Hello. Thanks for posting your query.
I totally understand your concern. The doctors are getting busy nowadays and I am sorry they treated you like that in the ER.
I also understand you have had 5 different shoulder surgeries and hence the pain is troubling you. But the issue is you have taken Percocet for 7 years and you have gotten used to the drug. This drug is prescribed only when a doctor judges that the benefits of the drug are more than its side effects. There are reported cases of some severe side effects ( even though the incidence is low ), such as respiratory apnea, respiratory depression, circulatory collapse. So it is better you don't use the drug anymore. It is better to use some OTC like Tylenol, which you can take twice daily, after food. It will also relieve your pain, and once your pain subsides you will get adequate sleep too. Make sure you take your meds after having food, otherwise it can cause gastric irritation. Also don't take it daily, take it as and when required.
Hope this helps,
Regards
Patient replied :
that's kinda my point. I haven't grown a tolerance for it. its as affective now as it always has been. I've never asked for an increase amount and prior to being perscribed them my DR and I tried many avenues and this was the most effective. I currently taking otc tylenol and they don't work. I feel like I'm taking an unhealthy amount of them also. the sleep has been an issue since a small child and a number of dr's and testing have concluded the insomnia. the pain just makes it 10× worst. from what I understand from your reply is that tylenol is what is perscribed for chronic pain? that seems very odd to me. I was hoping for better suggestions to do with truly effective medication. these are issues I've dealt with for many years and have and still do practice many non medicinal routes. IE meditation. acupuncture. yoga. but I do know I need effective medicines to live a functional life.
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Hello,
Welcome to DoctorSpring forum. I have been called in for the peer review. I will note down my views here :
- I would not say you are taking too many drugs, but I am sure you will need some modification of your medications
- Additional Tylenol is not needed , since Percocet has a similar medication called Acetaminophen
- First step should be a review of your pain situation. There are non medical methods (eg fusion of joints) that needs to be considered. It is important to confirm the diagnosis and potential treatment option before going in for a life long medication.
- You can shift on to Oxycodone (rather than Percocet which is Oxycodone + Acetaminophen). If you are taking Oxycodone alone take Tylenol as and when required (max 3 times a day).
- Next step would be too see whether this gives good pain relief , if not titrate up the dosage or add more medication.
- You will have a good amount of dependence on tolerance on Oxycodone and in that case a withdrawal can be considered in consult with your Pain management specialist.
I would like to know some additional information from you :
1. When was the last time you had an Orthopaedic evaluation ? (any additional information about the original condition will be helpful)
2. Has the pain severity increased recently ?
3. Is it like you are not able to sleep because of the pain ?
4. Is the pain pain generic or localised like over the shoulder ?
You can reply as a followup
Thank you
Patient replied :
the original injury in my shoulders were torn rotator, torn bisept, torn labrum. I waited years to get them fixed. when the did they found an abnormal bone growth that was scrapping and tearing the legaments. the removal of the bone has left the shoulders very unstable. my back was broken in a bad horse accident and is now arthritic. it feels like 2 rocks rubbing on each other. very painful to the point that I can't get up some days with out help. walking any distance hurts and I have to be very concious of how I move and what I do. I get up at 5 and exercise and stretch. also before bed. since not having meds for 3 months I can't do that, which has made things allot worse and getting worse by the day. not sleeping also compounds the issue. the sleeping has always been an issue. my parents joke that the horse accident kicked the sleep out of me. we worked for years to find a solution and the mogadon works great and has for 20 years. I take 1/2 a night. the pain is usually over the shoulders, down my arm and up my neck which causes head aches. thanks Brad.
Thank you Brad for the additional information.
You do require a proper pain management plan and protocol. I am glad to know that you have a pain medicine specialist. It is always to get a followup Orthopaedic opinion before that, just to have a look whether there are any good surgical options.
1. Regarding drugs - My recommendations would be use Oxycodon and then Tylenol for pain as and when it occurs. Further changes has to be made in consult with the Pain med specialist
2. TENS machine might be bit cumbersome to use but can be tried. If it gives some relief you should go for it.
3. I understand that you are exercising and stretching, but I would recommend a guided Physical therapy
4. An anti depressant medication needs to be added for sure. You can go for a medication like SSRI in consult with your Doctor. There are three advantages. One it helps in sleep, 2. elevates mood (if there is any depression) 3. helps in alleviating pain.
These are the recommendations for now from my side. Please feel free to ask followups
Thank you
Dr. Bhargava