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Avatar universal

Pain management after surgery

I am scheduled for a coccygectomy (surgery to remove the tailbone) on the 29th. I am concerned about pain management post op because I currently already take 30 mg of Oxycodone hcl 4 times daily and 400 mg of Gabapentin 3 times daily for chronic pain from severe Fibromyalgia and Coccydinia. I am at this high of a dosage because my body keeps building up a tolerance and doc has to adjust the dosage higher to control pain. I have been at this dosage for about a year. On pain meds for a total of about 5 years. First let me state that it does not make me "high" at all and never has and that's not why I take it. In fact the one time I accidentally took a double dosage it made me very sick. Honestly, I don't see how people use this med for recreational purposes. I guess it's because my body is used to it and it works for its purpose - to keep my pain bearable. I have read up on this surgery and the recovery time. Everyone's story I have read stresses that it is very painful after surgery and is a very long recuperation. The surgeon has told me I cannot return to work for at least three months. However, I believe he only prescribes Vicodin for post op pain. I am afraid that this is not going to help me as I am already on a stronger pain med and I am going to have more/worse pain than usual and I'm afraid it won't be touched by what I'm currently taking. #1 I don't think I can or should take the Vicodin along with the Oxy. #2 Does anyone have any suggestions as to what I might be able to take along with or in place of what I am currently taking? #3 I want to ask the surgeon about this but I am afraid he will think I am a "drug seeker". It is very sad and unfair that people do that and make it so hard for people who have legit chronic pain issues and I know and understand that doctors are wary of this. Sorry for such a long post but if anyone can advise me on this I would greatly appreciate it. I'm already scared/anxious about the surgery. I won't even be allowed to sit for three weeks post op and I dread having to lie there in more pain than I'm usually in. Thanks again in advance.
7 Responses
7721494 tn?1431631564
Jenni, most of us are chronic painers here, and we know that opioids don't make you high. On the contrary.

But those 30mg oxys are killers -- they'll build tolerance very quickly.

Has your doctor tried opioid rotation to manage your tolerance? This is a common technique to manage opioid tolerance, and one is usually able to lower the equal analgesic dose of pain medication because of a phenomenon known as "cross-tolerance."

Ask your doctor about opioid rotation. I've been managing my pain medications this way for over 20 years.

As for the surgeon, if you have the contract known as a controlled substance agreement with your pain management doctor, then you should not be receiving any opioid medication any other doctor -- to do so would violate your controlled substance agreement, and jeopardize your relationship with your pain doctor.

It is better to have your pain management doc, who knows your tolerance, to prescribe post surgical pain medications.

I've received a great deal of pain relief from a non-opioid -- Lyrica (pregabalin) -- for those times when I've had acute pain from surgery or dental work on top of my chronic pain condition. It is very effective for neuropathic pain. Generally, you start the dose a day or two before the procedure, and take for however long as needed.

To summarize -- ask your pain doc to prescribe for post-op. You may benefit in pain relief from rotating to an alternate opioid, for instance, morphine. For managing the extra acute pain, the use of pregabalin (Lyrica) may be a better pain stopper for opioid tolerant patients. Ask your pain doc.

Finally, for chronic pain, a long-acting opioid along with a breakthrough dose may be more appropriate. This prevents the highs and lows in dose levels one gets when taking a whopper 30mg oxycodone pill, helps with pain control during sleep, and should help retard opioid tolerance.

Finally, the fear of pain has been known to boost actual pain perception. Attitude counts for much with chronic pain, so seek the help of your pain manager.

Best wishes with your upcoming procedure.
Avatar universal
Thank you so much for your response. It was very enlightening. I've never been to a pain management Dr, just my primary care doc. He never did any rotation with me. I just kept moving to higher doses and stronger meds. Started with hydro 5's and progressed from there. I was at one time on both Lyrica and time release Oxycontin but lost my insurance and could only afford to pay out of pocket for the regular Oxy and definitely not the Lyrica. Only just gained full time employment with health insurance in July. I suppose I really should be going to a pain management Dr. but to be honest I've heard so many horror stories about how they treat Fibro sufferers and they continue on in severe pain. And also I am scared of withdrawing from the Oxy. I'm an addict in the sense that I am physically dependent on it. Get sick if I miss a dose as it is. All that aside I need to go see one, see what they have to say and make my own informed opinion. I can't do it before the surgery though as I can't sit or drive at the moment but I will definitely get my primary to refer me to one once I'm mobile. I do believe he would also call in an rx for Lyrica for me now if asked him since I was previously on it. It really will help with post op pain? I'm willing to give it a shot. Thanks again for the info, very much  appreciated.I'm apprehensive but also looking forward to consulting with someone who's an expert in pain management.
7721494 tn?1431631564
Your right about pain docs. Some of them don't believe in prescribing opioids, and then where would you be -- In withdrawal. That's no fun at all.

So, stick with your PCP. He sounds very sympathetic and wants to help your pain.

But if I were you, now that you have insurance, you might ask to move the bulk of that dose to long acting medication: OxyContin.

If you''re taking 30mg x 4 per day, (QID) that's 120mg / day.

Maybe you switch next month to something like 40mg BID (Twice a day) OxyContin plus 5 mg oxycodone QID (4 times a day) for breakthrough pain. This gives you 120mg / day, but without the huge ups and downs in serum opioid level you get from that 30mg pill. It is believed that those big swings in serum level accelerate opiate tolerance.

As for the surgery, ask him to give you a little extra every day for the first month to deal with the surgery. For instance, change that 5mg pill QID to a 10mg or 15mg pill QID during the first month.

This is not medical advice, but just a suggestion based on my own long experience as a man with a bad back.
Avatar universal
Phil gave you very good advice about rotating meds and whatnot. Also with what to do for post surgical pain. Also ask the surgeon what he would prescribe for you. He may have only prescribed Vicodin to a patient because they could be opioid intolerant, or maybe that's what works for them, but you won't know until you ask. And if its not satisfactory, then definitely get your regular doctor involved. And make sure you do this before hand, you don't want to wait until after surgery.

One thing to consider (after your surgery) is that your regular family doctor may, at some point, not be able to prescribe that in the future. Many states are beginning to regulate pain medications, per the DEA breathing down their necks. I'm not saying this is for sure, but it may happen soon and if it does, your doctor may not be able to even prescribe enough to even wean you off, so although he is sympathetic, you may eventually find yourself in a bad situation.

This has happened to many folks all over the country. Many of those stories you can find on this website alone. There are also new rules coming down about doctors having much more responsibility when it comes to paperwork, proof that they are prescribing correctly, even continuing education and certifications in pain management that many family doctors are just not willing to do anymore.

I only say this because I don't want you to end up like so many people who go in to get their next script only to find out that none is forthcoming and there is no legal recourse. You would be literally "up the creek, without a paddle". So it may be worth "interviewing" different pain management specialists to find one that is sympathetic and willing to help you. There are still some left, you just have to find them.

For example, you would get a referral or find one on your own and have your appointment. You would make sure you take all surgical notes, test results, medical records, etc. then you would ask him or her what their plan for you would be. As long as you don't accept a script, you can interview as many as you want / need to find the perfect doctor for you. Just something to think about. (after your surgery, that is. I wouldn't try to do it before surgery).

Oxycodone is notorious for tolerance problems. I just don't want you to find out the hard way, that's all. Your not really on that large of a total daily dosage, its just that it should be spread out differently, and it might control your pain even better. I've also heard some things about Opana. Some people think it doesn't work worth a darn, but some say its a miracle medication, so that's another long acting med to consider.

I wish you the best of luck, especially on your upcoming surgery. Please keep us updated on how your doing. We really do care, that's why were here. Good luck and God bless.
Avatar universal
Hello, I want to add something, but this is NOT to be taken as "advice" or a recommendation! It's just something to think about.

The response to your question (above, where Philnoir responded, "Finally, the fear of pain has been known to boost actual pain perception") got me thinking...

I'm wondering if your surgeon may want to temporarily prescribe an anxiolytic as an adjuvent to your opiod therapy? As long as you don't take enough of it, or too long, to become addicted? For example, 3 or 4 days worth of Valium or Xanax?

Anti-anxiety medications will make you care "less" about your pain (you may hurt, but "who cares" sort of thing).

However, they can be *EXTREMELY* addictive to some people, with withdrawals that will make even the worst opiate withdrawals seem like a cake walk! (I've heard there is no h*ll greater than that of a benzo withdrawal.)

But, in your case, if you are closely monitored, have someone to answer to, are under the watchful eye of friends, family, doctor, and pharmacist, and are *100% SURE* you will not become a victim, you may want to consider talking to you doc about a very short term (3 days or 4 days, 5 days MAX) of those pills.

Again, this is not advice, it's just something to think about, and bring up to your doc.
Avatar universal
so glad i came and read this, im only on 10mg of oxycodone and it doesnt stop the pain,really doesnt make it bearable but i make the best of it, and to the a-holes who have made this med tabu shame on you, im a veteran,young men and women comin home with horrible injuries,old veterans getting older and those old injuries comin back to haunt you,not to mention the nightmares,im so so angry,and they have the nerve to ask me am i depressed,oh god if they only knew,no one understands, the pain is more than i can handle,yet i try to smile and go to work every day, 25 yrs at the same job,yet the pharmacy gives you that dope fiend look when you hand them the script,the whispers to the head pharmacist.oh i cant take it anymore,i pray and i pray,one day my pain will be over, i will be gone,my pain will end,and may all those who didnt understand what i was goin through to hell with you, keep giving foreign aide money,keep sending young soldiers to suffer more than you will ever know,physically and mentally,yet you stand there and want to judge me, be thankful i dont load a clip up and treat you like your a taliban.sorry for the post but my pain and sanity are leaving, and i hurt so bad.
Avatar universal
I felt so bad reading your post. You sound exactly like my son, only 1 year older. I really don't have many words because I can't imagine your pain and anguish, but I do see what my son goes through on a daily basis, but if you ever want to talk, I'm here. Feel free to message me privately as well if you want. I may not have solutions, but I can lend my ear and support. God bless you.
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