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Oxycodone tolerance

Hey guys, I've been in PM for almost 5 years. My current PM doc is very strict and by the rules kind of guy, which I don't mind since my first PM doc got shut down by the dea. My first PM doc had me on 180 mg of oxy a day and the new doc lowered me to 120 mg a day. Which was extremely hard at first but I eventually got used to it. I'm going on 3 years with current doc and am getting almost no relief anymore and when I talk to my doc about it he says sorry that's as high as he can go with my dosage. Is it normal that my tolerance is gone this fast and my relief is minimal at best for maybe a half an hour to an hour after I take my 30 mg pill? My condition is severe kyphosis and scholiosis which had led to EVERY disk in my back either bulging, partially degenerated or totally degenerated. My life now consists of almost totally being bed ridden. Oh and btw I also get 2 10 mg hydrocodone for breakthrough pain which to me almost seems like a joke. Any advise or help would be greatly appreciated. Thanks
26 Responses
547368 tn?1440541785
Hey Tommy,

Sift through all the suggestions we've offered and take what you think will work best for you and discuss it with your physician.

Research any medications suggested here before you ask your provider to order them. Know what you are asking for - and remember just because it works for one doesn't mean it will be effective for another (you.)  Our systems are different and therefore we often respond differently.

I hope you'll find a solution! My heart goes out to you.
Avatar universal
Yes, for some of us it can be unusual to stay at the same  and same medication for 3 years and not become tolerant. Many Drs do not like to prescribe higher than 30 mgs of Oxycodone
Have you talked to your Dr about trying another medication? It makes no sense to keep you on something that isn't working any more. You might be able to switch to a different med at a lower dose and do much better on it. Another option would be to switch you to a long acting med with a short acting one for breakthrough pain.
I'm so sorry you're going through this. With these new laws many Drs are afraid to prescribe doses and medications that their patients need.
I would recommend making an appointment with him and talking about what I mentioned. Putting you on a long acting medication. Many people do well on 2 to 3 doses per day. And changing the Hydrocodone to something else at 4 times per day. Explain to him that you've been at the same dose for 3 years and many people do become tolerant to their meds after that amount of time.
Don't be afraid to talk to him. Remember that you are the one paying him and he works for you. If he refuses then you may want to think about finding another pain Dr. No one should have to be in so much pain that they're practically bedridden. It's just inhumane.
7721494 tn?1431627964
One strategy for dealing with opioid tolerance is an opioid rotation. Changing to a different opioid-based analgesic, especially one from a different opioid family, might help reduce your pain at an equivalent dose.

If your doctor is a pain specialist, he/she will know about this technique, and how to manage it.

Let me also add that in some states, 120mg of opioid analgesic is a maximum dose. You may live in one of those states.

However, if your doctor has his or her own limits, based on little than their "comfort" in prescribing (which means protecting themselves from scrutiny of local medical boards or expensive litigation), then find yourself another pain doctor.

Avatar universal
Thanks for the info. The only other mess that he actually considered was opana and morphine sulfate. My first pm doc had me on the mor sulfate for about 6 months to no avail. When he finally switched me to the roxycodone I was like omg I can do things again but like I said after about 9 months or so I was back to my same ole miserable self. When I researched the opana er a lot of people said that the withdrawal symptoms were way worse than oxycodone withdrawal and since unfortunaly about 6 times per year I have to experiance those miserable feelings It's really got me worried about what I'd have to deal with withdrawing from those. Btw there's nothing that can be done about those withdrawals because as one of you mentioned this doc really covers his *** and if my 30 days comes on a Saturday oh well, tough, I've got to wait till Monday or Tuesday to go see him, and this happens quite a lot. As far as going to a new doc my latest Mri is out of date and I can't imagine having to go through that again, I'd rather die than to be put through that misery again. My last one for this doc was close to 3.5 hours long of the most brutely painful things that I've ever been through. I called all my family and closest friends and told them that I loved them and to tell them goodbye. My mental or physical state of mind wouldn't allow it to happen to me again. I can only pray that my heart will give out and allow me to be free from all this misery. God it ***** so bad to be in this America suffering from such a horrendous spinal condition. Thanks dea and government officials from deciding how much treatment I am entitled to and I hope that once enough of us perish dealing with this misery that something can be done for our future generations. Sorry for all of my ramblings but sometimes it does fell better just to vent out some of my frustrations. Thanks guys!
Avatar universal
My pm doc wanted me to go see a psychiatrist because of all the depression that I've been feeling lately. I finally made an appointment with one about a month and a half ago and he put me on cymbalta which I have to admit has given me a little (emphasis on the word little) bit of depression relief. Unfortunately I can't stop thinking about the horrendous situation that I'm forced to deal with on a daily basis and fall right back into my miserable state. I'm only 45 and can't help but wonder how in the heck I'm going to be able to live a somewhat normal life. I was always an avid outdoorsman (now I go on boat rides when I feel up to it) and make two or three casts if I'm able to. When I go to my hunting camp which is one of my FAVORITE things to do I'm basically forced to lay in bed there instead of being the once very active guy that I was. My fav part of camp life is sitting around the fire and now my only way to do this is to pull my golf cart up next to the guys and lay across my front seat till I can't take the pain anymore. Don't I have a good reason to feel this much depression or is there something out there that can actually help me? I'm really getting sick and tired of laying in my bed reading and watching tv for sometimes up to 60 hours straight because of the inability to sleep because of the intense pain Once again sorry for the ranting, just trying to figure out the best way to deal with this misery.

Thanks for listening

Tommy
Avatar universal
Are you saying that your last MRI took 3 1/2 hours? That seems extremely long to me. I had one done a few months ago on my thoracic and lumbar regions and it was only about 40 minutes long, maybe less. They even gave me a warm blanket. I would ask my Dr why in the world it took so long for you.
There's no reason you should have to be in this much pain. I mentioned talking to your Dr about trying another medication, and that's the same thing Phil said too. The first med I was on worked great for a little over 8 months and then it slowly stopped working so I let my Dr know what was going on. She switched me to a different med at the same dose and it made such a big difference. It did have to be increased after a few months and then again it made a big difference.
There is absolutely no reason why you should be in this much pain and have to spend so much time in bed because of your pain. Not when there are medications available that could help you so much. Your Dr is worried about his own self and not the care of his patients. I think most of us know why Drs are worried. It's because of these new laws. I've been researching to see if there are any Drs that are actually losing their licenses because they're treating pain patients at the doses they need. I'm coming up with nothing.
Your current Dr is under treating you so of course you're going to have depression. Many of us that have chronic pain that is either not being treated or under treated have depression and anxiety.
Like I said, make an appointment with your current Dr and tell him that you need to try another medication. If he refuses then you really should find another Dr that will treat you properly. As bad as your pain sounds you may need to be on both a long acting and a short acting med.
I think Philnoir has a really good Dr because he does rotate Phil about once a year, I think that's a very smart thing to do because many of us only get about a year of of a pain med and then it stops working as well, or quits working altogether.
I'm sorry for the very long message. What you're going through is so heart breaking and it doesn't have to be this way. Do some research today on new pain Drs, okay. It will be a good idea to have some lined up just in case your current Dr refuses to put you on a different med.
Avatar universal
I just re read your first post and I saw that your previous Dr did get shut down. I also see that you live in LA. Like FL, this is probably one of the states that they really cracked down on. He may have gotten in to trouble for prescribing more than 4 pills per day. Do you think that was the case?
547368 tn?1440541785
Hi Tommy,

Welcome to our Pain Management Community. Forgive my tardy arrival to your thread - I was out of town for awhile.

I've read your entire thread and my heart goes out to you! I am so very sorry for your pain and all you are going through. I know my words don't help - nothing will help much until you get better pain control. Remar and Phil have offered some good suggestions. I agree.

I'm wondering if you are a candidate for a "Pain Pump"?  Intrathecal drug delivery systems are implanted for chronic pain when conservative therapies have failed. Does the condition of your spine prohibit this approach?

The depression you are feeling may be what's called Situational Depression. It's just what it's label indicates - Depression caused by your situation. Most of us Chronic Pain patients experience it on an on-going bases or consistently - often hiding just below the surface. It hit my once quite severely when I was forced to give up my second career that this horrid CP took from me. I was prescribed Cymbalta. It did help and in six weeks I took myself off it and went on.

I face the same that you do - a PMP that is afraid to RX enough opiates to effectively treat my pain. This is the 3rd PMP in 18 months and all were very similar. If you are ordered LA opiates you get only 2 SA opiates a day. If you don't take LA meds than you are ordered just 4 SA opiates per day. Low doses of them all. I am living on borrowed time and may be gone new week - but that doesn't even matter. They are not going to risk their licenses to effectively treat me - or you!!

There are a few PMP - even PCP that understand the laws better. I've read every "law" or guideline I can get my hands on. They all say that if proper documentation is preformed  - including monitoring and physical assessments of a CP patient than physicians are allowed to treat pain effectively. Most every document comes with statements that CP should be treated and patients not left to suffer needlessly. However every physician knows of - or knows someone that knows someone that has been sanctioned, audited or lost their licenses. Who can blame them for their fear? Well some physicians do blame them and do treat pain effectively - but they are far and few between. That's the PMP you need to locate.

I've found one in another state. He has a patient 5 stars rating. He treats my friend and has agreed to see me. However I just can't up and move - plus I don't like the weather in that state. So what does one do? We are between a rock and a hard spot. I feel your pain. I'm so sorry.

I apologize for this long and tardy response. I just want you to know that you are not alone - and we get it. Please stay with us - and keep us updated. Feel free to begin new threads (questions). We all vent sometimes and you're entitled to do that also.

The pendulum will swing - but I don't know how long that will take nor how far that "swing" will take us. Hang in my friend in pain. We're in this together.

Take Care,
~Tuck
7721494 tn?1431627964
Tommy, the best move I ever made in my pain management journey was to develop a permanent relationship with a pain psychologist. This man has provided me a full load of information and support, far beyond anything that a pain specialist can offer.

And when I've needed support in justifying a dose increase, my pain psychologist has been there, adding a medically trained voice in support of my request.

When dealing with intransigent physicians who refuse to offer more pain medicine than I require, he's helped me find other physicians who aren't so stubborn.

He's also recommended treatment options that current pain doctors were unaware.

And always, he's been a sympathetic and supportive listener to my frustrations and struggles in living with this disease called chronic pain. Often, he has suggestions to help overcome one or more aspects of my frustration.

But there's one thing he's never helped me with -- my depression.

Any physician who is unaware of the relationship between chronic illness and depressive mental states has his or her head in the sand. Most physicians know how to  treat clinical depression, or can make a referral to a psychiatrist for treatment.

Pain psychologists are usually not involved in the treatment of depression, because physicians are sensitive to the problem and (too) eager to offer antidepressant medication that may or may not be appropriate.

In my experience, when a pain patient has good care and adequate pain control, including symptom management -- like a treatment for lack of energy or insomnia -- they become highly functional individuals. Their family relationships improve, they achieve success in their careers, and their lives begin to work again.

With these improvements, depression fades without treatment.

When you are at your hunting camp, are you depressed?

Get your pain managed properly, and get your life back again.

547368 tn?1440541785
Good to see you. I agree with you. That said my experience with a pain psychologist was not good.

Early on in my CP journey this professional woman (I use that term loosely) labeled me a Malingerer - after a 40 minute "evaluation"  -  I almost lost it!!  Not only did I have multiple pain producing issues I had two undiagnosed conditions - one was DX the next week - the other took ten years!  It's difficult to be believed when you have that label hanging over your head.

Following that I luckily had three physicians that backed me. They each said to refer anyone I consulted in the future to their notes - each dismissed the DX of a Malingerer.

You are blessed to have a great pain psychologist. It's not true for all of us. However I'm hopefully that my experience was not the rule. I avoid that referral at all costs due to my experience.
Avatar universal
Omg do a quick research on dr joseph mogan. It was beyond prescribing to many meds by far but at the end he was prescribing me 5 30 mg roxycodone per day with 2 10 mg hydro for breakthrough. I guess this would help explain my severe apprehension towards finding another pm doc. I'm pretty sure this guy won't get shut down by the dea/mafia.
Avatar universal
Oh and as far as my Mri taking so long, I felt so bad for the X-ray tech. She had been doing her job for almost 15 years and said she hadn't had an mri come close to lasting as long as mine did. I think I mentioned earlier about my severe kyphosis( schermans disease, sorry spelling) but in order to get a good film they forced me to straighten up my spine as good as possible because it was on open mri machine and I kept blacking out due to the pain and would have to start over so as you could imagine my 45 minutes turned into an almost 4 hour trip to hell. I was heavily medicated but it made absolutely no difference. It was pretty ridiculous.
Avatar universal
Thanks tuck!! For whatever reason it does make me feel better knowing that I'm not alone through this. Thanks to everyone posting!! From the bottom of my heart thank you!
Avatar universal
Omg you couldn't imagine how depressing it is up there. I was the crazy fire builder always trying to make the fire bigger and bigger all the while sitting with my group of best friends (for close to 30 year so) and getting stupid drunk. Obviously my drinking days are done and idk it's just really depressing siting around watching them having so much fun while I lay across the seat of my golf cart in a silent stupor thinking about how fun this used to be. I always am the first one to bed and just lay there crying thinking how pathetic my life has become.
Avatar universal
Gee thanks tuck for making me have to pull out a dictionary to see what the hell that word meant:-)  (see you got some of my old sense of humor to come back thanks)but I almost feel like I'm being treated the same way or just looking for more meds( drug seeker)? I've even got 2 brothers 1 of which is so sympathetic and tries to help as much as humanly possible and the other makes me feel like exactly like you stated. Just last week we were at a friends house watching the saints WHO DAT!!! And one of our friends whoes a nurse and has seen my films was telling me how bad she felt for me and under his breath(my unsympathetic brother) said oh yea he's got it so bad laying in his bed all day staying all loaded on pain meds. Poor guys got it so bad give me a freaking break. I couldn't tell you the last time I felt any type of "buzz or high" from my meds as I'm sure y'all are all aware. Man it makes me so mad! I really appreciate all of you reading my ridiculously long posts and constant rants but in this situation that I'm in it feels so good to be able to talk to others in my situation. I've been holding all this stuff in for so many years.

Sorry everyone
Thanks
Tommy
547368 tn?1440541785
I checked on Dr Morgan as you suggested. It claims he has sanctions.
It's strange as the document they send you to is not for him. It's a Jed Lane Morris MD.

However after reading on I did see the new report. That's the DEAs side of the story. I'd be interested in hearing his side.

Your life isn't pathetic. You'll find (if you look) things that you can do - besides "getting stupid drunk" - I do understand it's the comradely with those friends that you miss most. I missed my softball friends and other sports and physical things I did.

Look, you'll find other things to occupy your time - and you don't have to give up those best friends of 30 years. True friends don't care if you can no longer drink - or participate in the activities you once did. They are not going any where.  
Avatar universal
Trust me my hunting buddies bend over backwards to help me out n any way they can. I think it's just so depressing knowing that I can't do the things with them anymore like I used to. So many of my friends jump through hoops to help me out and try to make me feel better. As I'm sure you know most of my brain is concentrating on the miserable pain I'm in.
1446517 tn?1304546575
Ask him if he will switch you to KADIAN ER.
I have it ONLY for break-through pain and I had to fight like hell to get it.
It is "ER", so it lasts 12 hours like oxycontin.
I take 65MGs when I have a flare-up that leaves me begging for a bullet.
I told my primary doc that its cheaper than me going to the emergency room.
I even offered to bring in the bottle so he can SEE, I only take it for breakthrough pain.
Its worth asking about....it is the magic bullet for me.
I have to say, I hated oxycontin but I can take oxycodone and they are really the same, one is just extended relief.
MEDICARE said the urine screenings are "not medically necessary" so I had to leave.....the "contract thing".
My primary doc only makes me fill out a questionaire once a year instead of the urine screening.
HE GETS ITS EXPENSIVE and for me to be just on oxycodone 20MG BID + the break through med (once every other month) its not worth paying $2,400.00 a year to have my pee inspected.
I use to be on (4) narcotics + controlled meds, and I weaned down in order for my primary care doctor to prescribe for me. (Its all about his comfort and not so much about mine)
Those urine screenings bring in the big bucks and everyone wants in on that.
Seniors are being screened for angel dust and crack cocaine! The more testing they order, the bigger the kick-back.
Plus, they tend to over prescribed,imo.
I call it the "constipation clinic"!   :-)
Been there done that, cannot afford the price tag.
1446517 tn?1304546575
Totally agree...I told her to request Kadian ER instead.
Lower dose like 65MG, and its extended relief.
Yes its morphine, but with a lower dose and her issues, I think it would be a good fit.
I hope she at least asks about it.
Avatar universal
Thanks I will. My pm appt is this Friday so I'm gonna go in with all of this info and see what kind of changes we can make to try and get me some much needed relief. It's been way to long but because of my insane fear of just being dropped for no apparent reason because I'm being a troublemaker I've just got to suck it up and finally do something. I guess we'll just have to see and just let the chips fall where they may.
Avatar universal
I really hope your upcoming visit with your Dr goes well. You got a lot of great advice from the members so you have much to think about.
If your Dr refuses to make any changes at all then you really should think about checking out other Drs. I understand it may be scary for you but I don't see a problem with at least making an appointment with a different pain Dr to talk about what your options would be if you became his/ her patient.
You're not alone, you have all of us here to support you. The people on this forum are so wonderful and they've helped me through some really hard times. I'm so thankful to have the friends I've made here. I think you're going to feel the same way too.
Avatar universal
Thanks remar and everyone else on here THANK YOU!  I'll keep you guys posted on what happens Friday. After doc appt I'm going up to the camp soo I'll probably get back on late Sunday or early mon. It's helped me tremendously already so I know exactly what you're talking about.
Avatar universal
Im late posting I cried reading your posts Tb70 Im only 41 I have DDD through my T.spine and hernation very painful I to was very very active but not anymore amd im always on oxycodone and feel very little relief my family doc cares for me my old pm doc was injection happy amd now I owe him a ton for shots that didn't do crap I cry daily I want my old life back so bad I was happy all the time i was in shape I laughed I lived life my kids keep me going thank god I have my kids so Indo know how you are feeling
Avatar universal
Thanks Corey! I really appreciate the sympathy. Idk if you have ever seen a psychologist but my spirits have def improved since I've started seeing him. He's the one that told me to go on the web and search for people in my situation just to talk to,and wow did it help me out. He also put me on cymbalta and my spirits are way up,but it still doesn't change the fact that I can't go the bathroom right now cause I can't figure out how to clean myself but I'm no longer so freaking miserable about it. Idk just something to think about to try and help you out. Stay strong! If you need someone to talk to don't hesitate to reach out. I along with everyone on here are more than willing to help you out in any way we can
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