Sorry you are having a hard time with a break through med. I can't quite remember but I think they gave me Immediate Release MS Contin or morphine. Anyway it never worked . Unfortunately NO pain meds work for me as I am polymorphic and do not metabolize them. I have been on over 20 - 25 pain meds at highest doses with no relief. Very frustrating. I read where they were using MIrapex for FM - but my doc said - no.
I can relate to your looking for a breakthrough med. I just wish I could find a med that could give me pain relief for even a brief period of time. Very frustrating situation.
How about Ketamine - drops on tongue or nose spray. I've used both.
Good Luck
Sydney

I saw the doc late last night.... (I love doctors who have 6:45 appointment slots).

Anyway, we decided to tweak the Oxycontin slightly, and raise the dosage of the percocet to 10mg to see if that helps at all.

I see the doc again in 2 weeks, and she said if these changes don't help within the next 2 weeks we can then switch to a different BT med at the next appointment... my git is telling me that I will be switching to a different BT med in 2 weeks because so far today I feel no different with the changes that were made last night.

The good news is that my doctors office is accepting several nursing school students who need clinical hours in a doctors office... and my doctor asked me if I wanted to talk to the nursing students about my experiences as a pain management patient at my next appointment... I'm excited (and nervous) about talking to a future generation of nurses about pain management.

I was pretty sure that percocet wasn't oxycodone so I checked---it's hydrocodone.

I'm not sure that there are any combinations with oxycodone besides oxycodone IR itself.

I'm taking very little pain meds, and I'm not sure whether being a puritan over this is for the best or not. I can deal with the pain I have--it just wears me out. Doesn't keep me from going to work and doing what needs to be done--just takes the pleasure from what doesn't need to be done, but which I'm doing for fun.

So I think of myself as giving myself "holidays" from pain. For these I take oxycodone IR 15 mg, at night, and only rarely during the day.

I find it works well for quick relief--a pain vacation.

My concern about using the pain meds more is the side effects--I find the constipation and bloating more debilitating than the pain itself. I get so bloated I feel 9 months pregnant by the end of the day, and my abdominal girth hinders my movement more than the actual back pain. I don't know if anyone else feels this way.

Also, I get 'holidays" of steroids. This weekend I'm to drive 2 hours to visit my daughter at college. I haven't driven more than 15 minutes in a year, and my doctor gave me a medrol dosepak to lighten the pain so I could sit in the car. Does anyone ever do this? Steroids for pain?

It's not a perfect pain pill, but it definitely makes a big dent.

Given that I'm on the medrol now, I'm superenergized and up here on the board at 1am. Not sure this post is actual useful to anyone, Wittesea, I apologize if I've babbled you through to fluff.

But I guess my point was: oxycodone IR works for me, and a medrol dose pak when I need a break of more than a day.

I looked in the PDR (physicians desk refrence - the doctors "bible" for medications).

percocet is oxycodone
http://www.drugs.com/pdr/percocet_tablets.html

vicodin is hydrocodone
http://www.drugs.com/pdr/vicodin_es_tablets.html

The links are to an online version of the PDR.



I take steroids for pain, low-dose prednisone daily. It helps with the inflamation -- it's the only anti-inflamatory I can take because all the others (ibuprofen, advil, aleve, celebrex, etc...) all give me stomach problems. The prednisone does help a lot, but I'm not sure I want to be on it for too much longer due to the side effects that can occur as a result of long-term steroid use. So far though, the benefits of the prednisone far outweigh the risks, so I continue to take it.

I take oxycodone IR 5-15mg for breakthrough pain and use MS contin for my long-acting med. The oxycodone seems to work pretty well for me, but I just started going to the pain clinic so this strategy is still new to me.

I like that there is more room to go up with the dose since there is no acetominophen in it. The percocet would max out at 10 mg of oxycodone (& 1000 mg of acetominophen), but the oxycodone is just limited by your tolerance, doctor's prescribing habits, etc. That is not to say that there isn't a dose at which you can overdose on the oxycodone... but as you become more & more opiate-tolerant and the opiates don't give you as good of pain relief at tlower doses, there is room for the doctor to increase your dose. (It goes without saying, but NEVER increase your doses on your own without talking to the doctor first).

Other things that I have used in the past for breakthrough pain are Norco & Vicodin (worked about the same as each other; worked sort of well), po Dilaudid (didn't work too well and made me puke), tramadol (works a little bit), and IV dilaudid or morphine (in the hospital; work okay). For non-opiates, I have gotten some relief from Toradol, as well as NSAIDs (aspirin, ibuprofen). The Toradol and anti-inflammatories make me need less opiates but don't really get rid of the pain on their own.

I have also had some pain relief from steroids, but I don't know why. There isn't a real "mechanism" for them to work in my disorder, a myopathy. I was taking the steroids for hives that kept coming back last fall, and a pleasant side effect was that my pain got a lot better.

So yeah... oxycodone IR might be a good thing to switch to... I have also tried a few other opiates for breakthrough... and anti-inflammatories/steroids might help, depending on the kind of pain.

I was interested to read that you are on low dose steroids. If you remember I posted on this thread earlier and said NO pain meds (including morphine, ketamine, etc.) have helped the pain. I must live with it constantly.
My family dr. recently recommended and gave me a scrip for low dose hydrocortisone - 5mg. 3 times a day. I told my pain specialist about this and he is absolutely against my taking it.
What amount do you take? How long have you been taking it? Any side effects?
I am so tired of this pain I am willing to try anything.
Thanks for your input on this forum.

I know you said you have fibromyalgia, and your doctor says it is definitely not peripheral neuropathy. I don't think fibro responds to steroids, but you could do a search on medline/pubmed to see if it's been studied.

There is clearly inflammation contributing to my pain, and steroids don't make me totally pain-free, but they go a long way to making me comfortable. If I had a clear auto-immune illness, then probably they'd be one way to go. My rheumie says that because I respond to prednisone, that predicts a good response to methotrexate. I'm getting near.

But first, acupuncture.

I take prednisone 5mg a day right now.

I started taking 5mg a day in the summer of 2005.

In december of 2005 we bumped it up to 10mg a day because I had a severe muscle strain in my back that caused a whole body flare. Afer the strain got better and the flare subsided, we slowly reduced it by 1mg a month until I was back to 5mg a day.

I have not noticed any side effects at all, and they have helped me a lot to reduce my pain and other symptoms.

There can be a lot of serious side effects to using steroids on a long-term basis, but for me the benefits outweigh the risks... so I continue to take the prednisone because it helps so much.

I hope that helps answer your questions, if not or if you have more questions, just let me know

Liz

I remember you said you were using prendisone (sp.) andwhen you had a whole body flare you upped the dosage. Do you mind me asking what condition you are using it for? I have Fm and RSD. You said it was helping so I was wondering what condition it was helping.
Also, Liza Jane - I am computer illiterate - how do I do the search on pub/med for sterod use for FM. My Dr. said no to using it for FM or RSD. However, when I said hydrocortisone he didn't seem as upset. I have to verify this with him next visit.
Any thoughts? I've sure tried everything else/
Not crazy about gaining more weight than I already have from everything else.

Sydney

Wittesea,

I had the same conversation with my doctor a few months ago. I take methadone for my "round-the-clock" pain med and Percocet 10 mg. for breakthrough.

At first we tried increasing the methadone but all that did was make me super loopey without helping the pain. So that's bad news for me - I'm at the point where increasing my base med won't bring additional relief. And, since percocet works best with nerve problems such as neuropathy, changing BT meds is not likely to bring relief either.

So changing my lifestyle was very important and something that I continue to learn how to do each day. I'm getting the hang of when to wake up, nap and go to bed to get the rest I need (I also have fibro with my PN). I'm also getting better at recognizing when it's time to stop doing something and get my feet on ice, which really helps me out. And, getting advice from my pals at NeuroTalk is a big help.

So good luck Wittesea on your changes, I hope they work for a long, long time.

Nancy