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Pain Management Message Board


Pain Management Board Index


Hello,

I just found this forum and am new here. I will give you guys a little background info about myself before asking my question. I have been suffering from chronic pain in my right knee for almost 20 years. I am a 31 year old man. I have dislocated my right kneecap several times over the years (a hereditary problem), and have had 5 unsuccessful knee surgeries to try to correct the problem. My most recent surgery was 3 months ago.

I have been taking 15mg Oxycodone 4 times daily since the surgery. I was taking 10mg Percocet 4 times daily before the surgery for about 6 months, and Vicodin and/or Percocet for the last 4 years prior (on average 2 doses per day). I have had surgery on my knee in each of the last 4 summers, one arthroscopic, 3 major surgeries (a lateral release, a Fulkerson, and a resurfacing of the knee). My latest surgery was the knee resurfacing.

I have been going to pain management for the last six months (before that, I was getting my medication from my surgeon). A month ago, my PM dr wanted to drop me back down to 10mg percocets 4x daily, I told him that the pain levels hadn't improved since the surgery. He kept my dose at 15mg, saying he would likely drop me back to 10 this month.

This was the first visit to this particular doctor. My original PM doctor had just moved to Fla, and the guy they switched me to (same dr's office) hadn't really heard my whole story of the years of pain. I am pretty sure he just thought of me as a typical patient fresh off of a knee surgery.

When the dr moved to fla, the practice hadn't found a new dr to hire in his place, and have not had much time to fit in all of his patients. Basically, all the old doctor's patients needed to be seen by the existing doctors who worked in this office, so they are overbooked (the day I go to get my prescription renewed is something like a 5-7 hour wait). The way this PM doctor's office works, is you have to see the dr every 4 weeks to get your prescriptions refilled.

Anyway, the 15mg Oxycodone has not been cutting it for the pain lately at all. I used to work in tile (I know... bad choice for someone with a history of knee pain). But the pain was tolerable until the most recent dislocation (4 years ago). Since then, I have been getting surgery every summer, and taking classes at a university in the fall and spring. I get the surgeries in the summer so as not to delay my graduation date.

However, when this semester started (3 weeks ago), the pain was too great, and I had to drop all of my classes. Right now, I can't do much other than sit on the couch. The 15mg Oxycodones work effectively for about an hour, then i am counting the minutes until I can take my next dose to get another hour of relief. I was nervous that my dr would indeed cut me back down to 10mg, but planned to explain my whole story, whether I had to wait 12 hours at his office, or not. Another problem with the Oxycodone that I had was the frequent ups and downs of taking the medication 4 times per day (mood swings, etc). I just wanted to find another way to get pain relief without the highs and lows of IR opiates.

I wanted to ask him to put me on some kind of extended release pain medication. I just can't do normal things without a very high level of pain. I can't work, and I can't even go to school right now because of the pain.

Two days ago, I finally was able to tell my doctor all of this and he showed me the 3 scars on his knee, and told me that his surgeon did everything correctly, but he took longer to heal than everyone said he should. He said his quality of life suffered really badly. It was a HUGE blessing to me to know that he understood what I was going through.

The recovery from this latest surgery, I am now told, will likely be a full year This is mostly because of the fact that my right leg is MUCH weaker than my left, and I have so much strengthening to do as a result of limping around on it for years and using my good leg to do everything. Also because of all the surgeries over the last couple years, it just won't heal like someone who had a strong leg to begin with, and just had 1 surgery.

My surgeon was optimistic, telling me that I would be fine in time for school, and I had told my PM doctor's this when I went to see them. We were hoping to only need to be getting these prescriptions for a couple months after the surgery. Now, when I tell my surgeon that I am in even worse pain then before the surgery, he says it will probably be a very long time before I see any reduction in pain. My surgeon was the one to suggest that I ask for Oxycontin from my PM dr.

The PM doctor told me that, as a practice, they do not prescribe Oxycontin, but he offered me a choice of 3 extended release medications that my insurance approved: Fentanyl, Kadian, or Methadone to help me live a more normal life, and to avoid the ups and downs of the IR medications.

He said he did not care which I chose, he was only concerned with the dosing level. We decided to try 30mg Kadian, twice daily (it is a 12 hour extended release morphine), along with the same 15mg oxycodones (still 4 times daily) for breakthrough pain.

Instead of a 4 week prescription, he gave me only two weeks, in case it did not work well, and we had to switch to the Fentanyl patch. He said that Methadone is usually his last choice of the three.

So here are my questions (sorry this post is so long!).

So far, the Kadian hasn't worked too well. I don't know how long it is supposed to take to get the full effect. I have taken it every 12 hours (starting at 1pm on Wednesday afternoon - a total of 5 doses so far), and it IS better than not having it (it has especially helped me to sleep a lot better), but I am debating whether the Fentanyl patch would be better.

I do not know what dosage level of the Fentanyl he would consider giving me, or how many/how strong of Oxycodones I would get along with it.

I was just hoping someone who has been on both could help me out to tell me which would be more effective pain relief. I have heard some scary things about Fentanyl, but I ASSUME that it can come in a pretty low dose? What is the Fentanyl equivalent of 60 mgs per day of Kadian? Should I switch to Fentanyl in 2 weeks?

Would someone with my level of opiate tolerance be able to handle a low dosage of Fentanyl, and would I still be likely to get four 15mg Oxycodone while on the patch? I am worried that the Fentanyl would be too strong, even at the lowest dose.

I am also worried that, if the Fentanyl is too strong, or I don't react well to it, but the doctor prescribed me 5 mg Percocets for breakthrough pain, then I wouldn't have anywhere close to enough Percocet to make it through the next 2 weeks of the Fentanyl trial period. At least with the Kadian, I knew that if I didn't like it, I still had the 4 15mg Oxycodone, so I knew I could make it through two weeks just with the Oxycodones, if I had to.

Sorry this post was so long, but I was hoping if I provided detailed information about my tolerance levels, and pain history, maybe someone who has been in a similar situation could help me out.

My #1 concern is, for someone with my opiate tolerance level, would Kadian or Fentanyl be a better choice, and is Fentanyl simply too strong for me? I am very tolerated to 15mg oxycodones right now, but understand that the patch is a whole new ballgame. The Kadian has helped a little, but not too much yet, and I don't know if it takes a week or so to get your body acclimated to the Kadian. Any help would be GREATLY appreciated. Thanks so much for taking the time to read. Hope everyone is having a great weekend.

Al





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