Help with quick tolerance to RXs?

[AngylHeart]

I have a problem that has caused me much grief throughout my life. It doesn't seem what kind of meds - such as Xanax, sleeping and pain meds - after two of three doses, I build such a quick tolerance that the meds become ineffective quickly. It's so bad that my Pain Management dr. would constantly have to increase meds I had previously never been exposed to, like Versed, when he performed ESI and trigger point injections in my spine, the doses had to be increased every time he did these types of procedures. The doses became so high that eventually he stopped performing them in the hopsital OR room became he was concerned that the dosage would rise too many eyebrows.

My GP says its because I have a good liver. I don't know about that, but I sure wish I were like some people who pass out from half a Benedryl!

Any suggestions, education would be appreciated!

[Leeaelle]

Hi AngylHeart ~ You and I are exactly alike. I'm one of those who wake up on the operating table. Surgeons tell me they have to give me enough to knock out 10 men!! :eek:

I can't get adequate pain relief because the doctors are afraid of the "authorities." I have NEVER run out of meds early, have NO record of abusing my meds. So I assume like YOU, I'm in pain constantly and have never, in the last 20 years since this all began, been anywhere near comfortable.

The only thing I can offer you is to keep looking for a doctor, pain doc or otherwise, who isn't afraid to prescribe a dose that will make you reasonably comfortable. I'm sure you have (or can get) your previous records to show what your needs have been in the past. Best of luck, and I pray you get some relief. God bless. Hugs, Lee

[911]

you both are far from being alone , everytime i have to talk about my meds its like OMFG your on THIS MUCH , ohh what do we do ????? yeh so i know exactly what your talking about , haveing just moved to a diffrent state i have heard this once i have heard it 100 times since i have been here and people seem to not know what to do except repeat stuff that didnt work before ??? so i know and feel for you ,,,,,,,,,,,, Dave

[AngylHeart]

I have a great gp who is very supportative and took over my pain manangement about 5 years ago (too few PMs that are either overbooked are incompetent in a large city). It's just so frustrating for both of us. We switch out my base pain med between methandone or Oxycotin to try to help with the tolerance and I have several drug allergies that include morphine that makes it a bit more difficult, but I have a new insurance policy and they are about to drive both me and my doctor insane with their pre-authorizations and denials for the few meds that barely keep me sane - and one of them is my BT med that I have been using for over 5 years.

So sorry for venting. Pain, sleep deprivation and the aggravation of it all is making a bit off and making me babble.

[Mark N]

This is a tough problem and I don't know of an easy answer for any of you. I am thankful that I can stay at the same level for years and not need any increase. I am sensitive to meds so life is easier as I just keep the dosages low.

I wish you could find a doctor that had an answer for all of you as this is a tough way to live with pain.

[jtroy]

Hey angel....saw your thread and thought I'd post as welll.....this whole tolerance issue becomes quite a nightmare as time goes along. If you take my case....I was on as much as 10 (ten) of the 100mcg/hr patches at a time....also would take oral Dilaudid 32mg at a time for bt pain...would take two, three, doses if needed.

Basically, as time goes along you will be able to better manage your pain relative to your pain meds.....some docs are just really "timid" and rightfully so....it seems like they are under a friggin microscope and the trolls out there are just waiting to pounce at a momen't notice.

The best thing that you can do is go in to your doc's office, have your material ready, and give him/her your thoughts and feelings about your pain management currently and how it affects your life, family members' lives, significant others, kids, etc.......whenever you put it into that perspective, especially the docs who have families and understand, they will more likely listen to what you have to say.....jumping on the "this dosage and that dosage" stuff sometimes is just an immediate turn-off to them (unfortunately that is what it has come to.)

As always, I am here is you just want to talk, get an idea on doc-speak, etc....you can email me at: tjandfon@hotmail.com.....feel freel to do so anytime. Regards, T. Jones, DVM

[Kathi49]

I tend to agree with Mark and I don't have any easy answers either. I am just the opposite...just too sensitive. My PM mentioned the other day that he is surprised I am NOT tolerant yet. I wonder why that is and I don't have any answers for that either. Maybe it is the metabolism deal; I just don't know. I know my liver is okay and things of that nature. But if I go higher on ANYTHING, I am a mess. I can handle and tolerate the spinal injections and I can handle Vicodin and Klonopin both. Just meaning they don't bother me and I can function just fine. So, this is another reason I wanted to try other things like Limbrel and/or Lovaza to help with some inflammation and cholesterol. All I know is that the PM said...it is just how I am made and that's that. I know that wasn't really a good answer but it is basically the truth although I don't really know why.

[mrsdoubtfyre]

There is a test available now that can tell you what your genetic
drug metabolic capability is via the liver.

http://www.fda.gov/bbs/topics/news/2004/new01149.html
The new test analyzes one of the genes from a family of genes called cytochrome P450 genes, which are active in the liver to break down certain drugs and other compounds. Variations in this gene can cause a patient to metabolize certain drugs more quickly or more slowly than average, or, in some cases, not at all. The specific enzyme from this family that is analyzed by this test, called cytochrome P4502D6, plays an important role in the body's ability to metabolize some commonly prescribed drugs including antidepressants, anti-psychotics, beta-blockers, and some chemotherapy drugs.

also:
http://store.genelex.com/index.php?main_page=product_info&products_id=17
Approximately 10% of the population has low to no levels of this enzyme, 7% have extremely high levels, and 35% percent have a reduced ability to create this enzyme. Drugs that 2D6 metabolizes include Prozac, Zoloft, Paxil, Effexor, hydrocodone , amitriptyline, Claritin, cyclobenzaprine, Haldol, metoprolol, Rythmol, Tagamet, tamoxifen, and the over-the-counter diphenylhydramine drugs, Allegra, Dytuss, and Tusstat. CYP2D6 is responsible for activating the pro-drug codeine into its active form, so this medication provides no pain relief to the 10% of people that have no or low levels of the enzyme.

A patient who shows unusual responses to drugs, can now be tested to
see what is really going on.

This site is also very interesting... if you navigate around in it ~it might be helpful to you:
https://www.dnadirect.com/jsp/reports/sample_guide.jsp

[Jo6]

AH, I am not as bad as you, but do have this problem. It's been a life long thing, getting worse with age. It's no fun waking up during a hysterR! If you find an answer, let me know. It is very discouraging to say the least. Good luck to you, dear.

Jo