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pain medication questions

Hi there, I've been reading posts on medhelp for months but this is my first post. I have a question about pain medication. A little background, I have a some disc disorders (herniated, bulging, degenerative) as well as a lot of nerve damage in my back. (I also have fibromyalgia but I use different, non-narcotic medications and treatments for that.) Anyway, I see a neurologist/pain management doctor regularly and a chiropractor occasionally. I'm doing all the treatments I can including physical therapy, nerve burning, injections, exercise, and medications. I take a muscle relaxer for spasms as well as naprosyn and norco for pain.

Because I'm still in significant pain and have been on norco for a while, my doctor wants to change my prescription and have me try percocet. He thinks it may help more and that I have probably built a bit of a tolerance to the norco. So next week he'll switch me from 4-5 norco 10/325 daily to 4-5 percocet 10/325 daily.

My question is, has anyone ever switched between norco/vicodin and percocet before? Which worked better for you? Did you feel the switch helped with your pain? I know medications work different for everyone, I just would like to get some opinions. I'm nervous about the switch, I've never taken percocet before. I know it's suppose to be 1.5 times stronger than norco, but I know some people feel norco relieves their pain better. If  I feel that way, my doctor should switch me back right? I also am nervous about how percocet will make me feel, I'm a mom and I work, I can't be feeling "high" all day. We've discussed other stronger and longer lasting medications before but I turned them down, I'm afraid of how they'll make me feel, and I fear addiction potential of stronger meds. I have a cousin who's a recovering heroin addict and I never want to go through what he's been through, I've read some of these stronger meds are up to twice as addictive as heroin so I'm not willing to take that risk.

Anyway, if anyone has used both norco/vicodin and percocet I'd really appreciate your experiences and feedback. I also wouldn't mind hearing your experiences with other meds and treatments for back pain, I'm pretty sick of being in pain all the time, as I'm sure many of you are, so any info would help! Thank-you for reading, sorry it was so long. Thanks for any responses.
18 Responses
Avatar universal
Oh, I also use hydrotherapy like swimming and water aerobics at my gym and we're buying a hot tub/Jacuzzi/spa/whatever you wanna call it lol
Avatar universal
Hello, I have been waiting for someone with more experience to respond to your post (I would be interested to know the answer too!) but since no one has yet, I will tell you what I have experienced. I too have DDD, arthritis and bulges/protrusions in my lower back, also question a possible fibro diagnosis but not official yet. Anyhow, I have been dealing with constant back pain for 3yrs and occasional for 5yrs +. I have tried PT (in it again), multiple injections, exercises, chiro, etc but nothing really seems to work. Currently on Vicodin, Neurontin, and Cymbalta.
Ok...where I am going with this is last March I had a hysterectomy. I had fibroids and endo, and my pain management DO thought perhaps my uterus was causing secondary pain to my back. I was put on Oxycodone-acetaminophen (Percocet) after my surgery. I really thought, WOW this has helped the back pain...until I went off the Oxy. I now know that the oxys were taking care of the back pain. It was the first time in years that I can honestly say I was "pain free." As far as a "high" feeling, I did not get that any worse than I did when I started the Vicodin (and I am sensitive to meds) although it did make me feel good and gave me energy (guessing because I had no pain for the first time in many years) as far as becoming "addicted," I don't have the answer to that,  I would say perhaps "dependent to alleviate the pain" I know this can be a difficult choice. I fear the same thing, and thats why I haven't gone back to the oxycodone. I too am a mom, and have a job that I can not be fuzzy for. I guess you have to weigh your options. I would try the Percocet for awhile and see how it affects you. Yes, if it does not work, your pain management doctor should be more than willing to switch you back. Sorry this is so long, I hope I was able to answer some of your questions, or atleast offer some support. Good luck, and keep us posted!
P.S.-Have you noticed a difference in your pain from hydrotherapy or swimming? Just wondering, thinking about giving it a try but worried it may cause more pain. Thanks.
1331804 tn?1336870958
Hi and welcome to the community!  

I have been dealing with chronic back pain due to degenerative lumbar interverbral disc disease with lumbar radiculopathy as well as due to myofascial pain syndrome and extensive nerve damage in my thoracic spine (mid back) for over 12 years.  Over the years, I have been through chiropractic, physical therapy, massage therapy, accupunture, 5 epidural steroid injections, and of course a long list of medications.  I started with just ibuprofen until it ate a hole in my stomach (ulcer).  Added a muscle relaxer called flexeril which helped a little for a little bit.  Then was put on valium which helped me regain my sleep back but was still in pain throughout the day as I only used it at night.  Then I was put on my first real pain killer, Tramadol.  That truly gave me my life back but it began to fizzle out and after 3 years it was barely working at all.  My doctor then added in Vicodin, which contains the same narcotic pain medication as Norco just with more tylenol.  That worked for about a year at which time I started my first long term med, morphine sulfate ER along with Percocet for breakthrough pain.  For some reason, when I tried percocet alone without the morphine, it didn't work as well.  It could be because I was on 1/2 the dose they plan to switch you to but the percocet did help significantly when combined with the morphine for treatment of breakthrough pain.  I needed both a titration in strength for both the morphine and percocet and my pain was still more than I could handle but it was much more controlled than it was in the beginning.  Switched insurances this year and had to find a new doctor and it was the best thing that has ever happened to me.  My new doctor put me on Opana ER, 30 mg twice a day along with percocet for breakthrough pain.  I only now need 2-3 percocets per day versus the 7-8 I was taking while on the morphine sulfate ER and my pain is gone for most of the day; it has been so surreal for me to not have to constantly battle pain every day, all day.

Percocet is quite a bit stronger than the norco you take (more than 1.5 times as strong).  Norco is about 60% the strength of morphine and percocet is 1.5 to 2 times stronger than morphine.  The Opana (oxymorphone) I take is 2 times stronger than percocet.  However, despite this revelation that percocet is more than 1.5 times the strength of norco, it is not too strong of a leap for you.  Many people are prescribed percocet who don't take opioids on a regular basis for things such as dental procedures or post surgery pain.
  
Less than 1% of chronic pain patients get addicted to their pain medication.  If you haven't felt the urge to take more norco for mental reasons, then you are at an extremely low risk of becoming addicted to pain medication.  Addiction and dependancy are two separate things.  Most chronic pain patients are dependant on their opioid medication such that if the medication is abruptly stopped, withdrawal symptoms would occur...the same symptoms happen to an addict as well.  Difference is chronic pain patients in withdrawal don't crave their medications psychologically for the "high", they simply don't feel well.  Many chronic pain patients don't realize their symptoms were even caused by stopping their medications abruptly because they are not addicted to them.  You are probably already dependant on the norco if you have been taking it for at least 6 months or more.  This is okay.  There are many other medications that have no addictive properties that cause withdrawal symptoms such as blood pressure meds (blood pressure spikes when the med is abruptly stopped), anti-depressants (mood swings and headaches occur when the medication is abruptly stopped).

It would be in your best interest to explore a long acting pain medication as it provides a steady stream of pain medication across a 12 hour period versus the roller coaster effect produced by short acting opioid medications.  Short acting opioid medications are typically used for breakthrough pain or acute pain (pain that is expected to last for less than 3 months).  Breakthrough pain is pain that spikes after taking a long acting opioid pain medication.  With the right dose of long acting opioid pain medication, you could possibly only need 2 pills per day of the long acting opioid medication and no norco or percocet for breakthrough pain.  I take 10 mg of percocet in the morning 3 hours before taking the Opana ER for breakthrough pain.  Occassionally, I need 5 mg of percocet in the evening around 5 pm but most days I make it through the entire day pain free without needing percocet.  It is considered optimal dosing when a patient only needs breakthrough pain meds 2 or 3 times a day.  

I am also a mother and I work as an engineer.  I continue to get great reviews of my performance despite me needing strong opioid pain medication.  I actually can concentrate more now on the medication as I am not thinking about pain every minute of the day.  As long as your doctor starts you out on a low dose of long acting opioid medication and titrates up slowly as needed, you shouldn't feel "out of it".  Most pain patients do not get "high" off of pain medication as they are not using the large amounts required to get "high".  People who abuse opioid medications take 5 times the dose I take everyday (many times more than that) to release the euphoria of the medication.  Long-acting opioid medications have to be tampered with to release the euphoria.  Drug addicts snort or inject the long acting opioid to defeat the time release mechanism as when taken properly, they don't get you "high".  There are chronic pain patients that need to take a large amount of pain medication to control their pain but their doctor slowly titrated them up to that dose such that no type of "high" was experienced or is experienced.  Hopefully that makes sense.  

I also take several adjuvant medications: an anti-depressant (changes the way the brain perceives pain and thus provides pain relief), valium, flexeril, and gabapentin (an anti-convulsant that helps a lot with nerve pain).  None of these alone provide enough pain relief but combined together with my opioid medications, they provide substantial pain relief.  These medications along with excercise and self-accupressure provide a comprehensive pain management program. I encourage you to continue your water aerobics even after your pain is controlled as it is good to strengthen the core muscles so they can better support your back.

I do hope that the percocet helps with your pain; however, I think the best approach is to start a long acting opioid medication so that you don't have to worry about pain and pain medication all day.

I do not use the term narcotic as it refers to drugs of abuse and includes illicit drugs.  Narcotic is a term that the DEA regularly uses but it is not the true term for pain medications that contain a substance from the poppy plant.  Opioid is the proper term to refer to medications such as norco, vicodin, percocet, morphine, opana, etc.  

Lastly, I encourage you to visit our "Pain Management Community" Forum on MedHelp.  There are a lot more discussions about pain medications for management of chronic pain.  I think you find a lot of support there also.

femmy
Avatar universal
Wow, thank you for the response. I know I am not the one who started this message, but your reply has helped me so much!! If you don't mind me asking what are your symptoms of Myofacial pain syndrome? When I went to the rheumotologist (it was my first time) she mentioned that she things I may be having this? I was just having aches and pains everywhere, I had trouble explaining it. Now it has improved some, but I continue to have a lot of achiness/burning in both wrist-hands and occasional achiness in knees and feet. My main pain is in lower back though.She did not feel it was Lupus/RA/etc, but did find out that my VIt D was severly low, now they are focusing on trying to get that replaced to see if that helps (no so far). ANyhow, I just wanted to say thanks for all the info!! I appreciate it!
1331804 tn?1336870958
You are very welcome, I'm glad I could help!  And, I think you provided a lot a great info as well for the original poster!  It is great to have two moms testify how much pain management has helped them.  :)

Myofascial pain syndrome is a fancy term for severe muscular pain.  The pain originates from several active triggerpoints embedded deep in the muscular tissue.  When the triggerpoints are activated, they send pain signals to various places in the body.  An active triggerpoint within the muscular tissue of the gluts can send pain signals to the right or left leg.  Where the active triggerpoint is, is usually not where the severe pain stems from.  However, when deep pressure is applied to the triggerpoint it can hurt but many including myself think that it hurts in a good way.  

You can locate triggerpoints by feeling where the tissue in the back appears to tighten and feel thick (or in other words, where thick bands of muscle tissue can be felt)...this is usually where people say they feel a knot in their back.  Accupressure is great at loosening these thick bands of muscle tissue and thereby reducing pain.  Typically, accupressure has to be repeated frequently at first as the tissue surrounding the trigger point tends to knot back up quickly but over time the therapy begins to "stick" for longer periods of time requiring less accupressure sessions.  

I do self-accupressure by using a Theracane.  If you google "theracane", a lot of great information will pop up.  I posted a couple of links below that you may find helpful.  The first one can help you locate the triggerpoints that may be responsible for the pains in your hands and wrists.  The second one is a .pdf file of the Theracane manual for proper use of the green candy cane shaped object for self-accupressure.  I received my theracane through physical therapy about 10 years ago; however, there are several sites on the web that offer theracanes for purchase and should come up when you do the google search if you are interested in purchasing one after reading more about it.  

http://www.triggerpoints.net/
http://www.theracane.com/TCmanual_English.pdf

Low levels of vitamin D have been shown to precipitate pain and also play a role in inducing depression so I think it is good that your doctor is working to elevate your vitamin D levels.  You can also further increase your vitamin D levels by getting a little more sunshine each day.  I hope over time your pain levels decrease from increased vitamin D levels and perhaps self-accupressure.

femmy :)
Avatar universal
Once again, thanks for the info! It is almost scary how many of the trigger points I have, but very very interesting, it helps explain a lot.  I know exactly what you mean when you say "hurts in a good way." Right now I am going to Physical Therapy again, basically the therapist is spending 30 minutes rubbing my butt. It is a little weird, but the deep massage feels good. It hurts pretty bad, get tears in my eyes sometimes but it is a "good hurt." It is so hard to explain, but I know exactly what you mean!!! So if you have these "trigger points" does a muscle relaxer help with the pain at all?  I have not tried one of these yet. Or is there anything else used to treat it? I am kind of at a loss right now. My pain managment NP was hoping that the Cymbalta and PT would help me enough to gradually get off the hydrocodone (and so was I) but the Cymbalta seemed to work for a short period now it has tapered off. I am having quite a bit of discomfort all over. I am a nurse and don't want to be getting on too strong of pain meds, but on the flip side don't know how long I can handle this pain either. It starts to affect all aspects of your life. Anyhow sorry to babble so much, I have been up since 3am with no one to chat with!! lol.....;Thanks!
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