... dose due to the tylenol intake risks. we are going to talk about other options for me. my question is what is my best next option?
If your pain is chronic (which arthritis is) and you take pain medication daily, you are much better off using a long acting drug and taking it around the clock, every day, to manage pain instead of chasing the pain with short acting medications that were designed for acute pain (short term pain conditions like surgery or a broken bone) Chronic pain is much better managed with long acting drugs. Percocet is oxycodone and the long acting version is Oxycontin. The difference is that Oxycontin has no acetaminophen (tylenol), it is pure oxycodone and made in such a way that it releases slowly into the blood rather than releasing all at once in a flood across the brain's receptors. There are many long acting drugs: MS Contin (morphine), Oxycontin (oxycodone), Fentanyl (comes in a patch that releases the drug slowly into the skin), Exalgo (hydromorphone), Opana ER (oxymorphone). Since you did well with Percocet for 4 years, Oxycontin might be a good choice but you may be becoming tolerant so rotating to a new drug may work better and MS Contin or Opana ER may be a good choice. Sometimes with long acting drugs, you get what is called "breakthrough" pain and this is pain the breaks through your maintenance dose. It often occurs as "end of dosage failure" which is, say, the drug is ordered every 12 hours, you may start getting pain after only 8 hours so you would take a dose of breakthrough medication to get you by until your next long acting dose is due. Another reason for breakthrough medication is if you do an unusual activity that causes increased pain. Other than that, your long acting dose should carry most of your pain relief. To figure your dose, honestly tell your Dr how many percocet 10's you use each day and he can total what you use in a 24 hour period, figure the equivalent dose of long acting med and divide by two for your dose to take every 12 hours. For example, say you are taking 10mg of Percocet every six hours so that is 40mg total oxycodone in 24 hours. If he chose Oxycontin, he would give you Oxycontin 20mg every 12 hours. If they try a new drug other than oxycodone, he may lessen your total dose slightly to account for cross tolerance. Just because you have tolerance to one medicine doesnt mean you'll carry the same tolerance to another opioid so they reduce the dose slightly (commonly 25-50%) to start so they dont "snow" you with the new dose. They can then raise as needed. If you are seeing a PCP for pain, you may ask about a referral to pain management. PM docs are very familiar and much better experienced at managing pain and they tend to know a little more than the average PCP about pain and using opioids safely. A lot of drugs got a "bad reputation" when docs who didnt understand pain management and didnt have experience with these powerful drugs tried to manage folks pain and they ended up harming people by giving too much or allowed them to titrate up too fast. Opioid pain drugs are the best thing we have to manage pain and they are very useful in the hands of someone experienced with them. But they can be dangerous. You must always follow your Drs recommended dose, dont add any other drugs without asking your Dr., including OTC drugs or alcoholic becerages. Never take more than the recommended amount or more often than recommended. If you follow instructions, you should be safe and have little chance of having problems with your medications. If you feel the dose isnt working, keep open communication with your doctor. Talk to him/her. Dont increase your doses on your own. People get into trouble when they dont follow directions and take too much. One of the biggest dangers with taking long acting drugs is altering the tablets. There is a large dose of medication manufactured in a way to release the drug slowly. People get into trouble by altering the tablets by splitting, breaking or crushing the drugs. This defeats the mechanisms that make the pill "long acting" and it can release too much drug all at once. When Oxycontin was new to the market, and before they made the pill tamper resistant, people got into trouble by breaking or splitting tablets (and some deliberately abused the medication by crushing and snorting or injecting the crushed tablet) and this caused overdoses. Some people didnt realize they couldnt break the tablets like you can with short acting drugs and they ended up overdosing. This is why I say it is important to follow instruction. If you are unable to swallow whole tablets, then long acting pills may not be for you but the Fentanyl patch may work well as it is absorbed through the skin. It is not without it own dangers though because things like heating pads, laying in the sun, hot tubs or hot showers etc. can increase the rate of absorption through the skin. It can be abused when people alter the patches. Some have a pouch with a reservoir of medication and people would cut this open to get more drug or they would chew the brands that have the drug embedded into the adhesive. If you sweat a lot or have oily skin, the patch may not be a good option for you. All drugs have benefits and all have downsides so discuss this with your Dr and find the right drug for you and above all, have patience. It can sometimes take a bit of trial and error to find the right drug or combination of drugs to give relief. Your Dr may opt for adding an adjunctive drug rather than increasing your opioid. Adding something like Cymbalta (an antidepressant drug that helps relieve chronic pain) or a drug to help with nerve pain like gabapentin or pregabalin may help the current Percocet to work better. This is a lot of information but it is good to have an understanding of how things are so you can make the right decisions. Learn all you can about your condition and the medications you are on. Read the literature that comes with your medicine from the pharmacy. Be sure your Dr is aware of all drugs you take as well as any over the counter (OTC) drugs, vitamins, minerals, or especially any herbal products you might use to avoid interactions. Try to use as much non-pharmicological treatments as you can. Dont forget the value of heat or cold packs, massage, osteopathic/chiropractic manipulations. They can really help a lot with the pain. Sometimes something as simple as a little heat can help and therefore decrease your need for medications. Try topical rubs like Capsaicin, menthol etc. Rubs like IcyHot, Ben-Gay, Tiger Balm, Aspercreme, patches like Salonpas, Thermacare heat patches among others are surprisingly helpful. There is also a prescription patch that contains the numbing medication lidocaine called LidoDerm patches that some find very helpful in managing painful areas. So there are many good options. My best advice is to keep an open mind and be sure to be honest with your Dr. Let him know what works and what doesnt, what your lifestyle is like and be sure he/she understands the nature of your pain: what makes it better, what makes it worse, what you have tried and what has worked or not worked, when your pain is at its worst, if weather affects pain or if any certain activities make it better or worse. Basically just communicate everything. Write down questions or things to ask to remember when you get there. Many people get caught up in the visit then forget to ask their questions. Have them "in hand" when you go into the room so you dont forget. If you can, take another person with you so they can help you remember all that was said. Dont give up hope. There is relief out there if you are patient enough to find what works best for you. Drugs.com is a great resource
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