Vic..sorry for the migraine. I know they can be nasty and I hope you are feeling better soon. I took the 10mg at supper like he told me to so it was with food. There are just some drugs I can not take. My stomach is still sore and bloated 4 days later. I am going back to see him wednesday morning to get his take on it. If he would prefer not to give me anything else, I will just take my demerol. I know thats probably not the best choice, but may be the only choice I have. We'll see what he says.
Hope you are feeling better.
Rach

Hi,
Sorry about the amitriptyline....
you can try other meds....
as for the demerol, it is not the best drug to be treating tos...it is very short acting and not a great pain med for long term use.....

so perhaps think about other meds...percodan, oxycontin....which is the same but long acting. the first few times I had it I was stoned then I got used to it after a few days so i was able to move around better. A long acting med is way better solution for you. You could also look at low dose morphine as it is even better to take for longer term than demerol....have a look at it in this

http://www.pbm.va.gov/criteria/meperidine.pdf
it clearly states for short term use....
I am going to assume you are not taking anything regularly.....not a good idea either....why suffer needlessly. avoid the ups and down and keep an even keel so that you can function at a better level. You will still have to watch all that you do as you are not getting rid of the problem just the result of it.
http://www.mywhatever.com/cifwriter/...fact/ff71.html
ignore the title just read the info....

http://www.cpsnb.org/english/Guideli...delines-6.html
go to the part where it says ...ah just read it here.....

GUIDELINES FOR OPIOID USE IN CHRONIC NON-MALIGNANT PAIN The underlying medical diagnosis causing the pain should be established, and the pain should appear to be commensurate with the diagnosis. For example, the physician should determine whether the painful process is somatic in origin (e.g. chronic osteomyelitis), visceral (e.g. chronic pancreatitis), or neuropathic (e.g. post-herpetic neuralgia). Patients with idiopathic pain are not excluded from a trial of opioids. Rather, the clinician should exercise particular caution in those patients whose pain is idiopathic or appears to be primarily determined by psychologic factors. A history of recent or remote substance abuse is a relatively strong contradiction; the available evidence suggests that chronic opioid therapy should be considered only under the most extraordinary circumstances in such patients. An adequate trial of non-opioid analgesics and adjuvant analgesics should have been carried out without success. One physician only should prescribe opioids. In order to start a patient on an opioid, the principles of the World Health Organization "analgesic ladder" should be employed. Patients first should be started on opioids in combination with non-steroidal anti-inflammatory drugs or acetaminophen. Opinion concerning opioid therapy is evolving and the decision to rely on combination products or other products prior to considering trials of morphine or similar opioids is arbitrary and based on convention, rather than pharmacologic principles. Fixed combinations of acetaminophen with oxycodone (Percocet) or codeine (Tylenol #3) are commonly used. No greater than 12 tablets of the above preparations may be taken per day because of risk of acetaminophen toxicity. Fixed combination preparations may be taken per day because of risk of acetaminophen toxicity. Fixed combination preparations are fairly safe, but usually need to be administered every four to six hours.

The role for agonist-antagonist or partial agonist opioids, e.g. Pentazocine (Talwin), is less clear. Experience with long-term opioid therapy, as conducted in the cancer population, has been almost exclusively with pure agonist opioids, and on this basis they are preferred over agonist-antagonist or partial agonist opioids.

Meperidine (Demerol) has relatively poor oral bioavailability, is short-acting, and can be associated with accumulation of a toxic metabolite, normeperidine. Anileridine (Leritine) is chemically related to meperidine. The use of these two opioids in management of chronic pain syndromes is not recommended.

Treatment of pain with opioids is actually a treatment trial, and like all therapeutic trials, may be effective or ineffective. Effective therapy may be defined as identification of a dose associated with meaningful partial analgesia and no adverse effects severe enough to compromise comfort or function. This dose must be one at which the clinician can comfortably maintain the patient given the clinicians level of experience and training. Opioids almost always need to be titrated upwards, and effective doses are commonly higher than the starting dose. Personal discomfort by the physician at the apparent level of opioid requirement is a valid reason not to proceed, and may warrant the referral of the patient to a physician who has more expertise in chronic pain management. If a fixed combination preparation of an opioid and non-opioid analgesic is not satisfactory, then the patient may be tried on oral morphine. The syrup preparation is convenient for titration purposes, and is recommended. We advise starting at 10 mg by mouth every four hours. The dose should be increased once or twice weekly by 25-50%. Increased doses should be accompanied by increased analgesic effect, although doses of oral morphine (or its equivalent) above 300 mg daily are unusual, but not contra-indicated in chronic non-malignant pain.

If the short-acting morphine preparation is useful and there are no features suggesting abuse, the patient should then be switched to a long-acting (q8h or q12h) morphine preparation.


http://www.merck.com/mmpe/lexicomp/meperidine.html
you can find this on the above web page near the bottom of the page...

Other warnings/precautions:
• Abuse/misuse/diversion: Healthcare provider should be alert to problems of abuse, misuse, and diversion.
• Acute pain management: When used for acute pain (in patients without renal or CNS disease), treatment should be limited to 48 hours and doses should not exceed 600 mg/24 hours. Oral meperidine is not recommended for acute pain management.
• Chronic pain management: Use is not recommended for the management of chronic pain.

ok enough of my nursing knowledge passed along!!!

take care and best of luck!!!
love and hugs,
Victoria

WOw...thanks for all this info Vic. I would like to get off the demerol and get onto something better. I see my family doc tomorrow morning again so I will see what he his suggestions will be. I will let you know what he says.
Migraine better?? Hope so
Rach

Hi,

Headache is getting better and I hope you get the help u need from your doc....look forward to hearing about your visit!

Take care and thinking of you and saying prayers!!

love and hugs,
Victoria

Rachael- If you get this in time I would suggest that you shoudl ask about Opana ER. It is also a very good long acting med- it is a 12 hour oxymorphone and comes in 5,10,20 mgs. The 10 mg is equal to 4 vicodin 5-500 over 12 hours.

many physicians don't know what it is because it is new (from mid 2006 i think), but i have found it to be a life saver for me....twice a day, keeps things under control and then I have some vicodin for breakthrough pain.

I think if you are taking something pretty regularly that vic is right, long release is the way to go because it is so much more stable...

here is a link to the opana web page:
http://www.opana.com/