June 13, 2009 - 4:03am
Hello everyone. First here's an abridged version of my injury and med history. In early February of this year I missed the top step at my home and fell down half a flight bouncing down on my lower back. I did the basic RICE and took a norco that I keep for my migraines. I went to work the next night and def had a rough night. (I'm a RN and work 12 hr night shifts) After a few shifts the paun continued so I went to my pcp an had a pelvic film and MRI ordered. He also Rxed soma and lortab. Luckily no fractures but some deg disk with bulges at L4-5, L5-S1. I also had what looks like a bone spur at L5. I finally had to just take time off bc I couldn't take proper care of my pts. I called one of my anesthesia mds and she suggested a PM md. I did about 6 weeks of aquatic PT and was told I wasn't progressing and my pain didn't decrease in the water either. I had a CT, flexion/extension films, and a nuclear scan. All showed basically the same as the MRI had. My pain increases with movement. I've tried soma, flexeril, ultram, toradol, lortab. I had an epidural steroid inj. After that I started to have radiating pain down the back of my left thigh with numbness in my two first toes. At my follow up she said she couldn't do anythig else for me and wasn't going to continue to "feed" me anymore narcotics. I was finally taking a relaxer, zanaflex 4mg tid that was working a little. As far as narcotics I was on hydrocodone 7.5/500 tid. It barely took part of the pain away and for a few hrs at a time but I didn't take more than was rxed. She suggested an ortho or neurosurgeon. My pcp wrote for more zanaflex and some norco10/325 q 4-6 ( I also have 2 peptic ulcers) and sent me to another PM. Neruosurgeon said most likely surgery but had a myelogram/Ct to be sure. Follow up shows a need for laminectomy, foramenotomy w poss diskectomy at L4-5 & L5-S1. ( as a cc nurse I dread the thought and know so many people that have needed additional surgery later on a level above or below). I've finally decided the only way I'll get back to work by mid August is to have the surgery and am scheduled June 30. (it'll be the end of my 26 weeks of short term disability and my hospital will have to let me go). Anyway back to my issue of pain. My new PM rocks!! He upped my zanaflex to 8mg tid and asked what I wanted for pain. I tried norco 7.5/325 q 6. Not alot of relief but wasn't sure w the increase of zanaflex. Next we went to oxycodone 15mg q 6. I had horrible headaches and nausea but much better pain relief(down to 4/10 from 7-8/10) just didn't last long. After my last ESI he once again asked what I wanted him to Rx. I'm out of my area of knowledge. He Rxed opana 10mg q 6. I'm getting what feel like no relief. I'm back to a pain level of 6-7/10 just about all day. I've continued to take it as rxed in case it is doing something and I just can't tell. I've called and have an early appt for this Monday. I feel sure he'll ask again if there is something I want to try. Again I'm out of my knowledge and comfort zone with medication. I know I'm having surgery in a few weeks but don't want to continue in this much pain. Should I try the oxycodone again but with an increase in concentration? I really have no interest in increasing on the opana. I know many of you have long histories of CP and have tried numerous types of analgesia. I appreciate any suggestions you may have for me. Oh also, nothing I've tried has seemed to last long enough. I have had problems with peaks and troughs with all pain meds. I intend on continuing the zanaflex as it's been the most effective muscle relaxer I've tried so far. Sorry this is so long, but wanted to make sure I got as much info about this as possible so an informed answer can be given without too much back and forth regarding my history is made. I don't mind any questions you all might have. I'm here asking for help and you can't give it without all the facts
June 13, 2009 - 5:03am
#2
wow.
tough situation...
Most people would agree that a long acting (LA) and short acting (SA) medication is the best approach. Common combinations that may be suitable are:
1-Oxycontin 20mg bid and percocet 10/325 q6h prn or oxycodone IR 15mg q6h prn if the tylenol isnt an option
2-Fetanyl patch 25mcg/hour and norco 10/325 q4-6h prn
3-Avinza (morphine extended release) 60mg (not really sure on common doses here) once daily and maybe 15mg instant release q4-6h prn
You are very fortunate to have a doctor that is open to suggestion. That is rare. If I were you I would research these 3 LA/SA combinations and maybe come up with a few others. Then when you go to the doctor, narrow it down to 3 potential combinations and ask his advice about which may be the best choice. It is important not to go in there dead set on getting one certain drug or the other. This may cause the doctor to be weary about prescribing anything.
Best to you and keep us updated!
June 13, 2009 - 6:40am
#3
I d suggest
the morphine sulfate ER in a 30mg to start out with the generics by mallie are good, norco 10/325 for breakthru, there was a good arthritis medication it was called Daypro
the morphine sulfate ER is a 12 hour release
if that did nt work, since oxycodone made you nausea an gave you headaches, oxycontin prob. would too, opana very strong medication , as well as oxycontin, I m sure you re concerned about work, an ability to drive
I m no DR. just a hillbilly, hope you find your combination
June 13, 2009 - 8:59pm
#4
thank you two
I have been thinking about the fentanyl patch. I've heard really good things about it and what a plus to not have to take so many pills and not have the peaks and troughs of oral medications. My concern is the the difficulty of finding the right concentration. I know I've read somewhere on here but don't remember. How can I find which pharms carry which generic brands? I am very lucky to have insurance. And I have been without at times and am still paying a week's stay from almost ten years ago. I know the crunch so many of you are in with none or underinsured. I use CVS but if they don't have the preferred brand of generic what do I do? I have a contract with my PM dr. Although Dr C is great I don't want to break any part of our contract. I esp don't want him to think I'm taking advantage of him. He is SO much more attentive than the other one. Woodstock, like so many NSAIDs Daypro is rough on my stomach. (I'm lucky to have proof and pics of my ulcers so I don't look like I'm just drugseeking). Thanks for the suggestion though. Also, I'm sorry I should have mentioned this. I'm on short term disability so I won't be working until i go back in mid August. I currently don't drive bc of the pain and well I'm a horrible person to be around Another question a lil OT. I had been taking some concentration of hydrocodone multiple times a day for about four months when I was switched to oxycodone. I asked to be taken off the oxy bc of the headaches and nausea. I've just kinda put it together. Do you gals and guys think I could have been going through w/D's? And maybe I should try it again?
June 13, 2009 - 10:56pm
#5
When I'm looking for generics
When I'm looking for generics I just call ahead to pharmacies. Some won't give out information about certain drugs (especially Oxycontin). If your usual pharmacy doesn't carry them then tell your doctor that you will be using a different pharmacy and explain the reason. I'm sure they would understand, but make sure you tell them before.
It is possible that switching from hydro to oxy there could be some light withdrawls. If your doctor suggests a combination using oxycodone, you should definitely try it. For some people it works better than any other drug. However most doctors would rather put you anything but oxy so the Fetanyl patches with norco for breakthough might be the best place to start.
I'm kind of curious about the patches. The ups and downs have been really taking its toll on my mental health. After a while being in pain just wears you down mentally. I too can be a really awful person to be around on my bad days. Its tough because I work with mentally ill people and without compassion theres no way I can be effective in my job. Having a more consistent pain relief source might help me in that area...
June 14, 2009 - 12:37am
#6
I think Oneir is spot on with
I think Oneir is spot on with getting you on some kind of long acting pain med and a break thru pain med. My PM doctor told me his goal in pain management is to get me on the least amount of medications and the least amount of pills. The more medications you take, the more side effects you will have whatever they may be.
Now the next part is tricky, finding what medications would suite you best. Its kind of like a trial and error, or guess and check procedure after that. Your doctor tries you on x medications, then you come back in a couple weeks to see how thats doing for you. Once he finds whats keep your pain at a reasonable level then you are pretty much on that same medication forever, or unless your condition gets worse.
I dont know how well your insurance is or if you have any, but I definitely would try MS Contin before making the jump to Oxycontin or the Patches. The generics are cheap and very effective, well at least for me and I also think Woodstock can vouche for that as well. I dont know personally how much oxycontin or the patches cost, but from what I hear its pretty much your first born child.
Well good luck with your surgery and let us know how everything goes.
June 14, 2009 - 12:45am
#7
Oh, I just read that you do
Oh, I just read that you do have CVS, well I find Walgreens where I live is way cheaper than CVS and pretty much their main generic they use is Watson. I take the Watson morphine sulfate 30mg extended release, and Watson hydrocodone 10/325. I really have never had a problem with anything Watson makes, whether it was pain meds or Ativan. Since you do have insurance I guess its not that big of an issue with you. Well once you figure out what medications you are going to be prescribed I would make a post asking peoples opinions on what manufacturer works best for that medication. But its funny how some people swear behing one brand and another person says they are crummy. I have noticed generally that most people dont like Malinkrofts hydrocodone products but swear by their oxycodone. But then again some peoples bodys are differrent.
June 14, 2009 - 12:47am
#8
Sounds like you have a gem of
Sounds like you have a gem of a doctor but you are also fortunate to be a nurse in which regards he/she trust you since you are dealing with patients in pain all the time.
You might want to bring up Suboxone for pain management. Also since you can give yourself injections you might ask the doc for IV Dilaudid since it is much more effective that way than orally.
June 14, 2009 - 1:17am
#9
About your meds.
Now I'm no doctor either, just someone who has been dealing w/ chronic pain for about 20 years and am finally able to function. I have tried everything available from darvocet to methadone and everything in between. What started out as trying to deal with the pain became NEEDING the drugs. Then I was really in a jam. Nothing, absolutely nothing worked anymore for me except the methadone and yet I was completely in the throws of addiction and was miserable on top of it. I didn't really hurt but then I was a complete mess. Just dead inside. I gave up, went to rehab and my doctor there, an addictionalogist and D.O. has been prescribing me Suboxone for over 100 days now and I'm much, much happier. I can deal w/ the mild pain I have now. I DO NOT have the severe pain I thought I would have. I walk my dog about 12 blocks a day now, I exersize twice a day, I'm even going back to school and am taking Medical Transcriptiion! I love life again. The ups and the downs. I only say all this because I was once asked what I thought would help me by a doctor and I wish I never would have gone down the road I went on after that. It took me quite a bit to get back and I want to warn you to please be careful, sometimes we can deal with a little more than we think. Just try the lowest possible dose of whatever you decide to take and if you actually feel more than just the relief of the pain, ie the head or body high from the narcotics, maybe you should try a little bit lower a dose. God bless and good luck. Oh and I take 20 mgs of Suboxone a day along w/ IBU's. Sometimes only 16mgs. It's funny I don't hurt that much at all now! And the meds are COMPLETELY non intoxicating to me. I'm alive and aware and happy and working a 12 step program. God bless!
June 14, 2009 - 2:26am
#10
OP, I think you will have no
OP, I think you will have no problems with taking these pain narcotics if you take them as directed. If you do this I feel you wont ever have a problem with the drugs taking over your life. Even if you feel you are underdosed NEVER take more than what it says because you will run out early and have ZERO pain relief. Also your doctor will think you dont have any self control and have the potential for becoming an addict if you take more than as directed and run out early. Just keep letting him know if its not enough. And dont confuse not feeling the initial effects of euphoria going away as the drugs not working anymore. I last that feeling a long time ago but my meds still help tremendoulsy with my pain and I would be nowhere without them. Take this advice and I think you will probaly not have any problems... Take Care
June 14, 2009 - 2:42am
#11
JJ
I think his/her concern for problems with meds was not abuse but rather side effects. The first post says something about nausea and headaches after starting percocet.
June 14, 2009 - 1:57pm
#12
Whatever
- course the OP takes in the end - JJMillertime's post stiil has value.
June 14, 2009 - 11:05am
#13
Oneir, my post #10 was
My post #6 and #7 were on topic, my post #10 was more kind of on topic to what brformindy was saying in #9.
I also think just got reading another post where some people thought that losing the euphoric effect doesnt mean that its still not helping with the pain, and I was just bringing it up again.
Well, I hope you find the right meds for you Scrubnurse, and keep us posted about the surgery.
June 14, 2009 - 12:29pm
#14
THE PATCH
the Duragesic patch or fenytnal would be a medication that if I d consider it would be on a week trial basis, everyone is different but when I was on it, it placed me in zombieland, I was having anxiety issues worrying about driving or everyday abilities to function properly.
but with that said everyone is different
to find your right combination its gonna take trial an error
but would agree with JJ the morphine sulfate ER , has been the medication thats changed my life
your issue with ulcers would make me think that demerol would be good for breakthru, it would be a weaker medication than the morphine IR
again i m no Dr., just a hillbilly
June 14, 2009 - 10:02pm
#15
Scrubnurse
I use fentanyl patches, 25 mcg/ hour every 48 hours. Woodstock, fentanyl patches can't be tried on a week long trial, as it would take longer than that to evaluate them. They started working in about 6 hours the first time for me, and last a full 48. The usual dose is to change them every 3 days, but they worked for about 2 1/2 days, then that went to just over 48 hours. My doc has me change them every 2 days. The medicine stays in your system for approx. 17 hours, so when you change patches, there is no up and down, they work very steadily.
They work very well for me, so much better than the ups and downs of taking pills every 6 hours. They don't make me tired, and I function well on them. And the pain relief is good. You may bring this up to your doc, about a long acting med. He will probably write you something for BT pain too.
If he writes you for fentanyl, he'll probably start you off at 25 mcg/ hour, and evaluate you from there. There are a few members here who use them, and swear by them. There are different brands, and Mylan seems to be the best, it's a smaller patch, stick better, and doesn't irritate my skin. I do use a small tegaderm patch over it, I tend to sweat in the summer, and the tegaderm helps keep them on. Although I haven't had the mylan's loosen up on my skin yet.
Anyway, ask your doc about a long acting med and see what he says. I'm glad I'm not taking a long acting morphine, or other long acting pill, because they too wear off, and I don't want that rollercoaster ride. Once we got the fentanyl dose adjusted, I find I don't need as much break through meds.
June 15, 2009 - 12:49pm
#16
Sorry everyone for the delay
Thanks everyone for such quick responses. Unfortunately, even though I'm on disability, I had to play Nurse Kitty this weekend for my mom. I'll responde to your responses and f/u with what happened this am at my PM visit.
Tacet-C: I don't have a central or PICC line so administering anything IV isn't a viable option for me.
Oneir: I know that I don't have the same kind of pain you do, but man-oh-man, if I was still working I think I'd be fired for being disrespectful at the VERY least to my patients or their families. I don't know how you do it. My gfs have a hard enough time hanging out with me a couple times a month for breakfast. My brother, just the other night, said he'd disown me if he wasn't staying free of rent in my spare room! Thanks for the heads up on finding certain brands of generics. It's something for me to keep in mind while I'm dealing with my injury.
BfroMindy: Congrats on more than 100 days! It is so wonderful when people are able to get their lives back in order after having to deal with the heart and body aches associated with such an ordeal. I know JJMillertime22 is also returning to school this semester. My hat's off to the two of you. I returned to college for my second degree a little later in life and wasn't dealing with the aftermath of a terrible accident or other ordeal. I hope you both succeed and remember to take time for yourselves as needed. College is stressful enough! Thank you for allowing me, and the other's on this forum, to hear your story. I also am interested in taking the lowest dose that will decrease my pain level. I don't expect to be pain free, just a lower level that allows me to live my life a little fuller than it is now. My dog Tina would love to go for a 12 block walk. I think she has a feeling that I'm doing my best with a half a block roundtrip walk just once a day. She pretends to be happy with a quick trip out the back door the rest of the time and I'm so thankful she isn't too grumpy about it.
JJMilertime22: I understood what you meant with the posts regarding the euphoric feelings. I know that some of those feelings are just part of the game to find the right medication/concentration. I wish they weren't though. I dislike not having a clear, natural feeling while taking such medications. 20 years ago I probably would have stolen or lied to others to gain such feelings. Nowadays they are simply associated with pain relief. I don't mind them, but again, if I could, I would opt out of having them. I appreciate you taking the time to mention it.
Woodstock: I am lucky that if good pain relief means I have to spend some time in zombieland, I'm be able to do so. Since I'm not working, and really have nowhere to drive except Drs appts, I can afford to be a little loopy for now. My 60 y/o Mom has to go grocery shopping with me since reaching, bending and twisting are no-nos for me and my back. I'm sure I look like an ingrateful daughter having my mom lift cases of bottled water and loading the filled grocery bags into and out of the trunk while I just hold the cart still. Of course it just feeds my Mom's codependence like you wouldn't believe. SHE LOVES IT!! As far as you know Woodstock, is demerol often Rxed? I've worked at dozens of hospitals that have actually become demerol free hospitals. It has such a high percentage of abuse that it has become a liability to have in facilities. One of the few reasons we give it at all to a patient is for uncontrollable shaking.
Tux: I would save you for last just because it draws into my dr's visit this am. I have read somewhere on here from another nurse that she is back to work because she's utilizing a fentanyl patch. I have heard that numerous people often times instead of needing to increase the mcg/hr actually needed to replace their patch at the 2.5 or 2 day mark instaead of making it the whole 3 days. I appreciate you also reminding others that it isn't a quick trial medication. I think alot of people believe it is a 24 hour patch.
I guess everyone's just holding their breath to find out how my appt went today..huh? Dr. C started by writing on the front of my chart to work me in anyday he has clinic hours if I am having issues with my pain not responding to my medication. We discussed me not responding to my last ESI, which is when I was Rxed Opana in the first place back on the 5th. He is also aware of my recent decision to have surgery the end of this month. After reviewing my radiology reports, he still believes that my disk issues and the bone spur isn't enough to warrent spine surgery. We spent 15-20 minutes going over the procedure and reassuring me that although my concerns of all the things that could go wrong were valid, they were small percentages and rarely go wrong in today's operations. He also reassured me that I have one of the best, if not THE best spine neurosurgeon in Houston performing my case. I really appreciate the way he takes so much time to make sure I'm comfortable with my decision even though he doesn't agree with it.
Then came the ever popular question of what I'd like to try next. I asked him what he'd like to try and he mentioned his next DOC was dilauded. I told him I'd like to try the fentanyl patch. He hasn't had good results with it, but would gladly let me try it. He wants me to be an integral part of my healthcare. He feels there is absolutely a difference between brand-name and generic with the patches. He continued to say there was a more consistant delivery of medication vs the generic, but it was considerably more expensive. He followed with writting brand name medically nec. on the Rx. and said if I got to CVS and it was too expensive for the 5 patches, to call the office and come right back and we'd make the decision to go with the generic or discuss another long acting med. If I feel I need something for BT pain, call the office and he'd call in some Norco 10/325 for me. I'm sitting here on the sofa, patch attached, typing this out on my phone hoping this is the jewel of relief for me. Like so many of you have mentioned, the fewer pills we have to take (and still maintain a good level of pain relief) the better off we are. I'm tired of watching the proverbial clock waiting to take the next pill. I'm not putting all my faith in the patch just yet. That would be setting myself up to fail. Tina and I just have our fingers crossed...that's all.
Kitty
June 15, 2009 - 8:26pm
#17
Good news there. Let us know
Good news there.
Let us know how it does for you
June 16, 2009 - 12:12am
#18
DEMEROL
Is used mainly in the operating rooms for procedures as colonscopes, an denists rx it for pain after extractions
you know you found the right combination, when you re almost painfree, an there s no eurphoria, or even better painfree
there are so many side effects with opiates its not funny, with hydrocodone constant ringing of the ears, any opiate can give you constipation or depress the respitory system
I hope You an your DR can find your combination
I m no Dr. just a hillbilly
June 17, 2009 - 1:30am
#19
Outcomes
Well everyone. The patch was great for the first few hrs. I put it on at 11am and felt some relief by about 5pm. By midnight though it was clear that the dosage was too strong. I took it off and spent the rest of the night reminding myself to breathe. As if my bubble beingburst wasn't enough, I had nothing for by pain. I called it PM first thing but he was in surgery all day. I decided to have the surgery on Friday last week. Don't you know they called Monday at 4:45pm to say they had a cancellation for Wednesday 06-17, today. I got amazingly, cleared for surgery and all my preop testing done inrecord time on Tuesday. The only prob you ask? My bp was SKY high!! I was still in slight freak out mode from almost oding, had had no analgesia in more than 16 hrs, and bc I've been on the nurse side of spinal surgery and have seen multiple "oppsies", I was so nervous and anxious I was visably shaking! Even I thought maybe I should head to the ER for a possible stroke out situation with my bp. The anesthesia md preoping me ordered some IM pain meds andxanax. 30 minutes later my systolic was acceptable. As of now I'm still anxious but am the first case for my lumbar laminectomy, foraminitomy and poss discectomy at l4-l5. Wish me luck! Also, I welcome any comments. If though you feel as though you need to chastise me or simply be rude in some way, please remember that it might be the last post I read before I go into the OR. It has been proven that people who feel impending doom before going under often have some negative outcome, be it minor or major. To the person that is all about being proven something, I will if necc when I'm able to in a few days.
Kitty--positive vibes and positive thoughts...
June 17, 2009 - 1:49am
#20
Good luck Scrubnurse, I have
Good luck Scrubnurse, I have total faith in you that your surgery will be a success. You got support from me because good people like you deserve it. If anyone does feel like being rude to her can they keep it to theirselves because she is in the medical business and could give some good advice or first hand experiences dealing with medical issues. After your successful surgery maybe the doctor can start you on something a little less potent like MS Contin or Oxycontin. Well take care and you are in my thoughts.
June 17, 2009 - 4:27am
#21
Best wishes for your
Best wishes for your operation.
You will be in my prayers!
Let us know how it went as soon as you can...
June 17, 2009 - 6:14pm
#22
good luck ScrubnurseK
An remember when coming out of sweet sleep, You may make some truthful confessions, so if your co-workers have smiles on their faces you know why.
best luck Woodstock.
Oh I forgot-- I also take aleve in the am and pm so I could have a little NSAID action without tylenol or ibu since those aggravate my ulcers horribly.