My Hydro 10/325s dont work...what do I goto next?

[StephieBee]

Hi....Im new to the site, but not new to chronic pain.

Ive had fibromyalgia and alot of other things for over 7 years now.  I have been treated form everything you could ever think of.  

The only consistant kind of medication that has worked is narcotics.  I have been prescribed anything from ultram to fentanyl patches which i took myself off because I was only 22 and I wanted pain relief options after the age of 40!

I have been on Hydrocodone APAP 10/325 mg once every 4 hours...and its just not cutting it at all.  My rheumetologist is in denial I believe or just scared.

My problem is...I know the next step is Oxycodone (Percocet), but for me it works exactly the same so its almost like there is no point in having to visit him for the refills because its a higher class drug.

What could I ask him for that would be a little stronger than Oxycodone or Hydrocodone?  I dont know what drug would be my next step?

Thanks for your help.
Steph

[drbobinc]

You are certainly correct about NC. Even my own doc said that NC was at least 30 years behind the rest of the country. When I was put on SSDI, the state (NC) cut off my Medicaid because I draw 1100 dollars a month, and in NC, if you are over 959 a month you get nothing-no Medical Care at all. I'm hoping the new law will help people like us in this backward state, but I have my doubts. Good luck, we sure as hell need it!!

[Goblin77]

My mother is 93 years old in excellent mental and physical health but with no cartilage in her knees (advanced demineralization of the bone with severe tricompartmental knee joint osteoarthritis with joint space narrowing, peaking of the inter condylar eminences, and periarticular sclerosis and osteophytosis) which causes excruciating pain when her legs are moved.  My mother has been prescribed Hydrocodone/apap 10/325 two tablets every four hours to help control pain, but it is not strong enough to prevent the pain which to her feels as if sharp pieces of bone are piercing through her skin.  My mother's internist has prescribed ddifferent pain meds over the years, but the above med has proved the best.  a pain specialist had prescribed a drug several years ago that did not help the pain but resulted in three weeks of hellish hallucinations of funeral dirges in her head that would not stop.  My mother, despite the pain, had been mobile using two four-footed canes to navigate from kitchen, to bathroom, to living room, to sunroom, and on hands and feet up and down full flight of stairs to and from her bedroom.  On 9 January 2013, my mother fell down a full flight of stairs breaking the c2 cervical vertebra with subluxation of c1 posterior lay with respect to the body of c2.  My mother was placed in a MiamiJ neck brace in the hospital.  She suffered contusions all over her body and a broken finger, but thankfully no paralysis, though the right arm does not function now as we'll as it did before the fall.  The physical therapy to get my mother to stand and be able to begin walking again or even to transfer to a chair was totally inadequate during her five days in the hospital.  My mother was transferred by stretcher to her home, where we now have a hospital bed set up in the living room.  A physical therapist comes to the home three times each week, but the extreme pain in my mother's knees prevents the physical therapist with our help to get her from a sitting position on the edge of the bed to standing in front of a walker.  My mother streams in pain and tithe tears flow.  It is. Now 6 February almost one month after her fall and we cannot get her out of the bed.  We are desperate to strengthen the muscles in her legs to get her as close to before the fall condition as is possible.  The pt has contacted my mother's doctor for better pain relief for my mother to permit the pt to be able to work with my mother.  We are in Arlington, Virginia.  Please help us with advice regarding better pain management.

  Compounding the problem of getting out of the house to any doctor office is that the first floor of the house is sixteen steps Above street level with no elevator or ramp possible.  My mother would have to be carried out in a stretcher.  We would be so appreciative of any help you can provide.

sincerely, suzanne

[tominnc57]

I am looking for a Compounding Pharmacie that will ship out of state.I live in NC and my Dr is in TX I take Hydrocondine/Dextrom 15/10 my current compounding center will no longer ship out of sate.Can anyone help me with any info.I suffer from cronic pain for many years.NC is such a hard state to be treated in.Thanks

[lightaftdark]

Hello - I really have no experience with this disease but I am very sorry that you have such pain from it. However I do have experience with narcotics and pain management in combating persistent migraine pain. I didnt know what Fibromyalgia was so I looked it up in google and found this website (listed below), which discusses (under the "Treatment" headline) dextromethorphan as a treatment option. Hope this helps!

http://en.wikipedia.org/wiki/Fibromyalgia

-Kate

[StephieBee]

Thanks for trying to understand it from my point of view.  Ive never heard of they cycling.  The only thing I hear is when my father's PM doc talks about detoxing him off the Methadone so his body can try to "re-set" its tolerence somewhat to a lower level.  If I were him Id be in a state of panic.

Im going to the Rheumy tomorrow and I will present him with the Hydro / Dex. compound and see what he says, but i have a feeling he will play dumb like he always seems to do.  

I try to tell him im housebound if not immobile most of the time.  And he'll even ask me if the norco is working and Ill say no...not anymore.  Then he usually shoves some other medication that is used off-label for CP.  Right now its Lyrica which has set me back even more if you ask me.  I cant even force myself to eat of this stuff and all I do is sleep on it.  Whatta life.

[embla_2010]

A couple of things.
1. I wasnt trying to demonize the F. patch, but reality is that there is a ladder of things that is normally taken before climbing the F.patch ladder.  

That ladder is normally through Oxy/Oxycontin (and a coupe of other things) and so forth.  Reality is that Oxycontin is no mooch either when handling pain and we're also talking about a long acting drug just as the patch is.  There you can start low and go to the higher end.  I am on 2 x 40mgs OxyContin a day with 5 x Oxy IR 10mgs for breakthrough.  This is after I wanted to lower it from just over 200 mgs a day as I'm hopefully going to have surgery sometime in the next millenia.  How well the surgery will do I have no clue, but I was worried about controlling the pain right after as I don't want to climb too high too quick in the tolerance market.

The other thing that we've done to avoid going up to the 80mgs (which I was overdue for) was/is cycling me onto Hydro compounds with a very low Ibu mix to control the tolerance.  Its worked very well.  Reality is that if you are looking at being on strong narcotic medication for a very long time/life then you need to keep in mind that going to the end/close to the end of scale is in most cases NOT a good idea, as it leaves you with relatively few places to go. Oxymorphone.... Methadone... and the likes......


2.  I have heard a lot of people talk about dex. and as I write this I am trying to find someones post from a different forum to post here (minus the name) to explain it better.  It was an RN that posted it.  It might well be a good option esp. when mixed with the 15 or 20mgs.  I think the compound way is a good idea and then perhaps Oxy, but in the end it is a VERY individual thing and you have to find what works best for your body.  I myself find that Hydro compounds seem to last longer in my body, about 6 hours, where as the 10mgs of Oxy IR only lasts about four.

3.  Please dont take offense to this as I do not mean any offense at all !! AT all.... This is also just an opinion and everyone has them.. as theyre like.. A*******.  I have never experienced the euphoria (fuzzyness) from the Oxycontin or Oxy IR that I am on.  not from the Percs I was on before, nor the hydro compounds.  Typically if you are correctly dosed you wont I think, but I could be very wrong.  It is not strange at all though to think that you wouldnt get the fuzzy's on hydro if you were on Oxy before as youre going to a lower dose of a sister-medication and it does take a while for that tolerance to completely come down (different between people).
When I first went on Hydro as a cycle-med it took me about a week to adjust, so it could be that its going to take you a few days of continued pain relief through hydro to get to that point.

Ultram will hit you differently than those two medications tho, as the make up of it is very different.  I never got pain relief off that and infact I only got nausea from it.  As I already had nausea this was not a great mix.  Due to the way Ultram is made, you will not ever get fuzzy feeling so many get, that I have heard from many a CP patient that has been on it.  How ever be very careful to not raise your dose as the side effects can be very very bad.  I have heard of seizures, but dont quote me on that.

4.  Reality is that some CP patients will come up against the stigma of being treated like seekers.  I have never had this happen, but I know people that are at deaths door that have been through this. It's very saddening that this happens, but I guess understandable in one sense.  It doesnt sound like you are a seeker *although I dont know you*. It DOES how ever sound like you are trying to come up with a long term plan to control pain as it sounds like you will like so many others be dealing with it for a very long time.  I can only speak for myself, but what you have said so far with wanting to slowly go up in strength and ladder up through the different meds, makes sense because as I mentioned in the end you have to have somewhere to go.  The other option like I also mentioned is cycling through on meds to control tolerance and that is done quite frequently.  My husband did that also while he went through his 9 brain surgeries and even after (he still has probs)

[Patricia0513]

have a question. I was taking oxycontin and oxycodone...I got off that **** cause I didn't like the stigma related to taking pain medications of that caliber... So, my doc put me on Ultram and all that did was make me dizzy, no warm fuzzy feeling...nothing. So, then my doc put me on Vicoden 10mg and still nothing no warm fuzzy feeling... What is going on? Can ultram make your receptors all messed up? I was off all narcotics a week before starting the ultram, which I did by tapering myself... Any hints...

[StephieBee]

Im sorry....I really didnt mean to offend you...I am no way trying to put down the patches...I think they are a wonderful form of pain relief for chronic pain.

I just get scared sometimes thinking that I will end up like my father who is on 120 mg of Methadone for a broken neck and has maxed out on everyother drug known to man.  He just turned 48 and he is looking at a future detoxing off of Methadone because there is nothing to turn to so he can re-set his system and start at a lower dose again.

I dont want to end up like him....dont take it personally, but what is happening to my father scares me.

[Jaybay]

Try not to demonize the fentanyl patch.  Yes, it's a strong drug, but they come in many different dosages, the smallest being a 12 mcg patch.  That is a very small amount leaving plenty of room for movement "up the ladder" if necessary.

I went from the hydrocodone 10/325's to the 25 mcg patch.  It's been a godsend for me.  No more roller coaster rides and going from one pain crisis to another.  I am no where near the maximum dosage and like you, am looking at dealing with pain for the rest of my life.  

I really wish there was a long-acting hydrocodone preparation available instead of just the short-acting ones we have now.  Once you get to the long-acting meds, they're all the really strong stuff - fentanyl, morphine, oxy, methadone, etc.

[StephieBee]

Ya Hydrocodone to Fentanyl is a HUGE jump...thats why I took myself off of them after being on 25 mcgs for about 6 months.  I was lucky enough to come out of in with no w/d's.

Im thinking about asking for 15-20 mgs of Hydrocodone compounded with something.

I have another post about something called dextromethorphan, which another person with fibromyalgia recommended to me.  She had it compounded with her hydrocodone one a 1 to 1 ratio.  So if I had 15 mg of hydrocodone id get 15 mg of dextro.  No tylenol, no fillers...they fill it at a compound pharmacy.
So I hoping to present this to my doctor and see what he says about it.  

I posted about it on another website's forum and got alot of accusations thrown at me like I was some kind of adolescent drug seeker looking to get high on cough suppresents.   (Its a cough suppressant and a main ingredient found in cold medicine)...it was totally ridiculous and they obviously didnt understand a word I was trying to say.  The legitimacy of my pain was even questioned.  Im just so totally disgusted.

[StephieBee]

I appreciate your help...
Unfortunatly Ive been the pain clinic route and all of the ones in Boston make in brutally clear up front on the phone that they will not treat Fibromyalgia with pain medication.  Some even go so far as to say they will not treat a patient that is on pain mediction.

I went off the Fentanyl Patches in the first place because I felt as though there were alot of other meds that I hadnt even considered and here I was on one of the strongest.  Im only 26 and I do realize that I need a long acting pain reliever, but I think fentanyl is a big jump right now considering Ill be on pain meds for the rest of my life.

[embla_2010]

I would take a VERY large pause before thinking of jumping from 10mgs of Hydro and onto Fentanyl.

I don't think your next logical course after 10mg hydro would be a perc which starts at 5 mgs.

You might get better results from Oxy IR 10mg, where you can either take ibu. or apap with it, then there is Roxycodone (perhaps the 15mgs).  

You might also want to consider going on Hydrocodone compounds to lessen the amount of apap but to up the Hydro intake (you can get those in 15 and I think at times 20 mgs mixed with either apap,ibu or dex).

If you need long term pain management (not just for flareups during the day), then perhaps an Oxycontin 20mgs (starting out with) might be an option.  How ever jumping from 10mgs of hydro and onto Fentanyl I would not think is the logical, nor the best option.  As you pointed out, having options later on in life is a good idea, not to mention that there is a logical progression with these things.

[Jaybay]

You might want to reconsider the fentanyl patch.  Since you sound like you need 24/7 coverage, a longer-acting medication might work better for you than the short-acting meds like hydrocodone and percocet.  And at least with the patch you won't have to worry about blasting your liver with all that tylenol.

If your rheumy doesn't want to deal with Sch. II drugs, then why not see a pain management specialist?  I have no problem with a doc honestly stating he feels uncomfortable managing chronic pain patients - as long as an appropriate referral is made.  At any rate, it sounds like a frank discussion is in order with your current doc.  He needs to know that the current treatment isn't helping now, and you need his direction on where to go from here.