What do i say or do?

[Boom56]

I have been on fentanyl patches and oxycodone for about 6 months now. prior i was just on oxycodone ( but a higher daily dose by different dr.). my current dr has increased me from 25 to 100mcg patch over the 6 month period. i was also taking 15 mg oxycodone 3x daily. with the increase in the patch he has decreased my oxycodone.. now i currently take 5mg oxycodone 3x daily. the patch does give me some relief, but the oxycodone seemed to work better. i told this to my dr and his response was " i think oxycodone is a bad drug". while not wearing the patch, i took 2 of the 15mg oxy at once. i wasnt pain free, but i felt pretty good, close to 'normal'.my patch doesnt last me 72 hrs. as it is supposed to. it doesnt give me the relief that my dr says it should ( or in his eyes idoes. he says that im just used to taking pills and that it is in my mind, its odd that my mind wakes me up in the middle of the night with back and neck pain). the 5mg oxy that im now taking 3x daily is NO help at all. i want to switch to another drug for treatment, but what should i say? i've done some research on such drugs as oxycontin and opana er. like all drugs i've found good and bad things. but i know from personal experiance that oxycodone really seems to work better for me. i dont know how to approach my dr. about this situation. i feel as if he is basing my treatment around his opinion of a drug. but im the one that is suffering. this is my first time wriiting a forum, but i need some help. what would any of you recommend as far as: What drug(s) would help and be a better option then the patch and 5 mg oxy? what should i say to my dr. to get him to try another drug treatment? any help and advice from personal experiances would be great. im 25 years old and i should not be in this much pain! i have herniated and slipped disk in my neck and back and i've lost about 70 % of the use of my r shoulder all from a mva. my dr has told me that his goal is to have me on such a high level of fentanyl that i will no longer need oxycodone. with the pain im experiancing now i really dont like that idea. please help !!!!!!!!!!!!!!!!

[Ghilly]

Herniated and slipped discs are all surgically correctable conditions.  At least the ones in your neck are.  The lower back is a lot more dicey with regard to whether or not the surgery will be successful.  Why is your doctor opting to keep you on heavy pain meds rather than correcting the condition itself?  

The discs in the lumbar area present more of a problem, because there's only somethting like a 50% chance that the surgery will actually correct the problem and not cause other problems to crop up.  But the cervical area is quite responsive to surgical correction, so it makes me wonder why you are being allowed to persist with chronic pain when surgery could take care of it for you.  You would probably still need pain management for the lumbar area, but it would be better than having your WHOLE back and neck hurting you.

Ghilly

[sandee1818]

http://www.ppmjournal.com/

This site does offer some information.
I have found several sites that do say the patch is not very effective compared to oxycodone. I have not found any copies of the studies done as you have to pay for them.
I hope you do find relief soon:)

[Toomanyadvil]

Hi ACHILDOFGOD

      I hope this new patch works for you and your find great relief until you decide about the pump. I've heard alot of great things about it and how much better it can work than oral medications because it puts the medication directly into your spine(I believe)
I know they also do a trial before they would do the surgery to put it in so that you would know what the pain relief may be like.  

I hope your feeling better

TMA

[ACHILDOFGOD]

I too use the fentanal patch 100 mc with not much success so far.  I was using 160 mg of oxcontin and percocet 10 x 2 for breakthrough pain,  when I fell into the coverage gap of my insurance and my prescription was over $600.00 for one month for the oxycontin. Even though oxycontin gave me my life back from chronic pain of over two years, when the drug company won their lawsuit and I could no longer get generics, I had to look at another option, that's when the doctor started me on the patch and started decreasing my oxycontin.  I now use the patch,, oxycontin 40x1 and 20x1 and percocet 10x2,twice per day.  eventually the doctor will get me totally off the oxycontin but I'm not sure we are going to stay with the patch. I even had tried different generic patches thinking maybe it was the delievery of the specific patch but it really didn't make any difference.  I even tried a trial of the nuerotransmitters into my spine for 12 days and that didn't work at all., so my next option the doctor wants to try in a pain pump.  It uses way less medication,so it's easier on the body, but I havn't made that decision yet.  Also as far as the percocet 10's goes they do work the best for me also but they don't last as long and the doctor is worrried about too much tylenol so he limits me to 4 per day but sometimes I have to take 6 since this patch is not working as well.  I will probably end up with the pump since they can use smaller amounts and cleaner medications but for now I will stay with the patch since I've just started this stronger dose the last couple of weeks and haven't really given it a good chance yet plus once i'm totally off the oxycontin things may change again.  hope this helps

[Toomanyadvil]

Typo: That is ment to sat Raise the patch does MAY make all the difference

[Toomanyadvil]

I was just told that most everyone taking breakthrough meds are taking the ones without apap in them.
So I guess just disregard most of the above as its not useful to you situation.
In that case being honest with your DR is the best route.
It sounds like you have a compassionate and caring DR as he is willing to raise the dose until you feel as much pain relief as possible as safetly as possible.
Raise the patch does may make all the differenc, so try and hang in there with him.

TMA

[Toomanyadvil]

Hi Boom

        Mt first thoughts were your DR may not want you to be taking too much oxycodone as it has acetomenophine in it. Thats why people in Chronic Pain are given medications without apap to take on a daily basis which release into the system slowly throughout the day. And breakthrough medication is given on as 'as needed' basis. Thats why your DR may be thinking if he can get you on a high enough dose of the patch then you wont need to take oxy daily.
Taking too much apap everyday can hurt your liver. My thought is that your DR may believe he is prescribing as much breakthrough medication he feels comfortable with with without risking too many side effects to your liver. There is a cartain amount of apap you can take daily, but because their prescribed to you on a daily basis for an extended amount of time your liver is continuesly metabolizing apap so DR's usually tend to prescribe below the allowed amount.
Usually when a DR prescribes a higher dose of short acting meds along with a long acting medication they assume your only taking it when needed so your liver is not metabolizing it continuesly throughout the day so are able to take more apap when you need it.
A prescription for breakthrough meds usually reads 'as needed'  
If the DR writes the prescription to say 'daily' then he means you can take it everyday if you want to, but the dose may be lower.

Now of course I dont know what your script says, and the above is only the perseption of alot of DR's and not all. But more times than not DR's are going to be very careful with how much apap the precribe a pt on a daily basis.
Thats why long acting meds are used, it's not that things like percocet and lortab arent as strong, its that they have apap and using an opioid without it means you can take a higher dose of narcotic for the pain.
.
Keep in mind that Opioids will never keep you pain free. They only stabalize and lower the pain so were able to function a little better. Thats why many people who take opioids for CP still may not be able to work and have to be on disability.
So my advice to you would be to try whatever your DR wants you to, If he does want to raise the dose on the patch, see what happens. The case may be that the dose just isnt high enough for you.
And just be honest.

I hope your able to find a dose that works for you and you find you dont even need the daily oxycodone!

TMA

[sandee1818]

Well my first thought is you do have a PM that does know your in pain and is willing to treat you. All Pm's have their drug of choice for their Pt's now my PM is more apt to prescribing oxy than the patches but if I were to say the meds you have me on just are not doing the job any longer he would consider other options.
The thing you have to remember is this is the first part of your treatment with your PM and your actions will determine how he is willing to treat you. Be sure and give his methods a fair chance and then if it still isn't working on your next apt explain you gave the meds a chance but could he think of another option for you as the meds your on just is not working properly to manage the pain. If he asks your opinion or input be honest with him. Being truthful and honest with your Pm will ensure a good relationship and therefore he will be willing to trust you and you him. Trust is very important and if your not being truthful your short changing yourself because the Dr will not be able to treat you to the best of his ability.
Give his opinions and methods a fair chance and go from there.
We are all here for support and advice and any questions you may have.