Prolonged Use of Oxycontin

[DMASON]

My mother has been on Oxycontin now for seven years (I was under the impression it's a temporary fix), or more, to manage pain, she's been seeing a neurologist for.

My major concern is the effects it is having on her health, functionality, and brain workings.  

Her RX is now at  20 mg/4x daily. It went to 40mg/4x daily, she made them drop it back. They NOW want to take her to 60mg/4x daily, she refused.

What's going on:
She does not over use it (which happens to be very unfortunate). She has begged her doctor to get her off it because it isn't helping pain and making living for a highly depressed person (before the meds.) more difficult, instead they continually increase the RX.

She attempted to enter a rehab and see other doctors to get her off it and none of them will help, BECAUSE SHE NEVER RUNS OUT EARLY (or, as they explain: "she's not abusing it"), even though she's unable to leave the house, walk properly, remember anything, hold a conversation, ect (her new GP has described her symptoms as in line with a typical stroke victims, w/o the stroke...but is not qualified to make changes ????).

Now, they've found another source of pain, a non-cancerous growth on her spin, which two specialist have not recommended having removed-- but instead decided to increase this prescription AGAIN (the 60mg dosage previously mentioned).

I feel like her quality of life is crashing fast and her, my father, and I can't comprehend any of the rational we receive on why she can't be given better healthcare, when her quality of life is suffering-- they have said there is nothing else to do. She has solid insurance coverage, my father has her covered at work and because she is disabled she has one, or two, supplemental coverages (we've checked they cover a lot).

I need help understanding:
(1)  is it normal to observe stroke victim symptoms  CONSTANTLY, with this use,
(2)  this medical advise she's gotten from several different doctors and/or specialist (DOES IT MAKE SENSE?),
(2)  what can we do or suggest?


                    

[Tuckamore]

Hello DMason,

Welcome to the Pain Mangement Forum. Your mother's reaction to Oxycontin is very unfortunate and I am confused by her physicians attitude. It's a shame that she has to suffer with the effects and still is experiencing pain. I'm sorry that you and she are going through this.

You do not give your Mom's age or the state where she resides. My father is 80, resides in WI and takes 20mg of Oxycontin twice a day with10 mg of Oxycodone for break through pain. After 2 (old) back surgeries his spine is literally crumbling and he suffers compression fractures monthly. PMP do not prescribe narcotics and routinely follow CP patients in our state. Our CP care comes from our PCP. Dad's functioning, ambulatory skills and cognitive ability has improved since his last increase because his pain is controlled. Until the increase a Home Health Nurse that visits our home (he lives with me) recommended that it be taken 3 times a day. When I expressed my concern about a 12 hour medication being taken 3 times a day she said this is quite normal. However I have never heard of Oxycontin being prescribed 4 times a day.  

I assume your mother has great pain and expresses that to her physician(s) and that is the reason they keep increasing the medication. Have you gone on the physician visits with your mother? If not do so and express your concern. I think about all the CP patients that come here and have trouble obtaining more than NSAID's and your mother's case appears to be just the opposite. It doesn't make a lot of sense. There is a piece of the puzzle that is missing.

I see you have a new PCP. Do you have a new PMP? The reason I assume you are seeing a PMP is because the new PCP says he cannot can her medication. If you have not seen a new PMP I would see another one and ask for their opinion and suggestions. If you've seen one than see another. Don't stop until you have answers that you and your mother are comfortable with. No it is not normal to have constant stroke (CVA) symptoms. In my opinion her system is not effectively utilizing the medication and/or she is over medicated. But when she tries to cut down where is her pain level? If it's high than what quality of life does she have if she's writhing in pain? She may be between a rock and a hard place but I beleive there are better answers for her. That will come from another physician, probably in your instance another PMP.  

There are a combination of meds that may be more effective than just one, allowing a cut back on the Oxy with an addition of another med that may help her pain. There are just so many more choices than to keep increasing her dosage. She has good insurance, use it. If she is 55 or over you may want her to also see a good gerontologist in the mix.

Best of luck to you and your Mom. She is blessed to have a concerned and loving daughter such as you. Please keep in touch and let us know how you are both doing. I will look forward to your updates.

Take Care,
Tuck  

[sandee1818]

I am sorry also to hear of your Mom's problems. She is very fortunate to have such a caring child.
As Red said she has built up a tolerance so she may need more than she did in the beginning but she should never ever have more pushed on her than she wishes to take. It is a 12 hour medication and as Red said some use it every 8 hours.
I also advise her to see a PM doctor as they will offer her more options and change her medications or try different approaches that does not involve medications.
I hope she is doing better soon. Keep us posted and let us know how things are going.

[Red931]

I am sorry to hear of your mother's situation.  I agree that it does not make sense to increase her dosage of the medication if she doesn't want to and she doesn't have to. There are other drugs out there that may be more effective with less side effects that she could try, however she has been on the Oxycontin so long she has become dependent and built up a tolerance to it so steps would have to be taken to change her medication safely. All opiates are going to have these types of side effects that you describe after long term use at his doses.

Is she in Pain Management? If not that would be the best option for her at this point. They may keep her on the Oxycontin at a lower dose and give her something else to take for breakthrough pain so that she does not have to stay on such a high and frequent dosing schedule or give her something else as I stated earlier.

Oxycontin is a 12 hr dose medication. Some doctors will prescribe it at 8 hrs after you build up a tolerance as your mom has but four times a day is too often and is probably why she is having most of the problems that you describe.

If she is not in Pain Management then I think that would be the best choice right now. If she is you need to find her a doctor that will listen to your concerns and don't stop until you find one.

Please keep us posted.