new to pain management, help please

[jamjr68]

Hello, I am new to pain management. My third visit to PM Dr is in two weeks and I am not getting any relief. I take my medicine as prescribed. I went from 10/325 oxycodone 4x a day to 30mg avinza, and now I am taking 45mg avinza still with no relief. My pain remains between 5-8 with 9 most evenings. I dont want to be labeled by telling my doc I am not getting any relief.

I am looking for suggestions.

Bulging discs in entire lumbar region with moderate narrowing of bilateral pathways and 2 central protrusions with narrowing coupled with arthritis.

Any suggestions are welcome, I am in unfamiliar territory.

[Tuckamore]

Hello and Welcome to MedHelp's Pain Management Forum. I am glad that you found us and took the time to post but sorry to hear that your pain is not being adequately controlled.

From the manufacturers web-site:
BEGIN QUOTE: " AVINZA® (morphine sulfate extended-release capsules) is a once-daily medicine prescribed for the treatment of moderate to severe chronic (long-term) pain in adults who need ongoing, around-the-clock pain relief for an extended period of time.
AVINZA® is used to treat osteoarthritis pain, low-back pain, and other types of chronic, non-cancer pain." END QUOTE

You are not on a large dose of this opiate. However physicians take care to begin at lower doses when initially prescribing long acting opiates.

I have several thoughts. Morphine has never been very effective in controlling my pain in any formulation. Our systems are all different and respond to medications differently. Finding the right regime to achieve good pain management is a trial and error process. This process requires  close monitoring by your prescribing physician as well as good communication and trust between the doctor and patient. So as suggested above please be sure to tell your PMP that this is simply not effective. Don't be afraid to be honest with him, it's the only way to build a good doctor/patient relationship.

Secondly you don't mention any break-through medications. It is fairly normal to have break-through or short acting (immediate release) opiates prescribed along with (extended release) opiates.

Those of us with Chronic Pain know that we will never be at a 0 pain level. It's probably wishful thinking that we'll average a 1 or 2. Pain levels that range between 3-6 are about average, with an occasional flare that will take us higher.

There are other treatments that if they haven't been considered maybe should be such as steroidal injections, never blocks or a rhizotomy. There are also other non-opiate medications that can be used in conjunction with opiates. As suggested above a TENS Unit may bring you some relief. I admit it did nothing for my pain but I have heard it has been beneficial for others. So please don't despair.

I've also consulted a D.O. (Doctor of Osteopathy) that performs OMT (Osteopathic Manipulation Therapy) that has been extremely beneficial. In my opinion maintaining your spine and supporting structures in good alignment is important in pain management.

A good Physical Therapist can also be beneficial. If you haven't been through a PT program in the last year it may also be a consideration.

I encourage you to discuss these options with your PMP. Be assertive.... not aggressive. Your PMP will respect you for your honesty and willingness to try alternative treatments along with additional or a change in your medications. If your PMP is not willing to work with you to obtain optimum pain control then it may be time to seek a second opinion... or maybe better put another PMP.

We may have Chronic Pain for the remainder of our lives but we don't have to suffer needlessly. There are too many options/possibilities available to us to accept consistent pain levels between 8 or 9. You are your own best health care advocate.

Please keep in touch and let us know how you are doing. I will look forward to your updates with interest.

Best of Luck and Please Take Care,
~Tuck

[Ghilly]

Avinza is morphine, isn't it?  Some people don't metabolize morphine well.  I am one of them.  If I take morphine I may as well have taken a tic tac because I get absolutely NO pain relief from it unless it is injected intravenously.  If you are one of these people, then going to a stronger version of the same drug isn't going to help.  Why not ask if you can switch to OxyContin or something other than morphine to see if that helps?  

I know you don't want to put your doctor off or make him think you're just looking for something stronger, but if what you are taking is not working, you may as well not even be going to him in the first place.  And if he doesn't listen to you when you tell him what works or what doesn't, he's not a good PM doc anyway since most of the battle is being able to communicate with your doctor.  

Ghilly

[bigsissie]

You need to tell your doctor what is up. Any good doctor will be willing to work with different medications to see what works best for you and not automatically assume you are just wanting pain meds so you can get high. If your doctor is not willing to work with you keep looking until you find one that will. You may be opioid tolerant and that could be why the Avanzia is not working for you. I myself can not take oxy's. As for the arthritis I take Black cherry extract capsules for mine and it works better than any otc arthritis med I have ever taken. You may also want to ask about a T.E.N.S unit to help control the pain. Best of luck to you and if there is anything else I may be able to help with just send me a message.

Sissie