Opioids 10x6mg Percocet isn’t cutting it for extreme pain , I need advice on how to safely potentate ... or shall I switch?

[Julianspinefusion]

Quick background- I have bad back pain. I’m guessing it’s nerve pain since my latest CT of my Spain stated that most of my thoracic have severe stenosis (narrowing) at the outlet of the nerves. I also have moderate narrowing up towards my neck. I also have a screw in my back (I have a spinal fusion) that is almost touching a nerve.

My Dr knows I need more but he says the DEA has him by the balls. He won’t do it. He’s scared. I get what I can find on the streets to supplement (hydrocodone) but those are like skittles unless I take 3-4. Which is very expensive. In my area, they go for $10. I’m not rich and the supply does dry up. My dr says he can go lateral with a different opioid but not up.

so questions

1.Is it possible 90mg of morphine may do better in the way of pain management? NEVER thought I’d be willing to stick anything up my butt but I read that anally, it’ll have a greater affect (or is this just for the “high”?) What about a low dose fentanyl patch? Is there a safe way to order some online and test it to supplement? Am I better off sticking with this Percocet and trying to potentate it?

2.If I do potentate it, does it only affect the” high” or also the pain relieving properties? I haven’t been able to find any info as such online, only people looking for the better high . I’ve only found a medical article that says grapefruit will significantly increase the plasma levels BUT it will NOT increase the pain relieving properties in ketamine as example.

3. I’m also on Xanax (1.5-2mg daily). Tolerance for this is a lot less than opioids (although I do take it daily). I usually take .5 at a time 1-3 times a day.

*Im also on a ARB and hctz for blood pressure

*loratidine/ cetirizine/ fluctisone/ azelistine for allergies

Also, I read someone’s comment that basically stated that the grapefruit just jump starts a chemical reaction and it really doesn’t matter how much you take? That really worries me if it’s true because I’d like to ease myself in, is this possible or was this person correct? I don’t want to kill myself with grapefruit.

please, I urgently need suggestions. I know there’s a lot of smart people here and I can really really use your help guys and gals. Sorry for the random thoughts all over the place. I’m kinda a mess, in 9/10 pain . TIA

 

[sekio]

It sounds frivolous, but evidence generally suggests that opioids are most effective when taken on combination with either acetaminophen or a NSAID (ibuprofen, naproxen), at least on traumatic pain.

That's a good place to start, I would try 500mg naproxen twice a day or something, with an antacid as needed. Might help quite a bit.

 

[Julianspinefusion]

It sounds frivolous, but evidence generally suggests that opioids are most effective when taken on combination with either acetaminophen or a NSAID (ibuprofen, naproxen), at least on traumatic pain.

That's a good place to start, I would try 500mg naproxen twice a day or something, with an antacid as needed. Might help quite a bit.

I made a mistake, sorry. I left out that piece of info. I do take ibuprofen 800 or naproxen 500 3 times a day. Although, I’m terrified what it might be doing to my kidneys, I take it like clockwork because it used to help and it’s just apart of my regimen. It seems to do nothing now. It feels as if everything just stopped working.
One thing my dr did offer was muscle relaxers but with the increased opioids and Xanax, I don’t know if it would be safe, plus I don’t remember having much luck the last time I took them (4 years ago)

 

[tacodude]

Get oxymorphone... Extremely long half life and potent mu agonist that in my experience had little to no histamine side effects. If they'll prescribe you anything six 10 mg a day would be more then enough, but unless you can handle the low oral bioavailibility you'll need to use them nasally at least.

 

[sekio]

If the doctor in charge of prescribing is being scritnized by the DEA, I don't think it would be likely for such a change to happen. Oxymorphone is like 10x the strength of morphine, oxycodone is about 1:1 with morphine. Even despite changes in BA, oxymorph would be more potent I would assume.

One of the ways they judge how heavy your usage is, they tally up all the meds you were given in a fixed period, then convert all the dosages to an equivalent amount of morphine, This way it's not as easy to game the system by having nonstandard opioids or multiple opioids thanks to it, and it's also more obvious at a glance how deep the hole you're in goes to someone reading your patient chart.

It doesn't matter what you try, red flags will appear and doctors will ask uncomfrtable questions once your usage gets to a certain point.

 

[Julianspinefusion]

This Dr in particular isn’t under investigation but I have been to a pain Dr that had a overdose/ death and they got really strict really quick. Needless to say, I was gone FAST.

current doctor is cool... to a certain extent... I’ve begged him for more pills as I’m in agonizing pain and he knows it. He’s thrown the option of a 90mg morphine equivalent at me (in the form of another opiate) about 4 times. But never once agreeing to go over, as he’d “trigger” the eyes of the DEA. I really feel he’s just looking out for his self,whichmakes sense ...

 

[Wilson Wilson]

Which other opioids is he willing to switch you to?

 

[tacodude]

I recommend opana because they said the dr to will change formulas, but not increase dose. I honestly believe oxycodone mostly provides relief through converting to oxymorphone. It's possible they're not covering it like they used to so just dosing the oxymorphone direct makes sense. Oxycodone ER 2x and oxymorphone ir 4x PRN would be the most stable regimen in my opinion.