13th April 2005
I, like the rest of you, have gone thru hell the last few years. Sorry, but this is going to be long. Please bear with me. I think the history here is important. What appeared to be a simple neck and shoulder injury from a car accident, has turned into a nightmare with several misdiagnosed conditions. In order to alleviate acute pain in my upper back that radiates out into my shoulder blade and down my ribs along my side and also up into my neck, I have gone thru the following.
*8 weeks of PT with minimal pain management (Ibu, Celebrex, Soma)
*ACDF surgery at c4-c6 with a pretty titanium plate and mild PM care (norco)
This unsuccessfull surgery and comments from my surgeon that my pain was a function of my addiction to narcotics (1-2 Norco qh6) led me to seek my own PM doc who put me on 10mg Oxycontin BID, 10mg Norco every 6 hours for BT, Soma.
*PM doc sent me to shoulder specialist who suspected rotator cuff injury (upper back pain??? OK) and he went in and scoped it, looked perfect, but did Acromioplasty because of bone spurs. Surgery was useless.
*8 More weeks of PT, no help, strenthening activities actually made it worse. Awesome Physical Therapist hooked me up with great GP and sent very detailed notes and called this GP with thoughts on my injury.
So, 2 months ago I switched GP's and he upped my meds to 20mg Oxycontin TID, 1-2 10 mg Norco every 6hrs, Soma, Cymbalta.
He then sent me to a "specialist" who specializes in cases like this. This new "specialist" is a PM doc but is very well versed in Nuerology and Orthopedics. Well beyond any other docs I had seen before.
This specialist took a novel and thought provoking approach. Instead of looking everywhere on my body that doesnt hurt for a problem that could be refering pain to where I hurt, he said, "lets look at where it hurts" Wow!!
So, another round of MRI's and Nerve Conduction studies show that I have 2 moderately buldging disks at t6-t8 and a poor conducting Serratus Nerve and Long Thorasic Never. He also noticed that my right shoulder blade is "winging" and doesnt glide on on my rib cage when I move my arm. It kinda skips. Keep in mind that I can feel this happening when I move my arm and ALL previous docs denied it was happening. So he sent me off to a facility that does Epidural Steroid Injection, Facet joint blocks and is even starting to use Botox in muscles that are causing problems. I am awaiting to hear from them for an appointment. I did have a consult with them last week and they concured with my "specialists" diagnosis. So that is great news, right?
Well, one would think so. With all this in mind, everyday is a major challenge for me. By the time I get up and take a shower and get dressed I am done for the day. I have to go lay down for 2 hours to take a load off my neck and back because I am in so much pain. After that, I cant get up and move around for an hour and then its back to bed. So, basically, for the last year (the pain has steadily gotten worse) I am living a very limited life. All my hobbies are gone. I can go out to visit friends. I cant have them over for more that a few hours. I cant drive more than a mile or so as steering and shifting kills me. It really really sucks. I used to be VERY active. Played golf 3-4 times a week. Went hiking often. Waterskiing...you get the picture. I tried to pick up on an old interest of mine, Photography, and I cant even carry around a 1.5lb camera in my own back yard for more than 15 minutes. After I set up my ****** and camera and get my gear out, before I have taken one shot, I am in so much pain that I cant enjoy it and have to head to bed and pray my med time is coming soon. Pathetic and really really sad. I am sooo depressed and bored at this point.
So, this bried (lol) history leads me to my questions. Sorry it so long despite my attempts to make it short. I see my GP on Thursday and will be discussing all the recent findings and plan of attack (injections). I really like to verbally all be on the same page. At this time I am planning to really lay it on the line about my pain meds. I believe that I am severly undermedicated. I suffer after doing the most basic things (showering) and this just doesnt seem right. I have never abused what meds I have been prescribed. I never took more than was alloted and I never needed a early refill. Trust me, there are many many times where I wanted to take more, but I didnt. I know where that would lead. I do not suffer from any strange side effects from what I am taking now. I had blood work done and my liver and kidney functions are fine. I dont get high or goofy from them much. They do take some of the pain away but not nearly enough. Now, I know that they cant take it all away but 20mg of Oxy is a LOW dosage so I know I have room to grow here.
So, based on my current meds, 20mg Oxycontin TID, 1-2 Norco q6h, Soma, Cybalta and the fact that I really only get a 10-20% reduction of pain at times (often less), what should we be looking at dosage wise.
Side note: The specialist that discovered my buldging disks is a PM doc but my appt with him was only a consultation and he wasnt asked to pick up prescibing my meds. He did make some comments on them. He likes a 80% LA to 20% BT med ratio. Im am way off that ratio. He also doesnt like Norco used as a breakthru med with Oxycontin. He says that they sould be from the same derivative and I should be taking Oxycodone with Oxycontin. Make sense? He also doesnt like Soma in use with narcotics.
So, when I see my GP and tell him flat out that I cant go on like this and explain what my life is like, what kind of dosing step up makes sense? I know they do not make a 30mg Oxycontin and I am not sure an extra 10mg TID is going to be all that effective. Im thinking more like 40mg. How would the 80mg of Norco I take a day convert into Oxycontin? The Norco is for BT but since the breakthru is all the time I take the up to the limit of the script. With that conversion what would be a logical step up to give me some relief. Also, the worst pain and discomfort I have is at night. I cannot sleep and often only sleep 3-4 hours in weired, spread out blocks. I feel I need a bump up for nightime. Is 60mg too much going from 20mg? Or should we be looking at just 40mg TID and an appropriate BT med for nite and maybe a sleep aid. Would 40mg TID be right considering the Norco conversion? Should it be more? For sleep, in the past I have used ambien but everyone freaks out over long term use. I guess its really a short term med designed to reset your sleep cycle. In addition, my insurance company is not fond of it because of the cost.
I hope all this makes sense. I dont want you to think that I am going to go in and ream my GP. We have a great rapport and I can be frank with him. Please help me sort this out.
*8 weeks of PT with minimal pain management (Ibu, Celebrex, Soma)
*ACDF surgery at c4-c6 with a pretty titanium plate and mild PM care (norco)
This unsuccessfull surgery and comments from my surgeon that my pain was a function of my addiction to narcotics (1-2 Norco qh6) led me to seek my own PM doc who put me on 10mg Oxycontin BID, 10mg Norco every 6 hours for BT, Soma.
*PM doc sent me to shoulder specialist who suspected rotator cuff injury (upper back pain??? OK) and he went in and scoped it, looked perfect, but did Acromioplasty because of bone spurs. Surgery was useless.
*8 More weeks of PT, no help, strenthening activities actually made it worse. Awesome Physical Therapist hooked me up with great GP and sent very detailed notes and called this GP with thoughts on my injury.
So, 2 months ago I switched GP's and he upped my meds to 20mg Oxycontin TID, 1-2 10 mg Norco every 6hrs, Soma, Cymbalta.
He then sent me to a "specialist" who specializes in cases like this. This new "specialist" is a PM doc but is very well versed in Nuerology and Orthopedics. Well beyond any other docs I had seen before.
This specialist took a novel and thought provoking approach. Instead of looking everywhere on my body that doesnt hurt for a problem that could be refering pain to where I hurt, he said, "lets look at where it hurts" Wow!!
So, another round of MRI's and Nerve Conduction studies show that I have 2 moderately buldging disks at t6-t8 and a poor conducting Serratus Nerve and Long Thorasic Never. He also noticed that my right shoulder blade is "winging" and doesnt glide on on my rib cage when I move my arm. It kinda skips. Keep in mind that I can feel this happening when I move my arm and ALL previous docs denied it was happening. So he sent me off to a facility that does Epidural Steroid Injection, Facet joint blocks and is even starting to use Botox in muscles that are causing problems. I am awaiting to hear from them for an appointment. I did have a consult with them last week and they concured with my "specialists" diagnosis. So that is great news, right?
Well, one would think so. With all this in mind, everyday is a major challenge for me. By the time I get up and take a shower and get dressed I am done for the day. I have to go lay down for 2 hours to take a load off my neck and back because I am in so much pain. After that, I cant get up and move around for an hour and then its back to bed. So, basically, for the last year (the pain has steadily gotten worse) I am living a very limited life. All my hobbies are gone. I can go out to visit friends. I cant have them over for more that a few hours. I cant drive more than a mile or so as steering and shifting kills me. It really really sucks. I used to be VERY active. Played golf 3-4 times a week. Went hiking often. Waterskiing...you get the picture. I tried to pick up on an old interest of mine, Photography, and I cant even carry around a 1.5lb camera in my own back yard for more than 15 minutes. After I set up my ****** and camera and get my gear out, before I have taken one shot, I am in so much pain that I cant enjoy it and have to head to bed and pray my med time is coming soon. Pathetic and really really sad. I am sooo depressed and bored at this point.
So, this bried (lol) history leads me to my questions. Sorry it so long despite my attempts to make it short. I see my GP on Thursday and will be discussing all the recent findings and plan of attack (injections). I really like to verbally all be on the same page. At this time I am planning to really lay it on the line about my pain meds. I believe that I am severly undermedicated. I suffer after doing the most basic things (showering) and this just doesnt seem right. I have never abused what meds I have been prescribed. I never took more than was alloted and I never needed a early refill. Trust me, there are many many times where I wanted to take more, but I didnt. I know where that would lead. I do not suffer from any strange side effects from what I am taking now. I had blood work done and my liver and kidney functions are fine. I dont get high or goofy from them much. They do take some of the pain away but not nearly enough. Now, I know that they cant take it all away but 20mg of Oxy is a LOW dosage so I know I have room to grow here.
So, based on my current meds, 20mg Oxycontin TID, 1-2 Norco q6h, Soma, Cybalta and the fact that I really only get a 10-20% reduction of pain at times (often less), what should we be looking at dosage wise.
Side note: The specialist that discovered my buldging disks is a PM doc but my appt with him was only a consultation and he wasnt asked to pick up prescibing my meds. He did make some comments on them. He likes a 80% LA to 20% BT med ratio. Im am way off that ratio. He also doesnt like Norco used as a breakthru med with Oxycontin. He says that they sould be from the same derivative and I should be taking Oxycodone with Oxycontin. Make sense? He also doesnt like Soma in use with narcotics.
So, when I see my GP and tell him flat out that I cant go on like this and explain what my life is like, what kind of dosing step up makes sense? I know they do not make a 30mg Oxycontin and I am not sure an extra 10mg TID is going to be all that effective. Im thinking more like 40mg. How would the 80mg of Norco I take a day convert into Oxycontin? The Norco is for BT but since the breakthru is all the time I take the up to the limit of the script. With that conversion what would be a logical step up to give me some relief. Also, the worst pain and discomfort I have is at night. I cannot sleep and often only sleep 3-4 hours in weired, spread out blocks. I feel I need a bump up for nightime. Is 60mg too much going from 20mg? Or should we be looking at just 40mg TID and an appropriate BT med for nite and maybe a sleep aid. Would 40mg TID be right considering the Norco conversion? Should it be more? For sleep, in the past I have used ambien but everyone freaks out over long term use. I guess its really a short term med designed to reset your sleep cycle. In addition, my insurance company is not fond of it because of the cost.
I hope all this makes sense. I dont want you to think that I am going to go in and ream my GP. We have a great rapport and I can be frank with him. Please help me sort this out.