IR Oxy to ER Oxy: Bad Equivalency?

[Sweet Jane]

I've got major back issues that are slowly getting better after surgery. I've been on oxycodone for about a year and a half ago, starting at 20-40 mg, four times a day, and bumping up to 20-40 mg/6 times a day, or a total of 120 mg per day, about 4 months ago. The surgery helped a lot in terms of helping me become more active and getting my life back. My activity level is about a hundred times greater today what it was a year ago. So, things are going really well, except I'm still experiencing a lot of pain -- something my orthopedic surgeon said could take up to a year to get rid of. I was also told it was essential to perform this minimal activity to encourage healing. I'd given myself until the end of the year, if necessary, before tapering off the drugs, with the expectation that the pain will be manageable by then. In the meantime, as I said, my life is going great, and I'm making strides in all areas of my health, well being, and lifestyle -- I'm off all the medications I was on a year ago except my pain meds; I'm doing everything I'm supposed to be doing and it's working.

In the meantime, I'm taking the oxycodone for pain. Lots of it. When I started exceeding the 120 mg per day, I called my doctor immediately, and told her, knowing that she would likely want to move me to a combination of the extended release and immediate release oxy, and really being okay with that. And that's exactly what she did.

Except ... she moved me to 20 mg ER oxycontin, twice a day, and 20-mg IR oxycodone, four times daily. When I told the physician's assistant that seemed very low, given that 120 mg of oxycodone per day wasn't working for me, she concurred and indicated that she had mentioned that to the doctor, and that the doctor said I was "poisoning myself" and we needed to bring the oxy levels down (please note I have lost a lot of weight, which may be one of my doctor's concerns).

Still, none of this makes sense to me because I would still have the 360 20 mg pills of oxycodone per month, if I hadn't tried to be honest and above board about the situation, and let my doctor know of my concerns. And I certainly don't want to start going backwards on improving my activity level because I made the mistake of being honest with my doctor.

Does this formula strike anyone else here as a little draconian? I'll try it, of course, in good faith, and wonderful if it works -- I just don't see how it can possibly work when it seems to be a fraction of what I'm taking that is not working already.

Any advice would be greatly appreciated.

 

[The Doc.]

I think its just the doctors covering their asses they can have you OD or anything and it seems your tolerance has skyrocketed very quickly which concerns some doctors. Some doctors will keep raising it till it's in the 500-1000mg range then others are scared to go over 100 cause they think your poisoning yourself. They obviously just want to see what the lowest possible dose they can use is and maybe with around the clock pain relief you won't need as much fast acting pills so this is why they would do it a bit lower. Your lucky you even got up this far I know people who have doctors not letting them go above 20-40mgs a day cause they think its too much ha so just be happy your doctors are working with you

 

[Sweet Jane]

Yes, your advice is good. I'm hearing the exact same thing from people who have been on longterm opiates for pain relief. My tolerance DID skyrocket after surgery, and then after about 100X more activity than I've had in three years, per doctor's orders. So, that's the dilemma -- the ton of medical issues I had before is now gone entirely -- my labs are about as close to perfect as you can get, and I'm moving two hours a day -- walking, stairmaster, etc. -- it's the combo of the higher tolerance and the activity I need to be doing in order to build the muscles in my back up that is causing the increased pain.

But, I'm determined to make this work, and I'm giving it my best effort right now. After the first couple days, the Extended Release did seem to be helping -- at first it didn't seem to be doing anything and I had to keep telling myself that was impossible, and I just had it in my head that it wouldn't work. So, yeah, I do notice some pain relief now. I'm going to have to ask my doctor for an increase in the immediate release though, to six per day -- that's only 40 mg three times a day, and only half of what I was taking previously, so I'm hoping she won't have a problem with that, at least on a temporary basis.

I've said over and over that I will not go into the new year still taking pain meds, and I am on track to accomplishing that. My ortho surgeon said 8 months to heal, 12 at the outside, and the surgery was in March. So, if the pain is still bad enough that I need oxy in March of 2015, I think it's back to looking at other solutions, surgical or otherwise. Drugs are not a viable longterm option for me; I need to go back to work, and I can't while I'm on these opiates. It's kind of a vicious circle. In order to maintain the level of activity that I need to heal my back, I need a lot more pain meds than I would otherwise. In order to keep my opiate use down, I have to forego the physical activity that is demonstrably healing me. I haven't been able to work out since the switch was made, and I'm starting to get depressed again that I'm regressing. At the same time, I know that the dosage I was on was not sustainable, as your comment articulates so well. So, hopefully, I can get her up to six 20 mg per day on top of the ER, which will hopefully be enough to push through the pain to keep my activity levels up.

Anyway, thanks again. I appreciate your time and consideration.