for going to tell him I am in more pain it isn't his fault and he really cant do anything for me except give me pain medicine.

[femmy29]

I agree with what marycarmel has stated.  You have most likely reached tolerance to the norco and/or your pain has become worse.  Research has shown that tolerance builds quicker when on short-acting opioid medications long term as the main med versus using them only for breakthrough pain while on a long-acting opioid.  

A comprehensive pain management program has been proven to be more effacacious than utilizing one therapy alone.  Even within the drug therapy category, adding a muscle relaxer, anti-depressant, and/or an anti-convulsant together with the opioid medication can provide prolonged analgesia than just taking opioids alone.  Have you tried physical therapy yet? I'll be honest, physical therapy didn't work for me but it has worked for many others and it may be worth a try.  Most therapies are worth trying at least once.

The pain from diabetic neuropathy manifests itself as nerve pain.  Nerve pain does not respond well to opioid medications and overall is the one type of pain that is very hard to control.  Neurontin and Lyrica have been found to be more effective at controlling nerve pain than opioids.  Not saying that opioid medications won't be a component to relieving your pain as you have stated that it has been effective long term for you but adding Neurontin or Lyrica could help reduce your pain levels to where they are tolerable again.

Keep in mind that when switching medications, there is an adjustment period that can be a couple of weeks to 2 months in duration where you won't feel like yourself.  Please be sure to give the new medications time for your body to adjust to them.  Don't throw in the towel too quickly.

I think I talked with you about this before on an older thread regarding switching from the norco to some other medication as you are bumping against the max dose of tylenol per day.  There are new limits that are coming out from the pharmaceutical company that state 2,600 mg per day is the new limit versus 4,000 mg per day.  You are at the 4,000 mg per day limit.  Long term, this is not good for your liver.  My doctor thinks I should stay below 2,000 mg per day if I plan to take tylenol every day over the long term.  

Lastly, as marycarmel said, you need to have a discussion about your pain with your doctor.  Tolerance is inevitable...the same dose will not continue to work for a lifetime.  Periodic titrations and/or medication changes are required to maintain sufficient analgesia.  And also as marycarmel said, consider seeing another doctor within the same practice...3 weeks is a long time to wait when pain is concerned.  

femmy

[marycarmel]

I'm not sure where your pain stems from or the type of pain you have, but there could be one or several things going on here.

You could need a different med than the Norco.  You could (likely) have built up a tolerance.  It's unavoidable.  Your pain could also be worse.  And there are times where the medications cause an increase in pain.

You need to have an honest, direct discussion with your pain management doctor.  Are you/they doing anything for your pain other than meds?  Sometimes we have to piece together different things to manage our pain.  Is your doctor in a group?  When mine was on vacation, I could see another one in the practice, though I generally preferred to stay with the one that knew me and my situation best.

[femmy29]

I agree with what marycarmel has stated.  You have most likely reached tolerance to the norco and/or your pain has become worse.  Research has shown that tolerance builds quicker when on short-acting opioid medications long term as the main med versus using them only for breakthrough pain while on a long-acting opioid.  

A comprehensive pain management program has been proven to be more effacacious than utilizing one therapy alone.  Even within the drug therapy category, adding a muscle relaxer, anti-depressant, and/or an anti-convulsant together with the opioid medication can provide prolonged analgesia than just taking opioids alone.  Have you tried physical therapy yet? I'll be honest, physical therapy didn't work for me but it has worked for many others and it may be worth a try.  Most therapies are worth trying at least once.

The pain from diabetic neuropathy manifests itself as nerve pain.  Nerve pain does not respond well to opioid medications and overall is the one type of pain that is very hard to control.  Neurontin and Lyrica have been found to be more effective at controlling nerve pain than opioids.  Not saying that opioid medications won't be a component to relieving your pain as you have stated that it has been effective long term for you but adding Neurontin or Lyrica could help reduce your pain levels to where they are tolerable again.

Keep in mind that when switching medications, there is an adjustment period that can be a couple of weeks to 2 months in duration where you won't feel like yourself.  Please be sure to give the new medications time for your body to adjust to them.  Don't throw in the towel too quickly.

I think I talked with you about this before on an older thread regarding switching from the norco to some other medication as you are bumping against the max dose of tylenol per day.  There are new limits that are coming out from the pharmaceutical company that state 2,600 mg per day is the new limit versus 4,000 mg per day.  You are at the 4,000 mg per day limit.  Long term, this is not good for your liver.  My doctor thinks I should stay below 2,000 mg per day if I plan to take tylenol every day over the long term.  

Lastly, as marycarmel said, you need to have a discussion about your pain with your doctor.  Tolerance is inevitable...the same dose will not continue to work for a lifetime.  Periodic titrations and/or medication changes are required to maintain sufficient analgesia.  And also as marycarmel said, consider seeing another doctor within the same practice...3 weeks is a long time to wait when pain is concerned.  

femmy

[GodWrksNmystryusWYS]

I understand what you all mean about giving medocation time too because when my dr gave me ms contin it took me a week to get used to it, when i stopped taking it when i got pregnant i ha withdrawals for a short tme too. so i was tolerable of it

[GodWrksNmystryusWYS]

I called my Dr today I couldn't take it anymore and he gave me a prescription for MS contin 60mg ER tablets 2 times a day. I took one and I feel pain relief already! I am so glad I called my Dr I don't know whhy I was scared to in the first place. He said that my pain could be getting worse or my tolerance going up. I feel so much better though. He said that take the norco for breakthrough pain, and to call him for any problems witht eh medicine and not only that but my pharmacist is really awesome and I can call them for any reason or any concern they always talk to me nicely.

[GodWrksNmystryusWYS]

Hey I forgot to add something:
I re-read what you said about the tylenol part and having only to be able to take 4,000 mg at once and it is the most. I got prescribed the wrong meds when I had my c-section and got discharged, when I came home I seen that it was 5/325 and not 10/325. I tried to get a hold of my dr and they said she would not be available for the next 4 days (it was new years eve and a weekend). I ended up taking over 6,000 mg just to help with the pain from my incision and I was getting headaches. I went to the ER because I was scared and thought I overdosed and the Dr there told me that I was fine and I didnt show any overdose of tylenol. I was so upset because she thought I was there to get "more drugs" because I explained to her that I have been on pain meds for over 5 years and I needed the stronger dose. She looked at me and said that the normal dose for after having surgery was 5/325. I was done and I left after that. She didnt hear anything I just said! I just wanted to know Iw as ok and I left. My mom gve me some medicine she had from along time ago that was really strong and I took it. I told my dr all about it and that I had to use my mothers pain meds which I know is illegal, but she said it was ok and she was sorry the hospital made a mistake. But it was shocking to me that I had taken so much tylenol and had not overdosed. I was pretty sure I was going to kill my liver in those 3 days having took way over the limit. I felt so alone and helpless after going to the ER and them not helping and acting like it was ok to send me home knowing that I was taking 6g of tylenol! I am glad I am not taking that much norco anymore I only take 6 or less per day since I started the MSContin

[jimgreg]

let me explain..these ***** docs get people hooked on pain meds..then contol us..y cuz they can..there ***** all of them..mine a good doc..she knows i,m medcal inclined..that helps..but if i gave her a RED FLAG she would mess with me..so to sum it up..they want you to get hooked then mess with your mind..some docs will prescibe narcotics to females for sex purpose..knowin you will be back..thats crap..then good ones like us they **** on..

[GodWrksNmystryusWYS]

You don't think you are being just a little paranoid? =) I think my Dr seen all the nerve tests done in my arms and legs and the referral response from the neurologist and facilitates my pain needs now. Before he just was a little hesitant, but listened. Now he listens and asks me my opinion and gives me what we both agree on. He doesn't just say "hey take this" and I am forced to do it like some of these docs out here.

I think some of your grammar is off, it was hard for me to follow what you were saying. If you can re-type it with no grammatical errors maybe I can understand more your standpoint on Dr's and their reign over our sexual desires.

[femmy29]

Sorry for the late reply.  I just noticed your additional note to me.

I am glad to hear that you were put on a extended release medication (MS Contin).  60 mg BID is a good therapeutic dose and it should work really well for you.

The limit of tylenol in one dose is 1,000 mg and limit of tylenol in 24 hours is 4,000 mg.  Exceeding 4,000 mg one time does not necessarily mean your liver will instantly shut down.  It can but it is not a guarranteed death sentence.  Nor is 6,000 mg every day for 2 weeks or every day for a month.  Not all livers are created equal.  Most importantly, doctors observed that exceeding the tylenol limits caused elevated liver enzyme levels in the blood.  Long term elevation of these liver enzyme levels have been shown to lead to liver disease and in the extreme cases, liver failure.  Since all livers are different, if someone other than you did the same thing that you did, they could have had serious issues right away, whereas for others it can take years of continual overdoses of tylenol to cause serious liver problems.

I had similar pain med issues after I had my gall bladder taken out last year.  My surgeon only wanted to dispense 20 percocet when I told her I needed something stronger as the pain from surgery would be at a level that exceeds what my normal meds for chronic pain can cover.  After much debate, she wrote for 40 percocet instead, which was not the solution I was looking for but it got me through the post-op pain.

I am glad that you are able to take a significantly less amount of norco given the pain relief provided from the MS Contin.  I think it will prove very beneficial to your health for many years to come!!  I'm am very happy you finally transitioned to an extended release med to reduce your norco intake and that you got evaluated for tylenol poisoning.  I am extremely happy to hear everything is functioning well and that your pain is back under control! :)

femmy  :)

[Cyndita]

I 'think my Dr. SEEN all the nerve tests..."?? Speaking of grammar, you would use the word "saw" in this regard. The doctor had seen, they had seen, we had seen...see?

[GodWrksNmystryusWYS]

Is this really all you commented for is to correct my grammar? The content was much more interesting (maybe not to you) then the improper use of the term "seen".

I am pretty sure I misspelled other things also, because I have neuropathy in my arms and wrists I get horrible pain in my arms after typing for a long time. So excuse me for not reviewing my post and fixing it, I was hoping people could decipher what I meant. It looks like they can from the responses.

I apologize to everyone for not writing correctly I am sure it was not readable and you had to spend a lot of time translating my improper grammar.