Most of us that have used narcotic pain relievers over a period of time have come up against tolerance problems. For some, their pain levels may have increased to a point where they actually need stronger doses. Unfortunately--or perhaps fortunately, there is an upper limit, a ceiling if you will, on the amount and type of medication available from most of the services discussed here. For many of you in this means the only recourse available is finding the increasingly scarce doctor or practice that can give you the type and doses of medications that can help.

Others, myself included, have not necessarily experienced perceptible increases in pain levels, but with a constant dose (or even a reduction of the dosage--we have discussions of how many have been cut back from 120 counts per month to 90) of medicine over time, tolerance issues will arise for just about everyone. So many have to "stretch" their prescriptions to last. Many of us, even the best, have grappled with the problem from time to time. I am hoping in this thread we can discuss strategies for dealing with this reality.

We have heard of taking a "vacation." Or stopping the use of the medication for a temporary period so that it will be more effective later. Of course, that has its own set of problems. First, and perhaps foremost is the fact that usually within 24 to 36 hours most will experience some form of withdrawl symptoms. Also there is the continuing problem that brought most of us here to begin with, pain levels when not taking the medication.

Another some of us have is the occasional rotation of medications.

A strategy I am thinking of deploying is a variation of the rotation. Perhaps take my medication in its necessary dosage during the work week and taking something else on the weekends. Perhaps a combo of kratom and advil or tramadol.

I know many here periodically use Kratom. This will be a good place to discuss its judicious use while taking other medications. This could be a very helpful thread is we are willing to honestly share our experiences, in my opinion.
PB

can you tell me more about kratom..I read a little about it...but has anyone ever bought it? how do you use it? It said it is not addictive if used correctly? Please let me know

I am on a rather high daily dose of Hydrocodone and so tolerance has alway's been a consideration for me. I do use the "vacation" (or drug "holiday" as is termed in medical circles) I do think that a 30 day hiatus from the med. does lower my tolerance levels at least temporarily, this obviously is NOT for everyone, but I don't have the Tramadol option, and NSAIDS don't agree with me, and neither does Kratom, using Catapres and low-dose Xanax does ease the discomfort of Hydro. W/D significantly. It is said that grapefruit juice will potentiate Hydrocodone. Given the current climate, I expect my own monthly regimen "may" be reduced as low as X 120 a month. My pain doc. has not indicated this so far, but I am bracing myself for that eventuality. I hate MJ, but Medical Pot is still an option here in Ca.
Just my two-cents.

i have also had great help using motherwort. the effects are similar to MJ, very soothing. found at any herb shop in capsule or raw form (you can also grow it in your yard 100% legal). i like to make a tea with a strainer and just adding a bit of honey.

Sorry guys and gals but I had to delete a few posts in this thread..
Yes..Shawn had to be the bad guy and ruin the fun.

Lets try and keep the topic to the LEGAL ways people try to stretch their scripts. A lot of what I saw was tips/suggestions for rec use. I'm not pointing any fingers..no big deal just can't leave stuff like that on the board.

EXCELLENT POSTS PB AND SHAWN!!!!

AS USUAL DAVID YOUR 2 CENTS ARE PRICELESS!

I AM SO BLESSED BY ALL OF YOU!

BLESSED BE!

I can look at chronic pain from a "temporary" point of view, ONLY. So, my addition here may not apply.

Starting in 1998, I started wearing full braces as a pre-operative step to getting a severe under-bite correction on my upper and lower jaw.

Mind you, I was 38 at the time and bones aren't as plastic then as when you were a child. My folks couldn't afford to get this done for me as a child.

Most of the time, my whole mouth felt like it was on fire from the constant pressure that the orthodotic devices put on my mouth region.

Once a month (or sometimes more often), the braces had to be "tightened." In other words, "it's time to put more force on the old jaw bones, Wayne!"

After this tightening, my whole mouth and jaw region was on fire! I talked with the orthodontist about pain relief. He told me he didn't have a license for narcotic medications.

I thought, "ARE YOU KIDDING ME?!?!?" An ortodontist can't write scripts for even codeine? I asked the orthopaedic surgeon in charge of my case for some relief, but he declined because his insurance only allowed him to write scripts for post-operative pain, not pre-operative procedures.

Well, that's when I went to work. I studied pain relief like it was the back of my hand. I found out that you can mix certain meds and not others. You can choose your favorite NSAID and mix that with acetaminophen. But you cannot mix two NSAID's. I asked my family doctor how much I could take of each, just to be on the safe side.

The family doctor would only give me so much vicodin, which was also part of my trouble. So I floundered through two and a half years like this. I also discovered that I could drive to Canada and buy codeine-based pain meds OTC. Since I live in northern Ohio, this worked out OK.

I asked about pain management, but was told I wasn't severe enough. But I probably should has pushed harder. I didn't know about on-line phamacies then or if they even existed. Eventually, I had the surgery and finally the braces came off.

I feel so deeply for those who have to live like this on a daily basis. When will our governments or medical science come up with a tolerable solution???

interesting posts, I can control my tolerance levels ,but its not always 'enjoyable'. I don't have success with vacations since my pain is a little severe sometimes and the WD is just as painfull, though its not as bad as it was 4 years ago.

Like many I was forced to take less a day because of prescription quantity problems.
Like say going from 120ct to 90ct a month.

Basically what I do is I bite in half a 10mg in the morning(or use a splitter) and save the other half for pre-lunch. Usually this is just enough to stave off pain and WD simptoms. I used to only have sucess with 15mg Hydro at every instance I take hydro ,but nowadays if I take a full 10mg ,I really feel it stronger than when I took 15mg 4years ago. It's weird but I've actually lowered my tolerance levels to hydro. You would think that after being on pain therapy ,hydro's ,for 5 years I would be on compounded large quantities now ,but I'm not.

Say for example you have only 3 a day hydro 10mg to take ,to get you through to next refill date.

Well you could try to take 1/2 of a 10mg in the morning then the other 1/2 at lunch . Then take another 10mg split it in half and take it pre-dinner ,then take the other 1/2 before bed.

Now you have an extra 10mg for the next day . I do this when I know ,say for example ,thursday my workload is going to be heavier ,so I prepare for thursday by doing the split-pill program on wedensday ,so when thursday comes I have a 'bonus' hydro for the extra pain I usally encounter while standing for 8 hours without a sit-down lunch or break.

4 years ago I regularly took 6-7 hydros a day ,plus at that time I could see myself escalating in tolerance levels and I was sure I was on my way to 10-20 a day ,like people on compounded hydro, but now I get by with as little as 2 or 3.

Hope I made sense ,but you can control your body's level of tolerance.

I have tried to stick a 1/2 a pill under my tongue ,but I'm not sure if Hydro's are even remotley sublingual,or at least when completley dissolved under the tongue even transfer that much into the bloodstream. I've tried this but I usually can't stand the taste so I swallow it before it gets a real chance to enter the bloodstream. Maybe someone can answer is hydro is more effective placed under the tongue?

this is a great topic and something I just started doing due to the difficulty getting meds and keeping tolerance in check.

during the winter, I had been given a cough suppressant called tussinex which I did not use since I was already on hydrocodone. but when my meds got low, I did the split pill regimen but I took a 1/2 tsp. dose of the tussinex in the morning and at night (12 hrs. apart) and took the hydro on a completely empty stomach as well,(not at the same time) with orange or grapefruit juice if I could. I also take .25 of xanax, which I split into fourths (gotta keep that down as well) and take that a bit before i take the 5 mgs of hydro. i got a little sniffly, but that was all...so at night when I was in pain, I took a whole pill, but cut in 1/2 w/juice on an empty stomach and it worked very very well. then another the same way at bedtime. SO that was 6am 1/2, 11am 1/2 then 4:30pm a whole then bedtime another whole with juice. then I cut out the tussinex as after a couple of days my body got used to the low dose. the tussinex is time released. I think it would be a good thing to take at the end of coming OFF hydro as a dose lasts 12 hours and you can easily lower it and it contains an antihistamine as well, which controls the sniffles and sneezes that I happen to get with WD symptoms. I have learned to respect the hydro and it's power and if I do not control it, it will control me...

a warm beverage too, is a good thing to take hydro with on an empty stomach or a sip of soda or seltzer...

the great thing is, my pain is responding to the lower dose, which I did not expect. I was looking to ward off the WD, so this was a bonus. Anyway, now that regiment still works W/O the tussinex. it was a good way for me to get started. if you can get tussinex, tho, it was very expensive! $120 bottle (a very SMALL bottle)in a regular pharmacy along with a 3-day Z-pack...a very expensive illness, but I was better by monday! so it was worth it! being sick and fevered makes my fibro flare up instantly.
Dawn

Is Tussinex a prescription med? I know Nite Time liquid cold medicine seems to help. If I need the cold medicine for a sinus flare up, I don't need the hydro at night.

I have been doing well using some of the methods you all describe, but my pain is getting worse. This is not a surprise, it is to be expected. That's why I have stayed as low as possible. But, now I am reaching a point where I will need more hydro, or start using a stronger med. I have a few years before I want to retire and I have it in my mind to use will power to stick to hydro until then. But, the quality of my life is suffering.

My Doctor seems to think one oxy with a few hydro is better than more hydro. If any of you have experience with this I would love to hear your results.

I plan to keep sticking it out for as long as possible, but I am interested in any of your ideas for the future. Patients know more than Doctors because they have real experience.

The only thing I can think of manny, and you undoubtedly know this, but the oxy is a bit stronger than the hydro. I know for me, I would welcome it. However, I am a hydro only patient. I know many here are prescribed the two in combination.
PB
PBPS: It does sound like you and I are close to the same age there manny. Only with me I think I will reach a "retirement age" without actually ever retiring. I do hope though, that I will be able to live a comfortable life doing what I do part time--until I die!

Oxycodone is definitley stronger than hydro in my experience. If you have a Dr. sympathetic enough to prescrib Oxy's ,your lucky and he sounds like a good Dr. Also you must be in some serious pain if he thinks Oxy is needed. If your pain is getting worse ,you might consider compounded hydro at a pain clinic. You'll get up to 20 pills a day and the compounds have either none or verry little acetomenophen aka tylenol to keep your liver out of danger.
Either way Oxy's are a definite step up from hydro's.

This message has been edited. Last edited by: KSDJ1,

Tussinex is prescribed, controlled cough syrup. It is a time released hydrocodone 10mgs and an antihistamine combo. It was prescribed one tsp. every 12 hours. I tried one tsp. when I first got it and I had an anxiety attack, which probably had nothing to do with the medicine. I'd had extra caffeine as I was not feeling well and had tea a few times and the caffeine brings on anxiety for me. I did not take it anymore after that until I ran low on meds and used it to stretch things...

I had been prescribed 5/325 oxycodone when my back got worse after my car accident and I did not find it working as well as a 10/325 hydrocodone. It also made me feel kind of down and draggy. Hydro peps me up and makes me want to move around, which is perfect for the fatigue that comes with fibro.
PB, I too will be working forever because I still am not settled into a position where I make any decent money and need to do that...I am not taking to widowhood very well, but I still have one child young enough to need me which is why I still work in the schools so I can be there to keep tabs and spend that quality time with my daughter. I hope that God is good and helps me find a good job once she is old enough to watch after herself and make good choices when I am not there....
Dawn

Hi Dawn,

WoW is all I can say about Tussinex! I had the worse cough in my entire life about two years ago, and they gave me this stuff, basically it's liquid hydrocodone as Dawn mentioned, and one tsp really knocked me on my a$$. I was training for a new position at the time, and I'm telling you it was very difficult to function during the day let alone drive back to my hotel after taking that stuff. That being said, it KILLED my cough like a 12 gauge shotgun!

-SKB

Thanks for all of the info. PB, you are right, I don't think I will ever really retire, I just want to retire from the ownership part -- and still work part-time. Everything I have ever read or heard about chronic pain people is definitely keep doing everything you can, as long as you can. Seems statistics say we can go downhill quickly if we stop. It sounds like a mental process and people lose their will to fight.

So Tuss is hydro with an antihistamine. That explains my accidental finding that night time cold medication helps. Actually, I began feeling worse at the onset of the allergy season and couldn't get my long-time Drixoral. The other things I tried didn't help and they contain Ibu and I don't need more of that. I ordered Drixoral from Canada but they are back-logged since so many people in the US use it and cannot get it. I looked at Zyrtec-D. The chemicals are very close to Drixoral and it does not contain any Ibu or pain med. So, I got it and took one this morning and this is the best I have felt in several weeks. Again, it could be "all in my mind" but it seems to be helping.

I really don't like the Oxy idea. Hopefully, I have a few good years left so I would rather save the "big guns" until absolutely necessary.

All of your information combined has helped me feel better again. The sharing of information here is unbelievable. I would be lost without you .