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Med Question
#11
There's quite a large body of medical literature that says taking 500 mg of acetominophen 4-5 times a day for month and year on end is likely to cause heart disease, cardiac events and kidney failure. Not Liver although there is a sub-group of patients whose liver enzymes will also be elevated. It simply makes no medical sense at all for Drs. to prescribe Vicodin for breakthrough pain when so many better alternatives and while the professional pain societies have been saying so for years it turns out that "pain Drs." don't read the Pain literature.

And even IF you think your Dr. wouldn't give you something that might not be good for you, exactly WHAT is the acetominophen supposed to be doing in there anyway ? You might want to look into the history of the FDA's classification scheme of Schedule II and Schedule III narcotics and how acetominophen came to be added to an opiate in the first place. I sure wouldn't take what you are taking, that's for sure.

Good luck.

http://www.brighamandwomens.org/Pressrel...PageID=221
http://www.brighamandwomens.org/publicaf...26_04.aspx
http://www.brighamandwomens.org/publicaf...ssure.aspx

Acetaminophen, aspirin and progression of advanced chronic kidney disease
Evans et al. Nephrol. Dial. Transplant..2009; 24: 1908-1918

http://www.annals.org/content/87/3/302.a...d;87/3/302

freebird Wrote:Your dosage of Vicodin OF 5/500 was for breakthru pain.
That is a weak dose of Vicodin. They make 10/500 which I take 4-5 a day for breakthru pain.
I wear Fentanyl patch also and use the Vicodin with this.

Liver damage becames a issue when you consume over 4000 mg a day of tylenol(acetaminophen) is 4000 mg a day. That would be 8 of the 5/500. This is what the experts say. Google it.
 
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#12
[quote=Cycler]
It simply makes no medical sense at all for Drs. to prescribe Vicodin for breakthrough pain when so many better alternatives and while the professional pain societies have been saying so for years it turns out that "pain Drs." don't read the Pain literature.
And even IF you think your Dr. wouldn't give you something that might not be good for you, exactly WHAT is the acetominophen supposed to be doing in there anyway
Good luck.

What "alternatives" are better than Vicodin for a IW like me who uses a fentanyl patch or any IW who uses a CR schedule II narcotic but needs help for break thru pain?

My last physical showed my liver enzymes were normal after 2 years of 2000 mg - 25-- mg of Tylenol 24/7.

Hydrocodone 10/500 works well for me for break thru pain when my fentanyl patch "needs assistance".

Cycler, I hurt bigtime. I would love to take a med for break thru that had no tylenol but .....

I am fixing to ask for Norco-hydrocodone 10/325.
 
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#13
The most obvious and also most common is immediate release oxycodone which comes in 5,10,15 and 30 mg tablets and can be taken every 4 to 6 hours for breakthrough pain. There are others of course but that's the cheapest and lest side effects.

Think of it in terms of total body burden of opiate for pain relief. If the goal of committing a patient to life long physical dependence to opiates and all the side effects and limitations opiates cause is a certain a degree of pain relief then the obligation is on the prescribing Dr. to meet that goal and is ethically bound to no under treat the pain. Therefore the baseline extended release opiate should be strong enough to meet that goal some 85% - 95% of the time.

Pain is episodic in that it has it's ups and downs so SOME, but NOT MOST, patients will have occasional need for a boost for short periods of breakthrough pain and a short acting agent can be prescribed for the OCCASIONAL breakthrough above the baseline. This is where MOST pain docs get it wrong unless they happen to be an oncologist who also will treat chronic non-malignant pain.

Think of it in terms of the total body burden of opiate required for a certain degree of relief from pain. If the patient is taking "breakthrough" med on a schedule such as every 4 or 6 hours because that is what the bottle says then that certainly is not pain that is breaking through, it is pain level that is being under treated.

Pain Drs. ( real ones, and you may have noticed an editorializing thread here and elsewhere) use the pattern of initial short acting analgesic, not calling it breakthrough, to determine the body burden required and titrate the base line medication upwards or downwards as needed, often changing with the seasons.

In your case one could argue that the patch needs to be increased to 100ug so that it is more effective and reducing or eliminating the need for any fast acting rescue dose, to use the oncologists term.

But more to the point of your question, opiates have varying degrees of analgesia referenced to 1 mg of morphine and most are much stronger on a mg to mg basis. Vicodin is weaker though while 1 mg of oxycodone gives more analgesia than 1 mg of morphine. Acetominophne is much much weaker in terms of analgesia obviooulsy.Fentanyl is much stronger than morphine also.

SO it 75ug of fentanyl is not holding your pain and then giving 10 mg of hydrocodone is a very small bump in terms of total body burden of opiate equivalency. The acetominophen is doing nothing for the pain since it is so weak in comparison to the on board fentanyl and relative to the hydrocodone, only added in there to RESTRICT the amount a patient can take in a day without risk of harm due to acetominophen overdose, not hydrocodone overdose.

Gee, that took longer than anticipated and that's not even going into the fact that what has been learned is that none of this really works anyway for non cancer chronic pain. It was an experiment over the past 15 years or so to see if chronic pain could be effectively treated with narcotics and the answer from the medical literature is no, it doesn't work due to the phenomenon of opiate induced hyperalgesia and the psychosocial factors. Patients are better off without narcotics in the long run.

freebird Wrote:[quote=Cycler]
It simply makes no medical sense at all for Drs. to prescribe Vicodin for breakthrough pain when so many better alternatives and while the professional pain societies have been saying so for years it turns out that "pain Drs." don't read the Pain literature.
And even IF you think your Dr. wouldn't give you something that might not be good for you, exactly WHAT is the acetominophen supposed to be doing in there anyway
Good luck.

What "alternatives" are better than Vicodin for a IW like me who uses a fentanyl patch or any IW who uses a CR schedule II narcotic but needs help for break thru pain?

My last physical showed my liver enzymes were normal after 2 years of 2000 mg - 25-- mg of Tylenol 24/7.

Hydrocodone 10/500 works well for me for break thru pain when my fentanyl patch "needs assistance".

Cycler, I hurt bigtime. I would love to take a med for break thru that had no tylenol but .....

I am fixing to ask for Norco-hydrocodone 10/325.
 
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#14
Cycler...I'm sorry but I still don't get how the ER and IR give the same blood level.......Lets say an IW is taking 40 mg of Oxi IR....he's getting the entire 40mg right away...Correct?.....now his buddy up the road a piece is taking Oxi 40mg. ER .....he's getting it more slowly....how can they both have the same blood level....You're are very educated in this .....my husband is changing PM Dr.s and I would like to be as informed as I can be.....do you mind a little teaching????Rolleyes Right now he's taking 60mg of morphine sulfate 3 xs a day with 10/325 of percocet for breakthrough......I know there's a better way....Fentynal he couldn't stand the feeling....couldn't function, Dilaudid did nothing for the pain..... and OxiContin also weirded him out.....the Dr. mentioned something that began with a "T" when we were talking about his Neurontin not working either and I can't for the life of me think of the name of it. He has nerve damage all over his chest from having his lung removed, a broken rib, a broken femur and his WC injury is his lumbar.....4 herniations....did a discectomy...which was good for a couple of years........Sorry to go on....I just really like your opinion of "things"Smile
 
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#15
[quote=Cycler]
The most obvious and also most common is immediate release oxycodone which comes in 5,10,15 and 30 mg tablets and can be taken every 4 to 6 hours for breakthrough pain. There are others of course but that's the cheapest and lest side effects.

In your case one could argue that the patch needs to be increased to 100ug so that it is more effective and reducing or eliminating the need for any fast acting rescue dose, to use the oncologists term.

.

SO it 75ug of fentanyl is not holding your pain and then giving 10 mg of hydrocodone is a very small bump in terms of total body burden of opiate equivalency. [quote=freebird]
[quote=Cycler]



My Fentanyl Patch is 25ug not 75.
I know this goes agianst "statistics" but Hydrocodone works as well for me as OxycodoneIR with less side effects.
The Oxycodone made me sweat bigtime. It was percodan 10/325 but I could not handle all that night sweating. I would wake up in the bed ringing wet and the sheets wet. My wife was not happy either. LOL
Personally, I think Hydrocodone is stronger than what they say. It works for me. I do not like the tylenol either but...
Also, I do not want to increase the Fentanyl patch. It has side effects with the biggest being constipation. I have to really control my diet with this patch. I change my patch every 2 day rather than 3. It is easy to maintain and I tolerate the patch well.

I do not want to increase my narcotic intake unless it is absolutely necessary. I do not live pain free neither do I expect to. I "push thru" the pain at times with mental mediation
.
 
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#16
My Chronic Back Pain has Increased Lately, and I'm starting to have Problems on My Left Side, and it was My Right Side that was Injured. I am thinking, and so is My PM Dr. that due to Inactivity from Pain and not getting the Required Physical Excursion I should have, My Arthritic Changes are becoming Severe, and there May be some Domino Effect taking Place. Now I take Methadone 10mg. every 6 Hrs., and My Breakthrough is Morphine IR 30mg. as needed. I also Use for Inflammation a Total of 2400 mg. of Neurontin a Day, along with 150mg. of Lyrica for Restless Leg. I have been through the Morphine ER of 200mg. every 8 hrs. and when that Stopped I Went Straight to the Fentanyl Patch 100mcg. per Hr. 3 Day Patch, until I became Immune to the Fentanyl and My Body started Rejecting the Patch, leaving Me with Chemical Burns on My Stomach. Different Meds. work Differently for All of Us, even with the amount of Meds. I Take, I'm still in Pain Daily. The Next Step May have to be a SCS, but I Fear Scar Tissue Issues there. So I Live Daily and do what My Body will allow Me to, and when I can't Move I do My best to Rest and Hope for Relief!! True Chronic Pain is a Living He** I wouldn't Wish on any Living Soul!!Wink
 
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#17
It isn't unusual that your body does better with one over anotehr, but your body certainly is NOT benefitting from all the acetominophen and Hydrocodone is not available alone to my knowledge., wish it was.

freebird Wrote:[quote=Cycler]
The most obvious and also most common is immediate release oxycodone which comes in 5,10,15 and 30 mg tablets and can be taken every 4 to 6 hours for breakthrough pain. There are others of course but that's the cheapest and lest side effects.

In your case one could argue that the patch needs to be increased to 100ug so that it is more effective and reducing or eliminating the need for any fast acting rescue dose, to use the oncologists term.

.

SO it 75ug of fentanyl is not holding your pain and then giving 10 mg of hydrocodone is a very small bump in terms of total body burden of opiate equivalency. [quote=freebird]
[quote=Cycler]



My Fentanyl Patch is 25ug not 75.
I know this goes agianst "statistics" but Hydrocodone works as well for me as OxycodoneIR with less side effects.
The Oxycodone made me sweat bigtime. It was percodan 10/325 but I could not handle all that night sweating. I would wake up in the bed ringing wet and the sheets wet. My wife was not happy either. LOL
Personally, I think Hydrocodone is stronger than what they say. It works for me. I do not like the tylenol either but...
Also, I do not want to increase the Fentanyl patch. It has side effects with the biggest being constipation. I have to really control my diet with this patch. I change my patch every 2 day rather than 3. It is easy to maintain and I tolerate the patch well.

I do not want to increase my narcotic intake unless it is absolutely necessary. I do not live pain free neither do I expect to. I "push thru" the pain at times with mental mediation
.
 
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#18
Cycler, I just want to thank you very much for your thoughts and info... Your knowledge has helped me many times, and this goes for every one heres also.. My dr is out til friday so I could not question his reasons for being on both.

The pain clinic does not want to take over with my meds for my dr has been from day 1.. I had problems getting my oxi filled due to My matrix (ins company) was denying for I am on vicodin.. I had to call my adjuster (real nice lady) and she took care of it while I was on the phone.. But anyways today I took 10 mg and still did not feel any more relief then Vicodin... And my dr only said 1 a day, somthing dont seem right with that.. I used to take oxy 20mg er twice a day, I just dont think he has me on strong enough dose..

But is this somthing I need to build up un my system before I feel results......????
 
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#19
2 weeks ago my DR changed my pain meds. He changed my pain meds to Percocet with no tylenol in it. I have been takeing it for about 2 weeks today and had a Dr appt with him today and he said now you are not going to die from tylenol poisoning. He wants to do blood work next month and check my entire system out to make sure there has been no damage done. I have been on pain meds with tylenol in them for 9 years now. I do have heart disease but not from the tylenol.
Cervical Fusion 2003, c5-c6. Herniated and damaged Disc L1- L4-L5 S1. Lumbar Spinal Cord stimulator implant 09-2008. Cervical ACDF revision with hardware c4-c5-c6-c7 Sept 2009.
SSDI approved 3-2010. NOW OFFICIALY RETIRED
 
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#20
My surgeon has me on Vicoden 5/500mg. I asked him to lower the tylenol ammount because I got spooked by the liver problems with cronic use. He said not to worry about it. But did agree to lower the tylenol to 5/325mg. He then said the tylenol dosen't help with the pain anyway. The drug company puts it in there so you don't take more than you should. He asked me if I want to go on a stronger pain med 'm affraid to do it. I think my body has gone to the dark side and "needs" it. I would be more affraid if I went with something stronger.
6/97--Discectomy L5-S1. 3/09--Discectomy L5-S1 (failed). 6/09--spinal fusion L5-S1. This year who knows?
 
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