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Help! 125 Fentanyl to OxyContin 60 mg BID
Blpenn posted:
I switched Pain Mgmt Docs because my old one would NOT listen to me, continually increased Fentanyl, and always recommended spinal cord stimulator (found out he gets a nice "kick back" from stimulator manufacturer. New Dr. actually listened to me when I explained that Fentanyl was not controlling my pain and I had lost about 130 lbs in 7 months (I had Gastric Bypass in 2009, lost 100 lbs, but regained most of that due to steroids a rheumatologist recommended. New Dr. gave me a choice in meds, OxyContin, Suboxone, and another that I cannot remember. Now, I cannot control the pain AT ALL! The morning OxyContin does ok. The second dosage, however, is a DIFFERENT story. I am awake ALL night long!! My night meds I take are Vimpat (anti seizure med for migraine prevention), Requip for RLS, Clonazepam, and Methocarbamol. Morning meds are Lexapro, Welbutrin SR, Clonazepam, and Methocarbamol. I also have Zanaflex as needed. I am having problems with the second dose of OxyContin. Since I am to take the pill 12 hrs apart, I have been skipping the second dose because I cannot sleep. Then I wake up the next morning in excruciating pain. As in vomiting pain! Any suggestions??? Thank you SO much!!!

Fibromyalgia / Chronic Fatigue Syndrome / Migraines / Restless Leg Syndrome Hx of kidney stones / Gastric Bypass 2009 / Total Hysterectomy 2011
philglesfan2013 responded:
WOW you are like a walking pharmacy ,no disrespect meant.I personaly am dealing with insomnia but I have a lot of career discissionos on my mind .i also am on roxycodone and sometimes oxy and thats all.I cant tell u what to do cause i am not one of these online dr.s but seems to me u have sometype of interaction going on.I know for me 30mg oxycodone tends to act like a stimulate on me ,and keeps me up nights so i would go to dr. and ask or go to pharmacist and discuss all the interaction possibly going on. wish u well
annette030 responded:
Is the doctor who prescribes the Oxycontin aware that you are not taking the second dose?

I would suggest that you takes ALL your medicine bottles in a brown paper bag to ALL of your doctors who have prescribed any of them and check for interactions, let them all know you are having trouble sleeping. Do this fairly soon. Meanwhile if you have access to a nurse line through your insurance company perhaps you could call them and explain what is going on.

Clonazepam, methocarbamol, and zanaflex all have muscle relaxant actions, should you really be taking all three at the same time? Ask your doctors?

I also have FMS, insomnia is part of having FMS, I know this because I have it also. It sucks big time. The less sleep you get the more pain you have. It can be a vicious circle.

Take care, Annette
terriblespine replied to annette030's response:
Stay off fentanyl for sure but try methadone.
77grace responded:
Hello Blpenn,

I know it looks like you take a lot of medication ,but that is between you and your Dr.!
It does send up a Red flag to me when you say you don't take the second dose of oxicontin,no wonder you wake up in so much pain !!!It only lasts for maybe 12 hrs. !That's why it is prescribed that way !Ask your Dr. or pharmacist about interactions !
Take care, 77grace
Blpenn replied to annette030's response:
My Pain Mgmt Dr and my Neurologist both know my medications, as they are consulting with each other. I also take all my medications to each visit to both Drs. The Zanaflex is PRN only. The Methocarbamol is actually pretty mild for me, but it does help a little. Thanks for taking the time to reply to me!
Blpenn replied to terriblespine's response:
Methadone is a consideration. We decided to try the OxyContin first. Thanks for taking the time to reply to me!
Blpenn replied to 77grace's response:
I am well aware WHY the Oxy is prescribed the way it is. I am taking the second dose each day now. However, I have slept a total of 6 hrs in 3 days now. Also, I'm still getting a significant amount of breakthrough pain. I spoke with the nurse for my Pain Mgmt Dr late yesterday afternoon and am waiting on a call back for an earlier appt. Thanks for taking the time to reply to me!
DknowsPain responded:
Hello BLpenn, I have had three neck surgeries all with fusing a herniated disc this past May four were fused together with a plate and pins to hold. Nine months before that I had my second major back surgery with four discs fused,a cage,plates,pins and titanium rod on each side , I know pain. I am currently on OxyContin which they increased my dose to 40mg every 8 hrs and I take Breakthrough pain Percocet 10mg every 6 hrs. Gabapentin(Neurontin) 300 mg every 8hrs. I was on zanaflex and it did better for muscle spasms . The methocarbamol I think is Robaxin so you are on 2 muscle relaxers . I had to go to Valium which is the Best for muscle spasms. And helps you sleep, also they can give you ambien, or something else as there are several sleep aids they can help you with. My tolerance is out the roof as I have had a lot done and a lot of meds ( still in a lot of pain if I try to be productive) but I went to the ER at one point after surgery in tears and they gave me Fentanyl 25 I'V, I felt nothing. I have a friend who is on 75 Fentanyl, 10mg Percocet for Breakthrough and a sleep aid( which she has cancer). So maybe if you had a breakthrough then took your next OxyContin and had a sleep aid as they know theses meds keep you awake, I still have some trouble sleeping a good bit but would rather deal with that than the pain that is unbearable. Did the patch help you as very few pain docs give that from what I have experienced. But see if you can get you a breakthrough and something to take at bedtime . As the OxyContin is a slow release and it is (oxycodone) which is what Percocet is but short acting. Hope you feel better, god blesss
ctbeth responded:
I have a spinal cord stimulator and my meds are over 50% less than before I got it.

First, why do you think your MD is getting "kick backs"? Second, if this treatment can help your pain and enable you to decrease some of your meds- why not give it a try?

Perhaps do a Google or Bing search to learn more about them. Since your MD has recommended spinal cord stimulation, he/she has already considered you an appropriate candidate.

Before a permanent implant is done, the patient early always has a trial. This enables one to actually feel the sensations and find out if it will help reduce the pain.

Whatever money the MD gets paid and/ or if he/ she is getting "kickbacks" should not be a factor in your getting pain management.

If your MD has invested in the biomedical company that makes the devices is really his business. The USA was built on a free market economy and the MD has the right to invest in any way he wishes.

Many have invested in biomedical devices as the future looks ripe for investors.

I think that you should be primarily concerned with managing your pain and let the MD concern himself with his investment portfolio.

Best wishes,

fibrofran17 replied to ctbeth's response:
BlPenn, my 2 cents, I noticed you are taking Lexapro AND Wellbutrin SR, that"s a doubling up of antidepressants and one is extended release, maybe running into your sleep time.?And when I took Wellbutrin it made me speedy so am wondering WHEN you take those meds, maybe try in the morning and pick one or the other? hope this helps, best wishes, fibrofran
An_246419 responded:
You are right some Dr's are like that all they want is how much they can make off of you, but there are some good ones who care more about their patient than kick-backs.
How did you do on the Fentanyl, did it help at all? Sometimes you might need a pain specialists? Maybe a MAYO Clinic or something to get your meds straight. If they could replace the nite dose with something that would let you sleep it should help. That is why I suggest a return to a pain clinic for a review.
Congratulations on the weight loss, I need it to, but at my age it would be to little to late. Getting an another opinion might help. I saw a neurologists for my shaking and I brought up my sciatic type pain, he checked my back x-rays and said a muscle relaxer might help it. I already had the one you use, but now I take more of it only when I get the sciatic pain and it helps me sleep as well as controlling the pain. lin19
ctbeth replied to terriblespine's response:
Excuse me, but none of us here has the right to tell another member which medicine to take or not to take.

Fentanyl may not be the right med for you, but this does not mean that It is not right for everyone.

Neither do you have the right to tell her to try Methadone.

She is followed by a pain management MD and a Neurologist.

A respondent on an internet support community should now be advising another member on what meds to take
cweinbl responded:
Be careful what you wish for... Everyone who uses an opioid long term will become tolerant. But it's important to understand that Fentanyl is the most potent pain medication available (at least 80 times more powerful than morphine). Many people who become tolerant to Fentanyl discover that switching to a different long-acting pain medication is a failure. In other words, we're better able to manage chronic moderate to severe pain with Fentanyl Transdermal even when tolerant, than by switching to Kadian, Oxycontin or another drug.

Suboxone is an opioid antagonist. It was designed to assist those with addiction disorder. Administration of an antagonist will defeat any opioid in your plasma.

What are you using for breakthrough (BT) pain? It's an axiom that those of us with chronic severe pain require a long-acting medication as our mainstay (Kadian, Oxycontin, Fentanyl Transdermal, etc.) AND a short-acting medication (Hydrocodone, Oxycodone, etc.) for BT pain.

In addition, people with chronic moderate to severe pain will almost always benefit from a powerful anti-depressant (Cymbalta is exactly this kind of drug), because it will inhibit the reuptake of plasma Serotonin and it has pain-fighting characteristics.

If you have neuropathic pain, you might do better by adding an anti-convulsant (Neurontin, Lyrica, etc.). These drugs are off-label for pain, but can be very effective.

Millions of people with chronic pain benefit from THC (the active ingredient in marijuana). If you do not live in a state with medical marijuana, ask your physician about an Rx for Marinol (the active ingredient is THC). However, research reveals that marijuana seems to be more effective when inhaled than when ingested. Either way, it deserves a try.

My best recommendation is to try, with your physician, each and every possible combination all pain medications until you discover the combination that is best for you. We're all different. What works well for one, does nothing for another. So, we need to try all combinations of long and short-acting medications, until we learn which ones work best with our unique body chemistry. To accomplish this, you need a very trusting physician. I tend to recommend family doctors and internists for this because in most cases, they have a long and trusting relationship with the patient. Meanwhile, a new pain-management physician may not trust you at all, or be unwilling to try all possible combinations of medication.

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