Advice please re: meds
 

Hi Gang. I started on Avinza 30 mg. and wow, what a dream: I feel no morning pain, can sleep at night, etc. - and even think! Then, ~ 1.5 months later I needed 45 mg., and now am on 60 mg. My internist sent me to a very tough PM doc/interventionist who insisted that I detox or she'll taper me down. It's true: I've developed a tolerance. She's concerned about opiate hyperalgesia - a topic that drowned me tonight in crash research. One UCLA doc said that I'm inoperable b/c of extensive DDD and that my facets (everywhere? getting him to say *why* was like pulling teeth) block my foramens that cause heavy shin pain.

So, school starts Monday and I'm seeing a new PM doc who might raise my doses but this can't go on indefinitely. I also have read countering stuff on opiate hyperalgesia that says it can increase pain from the primary source (here, my back) or be like a RSD thing and/or cause major radiating pain.

I am open to advice. Should I detox, would BC pay for this (I am waiting for UCLA to call/email back), try a higher dose or so, then reconsider, move to methadone - or what? Suboxone? If so, then what if I have acute/urgent pain? Wait two days? Gee, if only everything was easy, huh?

I am truly confused am in a true jam w/no easy answers.

That's why I'm asking you guys for advice!!

Personally, I lived on Vicodin and Celebrex for years but the highs/lows, intense morning pain left me wiped out during the day and I could barely function.

I wish I could say the check will be in the mail.

Hope I get sage advice in what I think is a very individualized, messy subject.

Begging, chubby, and crawling..

ans

I wish I had some magic bullet for you. I don't know if Avinza has a different tolerance building profile than other meds. With my lumbar problems years ago, and now with my t-spine issues, I take Oxycontin. This has been effective for me and I've not crept up on doses. I've always cut down when I felt better and RARELY take anything for breakthrough.

The forced detox is tough to face. That is a different style of pain management that may be good for some. IMHO, people with serious structural problems that are generate severe pain will require some meds to function. Yes, it's great to do without meds and they may be doing some people a favor by forcing them down... but they may be torturing others.

just my 2 cents.

Mark

Am wondering..
 

Allan,
Have you spoken with your Primary Care doctor in terms of ruling out any medical conditions that might explain a rapid metabolism of this particular drug ? Just wondering if that could be a possibility.

If you're to detox on Suboxone I'm thinking that perhaps you'd be able to stay on it in terms of pain management if it works to detox and cover you as well.

I don't quite understand detoxing you unless it's to rid your body of this drug and then to see what's going on with your pain while doing the injections.

As you know I've not increased my dose really in the last 9 years with Methadone however I think that's just because I haven't had to as my pain actually got better vs. worse once L5S1 autofused.

I'd recommend asking Terry Newton (correct name/spelling) for his opinion of the advice you were given. My experience seeing multiple PMs over time is that there are those that don't actually like to prescribe pain medications and just want to do injections and there are those that do both. I have chosen to go to those that do both because that's what I found has worked well for me over time.

Call me if you want to talk tho I don't really have any advice that's sage.. just opinions to be taken with a grain of salt..

Thanks Maria and welcome back. Did you get lifted to OZ in a tornado today? The PM doc was worried about morphine-induced pain (and I read this can happen with methadone). Before my procedure, I asked the anesthesiologist/not PM doc is this like Complex Reflex Dystrophy pain (which on inspection, it can be and also an increase of the primary pain). Dead silence. I awoke to her saying that she now wants me to do a complete detox versus a taper so she had it with me.

Thanks for being there and sorry your pain is up.

Mark! Thank you for your sage wisdom. I told her that if I feel excruciating pain while tapering that I'll perceive her like a Nazi Den Mother. I don't think it was the best click. Glad your dose is stable but then I wish I could be you.

For the rest of you, hang in there.

ans

my PM
 

If you'd like his name I'll give it to you as he's worth seeing even tho in San Diego that's if your insurance would cover the visits. I go every three months (get scripts for 3 mo. at a time).

*Thank you M*. I may have to go there if I keep running into this. My first PM doc - the one who refused to answer questions at UCLA would not sign a scrip post-dated a week in advance as of course, I am a craven criminal. You are lucky.

On another site, an MD who had an ADR said that one technique of pain medication w/these rx' is to "rotate, rotate".

Be well. Was online hours ago and boom! and an instantaneous flash while online by the window.

(No home defib. device; some have lousy ratings too).

My state just passed a medical marijuana law and I couldn't be happier. With cannabis I use HALF the Oxy I'm prescribed. (80mg instead of 160mg) Also no Valium anymore and rarely a breakthrough. If you're in Cali I'm sure you know all about it. If you are not a smoker, eating a brownie is better anyway. I will need narcotics the rest of my life. The fewer the better...

If your PM is old school...oof....good luck....

Wow Eddie, that's great this works so well for you and sorry you're stuck with pain post-fusion. I'm in CA and probably one of the few people who get paranoid on cannabis unless in raw nature. I never knew that mj potentiates (right word?) opiates so well.

Thanks and take care.

I'm gonna provide a link to a free pain mgt. journal. Best..