Please, I need some input before dr's appt.

[Suda]

Dear Pain Management Group,

You have always helped me in the past, therefore; I am turning to you once again.

For the last three (3) months my dr has had me on 30 mg. MS Contin per day.  She upped that from the original 15 mg. MS Contin per day as I had explained to her that it really didn't seem to help with my pain.

I am also allowed to take four (4) 10/325 percocet per day.  This I must do every day as there is so much break-through pain that it is necessary.

I'm going to see my physician this Friday and I am going to ask if she feels that prescribing me 30 mg. MS Contin at three (3) times per day is an outrageous amount.  I do so hope she doesn't feel that I am some crazy person, and yet I feel like a crazy person because from everything I've read these are very strong pain meds.

But even though the literature on MS Contin says it should last six (6) to eight (8) hours that simply isn't at all how if affects me.  Within about three (3) to four (4) hours of taking my morning pill, I feel horrible break-through pain, and then begin on the percocet.  Everyday I end up having to take all four (4) 10/325 percocet, and even then I feel some really intense pain.

I've asked you all for your help before when I was on 15 mg. MS Contin twice a day, and she upped it to 30 mg. twice a day, and yet still, I feel as if nothing has changed.

Should I even broach the subject of her prescribing the MSC so that I can take another 30 mg. mid day?  Or should I ask if there is something else that she thinks may help more than that?

I'm totally confused and also terrified as usual since these are such strong pain meds and it seems like asking for an even higher dosage is like something a drug addict would do.

I live with lupus, fibromyalgia, degenerative disc disease, and severe osteoporosis.  Hence, I am always living in some pain, and I also expect to always have some pain, but not this deep, bone and all over body aching pain.

If my physician decides that 30 mg. MSC three times per day, with the Percocets for break-through pain is way too much, then I am at my wits end and do feel as if I may break down and ask her to put me in the hospital and take me off everything because this simply isn't working.

I apologize in advance for this diatribe, but I'm always in fear of being seen as a freak, maybe because I feel I must be a freak what with these very strong narcotics not actually working well.  To me they would seem to be able to knock out a horse, but to my body, it's just so-so pain relief.

Any advice would be greatly appreciated, as you have always helped in the past and I have absolutely nobody else in this world to discuss this situation with at all!.

Thanks again!

Sincerely,

Suda

[Suda]

Dear Sarajmt,

Thank you so much for your response.  I have gotten good, no great advice from this panel of people.  I always do.  This place is a literal life saver to me.

I do intend to amend my notes via requesting the three times per day of the MS Contin at 30 mgs.  I will certainly ask my doctor for her advice as to exactly what to do.

I just feel like since she increased the mgs. last time that I thought she may be taking it slow, which with my history of drug reactions is the only medically appropriate way to go.

So, again, thank you so very much for your response to my missive.  I can use all the help I can get.

Sincerely,

Suda

[Suda]

Dear Tuckamore,

Once again, the voice of reason.  You are most likely correct in that maybe this MS Contin is not the medicine for me.

I also agree that I should just tell my doctor how things are really not working at all, and let her come up with some suggestion.

The sad part is that I can tell that the MS Contin is helping, only not as much as I'd assumed it would.

Why is it so very difficult for me, and I do think for a lot of CP suffers to request an increase of any kind.  I always feel as if I've failed my physician and that as usual, I am a wimp, as well as a freak of nature.

So, I will change my list of things and ways to approach this situation, as I always take in a list of things to discuss because I always get totally stressed out, and hence even more exhausted than usual when going to a doctor's appt.

As you mentioned, I too will never, ever expect to have any type of pain free day.  For me a pain level of 5 is fantastic!!.  It never seems to go below that, though there are certain hours in some days where it has gone lower and like you said, I am both amazed, thrilled, and almost call everyone I know who cares, but then of course, I don't.

As far as the Fentynal (sp) patch I am even more terrified of that!  Where, oh where would, or could I go up from there?

Again, you are always so very helpful, and that's saying quite a lot for a person who is living with CP.

I apologize for only coming on here when I need something, but as I said earlier, this is really the only place that anyone wpuld or could come and be even half way understood when it comes to living in pain at all times.

So, again, Thank You!  Thank You! and Thank you more!

Sincerely,

Suda

[Suda]

Dear Namnam46,

As strong as these meds I'm taking now, I have a fear of going up to something so very much stronger because where would I go next?

I thank you for your reply.  I appreciate all the help I can get and this is the place!  Hey, this is the only place, belive me.

So, thank you so much for your response.  I shall take it under advisement.

Sincerely,

Suda

[Sarajmt]

Hi Suda:  You've already gotten good advice.  So please listen to them. And absolutely you should let your doctor know about the lack of adequate pain relief.

[namnam46]

Tuck is right about the fact that Fetanyl won't leave you much choice further down the road. So you definitely need to consider that also.  :)

Good Luck to you.....Sherry

[Tuckamore]

Hello Suda,

It's good to hear from you again. However I am very sorry to hear that you pain regime is not effective for you.

You should not feel like a freak. You simply have a high level of chronic pain. Many of us do also. I have several thought on your medications but remember I am not a physician. These are only my personal thoughts.

It is not unusual to take three doses of a long acting opiate per day. So requesting to take three instead of two is not unheard of. However instead of 30mgs three times per day, 20mgs three times per day may be more effective and not all that much of an increase.

But I am wondering if the Ms Contin is the drug of choice to manage your pain? You may find another long acting opiate more effective. Your system may do better on another opiate. Or you may do better with a different break through medication.

Instead of asking for an increase I would tell your physician exactly how you have been feeling. Tell her just what you have told us, that after several hours you require b/t meds because the pain is so severe. Ask her for help. Let her make the decision rather than asking for this or that, ask for her help and use her expertise.  

All of us know that we must struggle with a certain level of chronic pain. No "pill" is going to take it all away, that unrealistic. However we should be at a tolerable level. My tolerable level is a 5 and I am delighted when I reach a 4 and ecstatic if it ever goes down to a 3. What is tolerable for you may be something very different from my  tolerable.  Whatever your level is discuss this with your physician. Set a goal number and base the effectiveness of every medication on that level.

Fentanyl is very effective for some ppl but if a less potent opiates will control your pain level I would "save" that for further down the road. When you get to Fentanyl it leaves little else if your pain levels increase down the road. But only you and your physician can make that decision. She knows your condition and you know your pain level better than any of us on this forum. So if that is her suggestion I would strongly consider it.

Please let us know how you are doing. As you know I will look forward to hearing from you again soon. Please share with us the results of your next appointment. My heart goes out to you. I hope that you and your physician will find something that will better control your pain.

Take Care Our Friend in Chronic Pain,
~Tuck    

[namnam46]

Hi Suda,

I'm sorry that your meds aren't taking care of all of your pain. It's NOT unusual for a CP Patient to have to take ALL of there BT meds EVERY day. In fact MANY PM Dr.'s EXPECT there Patients to take ALL of their meds each day.

If it were me I WOULDN'T ask for another MSContin a day. I'd ask if it can be raised or IF there is something else that will last longer.

Ho do you feel about the Fentanyl Patch at this point in time? It's beginning to sound as if you might need it. You would get BT meds to go with it. It keeps the medicine at an EVEN dose in your system at all times. There is a chance that after the first month you might need to have it every 48 hrs. if you metabolize it too quickly. I have to change mine EVERY 48 hours. MANY of the CP Patients that use the patch DO have to change it every 48 hrs. I'm sure that you will HAVE to try it at 72 hours first (if nothing else but to appease your Insurance Company).

I was given mine because my DDD is considered to be Severe. BELIEVE me it IS!!! :(

Please let us know how your appointment goes. We will be anxiously awaiting your update...Sherry