Sorry to hear of the uncontrolled pain that you have experiencing. I have been there but now I have control over my pain. I am not pain free and still have flare ups but my life is no longer in bondage to pain. My pain regimen includes the Fentanyl patch which I wear for 48 hours along with oxycodone IR for breakthrough pain. I also take Gabapentin, a muscle relaxer, valium, an anti-depressant, and OTC Aleve. The latter list of medications are known as adjuvant medications which help the opioid medications work more effectively.
The most effective way to control chronic pain is by prescribing a long-acting opioid medication to cover your baseline pain level and also by prescribing a short-acting medication for breakthrough pain which is pain that occurs in between dosing of the long-acting medication.
Types are long-acting medications are as follows:
- MS Contin (Extended Release Morphine),
- Nucynta ER (ER Nucynta)
- Ultram ER (ER Tramadol, brand)
- Opana ER (Extended Release Oxymorphone)
- OxyContin (Extended Release Oxycodone)
- Exalgo (ER Dilaudid)
- BuTrans Patch (ER Buprenephrine)
- Fentanyl Patch (ER Fentanyl)
MS Contin, Opana ER, and OxyContin are typically prescribed 2-3 times per day or every 8 to 12 hours. Exalgo is prescribed every 24 hours. The BuTrans patch last 7 days and the Fentanyl patch lasts 48-72 hours. Some of these medications you may not be opioid tolerant for or in other words may be too strong for you but not all of them are. Your doctor will know which one of these might be a good first long-acting opioid medication for you to try.
Types of short-acting medications are as follows:
- Vicodin, Lortab, Norco
- Opana IR
- Oxycodone IR
I recommend that you speak to your doctor about a long-acting opioid medication along with continued use of the Percocet or similar short-acting medication for breakthrough pain. I wouldn't request any of the medications by name except the ones you are already taking as this sends up red flags.
Short-acting medications like Percocet, increase the build-up tolerance due to how the immediate release action of the pill works on the body. Extended release (long-acting) medications slow the build-up of tolerance as the medication is released slowly and steadily over an extended period of time from 8-12 hours to up to 7 days of action. The Percocet you take now would become a breakthrough pain medication that you take in between doses of the long-acting medication only as needed.
Most patients require one or two dose titrations of the long-acting opioid medication before the dosing is considered optimal. Optimal dosing is achieved typically when the patient requires no more than 2-3 doses of breakthrough pain medication per day.
We wish you the best and please let us know how your appointment goes. Take care.
What kind of doctor do you see? They could up your gabapentin dose. Have you tried Cymbalta? Some have good luck with it for CP. I have bad arthritis, RSD, nerve pain, fibro ...the list goes on. I was at very high doses of a many drugs, including narcotics, and it didn't really help my pain. I've had better pain control after coming off the narcotics, though some of the flare-ups are bad. I found swimming helped my pain quite a bit.