Higher B/L or switch B/T??

[jena1225]

Hi everyone!

A couple of months ago I was taking 2 750/7.5 of Hydrocodone and 4 625/10 of Percocets a day. I was advised from a couple of nice people here that I was probably "chasing my pain". I and my PCP agreed so we got me on Oxycontin with the Hydro as B/T.

She started me on 40mg a day and that we will go up from there if needed. Well, it wasn't nearly enough for some reason, so in the middle of my 2nd month, we are now on 80 mg a day. I am worried because it's not always enough, and the Hydro does nothing, so I have to sometimes take Percocet that I still have for B/T instead.

A couple of questions:

Should I just ask to switch to Percocet for B/T instead of Hydro, or go on higher dose of the Oxycotin?

Does this mean I am becoming tolerant, OR could it be that I am just still finding my appropriate dosage?

Is 80 mg or more a lot? especially compared to what I was originally taking?

Is it normal for the medicine to wear off WELL before 12 hours??

Thanks everyone for any feedback :)

[Mark N]

First the Oxy doesn't seem to las for 12 hours as advertised so have your PM increase you to 3Xday instead of increasing your dosage.

Second, it takes some time and effort to find you baseline med and you may need to increase it to get the relief you should have. I started at 15mg of MSContinin 3 X day, went to 3omg and then 45 and finally settled on 60 mg. I have stayed there for the past 3 years now with no BT meds.

[jena1225]

Thanks Mark. I was just worried that I might already be getting tolerant. But maybe it's too soon for that? How does one tell?

[Mark N]

The way I tell if you are getting tolerant is if your meds handle your pain and as months to a year go by you need to increase your meds just to stay at your current levels. Then it could be a case of becoming tolerant to your meds. Tolerance just means that the meds don't have as much of n impact on your body any more so you need more meds to deal with your pain when lower amounts worked in the past.

As I was determining my dosage of meds I didn't get adequate pain relief from my MSContin therefore I had to increase my meds - that is not tolerance. Once I get my dosage set to get my pain under control and then need more medicine I am becoming tolerant to my meds.

[BrokenBladder]

Jena I'm on Oxy 80's tid. This way I don't have that 12 hour wait in between doses. I also take Vicoden for b/t every 4 hours as needed.

[Scar Tissue]

Hi jenna, I hope you're feeling well today. I have been in PM since Sept. 05. My MS Contin started at 60mg. every 8 hrs and has increased over time to 200mg. every 8 hrs. My Dr. and I are still trying to find the right mix of Meds. for me to take to have the maximum pain relief with the minimum medication. Each person is different and sometime it takes the Dr. longer to get this mix with some than others. If your main pain med. is wearing off too soon, then my opinion is that is what needs to be increased. Your breakthrough med. should be something used occasionally not all the time. If you are using your B/T more than you think you should, then the main med. is not enough. Just my opinion from going up and down the med. scale myself, hope this info. helps!;)

[jena1225]

The way I tell if you are getting tolerant is if your meds handle your pain and as months to a year go by you need to increase your meds just to stay at your current levels. Then it could be a case of becoming tolerant to your meds. Tolerance just means that the meds don't have as much of n impact on your body any more so you need more meds to deal with your pain when lower amounts worked in the past.

As I was determining my dosage of meds I didn't get adequate pain relief from my MSContin therefore I had to increase my meds - that is not tolerance. Once I get my dosage set to get my pain under control and then need more medicine I am becoming tolerant to my meds.

That does make sense. I just wonder if I could tell whether the meds arent enough anymore, OR if my pain is worse.

[jena1225]

Thanks Lisa. What is bid? 4 times a day? If so, I dont think I could do that. I do need at least 2 40 at one time. As a matter of fact, today is soo bad that I am going to experiment. I was just upped to 40mg, 2 times a day. I am going to do 60mg right npw, and just 20 tonight (I have only taken my vicodin so far today since I had a b-day party to go to, although I couldn't tell!). I want to see if 60 is at a time is what I need. If so, that would get me to 120 a day, is that too much? Maybe I need a different med?

Thank you scar. As you see, I am having a very bad day :(

[Pharmacist.steve]

What is bid? - twice a day
TID - three times daily
QID - four times daily

[jena1225]

Thanks Steve! I had always wondered about those but never asked.

Lisa - you take 80mg 2 times a day, right? Not 80 total...

[suemck2]

I had the best pain control on the fentanyl patch over a 2 year period the dose went from 25 to 50 to 75 micrograms a day and changing the patch every 3 days. Ultimately I came offif to prepare for surgery but it did work very well and there's a new generic version which worked equally well for me.

The general PM rule of thumb is to increase the baseline pain med if you're having more/more severe breakthru episodes
best of luck
SUe

[Kira]

I started out with MS contin and it just wasn't doing much for me. We switched to the fentanyl patches and they work better for me. When we decided to switch from the MS contin to the patches, we discussed how many increases, etc would be too much (I asked)... my pain doc didn't have a concrete answer to that one, but said that she will increase it a bit before giving up on the drug and switching to a new one (nice and vague, huh?)

I guess my only point is that if you increase the oxycontin dose and are still not getting good pain control, it could be possible to switch to a different long-acting med in its place.