Change of medication

[mellie4]

First off, I'm hoping that all those that were in the path of Hurricane Irene are okay.  Some downed trees and branches around here but nothing too bad from what I can tell.

Some of you know a few weeks ago I was hospitalized.  I'm feeling okay, not myself but hopefully will get to the bottom of things soon.  I have an appointment with my primary care doctor on Thursday.  I think this has been going on longer than I realized, possibly even as far back as a year ago.  Like a lot of things, my symptoms were symptoms of many things, and they didn't even seem to be connected.

I thought I was having hot flashes and chalked it up to peri-menopause, but I was running temperatures.  I felt itchy at times and chalked it up to dry skin.  The muscle weakness I attributed to fibromyalgia.  I could go on, but you all get the idea.  As this was going on, I had also been doing a taper, and due to trying to do it too aggressively, and for the wrong reasons, I was going in and out of withdrawal, which is unpleasant, to put it mildly.    I thought the nausea and vomiting was from that.

The medication I have taken the most has been oxycodone.  Right now I'm not taking any long-acting medications, and seem to be okay.  My problem has been that all of a sudden I'm getting nausea and at times vomiting with the oxycodone.  Initially I thought maybe it was just not agreeing with me, even though I never had any real trouble with it before.  A few weeks back they switched me over to morphine.  I'd tried that in the past, and I get a similar amount of pain control from that as I do with the oxycodone.  But with the morphine, I get a headache every time I take it, though it will go away with ibuprofen.  

After I got out of the hospital, the pain clinic team put me back on the oxycodone, and we both figured that now that I'm getting better, the oxycodone won't bother me any more.  Well, it will be a week tomorrow, and I'm still getting bad nausea with it, though only occasional vomiting.  I'll be talking with the pain clinic NP mid-week, and I'm thinking of asking her to put me back on the morphine.  I had no nausea with that, and even though I would rather not have the headaches, I know it will go away with ibuprofen, and I figure that's better than this constant nausea.

Earlier I was thinking of all the different narcotics we've tried.  Vicoden gives me a rash; so that's out.  I would rather not go on a long-acting med at this point because I seem to be doing well enough without it.  Tylenol with codeine isn't strong enough.  I was thinking about Dilaudid or Demerol, though I don't seem to see it mentioned much, and I was wondering why that is.  Anyone know anything about either of those medications?

Years ago I got a shot of Demerol when I was having my first baby, and I don't remember having any side effects from it, and I also remember that it helped.  Dilaudid was given to me after one of my surgeries and it was prescribed by the pain clinic I go to now.  I didn't have any side effects from that either, though it didn't work at all for my post-op pain.  Tylenol was more helpful.  But I'm wondering if maybe it would work now?  It's not the same type of pain, this being chronic and the other being acute.

The only other medication I know of is Tramadol.  I took that years ago for my hand pain, before I had any surgeries.  I didn't like how it made me feel.  It made me feel a bit high and out of it, and it didn't help much.  The other worry I have about Tramadol is that I've read it can be very difficult to come off it due to its antidepressant properties.

So just looking for some opinions or others' experiences.  I'd like to have some idea of what to talk to the doctor about later this week.  Are there any other immediate release medications that I'm missing?  The ones I know about and/or tried so far have been:  Tylenol 3, oxcodone, Vicodin, Tramadol, morphine, Percocet.  (I've also taken Cymbalta and Clonidine for nerve pain.  I couldn't tolerate the Cymbalta and I'm still taking the Clonidine.

I figure once I get whatever is going on under control I can switch back to the oxycodone.  But for right now, I need to have continued good pain control with as few side effects as possible.

Thanks for any insight!!!

[mellie4]

I am hoping to not go back on long-acting meds.  Although if they recommend it, I'll do it.  I let too many family members influence me regarding medications.  Now I am only discussing my meds with my doctors.  I definitely was on too much but I don't think what I'm on now is enough.

[augy]

I have RSD in my leg/foot. I went through all of the pain meds you mentioned plus a couple more before I was prescribed Opana. I take the extended release and the immediate release for bt pain. This is the only medication that has helped me.

[mellie4]

Thanks.  I just don't see it being used very much and wondered why.  I'll be hopefully talking to the pain clinic tomorrow and seeing if we can come up with something.  And after the past few days I am thinking about talking to them about something long-acting.  And once I get to a tolerable pain level, I'll be leaving it alone!!!

[horselip]

Hi Mellie-
I take Dilaudid as a break-thru med along with Oxycontin.It works quite well for me. I take 4 mg every 4 hours, max 4 per day. So far no tolerance issues and I've been on this dose for almost a year. I don't think that there would be any harm in trying it vs oxycodone.
Good luck in what ever you and your docs decide.
Horselip

[mellie4]

I'm actually on Neurontin and it does help, especially in combination with other things, with the nerve pain.  I didn't like the long-acting meds.  I've been on Fentanyl, morphine ER and OxyContin.  I'd like to take as little as possible.  I can deal with where I'm at with the short-acting med.

I just have a gut feeling that the nausea is more from whatever is going on with me.  And I have an appointment with my primary and hopefully we'll get to the bottom of it.  I think it might be something to do with my kidneys.  And I'm wondering if it's due to the really high doses of ibuprofen I've used for the last ten years.

My pain clinic NP is out until Wednesday.  I'm still taking the oxycodone and will as long as I don't start vomiting again.  If that happens, I'll be back at the ER with dehydration and withdrawals.

My feet, especially the left foot, are swollen and I do know when I was in the hospital I was spilling protein into my urine and my blood sugar was high (never had any of that ever before.)

I was just curious about the Demerol and Dilaudid as I don't see them mentioned very often.  It's worth a try.  Right now, I just want to have decent pain control with as few side effects as possible.  I want to take as little medication as possible until I get to the bottom of whatever's going on.

I may call tomorrow and see if they can fit me in instead of waiting until Thursday, or at least get the blood work done so it will be ready for when I see the doctor on Thursday.

[geminigirl1963]

I'm glad to hear that you're starting to feel somewhat better - you sure have been through a lot!  I'm also glad to hear that Irene didn't do major damage up there.

Just an idea with the oxycodone - I've heard and read that the manufacturers have chnaged their formula a bit to make it more difficult for the abusers to crush it/use it in a manner other than how it's supposed to be taken.  I've read that people have had trouble with it not controlling their pain as well with the new formula.  I'm wondering if, by any chance, the manufacturer of your oxycodone has also changed the formula, but instead of it not giving you pain relief, it's making you nauseas.  Or, perhaps it really ISN'T giving you the pain control you've had before from it and the nausea is maybe a symptom of a) increased pain and b) some withdrawal.  I don't know if ALL oxycodone manufacturers have made this switch, but it might be worth a try to a) check your prescriptioin bottle for who the manufacturer is and either try contacting them to see if they've changed their formula since the last time you were on it and b) continuing to try the oxycodone, however, before you turn in your prescription at the pharmacy, talk to the pharmacist and tell him/her tyou've been having trouble with the oxy's from that certain manufacturer (you could show them your old prescription bottle so they can see who it was) and ask them if they have any in stock from a different manufacturer.  If it is just a formulary problem, you may not have the same trouble if you can switch to a different manufacturer.

As far as the demeral or dilaudid - I've had both in the past.  I don't believe demerol is used very much anymore - for one, it's a VERY short acting med, so usually doesn't last more than about two hours, and it's not very effective at all in pill form.  I've had it in both injection and oral form and can tell you from my experience that is very true - the injection worked quickly, but only lasted about an hour or so (fortunately, it was written that I could have it every two hours, so that also shows you how short acting it is) - in oral form, it did absolutely NOTHING for pain for me.

I've also had dilaudid in both forms - in a PCA pump and orally.  I usually get relatively decent pain control from it - obviously a bit more in the PCA pump, as that gets into your system much quicker, but the pill form did work also.  As with any medication, you an dyour doctor may have to do a trial and error to see what dosage woudl be best and most approprirate for you.  The only side effects I experienced from the dilaudid was some sleepiness and some constipation.

Have you ever tried Neurontin for the nerve pain?

I wish you the best and hope you feel 100% real soon!

[AuntieCoosa]

How about trying an alternative approach?  Orthospinology Chiropractic ... he doesn't jerk your spine around, just aligns your cervical spine and once your neck is aligned, the muscles do their job with the rest of your spine all the way down to your tail bone.  There are so many nerve endings coming out of your spine that if there's any pressure on any one of them ... pain, pain, pain.

Worked for me.  Just an idea I'm passing along.  And I don't take any meds for any pains other than an occasional aspirin.

[nurseaudrea]

I just have one quick question first. I don't know your history, only from what I have just read. Do you mind telling me why you got off the long acting pain med? If you need good pain control it seems a long acting pain med would be the way to go? Were you having problems with it? Which one were you on? And why did you stop? Once those questions are addressed then someone may be able to help with sorting out a good short acting pain med.