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Opioids Chronic Pain Mgmt Question

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Camel-Man

Camel-Man

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Apr 22, 2013
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In April 2009, I suffered permanent nerve damage from 2 failed cervical spine surgeries. From the nerve damages, I also lost the functionality of my bladder. The resulting chronic pain problems were diagnosed and treated as Cervical Myelopathy, Cervical Dystonia, Post Laminectomy Syndrome, moderate to severe neuralgia and a couple other nerve related conditions. The resulting nerve injuries have left me with chronic pain problems affecting my neck, right shoulder, the center area of my back and especially, the lower right side of my back and right hip.

In the hospital after each surgery, doctors treated my pain issues with injections of Dilaudid. When I would be discharged, my doctors Rx'd a version of Dilaudi tablets. Those worked great.

But once back home and after about a week or so, that medicine was changed to lighter-weight ones. In the beginning, my doctors were stumped as to the cause of the continuing pain problems so they treated me with meds like Tylenol 3, Soma, Gabapentin and Tramadol tablets. Those meds didn't really even touch the pain issues I had. So, through some diagnostic tests and such, they realized my problems were more severe and adjusted my meds accordingly. Things tried included: the TENS system and the Fentanyl Patch but neither of those helped me either.

Then, after additional tests / exams, I was Rx'd 60mg OxyContin with 10mg Oxycodone for break through pain -- finally, the help I needed. I was able to return to work and so long as I took the meds and was careful at work, could manage my pain issues pretty well.

In late 2010 though, my insurance ran out and I began receiving care through the VA. The VA wanted to switch out the OC to MSContin and did. For the next year or so, I managed along okay. The pain relief with the MS Contin wasn't as good / long lasting as with the OC but still, it was helping me. In the fall of 2012 though, the effectiveness of the MSContin began decreasing. I reported that to my doctor but he left the RX alone and asked me to try to manage things.

Well, that was 6 months ago and now, the 3 daily doses of the 60mg MSContin + the 4 single doses of 10mg Oxycodone are not managing the chronic pain problems very well at all. I have always kept my my primary care doctor informed of things and have now had to scale back the work I was doing because it was aggravating the pain problems too much. And, with the ineffectiveness of the MSContin, I can only work about 20 hours a week as physical exertion wipes me out, robs me of stamina and leave me in tremendous pain and unable to work enough to support myself well.

I now have a new pain mgmt. consultation apt for the 3rd week of May. I'm hopeful that the primary pain medicine (MSContin) will be replaced as I beleive I've developed a pretty good tolerance to it -- so much so that the MSContin is totally ineffective for me.

Given the meds I've been Rx'd in the past, I'm hopeful of being Rx'd either Dilaudid tablets or put back on OxyContin as those are the only two meds that continuously worked well for me. I hope to keep the Oxycodone RX as that actually helps me a little bit although, I think i need to be taking three of the 10mg tablets at a time, not just one.

Yes, I have iv'd the MSContin tablets some in the past looking for immediate pain releif help but do not have any track marks or junk like that on me anywhere. Plus, at the VA, I have to take routine drug tests regularly to prove to the doctor that I'm not smoking dope or junk like that. Since I don't smoke pot or do other drugs (I don't even drink alcohol), I always pass the tests so my doctor has always been willing to work with me.

My medical records, tests, exams, diagnoses, etc are quite thorough, the back of my neck is very scared up from the past surgeries and my treatment record is accurate. I'm just over 50 years young and believe it or not, I do not want to go on Disability. I just want to work, want to be able to support myself but the pian problems I have limit me severely.

My question is: In addition to hoping for either Dilaudid or being put back on OxyContin, what are the other medicines I might be prescribed for the chronic pain problems I have?
 
I'm in a similar situate. I'm on OxyContin now with Oxycodone for breakthrough pain but was originally but on MSContin with oramorph (liquid morphine sulphate syrup) for the breakthrough pain but developed such a tolerance that massive doses did nothing for me. Switching to oxy has helped but not as much as I had hoped.
Other than that I could only think of tramadol, but that sounds like too weak an opioid for your kind of pain.

Have you enquired about getting a fentanyl patch? Fentanyl is a painkiller 100x stronger than morphine so even WITH a high tolerance you can start off on a pretty low amount. It normally comes in a 72 hour patch that get's absorbed - I THINK - subcutaneously, through the skin.

Oh and while I am stuck on 10mg oxycodones, they DO come in 30mg capsules. My Dr won't prescribed me that strength, but maybe yours will?
 
j

yeah i was going to ask about fentanyl too as ive spondylolisis from the L4-L5-S1 and sclerosis of my right facet joint so suffer around the clock chronic pain; other problems stem from the predominant dx's as a resulhet.

apart from some adhesive problems in the summer months for myself i would rank transdermal fentanyl with a small BT dose as required is as effective as one of my opioid mixtures; being morphine sulphate controlled release (100mg grey tablets.), IR oxy, codeine forte and diazepam.

*takes another heavy draw from my rolled cigarette blowing it right into this nosey cunts face hoping for.rany. like a fucking boss.
 
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i did. but all the oxy morphine and valium caused a proper brain fart. my sincerest of apologies, darling. i hope we can move forwatd!
 
I have been in pain management for 10 years and Dilaudid 4 is the bes relief for my money. just saying.
 
Thanks for all the responses. The first Fentanyl patches were the 25mcg versions. After a week or so, the doctor changed it to the 50mcg ones. But still, those didn't alleviate the pain, maybe the doctor should've gone to the 75mcg patches, I dunno. When 60mg OC with 10mg Oxycodone were given, relief came and came pretty quickly. However, the best chronic pain relief came in the very early days when after discharge following cervical spine surgery, I was Rx's hydromorphone tablets. I believe I took either 3 or 4 doses a day but do not remember the strength. Through the relief, I was able to complete extensive physical therapy, learned to walk again and eventually went back to work. But through the slow process of tolerance build-up, over the past 18 months or so, the effectiveness of the 60mg MSContin have pretty much gone away completely. As such, my ability to work has continually decreased.

From time spent on this board and other boards (particularly spine and back injury boards), I'm hopeful of being rx'd either OC or hydromorphone. Those meds worked the best for me when combined with oxydodoen for BT pain.
 
ive been in pain mgmt for 10 years and have had periods where i was taking 2 60 mg mscontin every 8 hours so i thing you can increase the amt of 60s your taking if they wont change your meds.or ask to go from 60s to 100s of msc.im post op now for a year and down to 1 60mg every 12hrs and am lucky they still work well for me.
 
Dear Oxy8_8

Dear Oxy8_8
I was reading your post and I just thought I would let you know that the fentanyl patch is absorbed transdermally, through the skin. I do not mean to offend you, I just saw the question mark at the end of your statement and thought maybe you would like to know. Subcutaneous means under the first few layers of skin, before you reach the dermal layer, that's where insulin is injected if you are diabetic. Just FYI, I also liked your post, very knowledgable.
 
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Dear Tentram

Hi tentram. I just have a suggestion for your adhesive problems for your patch in the summer. I'm not sure where you are from but if you go to the pharmacy, there are things called Tegaderm or Opsite, which are like clear sheets(all different sizes) that are like sticky plastic wrap but feel less flimsy. If you put one of those on over the patch it will keep it stuck to you, even if you are sweating. And if sweating is still an issue, you can use skin prep pads around the patch before you apply the Tegaderm over it, and it most definitely won't come off til you actually take it off to change your patch. And don't worry, neither will affect your patch's effectiveness, I just don't advise putting skin prep on the actual patch. I hope this helps you. :)
 
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