Avatar universal

pain med with no tylenol?

I'm taking 1-2 Hydrocodone 10/325 every 4-6 hours and I think that after 5 years at this dose I need something else...this keeps me right at the tear level on the charts..but the nausea and side effects from the Tylenol stuff adds to the problem...question is how to get my doc to understand?  I was told that i should be on Oxycontin with no acetaminophen stuff...help???  I know it wont take the pain away...I'm just looking to be able to "deal" with it...but I understand that I'm digesting way too much Tylenol stuff???  
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1331804 tn?1336867358
Hi and welcome to the pain management community!

I wouldn't rule out Oxycontin.  Insurance plans vary wildly as I do not need prior authorization for Oxycontin and it only costs me $75 for a 30 day supply and there are others that have insurance which provides the medication at a cheaper price than that.  So before ruling it out, be sure to get the cost information from your insurance.  I am not taking Oxycontin but I did price it as it was a medication that was considered awhile back.  There are other long-acting opiods such as MS Contin, Kadian, Avinza (morphine extended release) that are also good medications for the treatment of chronic pain.  

Being that you have been taking hydrocodone/acetaminophen for 5 years it is probably best to switch to a long-acting opioid and use the hydrocodone/acetaminophen or a similar short-acting opioid for breakthrough pain.  

I have been taking combination short-acting opioids for over 4 years now and I was just recently switched from percocet to oxycodone IR for breakthrough pain.  I think the combination short-acting opioids are not good for chronic pain patients as daily ingestion of tylenol on a long term basis is not recommended.  The current maximum dose of tylenol per day is 4,000 mg (1,000 mg maximum per single dose); however, there are new lower limits being provided by the pharmaceutical companies that suggest a 2,600 mg maximum per day.  To me, this is scary as it is apparent there are still people reporting liver problems despite ingesting 4,000 mg or less of tylenol per day.  Many doctors; however, use the tylenol in vicodin or percocet to curb drug abuse as most now know that it is the tylenol that has a higher chance of killing you than the opioid, if the max dose of acetaminophen (tylenol) is exceeded.  

Consider recording your pain levels in a pain diary on a day to day basis.  Also document all medicinal and non-medicinal therapies used to try to reduce the pain and bring it in to your appointment.  You could also consider bringing in some medical research studies that show that the most effacacious way to treat chronic pain is through administration of a long-acting opioid for coverage of the baseline pain level and a short-acting opioid for coverage of breakthrough pain.  I provided this information to my doctor a couple of years ago and I was finally switched to this treatment methodology after hitting a brick wall with him many times before.  It may take persistence on your part as well.  Don't get discouraged if nothing changes the first visit you provide this information.  However, after about 3 times of discussing with your doctor that your pain is uncontrolled and that it is affecting your quality of life; it is probably time to seek out a new doctor as your doctor may have "his way" of doing things which isn't going to change.

I am receiving my medications from my PCP (Primary Care Physician) and I also see a physiatrist at a orthopedics spine center within a teaching hospital for interventional therapies.  You may need to seek out a PMP (Pain Management Physician) as in some states, these types of doctors have more leverage towards treatment of chronic pain than PCPs.

Hope this information is of some help to you.  Wishing you effective pain management in the very near future!

femmy  :)
Helpful - 0
1271743 tn?1320892461
Too much Tylenol is def bad for you.  My doctor prescribes me the immediate release oxycodone 15mg with no Tylenol.  It is not extended release like the Oxycontin and I like it much better and do not have to worry about toxic Tylenol in the liver.  I would ask at your next appointment, they make the immediate release oxycodone in 5mg, 10mg, 15mg, & 30mg.  The Oxycontin is very expensive and most insurance companies require prior authorization and just won't pay for it... b/c there is not a generic for it.  The oxycodone immediate release tablets are fairly inexpensive compared to the Oxycontin.  I paid $52 for 180 tablets when my insurance ran out... not bad, the Oxycontin would have been over $1800 for one 30 day supply.
Helpful - 0
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st. louis, MO
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