Concerned about my new pain meds

[Suda]

To: Pain Management Group
Dear PMG:

I only type on this site very infrequently, but now I have a question for all of you who take opoids.

I've begun taking MS-Contin which is morphine (time released) 15 mg. twice per day.  With that my doctor prescribes percocet 10/325 mg. for break through pain.

I've only been taking the MS-Contin now for two (2) months.  But the problem I seem to be having is that I still hurt unless I take four (4) percocet a day along with the two (2) MS-Contin.

I had thought that with the MS-Contin I would only have to take maybe two (2) percocet a day for the break through pain, but this has proven not to be the case.

I don't have another appointment with my physician until April.  She never said I shouldn't and/or couldn't take the four (4) percocet each day for break through pain, but it seems to me that this is not kosher.  It just seems to be quite a lot of pain meds.

I have been taking opoids, just not these for the past 15 years now and here I am taking much stronger opoids and I still feel like something is not working properly at all.

I do apologize for going on and on, but my actual question to the experts out there is whether this is excessive or not.  After all these years has my body built up such a tolerance to opoids that it requires this amount to alleviate my pain.

Oh, and by the way, it doesn't alleviate it 100%, nor would I expect for it to do that.  I know I shall never live totally pain free, nobody does that whether they have chronic pain or not.

So, if anyone out there has the experience of taking opoids for quite some time, I would greatly appreciate your input.

I'm due to refill my percocet in two weeks and that was how the prescription was written before I began taking the MS-Contin.

HELP!  What should I do?  Make an earlier appointment with the doctor?  Call in the prescription as I would have before the MS-Contin?  Or, should I just try to take less of the percocet and deal with the break through pain.

Oh, I have lupus, fibromyalgia, severe osteoporosis, and now they have found also that I have degnerative disk disease.

Any help would be greatly appreciated.  And again, thanks for reading this long post.

Thanks,

Suda

[Suda]

Dear Justme555 & Tuckamore,

So from your expertise and information I shall be calling in my percocet to be refilled next week, as that will be 30 days.  

Still, I have a big fear that she will deny it.  Why are we chronic pain patients so terrified.  Or, maybe I should say why am I so terrified.  First of all if she denies it I will be highly embarrassed (sp). and feel just like the "dope fiend" I was talking about.

But from all your suggestions whether she ok's this refill and writes it or denies it, I need to probably make an earlier appointment.

I do think that if all these "so-called movie stars, celebrities, etc." would stop getting different doctors to prescribe copious amounts of opiates and other strong meds that they have absolutely no real medical reason to be getting it wouldn't be as difficult on the actual chronic pain patients.  It would still be monitored, as well it should be, but not like it is.  Because I'm not sure if anyone else has noticed but every other week some "celebrity" goes to rehab for pain pills they received from various doctors without any real medical reason.  Then the good physicians have to feel even more circumspect as to what they prescribe and to whom.

I apologize for my getting off track here, but this really makes my blood boil, as it makes it even more difficult for people in chronic pain to be taken as people with an actual medical need for such medicines, and not simply pill seekers.

Thanks to all of you for your input.  I feel less afraid about calling in my percocet next week, yet still a bit nervous about doing it, but I shall.

I will let you know if it is ok'd or denied.  I just wish more people understood that the term "chronic pain" means exactly what it says the pain is chronic!!  It will not heal and simply go away.  I wish.  I'm sure we all wish that were the case.

All my best,

Suda

[Tuckamore]

Suda,

Please let us know how it goes with your physician. We seem to all agree that your long acting medication may need to be increased.

However it is not unusual for ppl to require something for break through pain four times a day. A good heart to heart discussion with your physician seems to be in order.

Good luck to you,
Tuck

[Suda]

Dear Shanna707,

Thank you for your response.  Yes, this most likely is the situation, as I've just begun taking it for 2 months now.

I appreciate your responding to my query.

All My Best,

Suda

[justme555]

Sounds like you may need a higher dose. Better that than taking a lot of percocet which I believe has tylenol that can affect your liver (or kidney I can never remember).

I haven't taken mc contin but I know for oxycontin 15 mg is not very high at all. I was taking 250 mg oxycontin a day. Now that was high. But I think the point of breakthru meds is for the occasions when pain breaks through the longacting meds. If your prain "breaks thru" 4 times a day, I'd say that is an indicatin that you just need a higher dose of longacting meds, or perhaps a differnt long acting medicine.

My suggestion: try to schedule an earlier appointment on the grounds that your current regimen needs tweaking.

I understand  feeling paranoid about being viewed as a "dope fiend" that is a fear that is brought on by society and much of the medical community treating pain patients like criminals. But try not to rob yourself of legitimate and deserved care that is your right because of that stigma. It's hard but important to put your care first and stand up for your rights. Good luck

[Shanna707]

Just wanted to say that it is not unusual to need the mscontin dose increased and as long as your not getting over-sedated, where you can't stay awake or your breathing is difficult or lessened,  your dosage is probable not excessive.  It sounds like maybe you need to be bumped up on the ms contin so you can have less breakthrough pain.  Dr.'s like to start you out relatively low and then increase the dosage.  That way it's safer for you.  You may need to take the ms contin more than twice a day.  A pharmacist told me that more doctors have been prescribing 3 times per day because the patient still has breakthrough pain.  So, you do have a few options.  Talk to your DR about your concerns.  
Good Luck

[Suda]

Dear Shananava,

I don't know why she started me on 15 mg. MS-Contin 2 per day.  I had just begun taking percocet 10/325 at 4 per day and at my visit told her it was as if I was "chasing the pain" and that after taking a percocet I would wait because it was for 4 per day, but within 2 hours I felt as if it was time for another and it never was time yet.

I didn't realize that 15 mg. of MS-Contin at 2 per day was a low dosage.  Here I'm worried that I'm a lost cause because even with the MS-Contin I'm still having to take the 4 percocet each day for break through pain.

I have had really bad (deadly reactions to some other meds, NSAID'S 3 times)  the last deadly reaction was when I was trying a titration package of Savella, and anti-depressant that I'd read might help people with anxiety and pain as well.  (I was not depressed, believe it or not) I'd requested the Savella from her and she'd agreed and given me a titration package, but on the 2nd day I began to feel even more exhausted and had more pain, but I held out until day 5 and then quit.  But my body almost quit as well even after I'd stopped taking the Savella.  

My sister took me to the hospital across the street and as my blook pressure was close to non-existant they sent me on to their main hospital in the med center of Houston.  This was all a huge mistake on her part because none of my physicians had previleges at this hospital.  I finally checked myself out after 4 days because I never met the so-called attending physician at all, and I was blown up like a balloon because of the fluids they were pushing into me.  Obviously I lived, but I've sinced changed the person in charge of my medical notification away from my sister.  

Sorry about this long diatribe.  But I'm so afraid that my doctor will just think I'm a huge dope fiend because as I said, I thought 15 mg. of MS-Contin was a large amount, especially when I am still having to take the 4 percocets along with it.

I think I shall wait until it is time to call in for a refill for the percocet, as written at 4 per day, and if there is a problem, like if she says no to the refill, then I shall request an earlier appt with her to explain exactly what's going on.

Thank you so very much for replying to my query as I really don't have anyone else to talk to about this that has one iota of knowledge about these types of situations.

All my best,

Suda

[shananava]

Did she start you our so low to see if you had a reaction to meds? I was started at 30 but was switching from Fentanyl due to costs. I got moved up to 60mg 2/day but it never lasted 8 hrs much less 12, common for many people. Next was 75 2/day ,still not lasting. Last week was changed to 60 3/day and its some better but not covering like Fentanyl. I am on more BT than you and HAVE to have it.
You know your dr more than anyone. I called last time to move up my appointment as my meds werent covering long enough. I don't know how they would react. Using quality of life may be better way to confront your DR. Let her know what you aren't able to do, no just ask straight out for meds.
Shannon

[Suda]

Dear Tuckamore and you other kind souls,

She began my Ms-Contin at 15 mg. two (2) per day.  

My concern is that since I'm still having enough break through pain to warrant me taking the four (4) percocet per day.  The percocet 10/325 mg. was first prescribed all by itself because I'd been taking vicodin 10/325 for about 15 years and it felt as if I was taking nothing for pain really.

When I went to my last appt. I told her that even though I could tell that the percocet was much stronger than the vicodin, I still felt as if I was "chasing the pain" and that I knew the requirements were to take 1 percocet every 4 to 6 hours, but that I would feel after about two hours that it was time to take another percocet, and that's when she added the MS-Contin and told me to use the percocet for break through pain.

So, you do think that I should go ahead and call in my percocet when it is time, just as if I was only taking that medicine.  

My fear is, of course, that she will think I couldn't possibly need four (4) percocet per day along with the MS-Contin, but it seems that I actually do need that amount.

Mind you, when I say I'm taking 4 for break through pain, this is, as most days are for me, without me really doing anything physical whatsoever.

I apologize in advance for this diatribe.....but I feel that I am finally getting the pain control help that I've been needing now for years and I am terrified that my situation will make me seem as if I'm simply a lost cause.

Thank you all again for all you much needed and much appreciated help because there is absolutely no one else in my life I can turn to with this problem.  And, as I said earlier, I'm scared, no terrified that my doctor will just write me off as a dope fiend, although she seems quite well versed when it comes to chronic pain patients.

Thanks,

Suda

[Tuckamore]

In my opinion the dose of MS Contin may have to be increased. I don't think your percocet dose or use is excessive.

However it is my guess that the 20mgs was a starting pint. Your physician may very well evaluate the effectiveness of it and increase the dose. I am not convinced this is a tolerance issue, rather than the right medication for your individual needs.

If I were in your position I would refill the percocet as you normally would and call the physician to get an earlier appt. I can see of no good reason to suffer with more pain than you must. Pain is not productive. You can discuss your concerns with the physician on your next and hopefully earlier appt.

Don't be a stranger. Please let us know how you are doing. I will look forward to your updates with interest.

Take Care,
Tuck

[TrayCee]

if your Dr. prescribed 4 oxycodone a day then I would think it would be fine to take that amount. IMO your not on a very high dose at all.  I would ask her in April to raise yoru morphine dosage.  If your uncomfortable with your dosage then I would make an earlier appt.
No one can really answer these questiosn except you & your Dr.

Good Luck!!

[Shellshocker]

I have been having my current bout of cronic pain for the last 2.5 years.  I was started on oxycontin, then MScontin, and finally fentenyl.  Before the fentenyl patch was rx'd they increased and increased my doses and I never did have relief.  It finally took the fentenyl to give me some relief.  

I think you answered yourself, in that you probably have become tolerant.  Or maybe it is not the right medicine for your pain.  I think on your next appt you should discuss your pain levels with your doc and keep a pain diary so you can show your doc what your pain levels are with your medicines and how much you have to take to get relief.

Sorry to hear of your probelms and wish you the best of luck!

Shelley