[MeridianMan]

Hey Folks, I have been taking between 7 to 8 10/325 Percs. for nearly three years now for a multitude of back problems resulting from an offshore oilfield injury I sustained from a 17 ft. fall onto a steel deck. The pain used to subside somewhat with a management regiment of percs., trigger point injections from a pain clinic, physical therapy, and stretching and exercising. However, lately the percs. only make me sick and no longer work at all. My doctor is a good dude and has been with me the whole way. I am a 33 year old alcoholic who has not had anything to drink for nearly 3 years now but I cannot call myself "sober" due to the amount of narcotics I take daily. I have been up front with him from the beginning regarding my situation but with spine issues from my left shoulder to my lower lumbar I probably should be taking much more medicine than I am. More than likely I have become opiate tolerant. This week he is going to put me on a fentanyl patch prolly starting out at 25mcg but I am wondering about the transition from an oral route to trans dermal. My pain is becoming so severe at some points where I am worried about this patch not working and then I am going to be hooked on the patch and the pills, not to mention the beating my liver has been taking all of these years. If anyone reading this who has had a similar go around with these things could respond I would greatly appreciate any help regarding my situation. Life is becoming quite bleak at this point. Chronic pain is a bastard but addiction is even worse in my opinion... Thanks.

[mitchigan]

Hi MM,

I feel for your situation, severe work injuries can be a bltch!
Good thing is you usually have good coverage under these conditions. I take it you're not a surgical candidate? What about nerve blocks? Work-related injuries usually give you all the options! That said, why fentanyl? That's quite a step up from percs! While I am somewhat biased to opiate use right now, I have to wonder why methadone or morphine isn't a first option? Fentanyl is by FAR the strongest opiate prescribed. In my opinion that's a heck of a jump! I just don't see why somebody on 60mgs of oxy needs to go straight to fentanyl. I would discuss the other options, even as far as a second opinion. Curious as to what Robert thinks.

[Robert_325]

Originally Posted by mitchigan

Hi MM,

I feel for your situation, severe work injuries can be a bltch!
Good thing is you usually have good coverage under these conditions. I take it you're not a surgical candidate? What about nerve blocks? Work-related injuries usually give you all the options! That said, why fentanyl? That's quite a step up from percs! While I am somewhat biased to opiate use right now, I have to wonder why methadone or morphine isn't a first option? Fentanyl is by FAR the strongest opiate prescribed. In my opinion that's a heck of a jump! I just don't see why somebody on 60mgs of oxy needs to go straight to fentanyl. I would discuss the other options, even as far as a second opinion. Curious as to what Robert thinks.

I think methadone should be a last resort medication for pain. I also think that the patch is too much at this point as well. I would probably suggest an extended release med like ms contin or the equivelant with oxy (without apap such as roxicodone) as needed for breakthrough pain. Would be easier on the liver. I don't think it should be necessary to go with the fentanyl or methadone at this point. But there are still other options like nerve blocks, therapy, etc. That makes more sense to me. You can always get a second opinion with work related injuries. I would avoid methadone unless I was going to be taking it for life though. God bless.

[MeridianMan]

Hey guys, I really appreciate the input. I have tried both morphine extended release and methadone once before but due to sensitivity or a reaction (I wasn't on either long enough to find out) I became very sick on both. Nothing is worse than being in severe pain and vomiting sick all the time as well. I believe that since my doctor is very aware of my past severe alcohol addiction he is reluctant to escalate my pill use and believes that a patch would be less easier to abuse. I use counseling and support and try very hard to be honest but there is no denying how badly damaged my back is. So we are also looking at the best long term management plan but he thinks if he gives me straight oxy that I will abuse it. Not sure I am quite along those same lines of thinking I am just trying to manage this without becoming like I was on booze. Oh and the company I used to work for went bankrupt so I am having all sort of difficulties on that front as well in regards to coverage. I will research the nerve blockers as well but it is definitely nice to hear from others who have similar experiences. Thanks so much- Ken