July 4, 2009 - 3:14pm
Hello all. I have been browsing around your site for the past two weeks and have really enjoyed reading your discussions. I am 30 years old with Advanced DDD, currently seeking treatment through my PCP until my condition is no longer considered pre-existing in October of this year, which is also why I have not yet had an MRI. I am currently taking three 5 mg Oxycodone and three 800 mg Ibuprofen per day, which has not been sufficient. Most recently I tried two 60 mg Diclofenac daily instead of the Ibuprofen, which did not work as well, especially when considering the side effects. About a month ago I was also prescribed Elavil- one or two at bedtime- to help get me to sleep since I am still having pain issues. One Elavil puts me out, but also made me groggy for the better part of the next day. I continued to take for about five nights, thinking this might eventually ware off, but it didn't so I have discontinued.
Can anyone give me any suggestions to deal with the pain? Should I go ahead and seek PM even though it will be very tough without the insurance to cover most of the costs? From what I have read, I feel that they would not prescribe me more than I currently take.
Any comments and advice appreciated.
Happy 4th!
July 4, 2009 - 5:01pm
#2
seek
yes I'd seek pm care JUST to get the ball rolling maybe your PCP can refer you to one in your city or state and after pm treatment you and your PCP can have a better game plan to help deal with your pain a lot of times Md's like a 2nd opinion when dealing with pain patients my PCP took over my pain management from my pm after he saw that he could provide the same care for less cost to my health ins provider health-net ' hope this helps it takes a lot of suffering to get relief most the time thanks to dead superstars and friends and talk show hosts if your not in PAIN PLS DONT TAKE PAIN PILLS !!
July 4, 2009 - 7:14pm
#3
I would certainly look into other options other than
your PCP. And as FeliksD stated earlier, w/o imaging studies, you're gonna have a hard time doing anything. Until you get either one or both (?) I think you are S*O*L...
Ray
July 4, 2009 - 7:56pm
#4
the suggested maximum doseage
of ibuprohen is 800 mgs per day, sometimes excess doseage has less effectiveness as the suggested doseage, case in point, freind went to the dentist had a tooth extract , got a dry socket, he told me he took 5 vicodin an still got no sleep that nite, if he took 1 the medication would have sedated him, he took over the doseage an speedced his metabilisom up thus no sleep.
suggest you talk with your Dr. an let him tell you how much ibuprohen to take.
Woodstock
July 5, 2009 - 12:16am
#5
Woodstock
Where did you hear the max dose of ibuprofen is 800 mg per day? The maximum dosage of ibuprofen is 3200 mg per day, or 800 mg per dose.
http://www.drugs.com/ibuprofen.html
OP, a woman I ued to work with was taking elavil, and it seemed to have a long half life. It built up in her system, and when she had a blood test, there was way too much of it. Some people metabolize drugs differently. You can talk to your PCP about your current meds. But, without an MRI, you'll be where you are until insurance will cover it.
July 5, 2009 - 12:54am
#6
yes
Woodstock's absolutely correct in his statement that every1 metabolizes medication at differentiated intervals and that sometimes less is more. I would supplement these nice folks' comments with a dimestore axiom: an ounce of prevention....well you know ;-)
-Jog your dosing for starters, you can take a maximum of 800mg of IBU every 8 hours, do so. But the half life of oxycodone APAP is significantly shorter; try taking each oxyIR dose four or five hours after each IBU dose to stabilize fluctuations in perceived pain--avoid bullwhip effect in other words
-FeliksD is also correct. extended use of NSAIDS spikes your blood pressure & turns your tummy to mush. At the very least call a nurse practicioner and leverage some advice. Many pharmacies now offer in-house expertise of this very nature at competitive pricing.
-try supplementing with melatonin 30 mins before you retire for the night. A good night's rest is key to keeping cortisol in check.
-unless you're taking tylox version of oxycodone, you're only ingesting 975mg of APAP daily. Don't be shy with a couple tylenol PM @ bedtime or even here and there throughout the day SO LONG AS YOUR FIBER AND H20 INTAKE STAY UP AND YOU NEVER EXCEED 4000MG OF APAP PER DAY
-watch the diet and moderate your activity level to keep your physiology from further deteriorating. I'm certain you hurt, but no1 here wants you to hurt any more than you already obviously do 
Good luck kiddo
July 5, 2009 - 7:10am
#7
my knowing the maximum doseage of ibuprohen
was thru my DR. , He advise nomore than 800 mgs a day (24 hours) , one of the best Dr. s I ever had in my life will never doubt this Man s Word., I find I don t need to exceed this doseage, I have some hand, elbow,an hip an back pain at times but its tolerable.
To each their own s Dr advise
Woodstock
July 5, 2009 - 2:45pm
#8
Thank you for your responses
Yes, I was told by my doc not to exceed three of the 800 mg Ibuprofen daily (that is 2400 mg daily). And I absolutely need each one. My dosing schedule is as follows:
7:00am Ibuprofen
10:00am Oxycodone
1:00pm Ibuprofen
4:00pm Oxycodone
7:00pm Ibuprofen
10:00 Oxycodone
I stagger dosing times to make sure I can get the most out of what I have to work with. Believe me, I am in pain around the clock. I feel like if I could just get a handle on it for even an hour during the day, it would my life so much easier. Unfortunately, I do not have a pain free moment. The Elavil was put in the mix to try and help hit the pain at a different angle, possibly to relieve any nerve pain, but I still went down and awoke with the same amount of pain as before adding this medication. The side effects were not worth it to me. I have an 11-month old daughter that has been walking since 8.5 months and demands my full attention.
I did have X-rays that confirmed the diagnosis of Advanced DDD just before my insurance changed last year. Yes, I know that I am pretty much stuck until I get further testing. I am thankful that my doctor is helping as much as he is comfortable in doing so.
A side note, he switched my opioid medication twice, both times taking the remainder of my previous prescriptions. The first time I watched him discard them down the drain. The second time, he handed me my new script and walked away with 50 Norco 10/325, which made me very uncomfortable. He may have properly discarded of them also, but I would have felt better seeing it with my own eyes. I just wanted to share my experience with this as I had been keeping up with "Give my unused meds to my doctor? Hmmm" forum.
Randem: Thanks for the information. Maybe my doctor would consider still providing my care after being evaluated by PM and getting their opinion, depending on the treatment they propose. This would mean my paying out of pocket for those initial visits and for the MRI. I am almost to that point.
Doctor Feel Good: Thank you. I will try the melatonin first. I am concerned about Ibuprofen and Tylenol intake. But I know I cannot get by without my three daily Ibuprofen
Without imaging studies, they proabably won't prescribe "more than you already take.." The PM doc might try alternative therapies, or order particular studies that your PCP would not have thought of.
The most important point I would like to make is this. You, a 30 year old female, who's had no rearkable imaging studies done to confirm the "need" for treatment with opiod analgesics, will be a victim of the opiophobia (assuming you're in pain) that is sweeping the entire nation thanks to folks like Michael Jackson.
Any legit PM doc wouldn't raise your dose without good cause. He might give you some options so you could avoid ingesting 2400mg of IBU per day.
P.S. You mentioned Elavil- are they suggesting you may suffer from fibromyalgia or some form of neuropathy? Just wondering...