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Tolerance too high, pain meds don't work, what's next?
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Tolerance too high, pain meds don't work, what's next?

I have been on lortab 10/500 3 times a day for a little over a year. I have had 2 spine surgeries 14 years ago, have 2 rods, nine hooks, and a spine fusion about 2/3rds of my back. I only have 2 discs at the bottom of my spine that move, and both are compressed, bulging, and deteriorating. This all causes severe back, hip, and leg pain. I also have one hip slightly higher which adds to the hip and leg pain. I have endometriosis, and adenomyosis which not only is live, but has also left behind tons of scar tissue. I've already had one surgery for it, and it was unsuccessful pain wise. That causes severe bowel cramping, abdominal and pelvic pain. I also have a borderline functioning gallbladder and gallstones. My pain meds are no longer working as well, or sometimes not at all. As it is, I begin to have withdrawal symptoms at the 4-5 hour mark. What happens when they stop working? I'm only 28, I don't really want to increase my meds, or go onto something stronger. I've tried intervention methods, physical therapy, trigger pts, and blocks. Is there any way to rebuild a tolerance to the lortab? Could I switch to another med for awhile, and then back to the lortab? I don't know what to do, but I have been in a lot of pain, and wds, while still on the meds. If anyone has any advise, I'd really appreciate it.
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Oh Kelkel, I feel so VERY sorry for you and what you are going through!!

Have you discussed this with your PM?  There are several options if you don't mind increasing your meds, but since you don't want to that limits some of the things that you can do.  I know there are many people on here that can give you excellent suggestions on what you might ask your Dr. I have never gotten to where I had to do this so I'm unfamiliar with what might be appropriate for you. I'm sure that someone will be along either later this evening or tomorrow with some excellent ideas for you. Please hang in there and they'll be here in awhile.

Please take care and know that I'm thinking of you and wish I could have been more helpful to you.  I'm hoping that you will soon have some relief from you horrendous CP that you are experiencing.  

Be sure and keep us updated on your situation, I'll be anxiously awaiting news from you. Take care...Sherry
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Hi there.
First off I wanted to say, I understand the pain you are going through.  I don't have the same specific back problems as you do, I have degenerative Disk Disease, compressed L4, L5, Sciatica and scoliosis.  I have suffered from back pain since I was 16 when I broke my coccyx bone, and scoliosis from a younger age, I am now 36.  In 1999 I got hurt on the job as a Police Officer arresting a guy twice my size.  I have had repeat back injuries in 2001, 2004, 2006 and 2007.  I have literally compounded my initial injuries, but have never had back surgery, as the doctors I have seen gave me a less than 30% chance that it would resolve my pain.  With that in mind, I have been on several pain medications, starting with Oxycodone, then morphine sulphate.  After about 3 years, those medications didn't work well, as I had a strong tolerance to pain medications.  (I learned about this pain tolerance from a bilateral (double) knee surgery back in 1995 and they had given my Tylenol #3 but did absolutely nothing for me.  They switched it to Demerol, but even that did nothing for the pain.)  I had to literally suffer for months.  When I had the back injuries, my doctor remembered my high tolerance to pain medications and started me off with Oxycodone.  As I mentioned it worked for a while, but then I had to change to something stronger.  I was on 30 mg of slow release and short acting morphine sulfate to manage my pain, but when I became pregnant with my first child in 2008, I went completely off the narcotic pain medication and all medication for that matter for most of the entire pregnancy.  Near the end, I had to take 10 mg of short acting morphine because of the excruciating nerve pain, which was so bad I couldn't walk.  After my son was born via C-Section, I had the WORST frontal femoral nerve pain I had ever had, and the neurologist said it was a result of my sciatica.  I couldn't walk or get to the washroom unassisted by my husband (literally carrying me there and back) for 5 days.  The neurologist ordered me a Rx for Hydromorhone which I learned was 4 times the strength of regular morphine sulfate.  Normal dosing is 2-4 mgs 4 times a day, I was on 8mg.  After I left the hospital, I was told to continue that prescription for my pain.  It has helped me tremendously, but I am now pregnant again (planned after 5 months of trying to conceive) and I am stopping my medications again.  I never had any withdrawal effects from stopping narcotic medications and I attribute that to my incredibly high tolerances.  At most recent, I was on 18 mg of Hydromorphone SR, which I have reduced to 6 mg and from 8 mg short acting to 4 mg short acting.  My plans are to be off the narcotic medications by next weekend.  Despite my not having any withdrawals, I do not want to abruptly stop taking anything, as I have heard of terrible repercussions.  My doctor suggested at one time, when no medication was really working for the neuropathic pain to try methadone.  I thought he was crazy, but his pain management team and advisor explained to him that even though Methadone is used to treat Heroin addicts, it is also very good at relieving nerve pain.  There is a huge stigma associated with that though.    I looked up Lortab, and it doesn't appear to be an extremely strong narcotic.  (Which is good).  You could probably ask your doctor to switch you to Morphine sulfate at a low dose, for a while.  You asked if there was a way to rebuild tolerance to medication, and the only way I am aware of is to stop taking the narcotic pain medication.  Once stopped, your body has a chance to rebuilt a bit of a tolerance, but personally I didn't find that after not being on any medication during my pregnancy made any difference when I restarted taking them.  I suppose that might have had to do with my original tolerance.  I too have had epidural and cortisone injections, para nerve blocks etc.  All the physical therapies and chiropractics you can think of.  Nothing really has ever eased my pain tremendously.  The last resort that I have read of was doing a surgery that deadens the nerve that sends the signal to the brain the indicates the pain.  It doesn't stop the pain from happening, just your perception of it.  I don't know if I would ever do that, because to me, pain is our signaller that something is wrong, and to slow down or stop what is causing it.  If we block that out, what is to stop us from damaging our selves even worse?  As you asked, you could most certainly switch to another medication, that was what I have had to do on about 4 occasions to keep up with the pain management.  What you always have to be cognisant of is becoming addicted to the pain medication, not because you require it, it is a problem when you don't require it.  As my doctor says, addiction to pain medication is relevant.  To need to take it to resolve pain is correct.  To take it because you are addicted to it and it is no longer adequate at resolving pain is not correct.  So I would ask your doctor to adjust your medication, or change it so that it will be effective.  There is no point in taking something which will only be easing your withdrawal symptoms but not effectively resolving your pain.  It doesn't make sense.  Does your doctor know about your withdrawals?  If so, it sounds like you are not taking the right dosage to keep your pain down with out causing withdrawal symptoms.  It almost sounds like you are not taking slow release medications, only fast acting.  Which wont take care of your pain properly.  My pain doctors have always said, you shouldn't be taking your medication when you are already at a high point of pain.  By then it's too late.  You need to be taking an appropriate amount of pain medication to keep your pain from escalating to the point of having to take so much.  This is why they make a long acting version of nearly all pain medications.  They cover your pain for 6-12 hours.  And then you only take they type of pain medication that you are using now (ie Lortab) for what they call breakthrough pain.  I am not too sure if you have heard of what I am referring to or not.  If not, you need to talk to your doctor about it, and if he/she doesn't know about this, you need to speak with a pain management doctor who is a pain specialist.  With all that you have had going on, I am surprised you are not on a long acting pain medication, especially after a year of the same medication, and it not seemingly working well for you.
In addition to anything I have mentioned, please keep in mind, that while I or others may have extensive knowledge in many areas, you should always seek professional medical advice from your own physician, as it pertains to medical conditions or concerns.

Good luck, and if you have any other questions that I can help you with, please feel free to message me directly.

Sincerely,
Sandi (Dragon1973)
MedHelp Down syndrome Community Leader
& Ds Group Forum Founder/Moderator
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547368_tn?1332173665
Hello Kelkel,

I am so very sorry to hear about your poorly managed chronic pain. We at the Pain Mangement Forum can relate to your pain and concerns.

Rest assured that you are on a fairly low dose of a less potent opiate. Lortab is a brand name like Vicodin. It's generic content is acetaminophen (tylenol) and hydrocodone which is the active narcotic in Lortab & Vicodin.

I understand your concern for not switching to go to a more potent narcotic at your young age. I have thought that I too had a tolerance to hydrocodone. I've been on it for about seven years. Try skipping a dose and you will see how effective it actually is, at least that has been my experience.

Although I do not have major pain from spinal structure issues, I have major pain from SIJ Dysfunction. And I do have facet disease. I too have tried all the alternatives that could possibly ease my SIJ pain including,  trigger point injections, massage chair, steroidal injections, jacuzzi therapy, PT, massage therapy, heating pads, acupuncture, NSAID, novacaine type patches, NSAID patches, meditation and the list goes on.  None were/are very effective, or at least none were/are effective for any significant amount of time to any significant degree. Some help get me through a flare.

I have also tried many of the "Big Dog" opiates per my physicians instance. I just do not tolerate them very well or am allergic to many of them. So what did/so I do? I hate to say I learned to live with the pain because that is not entirely true. I have found a regime that helps ease my flares and includes some of the things I've listed above along with an increase in the hydrocodone and the addition of diazepam that relaxes my spasming muscles and tension.  

You might want to discuss the possibility of going up on your Lortab dose or frequency. Maybe taking it four times a day or increasing it to 15 mg's three times a day will help for now. Ask about adding a muscle relaxer to enhance the effectiveness of the hydrocodone. The right muscle relaxer can make a difference. I tried all the usual muscle relaxers, none of which seems to do a whole lot and left me with a hang over type feeling. Finally, again at my physicians insistence I tried diazepam which works wonders for me. I do not have to take it often. Indeed I avoid it because I don't want to over use it.  But when I really need it, I take it. It may help you also.

As I said earlier I have developed a routine when I flare that works for me. It includes, a jacuzzi or hot bath, my message chair (or a massage from my husband) followed by heat, positioning with pillows, my own form of meditation and a diazepam. It took probably close to a year of trial and error to perfect my routine. I admit it doesn't work 100% of the time but it is effective most of the time.

It may be worth a try for you to discover what alternative methods work for you. Each of us are different and just because something is effective for me does not mean it will be effective for you, and visa versa.

Please let us know how you are doing. If you require a low dose of a slow release opiate don't be afraid to try it. Every day medical science is discovering new remedies, treatments and medications. So what we know and have today may very well change dramatically by the time you are 38.  We do what we have to do today and hope that tomorrow will will be different and better options.

I'll look forward to hearing from you again soon. Please keep in touch and never give up. I sincerely hope that you will discover some effective methods of treating your pain. Please consider a request for an increase and/or enhancement to your medications..

Take Care,
~Tuck
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Thanks for the input. I have spoken to my primary care physician about my tolerance. He has suggested increasing my dose of lortab from 10 to 15. And instead of increasing the frequency, he wants to add a low dose of percocet in between. While I'm hesitant, I have tried living with the pain. I tried for 3 years living with the pain, only taking OTC pain relievers, antispasmodics, birth control, non-narcotics, muscle relaxers, and NSAIDS. I was existing, but not really living. I have 3 young children, and a husband. It was affecting them as well. My husband missing work because I was in too much pain to move, my children needs were met, but I didn't play with them. Housework fell on my husbands shoulders. We couldn't plan outings in advance, had to leave places early if I got sick. My husband missed out not only on work, but family events planned through the Army. Not to mention our intimate moments were non-existent due to pelvic pain. So while I'm hesitant, I don't want to find myself back there ever again.

My problem is my pcp is maintaining my current meds, and willing to change my regiment. But he's only doing it for so long before I find another pain clinic. I have been discharged from my two previous clinics, simply because they were uncomfortable with me as a patient. And at those clinics I had to jump through flaming hoops, and fight for the dose I got. Six years ago my husband left for a tour of Iraq. I was young, with a toddler, first time on my own, and we had just purchased a new home. I began an antidepressant, and because I was deathly afraid of being alone at night I used to wander my house with a gun all night waiting for a break-in. I averaged 2 hrs. of sleep a night. I began drinking one shot of bourbon a night one hour before bed. I started to get strange symptoms, confusion, agitation, OCD behavior, and others. My pcp had me seen by multiple psych drs. who each came up with a different diagnosis, and adding different psych meds. I just kept getting worse. I finally saw a really prominent psychiatrist, who told me it was alcohol induced psychosis from drinking with psych meds. That I was highly sensitive to the effects of psych meds, and alcohol, and that one shot was enough to produce my symptoms. I discontinued both the alcohol, and the meds, and was fine immediately, and have been since.

Now pain clinics take one look at that history, and I'm either flat out refused, or in two cases discharged after a couple months. They've told me they just aren't comfortable prescribing me with that record, even though I've never been non-compliant, and they tell me they have no doubts I'm in severe pain and need the meds, probably stronger ones, or higher doses. I am now searching for another one, because my pcp has in the past discontinued my meds without warning, because his clinic doesn't treat chronic pain. I also happen to live in Kentucky where prescription meds are widely abused.

So I don't want to higher or change my dose and then be denied later on and find myself back just existing and not living. I was hoping there was some way to lower my tolerance by switching meds, and then coming back to the lortab. I've even heard of some people taking certain medications at the same time as narcotics, and rebuilding a tolerance while maintaining their current dose.
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I am so sorry to hear bout your problems in the past. Often we tried to "fix" our problems our self through self-medication and unknowingly just cause more complicated issues. It can be a vicious cycle.

I certainly understand your fears and why you did what you did. It's too bad that some physicians can't be more understanding. I know they are constantly monitored by the DEA. Unfortunately anything that may look suspicious they quickly run from for fear of reprimand or losing their licenses.

I wish you the best with the new regime your PCP has suggested. Thank goodness for him.

Is it possible to consult a new psych and get your records cleared up or at least clarified? It may be a good choice in the long run....but I am only guessing. Your PCP can best advise you on this possibility.

Best of luck and please keep in touch.

Take Care,
~Tuck

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I have it all. degenerative disc disease broke tail bone in 1992  auto accident in 1998 causing 3 herniated discs
scoliosis, several bulges, hypermobility 3 desicated discs now meds n lnger work.  Morphine ER 30 mg 4 am, 3 PM, Soma, Norco 10/325 2 4 times a day.  Always sever pain Motrin 800 shots in back,yoga, accupuncture, tens unit, back to life machine, inversion table swimming and so on.  Always in pain.  What to do.  Maybe oxycontin.  I am affraid.  Was told surgery would be 12-16 hrs with 80% unable to walk.  I am 52 and look 30 something.  I am 5'4" and weigh 118.  I want my life back and I do not want to be sad all the time.  

Sincerely
Soso
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Welcome to the forum Soso. I'm so sorry that you have so much pain! We're not doctors here. We are chronic pain patients who try to help each other. Just wanted to let you know that. This is a great website because many people here really understand what it's like to live in pain every day.

The thread that you posted on is more than five months old. You will probably get more responses if you start a new thread. All you have to do is click on the green button that says "Post a Question" at the top of the page.

Have you told your doctor that you're feeling down? Depression seems to go hand in hand with chronic pain. Are you scheduled for surgery?

Hugs,

Flower

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Avatar_m_tn
Hi
I was wondering if you can help I have had 4 back surgeries I have taken various meds to help pain oxy morphine Demerol,
Unfortunatly none work is there a medical term for a person that these type of meds wont help Also to let u know I haven't abused any of them
Thanks for yout time
                                         Pat
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Avatar_m_tn
Hi
I was wondering if you can help I have had 4 back surgeries I have taken various meds to help pain oxy morphine Demerol,
Unfortunatly none work is there a medical term for a person that these type of meds wont help Also to let u know I haven't abused any of them
Thanks for yout time
                                         Pat
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1326416_tn?1370930601
This post is from 2010. It's a little old for anyone who posted previously to respond to your post, but i will! I'm sure there is a name for your problem. It might be very hard to find a doctor to really take your problem seriously, unfortunately. I think an anesthesiologist with a specialty in pain management would be your best bet in finding something to help with your pain. They can do nerve blocks, and know about a lot of different types of medications to treat all types of pain. Good luck.
            shinty
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