Question about breakthrough meds

[IC SARAH-CPP]

Hi Everyone,

I have a question to ask those of you on long term pain mgmt with narcotics. How many take b/r meds and how often do you take them. Also how often are you prescribed them?

I am asking b/c i have found I am using a lot of b/r meds lately. BUT -my pain is controlled better now than ever before. I am using the Oxycontin long term and the Oxy-IR for b/r meds. I am kinda concerned though b/c I using about 8 of the 5 mg pills a day, the max he gives me a day. I need a refill now and it has been exactly a month and what he gave me was a month supply. but I am worried he will think I am using too many of them. I feel kinda funny b/c I feel like b/r meds arent really supposed to be used everyday, you know? But Then I dont want to rock anything b/c I am just so happy I am doing well right now.

So I am just kinda wonndering how you use your b/r meds and how your doc feels about it.

Thanks!
Sarah

[Kimchi]

My Dr said if you are still having to take so many of BR meds, your base meds are not strong enough. I really can't answer this b/c you know mine is still not straight but I am allowed to take 4 Norco's a day. It's definitley something you need to discuss w/ him. Ask him how many you are allowed to take. 8 seems like a lot to me. What is the mg on the oxycontin you take?

[IC SARAH-CPP]

Thanks Kimchi. That is kinda what I thought, but I am finally feeling pretty darn good and I dont want to rock the boat. We already went from 30 mg - 3 times a day on my oxycontin to 40 mg - 3 times a day and I dont want to go up again. My doctor has the same theory and he generally doesnt believe in b/r meds but he said he made an exception for me. i just have SUCH ups and downs in my pain ,how can I be on the same amount every day. I know I have posted about this several times and others have the same dilemma.
I have an appt w/him tomorrow and I am just going to be honest about taking 8 of the 5 mg a day. I take 2 every 6 hours. I will also tell him I am feeling better and having a low pain score all through the day, unlike before, and see what he says.
I guess I just got worried b/c I usually have the b/r meds for much longer than the amount he prescribes but this time I need a refill right at 30 days. I dont think he will care though.
How are you doing Kimchi? Any better? Any news on the pain clinic?
Sarah

[ihurttoo]

Hi Sarah!! I am on 30mg 24 hr time release Kadian (morphine). I am on 10 mg Lortabs for breakthru pain. I get 60 Lortabs a month. (It is written to take 1 tablet twice a day.) However, he has told me I can take 6 a day if necessary during a flare, and I can take 2 at a time.)

Like you, my main med does not cover my base pain, so I find myself taking the Lortabs to cover the base, rather than for true breakthru. It helps get my overall pain to a lower level. Also, like you, I was concerned my meds were not right since I am having to use Lortabs to cover the base.

I told the pain dr, but he doesnt want to increase the Morpine right now. He said maybe in a few months, but for now he wont change anything. But, he knows what I am doing, so I guess I will keep doing what I have been.

I am glad you are feeling better, no matter how you are getting there. I would just talk it over with him, and be honest and tell him what you told us. I believe that MOST drs (except mine) would rather increase the base meds, and decrease the breakthru meds. Good luck! Hope you get it straightened out! Hugs, Amy

[Kimchi]

Sarah, you are wise to be honest w/ him. You will find the right mix soon. I still have not made any progress w/ my pn mgt. I can't even get my appts right or my meds straight. It looks like I will have to wait until August when I am already scheduled to see him. I have my letters of recommendation in hand! I am doing okay right now. I do not like the patch but I am getting by okay. He increased my patch to 50 mg last month and now I am short on my appt time. I called yesterday to tell them they needed to move up my appt but all I got was confused silence, a long hold and then, we will get back to you. Still have not heard anything. If they have not called me by next week, my butt will be sitting in that office until someone sees me. I am not going to run short on my meds! I ended up short a patch this month, probs w/ them not sticking, and have been pushing each patch an extra 8 hours to try to make it last till the full 30 days. It's madness.
I also have a call into another pain clinic but you know how that goes. Still waiting on that.

[Sarojini]

Sarah, I am having the same problem. I am in a flare right now that will NOT let up, and ended up finishing my breakthrough meds a few days early this month... I see the pain clinic on Friday, but it seems my base med (MS-Contin) is not really helping much these days. To be honest, after reading the transcript of Dr. Brookoff's talk here on the ICN, I am beginning to suspect my body is just metabolizing the stuff like mad, and that it's time for a base-med switch for a while. Would your doc be willing to try that??

However, it's terrifying to ask the pain doc for this because I too don't want to "rock the boat" as you say -- the base med does help some, it's better than nothing, but I do worry about my breakthrough pain; today it's so bad it made my head spin and then made me barf at work (embarrassing to be throwing up in the restroom here), but I don't have any B/T med to take.

*sigh*

[Kimchi]

Oh jen... I am sorry you are having such a horrible day. I have run out of BR's early too and when I called to ask for more... I got in so much trouble. Then the Dr made me go almost 1 whole month before giving them back to me. Since my patch was increased, I have better pain relief so that is good. I just hate the darned thing. I sweat alot so it does not like to stick. So, you have 1 more day to go before seeing your pain Dr? Sounds like you need to go home and rest.

[graceimnot2096]

I've had alot problems with running out of breakthrough meds also. Seems as though we all have. My previous uro had no problems giving me all the pain meds that I needed but when he moved I had alot of trouble finding a doc that would prescribe the meds. The uro I have now won't prescribe narcs to ic patients. He is a real @#$% if you know what I mean. Thinks he is God. I'm trying to find another one but it is hard to find one that does interstim around here. I found a great primary that has no problem giving me the pain meds now, THANK GOD!!!!!!!!!!!!!
I take the big hydros, and lortab for breakthrough. I have taken the oxy combo but found that the hydros are more effective for a longer period of time.For the last several months I've been taking the max on both and am hoping that my pcp won't start to question that. Whenever I take the max or run out of meds early I worry that he will think I am abusing them when I'm not.My b/f doesn't think I need to take any meds for pain and that it is just mind over matter. The worst pain he has ever had to endure is hemeroid surgery.We all know that doesn't compare to the pain we go through everyday, I love him to pieces but sometimes I have to wonder what he's thinking.I've tried to tell him that they don't give these types of meds just because I ask for them. I don't like living in the pain pill fog and I'm sure alot of you feel the same as I do, we just don't have a choice.In order to function half way normal I have to take the meds. Whatever normal is anyway.
The more I talk to everybody here the more it tells me how hard this disease is to treat and that I need to be a little more patient with the doc. There doesn't seem to be one treatment that works for all of us, no one mixture of meds that work for all of us. I'll tell ya, the thing that scares me the most is what is going to happen when these meds don't work anymore, then what?!?
I know I got off the subject a little, and went into a little rant of my own, sorry about that.
Sounds to me like you have a good doc and that he will understand why you ran out early. He knows that you hurt alot and will do what he can to help you with that.

[Sarojini]

Thanks, Kimchi -- I actually am going to go home early today, give myself a heparin/lidocaine instillation, and lie down for a while to see if that helps, although I did one yesterday and it only worked for an hour or so-- I think the catheter just irritated everything even more. You know what the worst part is? Today is my WEDDING ANNIVERSARY (3 years). I hope a little rest this afternoon will help me make it through and get to go out with Hubby for a nice anniversary dinner anyway....

Anyway, I think it's okay that everyone has ranted about their own pain med struggles here -- I think Sarah won't mind since she will see that we are all dealing with similar problems ;)

[Kimchi]

(((((Jen))))), happy Anniversary. On my anni, I was flared so we stayed home and I took pain meds. Woohoo. Gosh, what I would give for a nice glass of wine or sex w/o pain..... I miss it so much. Anyway, I don't think Sarah will mind. It's nice to see everyone else has the same problems..... I think. I thought I was the only one who used the b/r too soon and even posted here once and only Sarah responded. I felt really bad about it too b/c I thought I was the only one who did that! This subject seems sort of taboo around here.

[Sarojini]

I know -- I wish hubby and I could share some champagne and then have an "intimate" evening together after dinner, but IC itself rules out the champagne, and the flare rules out the bedroom fun... guess we'll just have to put it off for another day.

And no, you're not the only one that runs out of b/r early. There are many people around here who've had that happen, unfortunately. For me, it happens sometimes -- there are many months I'm fine and don't run out, but then there are these months when things have just gone haywire in my bladder and I do. Usually I just tough it out until the pain appt. if that happens. I guess we just don't talk about it much.

[Kimchi]

Before going on the Duragesic patch I would indulge in a glass of wine now and then. I could usually flush the flare pretty fast. My IC is not really triggered by good though I am careful what I eat. That seems to help control it.

[IC SARAH-CPP]

Wow I was so happy to come in and see all the responses to my thread!
Jen I am so sorry that you are in a terrible flare. Are you still on the MScontin 60 mg AM and PM? I wonder if your doctor would be willing to try Oxycontin? I found Oxycontin MUCH more effective than MSContin. Oh yeah, I wanted to tell you my doc has this theory that b/c I move around so much and am always on the go that I metabolize the meds much faster. That could be what is going on with you. I feel a close kinship to you because we both are career women with very stressful jobs. There are days I just feel like I won't make it through the day, but I usually do. You know what I have been doing lately? I bring a soft squishy pillow to work and a book on tape with headphones. At lunch or if I get a chance during the day, I will try to lay down for a few mins or listen to my book. I find this helps me calm down.
I also have been vomiting a lot lately from pain or something. My doctors are stumped. They have done every test in the book and cant figure it out. I have to go for a cat scan to see if my liver or kidneys is the reason. It REALLY sucks to throw up at work. Yesterday I threw up out my car door on the way home. That wasnt fun either.
So my pain doctor was as wondeful as always. He is SO laid back! I dont know how I got so lucky. He says he isnt really like that w/ all his patients, that we have a special relationship.
I told him everything about the b/r meds. I was very dilegent and kept my pain diary with EVERY time I took them and how I felt before and after. I told him I myself worry about taking so many but dont want to rock the boat b/c my pain is controlled very well now. I was very against raising the oxycontin again. I have already went from 20 mg - 3 x's a day to 40 mg - 3 x's a day.
He said that it is obvious I am aware of what I am doing and that I am not just popping them whenever I felt like it. He was just happy that I was feeling better. He has told me so many times he wants so badly to help me. I know I have said this before but he and I would most likely have been friends in different circumstances. We have the same political ideas, outside interests, etc. He told me that we will try to cap it at 200 of the pills a month and that he was okay with it if I was okay with it.
ONe thing that concerned me was he wants me to go to 300 mg od lyrica a day! That is alot! I will try it for a few days and see what happens.
I am glad I am not the only one who takes b/r every day. I still feel it will be better for me to take a lower baseline and then a high amount on tough days.
He also pointed out the amount of stress I am under and said that would affect any person.
Hope you get to go home Jen! I love ya all
Sarah
P/S- My 3 year anni is in Sept. I still feel like a newlywed. We just had our 7 yr together anni and couldnt even have sex. :(

[IC SARAH-CPP]

BTW- Of course i dont mind you all talking about whatever you want here! I love reading all your responses .
Sarah

[Kimchi]

Yea Sarah :woohoo: I am so happy for you. It shows there is hope and caring Drs are out there. We just have to keep pushing to find them.

I finally got thru to my pn mgt Dr and now have my appt straight. One thing at a time, I keep telling meself to be patient. It will all work out.

[Hangin' Tough]

I wish I had an opportunity to post more; but alas, I don't. I also have the problems of running out of b/t meds. My PM doc only gives me 30 per month (5mg oxycodone) to go with my 20 mg oxycontin 3X per day and 50mg lyrica 3X per day. I think that at my next appt. I am going to ask either for an increase in the oxycontin or more b/t meds. My PM doc says that if you need to take any b/t meds then your base medication should be titrated upward. I agree with that, but I don't believe that they will ever increase my base meds to completely control my pain. I hope you all find some relief.

Tough