Need a med reccomendation for chronic pain

[wheatpenny]

Slightly long backstory:
I have fibromylagia, so my current treatment plan includes narcotics.
However, I cannot take anti inflammatories in any form due to a stomach surgery a few years back.
I also have developed a serious Tylenol intolerance (as in, puking every time I take my vicoden) not controlled by anti nausea medicine at all.

I am on a fairly low dose (10mg / day) and have no current insurance, so paying out of pocket until my local hospitals charity care kicks in (soon, please!!).

Other meds I am on are Lexapro, so no SSRI's for fear of seratonin syndrome, Lyrica when I can get free samples, and .5mg Xanax as needed.

I have tried the following to no avail:
Tramadol, Trazadone, Cymbalta, Lyrica, Amitriptyline, Butalalbitol, Vicoden, Percocet, Fentanyl patches and surely more I'm forgetting.

Narcotics work REALLY well for me, in regards to pain and keeping a reasonably clear head. BUT- my doc and I can't seem to find a med that doesn't have APAP/Tylenol or and Anti inflammatory, and has a low enough dose for me. I've been trying to stick to the vicoden 5/500 x2 because it can be called in, etc But I had to move to percocet this month because it's available in 5/325 formulations.

I'd like thoughts on what to ask my doc for. We're both trying to do research, and I have a pain contract so it isn't in appropriate for me to ask my doctor to let me try a different drug.
Appreciate any thoughts!

[doctor diesel]

Well, what's the problem with your doctor prescribing opiates that aren't combined with tylenol or ibuprofen. I don't understand.



Doc

[GOLD N DIEMONDS]

Originally Posted by doctor diesel

Well, what's the problem with your doctor prescribing opiates that aren't combined with tylenol or ibuprofen. I don't understand.
Doc

YES me too?
FENT patch did not work?
morphine ether IR or ER is cheap and doses in just about any amount
low dose of methadone- also inexpensive
what sleep meds do you use?

[Narkotikon]

If you can't take your Vicodin because of the Tylenol, what about Vicoprofen? It's hydrocodone with ibuprofen, not as commonly prescribed, but it wouldn't have APAP / acetomenophen in it. Although I guess that would be ruled out because Ibuprofen is an NSAID / anti-inflamatory.

Hmmm...

My thoughts for something that is narcotic / opiate-based AND without any kind of other active ingredient (i.e., APAP / NSAID, etc.) are:

1. MS-IR or MS-Contin
2. Oxy-IR / Roxicodone or OxyContin
3. A low dose of methadone (5mg t.i.d., etc.)...they also come in 10mg pills too.
4. Dilaudid (although orally Dilaudid / hydromorphone sucks IMO, but then again I'm thinking for the "high" factor, not pain relief).
5. Demerol / meperidine / pethidine, although you need to know that you should NOT take high doses of Demerol OR for extended periods of time, as it producdes a toxic metabolite that can cause heart-damage and other problems.


In terms of cost, methadone would be the cheapest, but along with all of the choices I listed, they're all C-II's, so your doctor won't be able to call them in, and also C-II are usually harder to get b/c, well, they're more addictive / fun / abuseable, and also because they probably carry more paperwork / stigma for a doctor to prescribe.

I can't believe Fent Patches wouldn't help your pain. What dose were you on? Would a higher ug/mg patch work, or did you just have a bad reaction to fent for some reason. Most people say fent works great for pain. The problem is that the patches are expensive.

If you're looking for something cheap cheap, methadone is going to be your best bet.

[Eric5989]

If you have a problem with apap you should ask for the 5mg IR oxycodone capsules. It's the same as percocet but without the tylenol. Morphine also comes in pretty low doses.

There is also other formulations of fentanyl like the suckers, and sublingual i think. If it was the patch itself you had problems with.

[drmom]

Methadone is the least expensive but some docs don't like CIIs. Pharmacies around here will formulate hydrocodone 10 or 15 or 20 with only 50mg of tylenol and it is a CIII just like vicodin so refills and phone-ins are ok.

[Paregoric Kid]

methadone with tramadol and possibly lyrica. a friend of mine who has the same problem you have gets good relief with the combo of those 3 meds. tapentadol (nucynta) may be another good choice for you to look into.
methadone might be especially useful because it works not just as a strong opioid but also kills pain through NMDA antagonism which is good for fibromyalgia and neuropathic pain. levorphanol also works like that too and as a NRI (norepinephrine reuptake inhibitor). tramadol is good in addition to a strong narcotic because it boosts it and also acts as an SNRI and to a lesser extent as an NMDA antagonist and effects GABA. and you can still use it with SSRIs you just need to monitor dosing and side effects. tapentadol is much stronger than tramadol so its a potent opioid that also acts as an NRI but does not inhibit serotonin reuptake.

[jersey_emt]

Oxycodone is available in 5mg doses, with no APAP. It's generic too, so it will be cheap.

[wheatpenny]

See, this exactly the kind of info I needed. Couldn't figure out how my doc didn't know there are forumlations sans APAP or Anti inflammatories.

I rotate between seroquel, ambien, and otc sleep meds, so they don't stop working.

How much of a junkie might I look like (I'm not- the difference between dependence and addiction) if I walk in to my next appt with a list of meds pulled from this thread? I have a good rapport with this doc (after lots of struggles with various others), but due to my age (under 30) it's been a lot of trial and error for me with meds.

The fent patch 12.5 micrograms per hour worked GREAT for chronic pain, I woke up in a great place, but throughout the day any acute pains were terrible, and I was told NOT to mix the fent with anything on top. So I prefer to dose as needed during the daytime and then definetly pre sleep. If i get quality pain free sleep the next day is good too.

I understand methadone is MORE addicitve then vicoden/percocet - so far I've been very lucky walking the line with my opiates.

One more question- with the ER products, where is the absorption? My digesttive tract is not "factory", and I can't take extended release anti depressants or anti anxiety meds because they are out of my system too fast.

REALLY appreciate the knowlege sharing from you all.

[clonaze-whammed]

Originally Posted by wheatpenny

How much of a junkie might I look like (I'm not- the difference between dependence and addiction) if I walk in to my next appt with a list of meds pulled from this thread? I have a good rapport with this doc (after lots of struggles with various others), but due to my age (under 30) it's been a lot of trial and error for me with meds.

Dont walk into the doctors with a print-out from this thread.

Just mention you've been doing some research online and suggest low doses of any of the following:

morphine IR
Oxy IR,
Dilaudid,
Opana IR
Actiq fent pops

If I had the choice and insurance would cover I'd try opana IR.

[Paregoric Kid]

methadone gets a lot of bad press but its really great for people with your type of pain. if nothing else works it couldn't hurt to give it a shot.

[Restharrow]

If I understood the OP cost is a big factor.

IME methadone was a cheap pain med. Also generic morphine instant release. I am not sure what the cost of instant release Oxy is (like Roxiecodone 15mg. or 30 mg.)

will

[mikey5string]

all good recommendations. i was going to say oxycodone 5mg IR.

i would however second the NOT bringing a print out of this thread or even mentioning this website at the docs office.

[blackman]

^^^^^^^^^^^^^+1, mikey.
no mention of this beautiful place is smart.

[edhorfin]

Your doc is trying to avoid addiction, using a slow long ladder. Next step would be opiates wthout APAP. So far, he has used mainly CIII (schedule 3) meds, which are subject to less control than CII meds.

CII is your next step, and your doc is aware of ALL the CII narcotics. He just doesnt want to go down that road yet, because he's concerned you will become addicted to CII more easily than CIII. He;s probably right.

If our fibro is chronic and no one can find any root cause, chances are, you will become dependent on pain meds.

You need to know: ONCE ADDICTED YOU CANNOT GO BACK. At least not without LOTS of work. Its like trying to unring a bell......lots of perfectly good meds listed in this thread.

Roxicodone is a probable next step.