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What do I tell my pain management peopke

Started Pain Mgnt. IN October. They reduced my hydrocodone from 180 pills a month (10mg/325) my primary Dr was prescribing as they no longer helped without taking more than prescribed ( which is why I went to pain management) they reduced me to 60 of the same pills ( Norco) but only twice a day plus a 15 Mg morphine pill which did absolutely nothinh but cause my pain to stay at a very uncomfortable level. Fyi, I hate the pain rating they ask. It varies based on medication
Anyway, after telling them it was no help but worse, they had me start on 25mcg fentanyl patch which it too did nothing. No change in pain diminishment.
Why have they not tried percocet  10/325? I had them once in between doctors, my primary and the one who did my shoulder replacement. It worked unbelievably. Why is it morphine does nothing, fentanyl patch ( which I hate the process plus the repercussions should Any advice?
my grandkids touch one that doesn’t stay stuck on or my dog eats it)
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Avatar universal
I have literally been on every narcotic out there at some point in the last 30 years.  Since insurance has narrowed the long acting drugs they will cover down to very little, I take long acting morphine and hydrocodone for breakthru.  When I start seeing signs of tolerance, we switch to xtampza and Oxycodone for several months then right back to my usual.  Works great.
If I had to guess I would say 15mg long acting morphine was not enough for you.  30mg would be worth a try.  I know lots of people do well on the fentanyl patch.  For me it didn’t feel consistent.  I felt like I used to when only taking short acting meds.  You know, the rollercoaster.  Up and down.  The whole purpose of the long acting med is to stop that.  Long acting morphine(MS Contin) does that pretty well for me.  Any one who’s been on narcotics for a time would probably have to start out at 30mg twice a day.
Also on the patch same thing.  25mcg probably wouldn’t be enough.  I started at 50mcg and ended up at 75mcg.
I just wanted to encourage you to keep on trying.  Many doctors want to titrate your dose up slowly so it may take awhile to get to the dose that works best.  
Let us know how things work out for you!
Helpful - 0
20803600 tn?1546262537
COMMUNITY LEADER
Unfortunately- taking more than prescribed only serves to increase tolerance and medications lose their effectiveness over time.
I am not that far in years behind you and have multiple spine surgeries, def arthritis in entire lumbar spine and spinal cord damage.
No doctor is required to continue medications or dosages given by a previous provider and with the current attitudes and concerns about opioids - even less  likely to give patients that many norco -Tylenol and hydrocodone at the dosages you were taking it previously.
If one opiate is not helpful- you may need to try different ones under the supervision of your PM doctor to find one that works.
PM is about reducing pain to tolerable levels but it is not going to eliminate it completely. There are topical creams and ointments that may offer some relief as well, used in combination with oral meds.
The thing you are going to keep in mind though is that extended release meds don’t give you that feeling you get from norco- they deliver a consistent level of meds for a set time frame - and some of them require that you take them as directed for several days before you notice a reduction in pain levels.
Helpful - 0
20803600 tn?1546262537
COMMUNITY LEADER
For fentanyl patches- there are cover tapes called tegaderm or opsite that you can place over the patch which helps keep it in place. It is also important when placing them that you choose an area of little muscular movement- shoulder blade, upper arm, lower calf muscle- and hold it firmly in place for about a minute.
I think you may be confusing not ‘feeling’ the onset of the medications and misinterpreting them as not ‘working’ because you aren’t getting that feeling many get from immediate release meds.
Because extended release deliver a steadier blood plasma level as you continue to take them and once you reach the steady plasma levels- there is a noticeable decrease in overall , every day pain.
The norco now appears to be used only for breakthrough pain- and either the morphine or fentanyl is your main pain medication. The nice thing about the fentanyl patches is once you adjust to them- you’ll come to enjoy not being tied to a pill bottle all the time and the overall pain control is far more stable and less.
Helpful - 0
20803600 tn?1546262537
COMMUNITY LEADER
Hydrocodone is an immediate release medication- meaning that most ‘feel’ it kick in after taking its within half hour/1hr.  It is also short acting- meaning  as 4-8 hrs pass- those using it notice the effects lessen over the time frame.
Morphine ER is an extended release- most taking it don’t feel it ‘kick in’ like the immediate release options and often believe because they don’t ‘feel it’ it’s not working. Extended release meds are meant to deliver a steady blood stream level of medication over its dosage time.
Fentanyl is hundreds of times MORE POTENT and powerful than other opiates and is absorbed through the skin- over three days. When using fentanyl patches- you won’t feel it immediately since it takes time to reach a steady blood plasma level - for new users- typically two or three patch changes.
With extended relief and medications like fentanyl- instead of noticing it kicking in- most patients notice an overall decrease/more consistent leveling of pain.
IMPORTANT- NEVER allow anyone to touch fentanyl patches and once removed- put used patches in coffee grounds or used cat litter to prevent someone from using or touching them.
There is a VERY real danger of accidental overdose for someone to come in contact with fentanyl or opiates they are not prescribed.
I think you need to give either the fentanyl or extended release morphine a longer trial period before discounting them as ineffective. Both medications are the most potent available.
Helpful - 0
2 Comments
I had a major surgery 20 years ago. A nurse came in my room and injected something into my IV. Shortly after, the surgeon came in and ask how I was doing. I told him Ivwas still hurting. He looked at the nurse and asked and she told him she had just given me a morphine injection. I asked him how long does it take to start working. He said immediately.
Two years ago I went to an ER due to severe pain in my right shoulder which my shoulder had to be replaced ( reverse arthroplasty), at the time in the ER they gave me a Fentanyl injection. Nothing happened. The pain never let up. I was told that it happens occasionally.
I have what was called degenerative arthritis in my lower back, lumbar region and having IBS ( since I was a teenager) tylenol, ibuprofen, etc cause very irritability in my stomach, thus I was first put on tramadol which caused my body to itch like crazy, so they put me on what was then called Lortab, now called Norco ( hydrocodone)
After many many years on it, my body has built up a tolerance of sorts and taking two pills caused the pain to subside but my doctor felt I was abusing. He was not the original doctor but a new one.
I understand the opioid issues but being in my 70’s, hurting is not fun and living on an acreage I stay very active in taking care of it. Mowing, weedeating, tree trimming etc plus I have 14 years of martial arts in my past which I started at 35 and was told to quit at 50 due to the arthritis pain.
Had my left hip replaced in 2020 due to deterioration of my ball & joint, then my right shoulder in 2021 for same reason, arthritis deterioration.
Now having knee issues requiring surgery soon but no one will administer anything that works other than 4-5 days worth.
Hi MrE51,
I’m sorry you are suffering so much pain. I see you are getting some advice here…I want to just caution you about Fentanyl patches. I was on them for 7 years, starting with 25 mcg/hr  - it didn’t last 3 days (my genetics test showed I’m a rapid metabolizer of opiates) so my Dr rx’d it every 60 hrs. Slowly over the 7 years I needed to increase to 50 and then 75 mcg/hr and to changing the patch every 48 hrs.

Fentanyl brought out addictive effects in me, it’s very powerful, and soon I was taking the used patches and “cheeking” strips of it. I ended up voluntarily at a pain management/treatment facility and got off the F patches- I was very surprised and shocked at what the craving caused me to do-
So all this to say, be careful with Fentanyl in any form, if you find yourself acting on the cravings/higher pain, please talk with your doctor.

Also I note you have IBS and lower back arthritis. It’s possible you have a form of ankylosing spondylitis- a type of arthritis often associated with a genetic factor called HLA-B27. AS, IBS, uveitis (eye) and psoriasis are the 4 conditions associated with HLA-B27. It might be helpful for your doctor to order this blood test, possibly see a rheumatologist, as this is an inflammatory condition and other meds might help you.
Best wishes and May God bless and guide you!
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