Saw my new pain management doctor today

[Cindylou]

Hi everyone,

I had my appt. today with my new pain management team. I really liked them alot. (you meet with a nurse, a nurse practioner, and then the doctor) They are going to try me on a longer acting pain med, and then use the percocet just for break through pain. I've always thought this made more sense, instead of popping pills every 4 hours for chronic pain. When he examined me, he also thinks I have some significant SI joint issues. He couldn't give me any SI joint injections today, however, as once again, I have to be off the coumadin for 5 days. So I have an appt. on February 6 for those injections on both sides, and to see how the meds are working. It was a long day over there, and I was hurting so much I had to come directly home. I need to get back out to get the scripts filled, but........I may wait till my husband gets home from work and ask him to do it for me. The saint. Anyway, I was very encouraged meeting with them. Hopefully, this will give me some good relief to enjoy Mexico. I can't get out of here fast enough. Thank-you all so much for the support.

Cindylou

[mmglobal]

Cindy,

In my (dumb-assed, layperson's) opinion, taking fast-acting meds on a daily basis for long-acting pain is not reasonable when we have long-acting meds that more closely match our serum levels to our pain levels. IMHO, if you need breakthrough meds every day, you are defeating the purpose of the time-release meds.

I'm glad you are getting someone to work with you on this... please keep us posted.

Mark

[Terry Allen Blackburn]

Hi CindyLou. I agree that the long acting pain medications make more sense. It sounds like you met with someone who is knowledgeable about dealing with chronic pain. The long acting medications combined with breakthrough medication leads to less chances of a psychological dependency issue with the pain medication. You may still become physically dependent which is easy to treat by a competent physician that understands this. Too many primary care physicians get in to prescribing the short acting medications and then freak out when the patient shows signs of dependency, then cuts the patient off. This forces patients to do desperate things, as the withdrawal syndrome is so difficult.

I have also had the SI joint issues. I did get injections prior to going home for Christmas which did help some. I may need some more sooner than anticipated as the physician who did my injections did not understand my history very well. My normal physiatrist was on vacation so I was desperate to get something in to my system before vacation.

I wish you well and continued good success with the new pain management physician.

Terry Newton

[mmglobal]

I've gotten a few questions about this thread and I'll answer here instead of PM.


Obviously, all med issues are between you and your doc... you should not be based on internet info. It's all just info into the hopper and should be treated as internet info which should always be suspect.

Having said that, if you seek out technical information on your meds... half life... graphs of serum levels, you'll begin to understand how the retarded (that what they call time-release in Europe) meds give you smoother coverage. If you graph the use of immediate release meds, you'll see you get faster peak serum levels and faster elimination from your system. You'll get higher peaks and lower valleys of 'coverage'.

If you map your pain, you should get a graph that you'd like to overlap with the graph of your serum levels. If you don't need any meds between your peaks of pain, then short acting meds may be most appropriate. If you have pain all the time, a baseline of time-relase meds, dosed to give you the smoothest possible coverage may be more appropriate.

I've been frustrated when I hear clients tell me, "I take 60mg oxycontin 2 times a day." From my experience, I was able to get by on much less medication if I spread it out to get smoother coverage. I would do much better on 20mg 3x than I did on 40mg 2x. It's 25% less medication, but smoother coverage.... without the low valleys you get with 2x dosing. This is just my experience... you'll work with your doc to figure out what works best for you. When I could get by with less meds, I went to 10mg 4x... again, less meds, smoother coverage.

Cindy, sorry to hijack your threads, but a couple of PM's referenced your thread.

BTW, with my lumbar problems years ago, tramadol was completely ineffective. With my lower pain levels, but more constant pain I experience now with my cervical problems, I'm finding tramadol working well. I'm taking the IR stuff, (only a couple/three days a week and never more than 1 or 2 a day), but based on this conversation I may ask for ER (extended release vs. immediate release). For some reason I undermedicate now and have to get pretty bad before I take something. Things have cranked up a notch and I may be taking meds more regularly.... spine problems suck!

All the best,

Mark

[Cindylou]

Not at all. Thanks Mark for the valuable information on short term vs. long term meds. I also appreciate all the feedback.

Cindylou

[SandyW]

Thanks guys,

I never know when it's ok to ask personal questions in someone else's thread . Sandy

[treefrog]

Mark, did you go by the fact that twice a day coverage was leaving you with pain before it was time to take the next dose, as reason to go for lower doses more frequently?

I'm just wondering, because I take extended release meds (twice a day), and I don't feel any additional pain in the time before the next dose, but my doctor was asking me about it. I guess if it wasn't lasting the full 12 hours, she might have done a similar thing, going with a lower dose three times a day.

I was taking short acting meds, 4 times a day. I much prefer taking the long acting meds.

[Cindylou]

I am noticing (granted, after being on this extended release less than 24 hours!) that the 10 mg. is just not cutting it. Does it take awhile to get into the system? I took 1 dose last night at 6pm and a second dose at 6 am this morning. I'm only supposed to take 2 percocet a day for break thru, and I have already taken 1 today, and it is only 1:10 pm. Is this normal? Now I'm really nervous about going out of the country tomorrow. Should I call the pain management clinic to give them a head's up?? Any suggestions?

Thanx!

Cindylou

[mmglobal]

If you can handle it, I'd let things settle out for a few days. It gets tougher and tougher to communicate with the doctors and their offices if we try to manage these issues on a short term basis. Yes it does take some time to build up the levels... how does your new dose compare to your old dose in terms of total/day. You need to remember that the total is spread out over a longer period for the extended release meds, depending on how you take them and how you took the IR meds. Obviously, if you are concerned... call the doc.

[Justin]

Hey CL,

If you haven't been on a medication consistently, it will take some time to reach a therapeutic level. Unfortunately, you can't speed up this process. In the meantime, you may need to adjust your dosing based on your current pain levels. You can also take half of the percocet in between your regular doses to help bridge the peaks and valleys until you have a therapeutic level in your system. What you are experiencing is normal.

Good luck and feel free to PM with any specific questions... (as always, this should not be regarded as medical advice). BTW... have FUN on your vacation!!

Originally Posted by Cindylou

I am noticing (granted, after being on this extended release less than 24 hours!) that the 10 mg. is just not cutting it. Does it take awhile to get into the system? I took 1 dose last night at 6pm and a second dose at 6 am this morning. I'm only supposed to take 2 percocet a day for break thru, and I have already taken 1 today, and it is only 1:10 pm. Is this normal? Now I'm really nervous about going out of the country tomorrow. Should I call the pain management clinic to give them a head's up?? Any suggestions?

Thanx!

Cindylou