What next? Developing a tolerance to oxy and I need advice...

[Jmacattack626]

I have been prescribed hydro, then morphine sulfate ER, then oxy. Over a 9 month period I have tried different combinations of oxy IR and ER, and I am now prescribed 30mg ER and 30mg IR daily for pain management. It seems like the ER is more effective, but my pain doc doesn't want to give me all the 60mg of the same meds... I honestly have to take more than I am prescribed to actually control the pain, but if I tell my doc that it wouldn't benefit me at all. I have tried methadone and I was surprised by how effective it was and I actually felt a substantial amount of relief, but again, I can't really tell my pain doc that I tried it and I don't think they would prescribe it anyway. So I am trying to get any advice or feedback as to whether there's something I can suggest to my dr without coming off as a "seeker." I really just want to be able to control my pain and be able to live my life without constantly worrying about having enough meds to make it to my next appointment. I Am pretty sure my doc doesn't want to increase my dose of oxy, but I don't know what options I have other than that. Any suggestions or thoughts, or even if you want to share your own experience with me would be much appreciated.
Just to provide some basic information:
I am a 32 y/o male and I weigh about 165.
I have a thoracic disk herniation and some muscle tears in the rotator cuff. I think there may be some other issue causing pain around my side and ribs, as the stabbing sensation I get through my ribs doesn't seem to be like the nerve pain I have in other areas, but I have no idea at this point and it's been over 2 years and continues to get worse.

 

[Steady Scootin]

I'd say your best bet would be talking openly with your doc,
voicing issues you've been having and seeing what he might suggest, as opposed to you giving him suggestions.

If not that, I'm honestly not sure what to tell you. Oh, and regarding the thread title, you're going develop tolerance to any opioid he may prescribe you to take daily, not sure how that's avoidable if you continue to take them.

 

[Pickledlemons]

I agree that talking with your doc is a good idea.

I've heard taking small doses of DXM with your opiates can help stop tolerance from developing (like 50mg.. not enough to trip out). I don't know much about that... or if it even works. Maybe somebody else could chime in with more info... lorne ???? seems to know everything.

 

[Deemgd]

I'm in the same situation. Only I'm worse off because I started on painkillers having a huge opiate tolerance already from being a heroin addict. I get Morphine sulfate and hydros and they don't touch the pain unless I take 4 times my prescribed dose. So for free first week and a half I'm pain free, the last 2 1/2 weeks are hell.

If you can, try to reset your tolerance by not taking anything for a few weeks. When you start taking them again, they should work, but tolerance comes back fast, so you will have to continue to take breaks from your meds once they stop working, to force your tolerance to come down.

It sucks because that means you have to suffer with no meds, and I know the horror of chronic pain. But unless you can talk to your doc and get them to up your dosage, that's about the only option. The plus side of taking a med break is that you can stock pile your pills for When you start using them again, and you will have extras for When you need an extra dose, So it lets you get ahead a little in terms of the dosages you can take.

I wish I could give you a better solution, but like I said I'm in the same boat.

 

[Trabbamab]

Have you tried taking a potentiator with your meds? Things like grapefruit juice or Tagamet (cimetidine, an OTC antacid medicine) can have a slight increasing effect to the maximum peak of the drug but in many circumstances it will make it last much longer. I am not sure if peak effect or duration is where your meds are falling short, but these things can help with both (peak marginally but duration for sure).

Overall though there is little you can do without talking openly with your doctor as others have suggested. It is interesting you mentioned methadone and that it really helped you. If anything ever fell through with your doctor you could of course go to a methadone clinic if there is one in your area (they usually don't advertise openly; check online if you need to) provided you went fairly quickly while you had meds and could fail the drug test. But that should be a last resort. Maybe it will offer some comfort at least knowing you have some kind of safety net there. I know that the crack-down on opiate prescriptions has made a lot of people going to pain management worried that they will be taken off their meds.

I don't know if your doctor will be able to prescribe methadone and it is probably a good idea to not bring it up. If you really felt it was the option for you and you were not ready to check out of pain management and check in to a clinic, you could say you read about it online and a few people on a pain management forum said it worked for them better than your current meds do for similar ailments. However I have heard that it can be difficult for non-clinic doctors to write a decent amount of methadone since a lot of laws in various areas keep higher doses only to the clinics where there is much more contact with the patient to prevent diversion. Most scripts I have seen are in the 10mg or less area which I don't think is going to cut it for you.

I guess I am starting to ramble at this point but I think my best advice would be to simply discuss the issues you are having. Don't talk about specifics drugs or ask for any specific changes or specific ratios between ER or IR oxy. Just tell them what problems you are having and let them try to dial your dose and medications in. It is their job and they know a hell of a lot more about managing pain than I do. Also do not discuss potentiating your pain meds with your doctor either. It scares the crap out of them (it is a drug interaction after all) and could flag you as an abuser.

Best of luck!

 

[Rexeh]

Try asking for Promethazine 25 mg / Cimetidine (Tagamet) and buy some Benadryl and some DXM cough syrup/gels. The Promethazine is a excellent Opiate potentiator IME and the use of an anti-histamine also might work wonders, just like the DXM in small doses (say 60-90 mg). You can always ask for breakthrough pain medication such as Dihydrocodeine / Hydrocodone / Morphine or even simple Codeine or Tramadol. Your tolerance will build not matter what you do so try being open and honest with your doc. I once started out on 30 mg OxyContin an now I need two OC80's to keep me well during the day :/ so you see it's a lifelong process and won't happen in the course of a few month's but you'll get there eventually.

Another tip I have for you is to seek out Kratom, it's an Opiod-like herb with good effects depending on strain or region where it's from, try seeking out more information about Kratom really, it's not something that should be overlooked IMHO...


-- Peace o/

 

[Keif' Richards]

OP, you have an advantage working in your favor in that there shouldn't be any deception required to get what you need. My first advice would be to continue a completely honest dialog with your doctor. Complete honesty would include explaining that you are still in significant pain, but are afraid to ask for more drugs due to the current climate surrounding Opioids. Complete honesty is always best.

Aside from that, I can only speak to my own experiences with pain in the past. The primary difference between us is that my pain is typically as the result of surgery and is of an acute nature. Basically, the entirety of my pain control focuses around:

Opioids

Cannabis

Gabapentinoids [Gabapentin (Neurontin), Pregabalin (Lyrica), Phenibut (OTC Supplement)]

OTC pain relievers

I'd like to know a little bit about your experience with these drugs. Let us know and we will go from there.