question on pain meds

[CindyLou]

Hey guys, I'm hanging in there. My surgery is a week from today: anterior ALIF of L6-S1, and posterior Laminectomy. On my last pain med refill about 2 1/2 - 3 weeks ago the PA wrote on the script to take one every 8 hours for pain. (Percocet) I called the medical secretary of my surgeon last week to let her know (and to document) that I was having to take more than that dosage prescribed. 1 every 8 hours was not cutting it. So I told her I am averaging about 5, some days 6 a day. My pain level is quite high. My question is: does that dosage seem extravagant? I am not taking anything else for pain but that. Most nights I have difficulty with sleep because of the nerve pain all down my right side. I'm just curious. I am down to my last 4 pills and she said the PA wouldn't refill it till after my surgery. I reminded her of our phone call a week ago, and she said she'd have the PA call me. I am aware that it can be more difficult controlling pain levels after surgery, if one is on too much pain medication. And my guess is, they'll prescribe Percocet after surgery. Don't know for sure. Should I try and really cut back before next Wednesday? It's so hard for me to get thru the day, but maybe I should try. Thanks for any and all insight. Terry, you're the drug expert. I really hope for some nuggets of wisdom from you too.

[Lyndsay]

Hi Cindy

I can't answer your question I'm afraid (I don't even know what Perocet is!?!) but surely your Dr can't expect you to stretch 4 pill's over the next week?? That is just pure cruelty if so!! Do Perocet cause withdrawals? I really hope your Dr will give you some more pill's if only to last you until you're admitted to hospital!!

You mention nerve pain, are you not also on something like Lyrica or Neurontin? I take Lyrica which I've found really good for nerve pain, maybe your Dr can also prescribe one of these for you too?

When I had my original ADR I wasn't on much by way of meds, I had Co-Codamol, Tramadol & Baclofen though I wasn't taking max doses most of the time as I didn't like to. I also was allowed to keep Diazepam in as it was the only thing to touch spasms when they hit. When I came round in recovery my pain was totally out of control & even with the PCA machine they were having to keep administering additional Morphine. The following day the PM came to see me as even with the PCA I was still having to be given additional pain relief. The PM put me on some really high doses of meds, some I'd never been on before. So, it certainly couldn't be said that my meds, rather lack of them contributed to me having pain control issues post-op. I hope that makes sense!?! (I'm typing with one eye open the other closed as I'm tired & have a headache!)

Before I close I do have a question if you don't mind? I see from your post some of your L5/S1 revision is being done posterially but can I ask, how is your surgeon managing to go in anterially again? I too am facing revision but have been told it will be a posterior & lateral approach as an anterior approach would be too dangerous now.

I wish you all the very best with your surgery & will follow your revision & recovery with a personal interest.

Take care,

[Harrison]

Cindy, that does "seem" like a high dose, but it really doesn't matter what I/we think. I would follow your intuition and try to discuss it with the entire medical team. Your question seems to be HOW to reduce the pain med dose to something less -- and that's a toughie.

I agree with your thought process, though -- try to reduce the number and amount of meds going into surgery. That said, someone on the team needs to address your specific concerns about which meds HAVE been effective for you; if they aren't going to refill the script, they should have SOME kind of solution waiting! Hopefully, your pain will be greatly diminished after this procedure.

[Terry]

CindyLou:

Most surgeons are going to want you to cut down some prior to the surgery or it will be very difficult to get your pain under control after the surgery. Having said that, it still does not solve your immediate problem of not having enough pain medication to get you to the operating table. This still needs to be taken care of. Only you and your doctor can solve this problem. I would not be comfortable having a PA determine my destiny. I would be asking to see a general internal medicine doctor. Good surgeons can get around the pain medication issue as well. They get people coming in with massive doses of pain meds and are able to do different things to help out. Epidurals and other nerve blocks can be utilized to help control pain. I also agree with the possibility of getting on Lyrica or Neurontin to control some of the nerve pain. Slight weight gain is the least of your worries with the Lyrica. You need to be assertive with your medical care and, if the person is not being helpful, it's time to see someone else.

Elizabeth says to say hi and she and I are praying for you for a successful surgery and a good recovery.

Terry Newton

[Billy B]

Cindy,

It is a high dose. However, I was prescribed Percocet 10/325 every 4-6 hours as needed. I was taking them that often too. I have been worried about addiction so I have had my doc cut me back to Vicoden and have been trying to lower the mg per every time I get a refill. The pain has gone up, but with surgery looming I wanted to start weening myself back just in case. Hope that helps a little. Best of luck.

[OsteoRach]

cindylou,

you mention not taking any other meds for pain. may i suggest when you talk to your doc you talk about using additional analgesia such as paracetamol (i think you guys refer to it as tylenol?) and gabapentin/sodium valproate or similar (nerve meds, neurotin / lyrica?). the reason i suggest this is they all work on different pain pathways and if the percocet is not working you may find a combination may work (percocet is a combo oxycodone and acetominophen which are different again).

re post op you need to talk to your anaethetist who should be controlling your pain post op, i had a ketamine continuous IV and fentanyl PCA (plus lots of other goodies) as i have an allergy to an unknown narcotic hence no morphine. on all but a couple of occassions my pain was very well controlled,

good luck with your alif

[CindyLou]

Thanks you guys. And Lyndsey, you bring up a good question about surgical entrance. I will ask that question on Monday when I see my surgeon with "all my questions." They did refill the pain script after I talked with them. I have to pick it up today to get filled. And I think I will cut back these next few days prior to surgery. I haven't been taking the Lyrica due to the weight gain issue. But I will surely take if after surgery, if it is recommended. My P.A. told me yesterday at my pre-op physical she didn't think I needed to donate blood (in the event...) for my surgery. She said it is a pretty tidy surgery, not much bleeding. Hope she is right. Thanks again you guys.

[Liz]

hi cindylou-

i just wanted to wish you the best of luck next week. you've been so supportive of me and everyone on here and i'm so sorry you are having to go back in the operating room.

i think your plan of tapering the percocet a little over the next week is a good one... i did the same pre-op. try and keep your mind focused that it's one more week of suffering before surgery. re: the bleeding, i assume they've told you to stop taking ibuprofen, vitamin e, etc. i donated 2 pints of blood pre-op, yet even though i lost 500ml during surgery my blood was not used. some surgeons think your body will eventually sort itself out and would rather not run the risk of infection by even giving you your own blood back.

all the best,
liz

[CindyLou]

Thank-you Liz for the nice comments. And yes, you're right...just focus on one last week of suffering before surgery. I'm definitely cutting back before surgery. I have to, so the meds will work afterwards. I can't wait to get this over with. And on to the healing process.... Take care.

[Justin]

I can't wait to get this over with. And on to the healing process....

Amen! We're rooting for you CindyLou!

Justin