Best approach for pain relief and lucidity

Have some decent nerve damage, the details of which can be found here: http://www.hipforums.com/newforums/showthread.php?t=351900&f=120

For the next week I have 21 20mg time released Oxycodone, 42 5mg IR Oxycodone (Roxicodone), 42 10/325 Hydrocodone/APAP.

I did have a week where I basically went nuts and took a month's prescription in a week, leading to me getting scripted by the week now. (It also got my scripts raised from 40mg a day. Took 1200mg Oxycodone extended release in 7 days...didn't really make it to classes.) I think I have learned from this not to go too nuts. I would describe my tolerance as moderate.

I am a FT grad student, so I need to be lucid for all of Monday and Tuesday and the morning of Wednesday and Thursday. The hydro the best bet there? I can take up to 6 a day...how close together do you think I can get them before the APAP becomes a problem and they start to cloud thoughts?

For someone used to Oxy ER, how much difference will the immediate dosage be? (I requested 15mp capsules, got 5mg instead). Do you think I can use these during school/studying? Should I just use them when I am lying in pain in bed?

My pain steadily rises all day, reaching a crescendo when I am attempting to sleep. Am already budgeting 40 mg of the ER and 2 of the 5mg for this. How would you approach this situation?

 

So lets see... that would be 3x20mg oxycondone ER, 6x5mg oxycondone IR, and 6x10mg hydrocodone per day.

Are you taking them normally or crushing snorting/parachuting? Are you looking for just pain relief or something more "entertaining?"

How much do you usually take in a day if you are just laying around out of it? How much per dose how often?

Sorry, it's a lot of questions to your question, but I think it would be helpful in being able to give you a reasonable answer.

EDIT: Oh and the recommended dose of APAP per day is 4grams. 6 of your hydros is 1.95 grams. It's also not recommended to go over 2g of APAP per dose.

 

You got it on the daily dosage. I am just taking them normally. I'm a little skeptical of snorting the ER, simply because you're also snorting the time release mechanism as well. That's probably worse than your normal filler. I have chewed them when I needed instant relief, so I guess I have parachuted a few. I am hoping the Roxy's will keep me from having to continue that practice.

I took 180 OC ER per day for a week and was out of it. I basically slept and watched Justin.tv, so that is probably past my upper limit. A 40 mg OC ER will make me drowsy, but still functional. I don't feel anything from hydrocodone, but there is some pain relief. So, my tolerance isn't super, but there is one there, I've been on some form of opiates for 8 weeks now (still miss iv dilaudid).

I guess what I am looking for is, if a recreational user (which I can sure see the appeal after my week at 180mg. Damn that was fun. Didn't do shit, but it was fun. Only real euphoria I have felt from the opiates so far) had my supply, how would the recreational user stay mellow. Not a two day binge fest, but a week's worth of good feelings, because that's really what I need out of this collection as well.

 

Well the reason for my questions was to kind of guage your tolerance. I've been on oxycodone ER before so I've a bit of experience. Been a chronic pain patient for a few years now.

Well depending on how you need things for pain and WD throughout the day I'd probably use as little as possible and have fun on the days/nights you can.

From what you said and my personal experience this is probably what I would do (please note this is not medical advice nor do I "recommend" going against what your doc has told you. read: "I don't take responsibility for your actions") That being said:

During the day where you need pain relief but don't want to be out of it, I would take 2-3 of the hydros (normally, un-crushed) 2-3 times. I'll write it as a schedule and you can adjust to fit yours.

8am: Wake & take 2 10mg hydro.
1pm: take 2 10mg hydro.
6pm: take 2 10mg hydro.
11pm: take your nightly oxy-ER & IR that you've set aside for the night.

That would leave you 1x20mg oxy-ER, and 4x5mg oxy-IR. Depending on your pain levels you can take either the oxy-ER whole early in the day to provide a boost for the hydro, or take 1 of the 5mg oxy-IR when needed during the day.

In any case that would leave you at least 20mg of oxy at the end of the day. 40mg if you can stick to just the hydro during the day. In any case this would mean that at the end of each day (preferably 4-6 hours before you go to sleep) you could take the remaining extra oxy-ER/IR crushed orally + the IR you set aside from the night. That should get you feeling pretty good each night and if you time it right it should still keep the pain away until you actually go to sleep and take the remaining 40mg oxy-ER to keep you pain-free through the night.

Again, it really depends on your pain level during the day and how much you need to get through it pain-wise and WD-wise.

Basically the way I use my medication (currently Opana ER & poppy pod tea - hopefully getting some Opana IR soon) I take just enough to keep me functioning during the day and have enough left at night to zone out with and actually feel good. It's hard to keep that going long term of course. As your body adjusts to the doses your taking at night you'll need more during the day.

Anyway, this is how my entire schedule would be based on what you've said about your pain and such:

8am: 2x10mg hydro.
12pm: 2x10mg hydro.
4pm: 2x10mg hydro.
8pm: 4x5mg oxy-IR + 1x20mg oxy-ER crushed (orally) (total 40mg oxy)
12am: 2xmg oxy-IR + 2x20mg oxy-ER whole (assuming you've been taking it that way)

I would change that a bit depending on whether you are taking the oxy-ER at night whole or not. And of course how well the 20mg hydro works during the day. If the hydro isn't enough I'd try something like this:

8am: 2x10mg hydro + 1x5mg oxy-IR.
12pm: 2x10mg hydro + 1x5mg oxy-IR.
4pm: 2x10mg hydro + 1x5mg oxy-IR.
8pm: 3x5mg oxy-IR + 1x20mg oxy-ER crushed (orally) (total 35mg oxy)
12am: 2x20mg oxy-ER whole (assuming you've been taking it that way)

Anyway, this is long and may or may not make sense let alone work for you. But those are some of the ideas for how I would use it based on what you've said. Personally I wouldn't think you'd need the 40mg oxy-ER for sleep and could get by with a 20-mg ER and 10mg IR and then put the extra into your "having fun" dose around 8pm. *sigh* I'll shut up now.

 

Wow, thanks for the advice here. Not sure I can go the whole day on just the hydro, but I will give it a shot tomorrow. If I have anything going in my favor usually the pain is greater during the evening and isn't too bad in the morning.

As for the pain itself, I am still getting used to chronic pain. THey have hope that the nerve can regenerate, so I am hoping I can be pain-free at some point. The last 6 weeks have made me respect and appreciate what people who live in tremendous pain go through. It saps your strength, it makes it more difficult to think, then the drugs come in.
Best of luck.

 

Well I'm not sure if you've tried, but I've found Lyrica to be a god-send as far as my nerve pain goes. I got to a dose of 3x75mg twice a day and was basically pain free... for a week. At that dose it caused swelling all over my body which ended up causing just as much pain (if not more toward the end) just a different kind of pain.

Needless to say I had to stop taking it at that dose and now only take 1x75mg at night. Even at that dose it does help with the pain/sensations in my lower back and leg where the pain travels. I also have an unknown form of headache (my PCP called it a cluster migraine) which at one point I had been getting almost every day. The pain level for these headaches was so intense it eclipsed everything else by the end of the day (what I'd call true 9.999 out of 10 on the pain scale... and I try to be lenient when judging pain levels. I figure something should be saved for losing a limb or something like that. The Lyrica has stopped those and I now get maybe one a month or so that is bad and even then it's not the same as it was.

Anyway, if getting rid of the pain is the main goal (which I know it is, but at the same time you want to get something out of it all) it would be worth a try. It's a bit expensive itself though. My understanding is that you wanted to be rid of the pain during the days you need to study/work/go-to-class and still get to "enjoy" something as often as possible. Basically a similar situation as myself. Sadly I have the same problem you had... getting a month supply and having an awesome 10 days and then being screwed the rest of the month. Why I turned to poppy pod tea. I use it the rest of the time and while it doesn't have any enjoyable affects for me, it does help some with the pain and I don't go through any WD symptoms (physical or mental). I mean don't get me wrong, I'd still love to have something when I'm on the tea, I don't think about it the same way you do when you're out and in full WD.

Anyway, I think I'm babbling again. Let me know how it turns out and I'm sure you/we can come up with something that will get you where you need to be. Also I know what you mean about sapping strength and such. The first year I did pretty well with it... the last 2.5 years have pushed me near breaking, but I think I'm getting that through to my doctor, if slowly. While I'm scared to ask for it (and never had it outside of a hospital setting) I think a mild dose of Xanax or something like that would be beneficial for myself anyway.

 

I am on Lyrica and actually just made a post about it in the pharmaceutical section. I spoke with a neurosurgeon who upped me to 375mg a day, because a 225mg dose was not providing much/any effect. The information that I have gathered is that Lyrica works really well when the nerve damage is at the site of the injury. That probably sounds confusing, so let me see if I can explain. You have back problems and back pain. Lyrica works well for you. Lyrica also is used by people with shingles, which causes nerve pain at the site of the rash. The same thing is true with postherpetic neuralgia. Lyrica is also used to treat fibromyalgia, which many people can't even agree is an actual disease. If it is, it seems that the nerves treated are in the same area as the pain generated.

In my case, the impacted nerve is in the hip, but it causes hypersensativity in the calf and the foot and pain in the arch of the foot and the joints of the toes. The injured site is three feet away from the pain sensations. This is the only difference I can see that would explain why I get no relief from Lyrica. The other thing is I have been on Lyrica since I got out of the hospital. Maybe I need to go without for a day or two to see if I notice a difference. The problem is at the dosage I have been on for the length of time I have been on, I guess there is the possibility of seizures if I come off cold turkey.

I have an appointment with a pain management specialist next week and also see the neurosurgeon again. I am planning on putting this question to both of them. The only thing I worry about is if either of them take the idea that, if Lyrica isn't working, the pain must not be that bad.

As for your post:
Wow! I cannot imagine a 9.9 out of 10. That sucks man. At least with nerve damage and nerve pain, there is an explanation and something to blame when you get down and sick of being in pain. Migranes that come out of there and hit you like that...I have to think they leave you in a state where you are just praying for relief, not able to try to blame anything for putting you in that pain.

I cannot imagine getting such great relief from pain, then having a side effect come and bite you in the ass like that. There's not much else in Lyrica's class at the moment, so it's a damned if you do, damned if you don't type of scenario. Feel for ya. I haven't noticed swelling from the Lyrica. My leg is still swollen some from the hip surgery and the trauma of the MVA, but nothing else I can tell.

I have read numerous references to the poppy pod tea since I started perusing these boards. Is this something you find at a head shop? I am loath to order anything online, but there are stores and ebay auctions for these. Have people found any online source to be reputable? How frowned upon is the sale of these pods? Is it like salvia where it's just a matter of time, similar to the sale of detox drinks where there is only one reason to be purchasing them? I ask because I am planning on entering a licensed profession that has a character/conduct and fitness requirement. I need to make sure that I am not dancing on the edge of illegality with the pods.

As for the rambling, I get it too. It's not as bad online as it is in person, but it is still there. I feel bad for the people who talk to me after I have taken 20-40mg of oxycodone. They can't get a word in edgewise.

 

Yeah, the headaches were terrible. I haven't had one in a while now (*hope saying that doesn't ruin everything*) so I'm quite happy to be rid of them. Basically once one started, the rest of the day was gone. Time/sleep were the only cure. At the time they started I wasn't taking much in the way of pain medication and was given a small script for oxycodone for them. While taking even just one at the time (only 5mg) would get me feeling nice nothing touched the headaches. Not even 2-3 which would have made me incoherent at the time. I guess I was lucky back then in that opiates affected me strongly. Even a 7.5mg of hydro at first would put me on top of the world.... wish I could go back to that.

As for the Lyrica I know it doesn't work for everyone, but I wanted to throw it out there. The swelling was something even the doctors hadn't seen on that level, but sure enough when the Lyrica dose went down so did the swelling/pain associated with it. Of course at the same time the nerve pain started to come back, but there were a few good days in there before being back to "normal."

For the poppies... well I don't want to break any rules and I honestly don't remember what they are for this particular forum, but I've been using eBay. Legally... well I have no idea. I would guess to say it's on the illegal side of the line, but it's got to be close. I mean there isn't a specific law in place to prevent you from making tea from a plant that is not illegal itself, but at the same time you end up with morphine-laced tea. And it does show up on a drug test as morphine/heroin (whole different story on how I found that out). Still, I would hazard to say that if I was in a position to tell my PM doc about it that he'd <probably> let me off with a warning. Granted I'd be saying that I had heard making a tea from poppy seeds had some natural herbal method of pain relief. Which is true, just... not quite the whole of the situation. The sale itself is perfectly legal, though it is not sold as a consumable material, but rather for florists and crafting.

I'd say it's more likely to stick around that things like Salvia and Kratom.

I know there are tons of methods out there for making the tea, but I'll be happy to share mine if you like.

Good luck with your situation. While the pain I have is different (though the pain does travel down my leg) I have also had the "hypersensitivity" you mentioned before. I had pinched a nerve in my shoulder or neck (happen a few times actually) and it caused that all down my arm, at the elbow and outside of my hand. Normal touches seemed fine, but any slight brush against the hairs or skin was an intense amount of pain if it only lasted a split second.

Well I should have been asleep hours ago...I'll try and check out your other post tomorrow.

 

The site of the pain stuff sounds true to me. Ive never got any help from any of the anti-seizure medications for my neuropathic pain. Ive tried high doses of lyrica, neurontin, and currently using tegretol. My nerve damage is in my lower spine but is ridiculously painful down my legs and especially in my feet.

 

Just wondering how things have been going for you since you last posted? I know how hard trying to keep a schedule is... I've honestly never been very good at it myself.

 

Tough for a schedule. I had/have a few factors working against me.

1) I am on 7 day prescriptions. Well, due to Dr demand, it had been 8 days since I last saw him, so the 7 day scripts really only have/had to last 8 hours Thursday, Fri, Sat, Sun, Mon, Tues, 8 hours on Wed...so there is a fair amount of wiggle room

2) The girlfriend was up for the weekend. I have/am rough to deal with when I am in pain, but Opiates make me insensitive of others feelings and make me feel groggy. I wanted to not make her feel like a piece of shit, but I also didn't want her to see me in a lot of pain.

3) No class Fri-Sun and nothing really to do over the weekend. Lucidity is over rated.

In answer to your question, not great in terms of planning and scheduling. What I have done more of is counting from the meeting with the pain management specialist, which is at 2 on Wednesday. I figure I need 1 20 mg, 2 5mg and 2 Norco for Wednesday. For Monday and Tuesday I need 3 20 mg, 6 5mg and 6 Norco each day.

Right now I have 7 20 mg oxy and am ready for bed tonight (OK on that front). I have 22 Norco, so I am 8 to the good and can start to hold a little back in case of emergency down the road (of course it is the weakest stuff I am on). I have 16 5mg ER pills left. That is two more than I should have, but I can see me taking the two extra with two of the Norco if I wake up in serious pain during the night.

The other problem of course is that I have gotten a free day in here. Add the seventh day back in (DR appointment same time on Thursday) and I am 3 20 mg behind, about even on the Norco and 4-6 behind on the 5mg IR.

Right now my bigest fear is that the Pain Management guy gives me an RX for a month. Even if he bumps me up to 80 mg ER, 45 mg IR and keeps the Norco the same, I don't know how I am going to be able to stay on a strict schedule. The extra day that I had saved my ass this week.

Thank you for your concern. If there is anything I can do for you, don't hesitate to ask.

 

I'm doing alright. Just was curious how things turned out for you. I went in for what was supposed to be an appointment to pick up some Opana IR... my doc seemed to have forgotten all about it and suddenly didn't even know it existed. Dunno what was up with that. He still seems willing to prescribe it though and is having his secretary look it up and I should be going in Monday to pick up the script. We'll see...

How long have you been taking opiates for? I am surprised that you're still feeling groggy/sleepy/sedated after taking them. Usually most side affects like that and nausea go away after a week or two of constant use. I guess everyone is different though.

I agree with you that lucidity is overrated... at least to a degree. For me there is nothing better than dosing up and playing a computer/video game for a few hours. Many people like the whole "nodding" aspect. I can't say I want it to happen, but I will admit that when it does (which is often with Opana for me) it still feels good. Just sucks that you can't accomplish anything like that.

I understand what you mean about not knowing how to dose when your gf is over. I have the same issues. She always worries about me being in pain, but at the same time if I take my medication like I normally would then I typically just want to sit around and do my own thing. I'm lucky in that she does her own thing as well (some would call it a crazy relationship) though she doesn't take any medication like that.

Hopefully stuff with your doc works out. It's always a touch situation. Even if taking everything as prescribed I would worry when seeing the doc. Because of my age and condition I just fear they may say "sorry, we don't feel it's right to continue this" and then I'm screwed. If the doc is worried about you "abusing" your script you might want to mention Opana to him. It is a step up in a sense from OxyContin, but the big thing they are pushing with it is is lack of abuse potential. Still it works really well for a lot of people for pain and seems to typically have fewer side affects.

 

Update: Not quite: I had a girl come visit me Saturday and she stayed over. I didn't want to appear to be in pain, so went heavier than I should have. It continued through Sunday and I took my last 5mg Oxy IR Monday afternoon. I have only one lonely 20mg Oxy ER for tonight. I have 6 10/325 Hydros left for today. I see the pain specialist tomorrow. I won't have a great day today, but the hydro should make it tolerable. I do have sleeping pills for tonight, so I figure two Lunesta will take care of getting to sleep.