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Pain Medication Efficacy and Differences

Hello guys, this is my first post though I've read a few threads from this forum while researching my pain management schedule. What I basically want to get information on is the type of medication I should stick with, and strategies to maintain efficacy.

I'm relatively young but had a few sports injuries when I was in high school and shortly after. End sum is back pain: Protruding discs at each level of my spine (L, T, C), mild-medium scoliosis resulting from my right leg being short, and onset of arthritis in my lumbar spine and cervical spine. Then I have chronic headaches, possibly from Chiari Type 1 but more likely from the disc problem. Also have onset of arthritics in a couple of those spots.

Anyways, my doctor started me on a a medicine regiment in addition to other treatments. I want to focus on the opiods and see if I can glean some knowledge off the people here who know better. She started me on Oxycontin for long-term relief and that's basically not changed. For breakthrough pain she started me on 4 x Per (10/325) a day which I stayed on for about 6 months. When flare ups in my back and head weren't getting broke through by Perc anymore she switched me first to Tramadol for a couple weeks, then do Dilaudid 2 mg 4 x a day. TR just didn't work, and Dilaudid seemed a little better but died off too fast. So for the past few months we've been alternating between Dilaudid and Perc to try and maintain efficacy/reduce tolerance. Last visit I told her the Dilaudid didn't help much with the headaches, and that before going back to Perc I wanted to see if there's another more effective. Now I have Morphine Sulfate 30 which I don't like for a number of reasons (side effects, efficacy).

We've discussed my concern about finding one that works for me, and she always lists off the standard short-actings for me to choose from, i.e. Morphine, Hydromorphone, Hydrocodone, Vicodin, Percocet, etc. The one time I brought up potentially going from 2mg Dilaudid to 4 mg Dilaudid she simply said she didn't want to increase strength. We have good rapport and she knows I'm being honest with her.

Is there a better way to approach looking for something more effective? Is there a reason she'd be so hesitant to increasing strength/dose (i.e. legal, ethical, fear for me getting addicted, etc)?

Sorry for the superlong read! Hopefully I can get a good opinion or two on how to go about finding a better short-fuse opiod that will help my pain. My doctor seems open to any option medication wise, but it seems like she may have a red line she won't cross when it comes to doseage and we may have to cross it to find the right combo. Thanks again!!
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Avatar universal
Peekawho, thanks for the advice. It makes sense that eventually you hit a wall and it just doesn't help as well anymore. I'm going to start looking at some alternative treatments in addition to my current regiment; acupunture sounds like a good start. Thanks again.
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172023 tn?1334672284
The trouble with using narcotics as a first line treatment for non terminal pain is that eventually you will build up so much tolerance to them that you will max out what you can take, AND you will still be in pain.  
You are already on high doses of some very potent medications.  

I wish I had some words of wisdom, but actually I don't.  I'm going to be in your situation eventually.  

The only vague mention I can make is that I take Opana ER, which is a long acting drug loosely related to dilaudid.  With Norco for breakthrough.  This combo was working fairly well for me until now.  

I might suggest trying acupuncture, if you haven't.  I was a complete skeptic, but after a few treatments, it has helped some.  I consider it helpful adjunct to medical care.  It's not terribly expensive.  

Good luck!

Peek
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