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Pain Management Message Board


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great post SC, for many reasons. but just wanted to add that roxicodone DOES actually start out at the standard 5mg dose then on up too. but another possibly better option here would be at this point, after 20 some years(thats just a VERY looong time) using ONLY the percs. i think it would be high time to at least see if her doc would be willing to at least go to the long acting form of oxycodone(her percocet changed to oxycontin or another form of long acting type of narcotic) without all that tylenol too? just out of curiosity, what WAS her actual most current doseing with the percs and how much tylenol was in this?

and i am a huge believer in ALWAYS having someone also go in the room with the patient TO specifically help advocate for them as well. YOU could do wonders here FOR your family member by just being IN that room(if the patient allows this which i WOULD push her for if i were you) which would also tell her PM doc that there is nothing to hide, in your FMs use of the meds either? that is a huge issue with PMs and rxing ANY narcotics to patients, whether or not it IS abuse/diversion or an absolute need for true pain relief type of situation unfortunetly. you simply 'being there' at all tells that doc that at least ONE other person in your family is simply well aware of all her med usage, you know what i mean? and YOU also being able to even tell that doc how bad the pain just is and what it keeps her from doing too, just helps to better validate the true need as well. this could help her TONS just by you coming with her to at least some of her ongoing appts. it just CAN matter alot in some cases esp with certain docs.

i do not understand the 'whys' here as to what is prompting this particular doc to actually go 'down' in what would be considered overall strength of the narcotic either(tho no one truely 'knows' despite actual supposed 'strength' just what any given pain response just may be, even with a "lower level" of stength narcotic its all in how any patients pain will simply 'attach to it' that matters more). unless there IS some stupid thing in this docs head about your family member that is making HIM/HER feel uneasy about trying the LA versions or just getting rid of that tylenol all together when he KNOWS that they DO also make the same med as percocet but W/out all the tylenol that she could very easily be switched to here??

its just after 20 years in a PM situation, that family member realistically should have been switched over to any one of the really good and very effective at keeping pain on a more 'even keel' type of the more longer acting pain meds avaliable out there now. this just IS pretty much the 'standard' with a good PM doc, getting the patient onto the longer acting pain meds with perhaps a few of the shorter axcting to help with pain flares. this is what the majority of us here who actually ARE also in PM have as our underlying 'set up' per our PMs.

perhaps if you just DID go with this familiy member and ask about the longer acting types of meds(do some more research, even here), it may help this patient in all the best ways? the best thing that YOU can do is what you are already doing, researching and hopefully really helping to advocate for her until her PM just does the 'appropriate' thing in rxing the right types of meds for the patients actual pain and the generators of it(as already mentioned, that just CAN be many 'other types" of meds depending upon whats creating this in the first place). that IS what this comes down to, appropriate for the pain generators and levels of pain suffered.

do you actually know just what IS generating this persons overall pain? was it injury or some type of disease process/condition they were dxed with? that 'generator" or in some cases multiple types of geneators of a persons actual pain really NEEDS to be looked at for the very best ways to best try and treat it. but i DO really hope you can go with this person to advocate for them and to better assure that doc that this is not 'only' the family members 'secret" all alone? it DOES give a certain "perception to certain docs when any patient just continually shows up totally alone in that exame room at times. alot of how any doc will react or respond also comes down to the patients overall demeanor and the more solid documentation of ANYTHIMNG that just could very easily create a very painful response in them.

unfortuently with soo much diversion going on out there with stupid people/stupid docs going to see PMs that ARE basically what are called 'pill mills' where just about ANYONE can get an Rx for even the strongest narcotics in order to divert/sell them. every single PM out there and the many REAL pain patients DO suffer from THAT alone with increased and at many times 'undermedicated' pain. unfortunetly, this just IS what we as chronic pain patients have to also learn to live with, 'proving our pain' at times.

honestly, any real advocating or true help you can give this family member to just get their pain to a much more tolerable level will help tons for them. and also to get the heck OFF of any and all tylenol products too, esp after this many years using it on a more than likely daily basis? there just ARE soo much safer good and effective meds out there that do not place a persons liver and kidneys in dire peril with the consistant use of tylenol. if a patient WANTS to take a bit of tylenol here and there, they still can. but it should NOT consistantly over this many years just be the 'only' option or shoved down their throats becasue they are suffering and this crap is the ONLY option they have been given by thier docs. good luck with this and to your family member who is also suffering. but we ARE here to help you to help them too, K? any answers to the questions i asked would REALLY seriously help us to help you help her in the very best ways right now too. marcia
i am really confused here too. as jon stated. tylenol, as far as real 'impact' upon just the stomach is NOT one that would normally be of any real concern like some meds she "could" be taking here. the statement just does NOT make any real sense at all.

if at ALL possible, simply see if you can go with her to her next PM appt and ask the PM about just that, the statement about tylenol along with wanting to change to a med that has just as much tylenol. or help her make a good list of questions to just ask the PM about, and then tell her she HAS to ask them in order to get any real help with her pain management. any help that YOU personally could be to her, trust me hon its huge right now considering what is simply generating her overall pain in the first place.

the lowest she can go with what IS out there if she went to hydro would be at least 325 mgs of tylenol, but that is norco and is ten mgs of hydrocodone with that amount of tylenol. anything like the 5mg hydro, i cannot recall exactly, but i do seem to recall that in the 5mg, the lowest you can actually obtain would be higher at 500mgs of tylenol? so i really am confused even more about what this PM is actually thinking at all with hydro?

while she could very easily just go onto the 5 or 10 mg version of the immediate release form of plain old oxycodone(also called roxicodone, or oxy IR(immediate release) with absolutely NO tylenol, it would help alot here in also giving her a bit more of a 'hit' on any pain flares. she could also need a raise in her actual oxycontin too,depending. that is something that usually has to be done over time becasue of a little crappy thing called 'tolerance' where her body/pain gets kind of too 'used to' that particular dose so it simply loses its real effectiveness. and of course the overall increase in pain over time if she just DOES actually have that many real solid herniations that are impacting things like nerve roots in her spinal(not to mention what took place like 20 years ago too which does have its OWN typer of impact upon the levels above and below the fusion site) can also create more pain as THAT all progresses.

does she have ANY herniations that are compromising her spinal cord at this point? i am only asking given her history and the 'amount' of herniations, and what also just happens post fusion down the road? alot just does matter here as far as even having ANY neurosurgeon touch you with an 'unstable spinal"(i am in the very same boat myself with my c spine) as to what will even get them to THINK surgical. but if ANYTHING just IS impacting the actual spinal cord, that DOES change everything since it can be possibly even now or it will be over more time, a much more dire situation depending. so any 'good NS would have to start thinking about at the very LEAST, relieving ANY impingment upon that cord itself in THAT type of scenerio.

but if this is just alot of areas where there is drying out of disc material(dessication)bone spurring, stenosis and the other crappy stuff that one can simply 'get' over time and also arthirtis or DDD(degenrative disc disease which could be very likely there in her given what you stated) it can and will generate pain that if there is any previous surgeries and instabulity. and trust me on THIS one, getting ANY real surgeon to WANT to 'do' anything, well they tend to treat you like you have the plague or something. i have seen two seperate nonaffiliated NSs for MY ongoing and deteriorating mess up in my c spine, and they honestly would not lay a finger on me, even to do a simple eval(i also have spinal cord injuries too)? like i was going to break or sue them if they 'did something' TO me at a visit type situation? very very sick and rather insane considering my areas of impact and my pain too. but this just IS how one can be treated by other surgeons when you have had previous surgeries mostly the spinal ones. unless you are lucky enough to just have that very same surgeon do every single surgery, no one wants to take on responsibility for YOUR liability onto themselves. it is sick but unfortunetly true. so i CAN totally relate to her not being able to get anything 'fixed" in there that could possibly bring down pain. but on the other hand here too, anymore surgeries CAN also create even MORE instability and will also just naturally generate MORE and more scar tissue accumulation that can also impact areas of the spinal depending upon just where it decided to 'grow'. so it IS one of those lessor of two evils here with simply even doing anymore surgeries on her at this point.

is she is actually on ANY other meds besides "just' narcotics for THIS type of pain generator(and the muscle relaxers)? generally speaking, with what is the most likely generator when the spinal is simply involved, the pain will not usually respond well to 'only' narcotics. there usually needs to also be at least a form of like the anti siezure meds which help to calm over excited/overly firing nerves the way they help stop siezures within the brain? these CAN really help with some people when used along with the narcotics. lyrica and cymbalta also have been helpful to many people too for this type of pain. but there ARE alot of different types of mweds that can seriously help with the type of generators she has that can be tried just to see how well they work for HER levles of pain.

but i am also wondering, and this is more for her 'muscle/myofascial" pain just based upon what she has in her spinal and that any muslce relaxers were actually also rxed to her too? has she ever tried lidocaine patches to at least cover the 'trigger point" areas where the main pain starts to radiate outwards TO the "attached' muscle groups from the spine? these little wonder patches have been wayyy helpful to me with alot of different types of pain i have and have had along the way over many years. simply 'numbing' certain areas stops the radiating part. they really DO help depending upon where you place them and what the true underlying generator actually is.

there is also an amazing therepy that i was referred for like over three years ago for my level of very massive muscle/myofascial damge from not just my spinal crap, but from a surgery done from the upper back/neck area where they had to actually cut thru all the very thick muslce just to perform a surgery inside of my spinal cord. the damage is just pretty severe and was loaded with globby wads of balled up tissue/muscle too(some were from that surgery and others generating strictly from my already messed up c spine crap). these are what trigger points are made up of, wads of tissue and muscle/fascia that 'balls up when too repeatedly stimulated from signals that just go TO it. that fascia just is the outter covering surrounding every muscle, organ and blood vessel we simply have within our bodies. this is the 'reactitive" part(underlying pain generator) that even causes the muscles to wad up when IT gets hit with inflammatory signals from anything that is simply inflammed, esp within our spinal levels. i started the myofascial release therepy with an open mind, but not having a freaking clue exactly what it was or did or anything really about 'it'? and honest to god, three years later, i am still seeing my myo therpist for this ONLY becasue it actually was the FIRST therepy of soo many that actually worked for my level of muscle pain. i keep regenerating crappy stuff becasue of my c spine, but he took my overall pain levels down like at LEAST three solid poiints from where i was when i started and now. i just need 'tune ups' now,lol. but his IS one really fantastic way to help with even the msot severe types of muslce hell. something she CAN ask to be referred to by PM or her primary too that works.

i just DO hope that you will be there for her and help her deal with at least advocating for herself at at least "some' appts til she CAN do this on her own. it really DOES matter for what she is dealing with. and you DO NEED to find out just what IS up with that tylenol comment. good luck, marcia
I agree with feelbad btw, after 20 years of regular use, it seems like the change to an LA type med is well overdue

The 325mg of acetaminophen in these products has virtualy no analgisuc activity (650mg is the minimum analgesic dose, and 1000mg is the optimum dose, I dont know why these 325mg doese are so popular - it would make a lot more sense to give a plain narcotic, and allow the patient to add Tylenol seperatly in appropriate doese when this was appropriate
jlec, trust me, i did not know either that they even MADE any type of pain meds that were 'just" plain old oxy other than of course oxycontin either til i was placed ON IT back in 2004 at my PMs(i went in on low dose OC and percs 5mgs for BT pain). there just is alot to know/find out about when you simply even ENETER THAT lil world. i would 'think, as my PM does that the majority of PMs out there simply DO tend to go much more with the tylenol free products only becasue the types of chronic pain patients they care for tend to have to take their pain meds, multidosing on a daily basis. and tylenol, esp the cummulative impact over many years CAN seriously damage both the liver and the kidneys. so it simply does make much better sense here to give the "patient' the option of possibly adding their own tylenol if they truely 'feel' that it helps, OR no tylenol at all if desired. i personally do NOT use any tylenol products from my PM(i have one med tho i have to use that is rxed by my primary for severe headpain caused by deterioration of c 2-3, and DO use it very sparingly becasue of already present liver and kidney disease from a genetic disorder) but my PM will not rx ANY types of tylenol based narcotics either. that is just how 'my' PM is.

i am thinking here that what med you were specifically 'thinking was just percocet under a different name was one called 'roxicet"? this one DOES also contain tylenol and IS pretty much the same old percocet you already know. the thing here is, its the actual drug manu whos name is 'roxanne' who makes BOTH meds and thats what THEY decided to call their own generic version of the percs, while roxicodone(they make this too) is called only 'roxicodone"/pure oxy no tylenol. that could be where YOUR confusion came in. it is 'just what any given drug co decides to even call their products here that is where the names for them come from. there ARE also other 'roxi-something' types of products out there too,all made by the roxanne company. but 'just' roxicodone ONLY IS no tylenol. this can also be called, as i mentioed in a previous post 'oxi IR(immediate release) too. but those two meds are strictly oxy only with NO tylenol added, and just much safer overall if needed for CP and taken on dailiy basis many times esp, in my opinion anyways.

another really great thing about using the more pure true opiates like morphine and oxy is that there just is NO actual 'ceiling effect" to them. meaning you CAN, in theory continue to titrate upwards on them on an ongoing basis and still will have a good level of effectiveness, unlike the limits with the hydro based meds and other more synthetic(created only in labs, not from pure opiates)'narcotics" would when a certain 'amount' is just reached and they stop working. but becasue of particular 'limits set by alot of PM clinics, like mine, they will only 'allow' a particular daily dose limit to be hit, then they will switch you over to a different type of LA med at times too? but you 'could' actually continually go up alot on this stuff and for YOU, who IS the patient, could end up on some pretty incredibly high doses that would actually possibly kill someone else who ever even 'tried" to take YOUR particular dosage? its the "tolerance thing.

i do think the main reason some wont Rx 'plain/pure oxy is that fear factor of possible abuse happening since tylenol DOES in most cases, prevent someone from using this stuff in a way it was NOT intended(but some did know how to get around THAT unfortuently)? thats just MY own theory there, but it does make sense given what we already know about what certain people, usually NOT CP patients are doing with these types of meds, and the main reason that they DID go ahead and change what was already a great pain med with less side effects than this 'new version', the oxycontin? just the abuse potential with the "old' OC, the huge diversion which which will ALWAYS get the DEAs attention, and the insane amount of pharmacy robberies that were going on where they ONLY wanted the OC was really getting a bit over the top too. i know i live in a really great area, with lesser crime and in the burbs, and even some of our closer walgreens were also getting robbed as well? that really scares a person ya know? could you EVEN imagine actually being IN that drug store when that could have happened? yikies.

but if either yours or your FMs overall pain is simply NOT being well maaged here, DO go with her to help her get onto a much better combo of meds and for you too. you CAN change PMs if they are simply NOT doing the appropriate job for you too. we hire them and we can also fire them. but possibly with some adjustments made for your FM, things just could be much much better for her. trying other types of meds is also kind of the 'usual standard" too when simpoly dealing with what IS responsive to narcotic type pain but also a bit of non responsive too like alot of spinal indi=uced pain simply IS kind of also a 'combo of' as well? so it simply DOES make sense to ahve to try and treat this THAty same way, using multi meds of different types/make ups that really CAN also make a huge impact for some with this same nasty deterioration of spinal crap. but eirher way,she does NEED to better communicate with ehr PM in order to even GET the best combo of meds and or therepies, like the myo release for what i KNOW she also has to have given what she also has as her spinal as the main generator as myofascial/muslce pain? amazing therepy that does help ME personally to actually drop my pain. anything that just CAN possibly help here when trying to treat CP should at least be given a fair shot before anyone decides it simply does not work either. some things just DO take more time than others, ya know? good luck hon, marcia



sorry i did forget to mention that in my PM clinic, most patients will ONLY see their actual NPs or PAs for most of the actual monthly follow up appts too? the only time i even see my actual PM doc is for strictly "procedures" alone(or if i actually 'request" a visit with him). like my needed sympathetic blocks, and what used to be before i found the myo release therepy, TONS of ongoing trigger point injections and the like? but i do think the majority of PMs DO do it this way simply becasue of overall patient loads at some clinics? but that is NOT at all unusual to have hon.





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