Rick, we become tolerant when taking opiate-based analgesics for a period of time. Often rotating opiates helps get pain and dosing under control.
I've been maintained on opiates for over 20 years, and every few years have had to rotate through fentanyl, oxycodone, morphine, methadone, and hydromorphone.
For instance, I was having trouble recently getting effective pain relief from hydromorphone after using this medication exclusively for the past 3 years. My docs switched me back to oxycontin/oxycodone combination and my pain is again under control.
The biggest problem with opiate pain medications is that when you take them so that they are always in the body, the body makes more pain receptors and you develop a tolerance, and you just have to take more and more. I have a patient who takes oxycodone 30mg 5 times daily PLUS long-acting morphine and she is in pain because I just don't want to go any higher. You have to really maximize the use of all of the non-narcotic pain medications like gabapentin (Neurontin) or Lyrica, Cymbalta (duloxetine), Lidoderm patches, and if you live in the right state, medical marijuana, which does offer a fair amount of help. You might actually work with a pain management specialist and ask about a "drug holiday" and suffer through a period of going off of opiates altogether for a period of time. That way when you started back on them smaller doses would offer you relief. Good luck with it.
I'm with sblythe on this one.. The only time I've ever needed something stronger than Norco was when I had cardiac surgery but having long term back problems and young, I have a heightened awareness of the long term effects of using opiates for the treatment of chronic pain. Sometimes there are just no alternatives. However, more often than not, in order to get your pain medications working again when up to the level of oxycotin and other high opiates you may have to have a "medication vacation" as sblythe elluded above. Additionaly, rotating on pain relievers following the medication vacation may yield better long term results where you may be less likely to quickly develop tolerances as fast and less likely to have to repeat future medication vacations. I take mild opiates but I rotate. I will most often limit opiate use to two weeks or will limit daily use to the most painful time of day. With that said, it is important to achieve pain control. Chronic pain sufferers rarely experience total pain relief without surgical intervention. Oftentimes patients find that they have to increase dosages when they allow pain to get out of control. Its a learning experience and one that requires some trial/error COMPLETE honesty with your physician and I highly recommend sticking with a pain management doctor. Some people do better when they complement their pain management treatment with antidepressant therapy. Depression that is secondary to dealing with chronic pain can increase perception of pain and when you are coming down off of opiates you are at risk for as well. If you are nervous about taking a medication vacation ask your physician if you can go through an inpatient rapid detox. That way if you are concerned about withdrawal or experiencing high pain from your condition the clinic can monitor and treat as needed. Having to go through detox doesn't mean you are a drug addict it just means your body has become dependent on the medication and detox helps you get your body to respond to lower doses again. If you do go through detox please remember that you should not take any dose higher than the doctor tells you. What often causes fatal overdoses is when patients have been off of or on significantly reduced levels of opiates and then suddenly take a dose they were previously able to take without issue. Ask your doctor about complementary alternative therapies or treatments to go with that. If you are having back problems is there an option of surgical or device implant treatment? Can TENS help? Epidural injections? etc. I'm not a doctor - just offering some possible things to look into
first off let me say thank you for the responses. I have talked to my doctor about my situation and he has put me on an additional medication and it is an antidepressant called nortriptyline 50 milligrams but the problem with this I have just noticed is that it is turning me into a zombie and I am a construction worker that works in a refinery.as four surgeries I have two issues with my lower back I have to bad discs and I have spinal degeneration and the combination of the two my options are limited I have had injections but they only last a couple weeks I have 10 more years of work before I can retire so I'm not sure what to do anymore.I guess maybe it's time for a career change.thanks again for all your help I'm a go ahead and do the drug holiday as you have suggested.
Ask your doctor about opana. I had the same problem nothing was working for me so they switched me from oxycodone to exalgo which is just a long acting diladaud. That did not work for me so they put me on opana 40mg and oxycodone g for breakthrough pain
Goes to show you that everyone responds to medication differently.
There's no reason that medicine knows why hydromorphone (Exalgo, Dialudid), was not effective, and oxymorphone (Opana) was effective for you. For me, methadone is the "gold standard" in oral analgesics.
This is why opiate tolerant, chronic pain patients who are not getting relief with one of the major pain killers should try another. Pain doctors know this, but this kind of training is not provided in medical school.