Medication Tolerance?

[TMJLady]

Hi Everyone. I have Trigeminal Neuralgia, Arthritic TMJ, and have had my entire left jaw replaced, which left painful damage behind. There is nothing else they can do for me, so there is no "cure." I am left with severe chronic pain that will always be there. I will always be in pain management to control the pain and provide a normal quality of life, or as close as possible. I have been taking oxycodone 10 mg for more than a year. It was working well, with other medications and non-medical management, but recently, it doesn't work as well as it used to. I'm thinking that it's probably a matter of tolerance. But how do I bring this up to my doctor without sounding like a drug seeker?  I don't want to go in there and say "I need stronger meds" or "I need more pills a day."  That seems like it would set off a red flag and I could lose my pain management altogether if that happens.

[ShooterDeb]

I was in the same situation.  I was taking OxyCondone and it was not taking care of the back pain.  My pain management put me on XR OxyContin and I took that until my back procedure was scheduled and done.  My DR's were very understanding and helpful.  My BP is always higher when I am in pain, so there is no fooling anyone.
Good luck

[Tuckamore]

You're so welcome. I bet you'll do fine with your PMP.

Good luck at your appt. I hope you'll share with us what your practitioner has to say.

Take Care,
~Tuck

[Tuckamore]

Hi TMJLady,

It's good to hear from you again - but sorry to hear about your increased pain. You've obtained some good suggestions, as usual.  

My first PMP - the best Doc in the world :o) - didn't believe in tolerance as much as she did a worsening of the condition causing the pain. I tend to agree with her assumption. However I'm not so stupid that I don't realize that tolerance does occur. I just think the numbers are much smaller than most providers report.

I was on the Patch some years ago. I couldn't take it long enough to determine it's effectiveness. The first 24 hours my skin became red and inflamed. In 48 hours my skin was blistered from the adhesive. I took the Patch off.  It was horrid - and I don't have a true tape allergy. It was the adhesive itself.

My Doc prescribed some skin cream to help in the reaction and Benadryl IF the blisters returned. So I applied another Patch. The blisters returned in less than 24 hours with a vengeance. I tried different locations on my body - nothing worked for me.

I agree with Remar that you should try an increase or another oral opiate before going down the Patch Path! I assume when you said you are on Oxycodone you meant the SA form. The LA form is normally referred to as OxyContin - because that's what it is. So are you ordered 10mg QID - four times a day? Sometimes adding a small dose of a LA opiate will better control your pain.

Have a discussion with your PMP. I'd begin it by saying, "I need your help." Then tell him how high your pain levels are - and how that affects your daily life and functioning.  Don't say, I need more or stronger meds - just ask for his help. That's what they are there for - to help us. Maybe he can come up with a great combination that we haven't even thought of here.

Thanks for returning to MH. You've been missed! It's always great to hear from you - and all our members! I'm just sorry that you pain has increased. I'll look forward to hearing from you again soon.

Best of luck my friend in pain!
~Tuck

[TMJLady]

Thanks, Tuck!  I've got an appointment soon and will just tell him what's happening and ask what he suggests. I agree that specifically asking for meds or stronger meds can be seen as drug seeking behavior. I don't want to cause any concern on that part. I just need better management; another tool in my arsenal, so to speak.

[remar]

I'm so sorry you're going through this. We should not have to be afraid to talk to our Drs when we have more pain.
Is Oxycodone the first pain medication you've taken? If so, you may need an increase, which you mentioned. If you've tried other meds it might be time for a change. I can only give you my opinion. It sounds like your current med is still working but just not as well as it used to. Talk to your Dr about this. He may go ahead and increase your dose or give you an extra pill or two per day. He also may want to add a long acting med and keep you on the Oxycodone for breakthrough pain.
There is no need to suffer. Your Dr works for you and his job is to keep your pain levels as low as possible.
I went through this same thing a little over a year ago. My med was just not working any more. I went for my regular visit and when my Dr asked how I was doing I just busted out crying. I apologized but explained that I was in so much pain that I couldn't take it any more but was afraid to talk to her about an increase or a change in my med. We decided on another med and it was the best decision for me. I've been doing well for over a year on the same dose. I'm not saying you should change your med. I really think you should try an increase before doing anything else.
Please keep us up to date and make an appointment very soon to talk to your Dr about this. We're always here to help any way we can.

[AlberniShel]

Hi. Are you on short or long-acting oxycodone? Depending, actually either way, you might want to ask about fentanyl patches. Doctors in my area are converting many from oxycodone pill form to the patches. Less of a concern re. BC College of Physicians and surgeons. I have done the switch but am pretty sure I am having an allergic reaction to the adhesive and thus back to the docs in a couple of days. Otherwise, the patch is ok, and many find it to be a miracle. Personally, I have found it no better or worse than oxys.

[TMJLady]

Thank you for your response. I have read about Fentanyl patches and considered asking the doctor.  I have had allergic reactions to adhesives before so not sure if it would work for me. Can you tell me anything about your experience with pain management and side effects from the patch, please?