Monday, March 23, 2009

Developing Tolerences for Medications

Over the last seven years I have been taking Morphine S04, also known as MS-Contin. It is given to alleviate pain, and is on a time release. From the start, when I was on 30 mg twice a day until today, when I'm on 80mg twice a day, I've developed a tolerance for the drug- so much so that although I do see differences when I am delayed in taking the pills, I also find that I'm in far greater pain now than I have been in years. Every few years I get x-rays that determine the extent of the joint damage Ehlers-Danlos has taken, and in that time, I also get re-evaluated for pain medications.

It is true that the difference before the pharmaceutical and now is the ability to walk or not. I have a motorized wheelchair at the ready, and as I type this blog my left shoulder is working its way back into the socket. For those of us dependent upon pain medication, the ability to perform simple tasks is often an indication of how well the pain is managed. No one has ever said to me, "Oh you're high!", or "You seem a bit out of it", because the pain medication does its job. It isn't designed to be a recreational activity for me- or millions of others.

But, our bodies develop tolerances to long term medications. Women who take birth control to help with break-through bleeding find that after a few months, or years, the symptoms return. Someone who was able to wake up after a cup of coffee may find it takes up to three to feel that same way later in life. And, those who are on opioid medications also find that after time, the body develops an ability to reconnect with the pain. There is often an additional prescription or recommended drug given for the pain that occurs between doses, and many times, this increases side effects, and may prove to be less than useful in assisting against the searing, throbbing, or piercing sensations.

Some doctors will attempt to offer several options to handle the pain-between-dosages. In my case, it was first a simple Naproxen. This over-the-counter solution does wonders for my headaches, and if I have a cup of tea- I'm set to go for the next few hours. But that soon lost its effectiveness. I was put on Hydrocodone, also called Lortab or Vicadin. The side effects made it fairly difficult to appreciate the pain-killing properties. Then I was given Oxycodone. Now most pharmacists will say, "Morphine and Oxy don't mix", but pain specialists seem to believe that is an error, and if taken as directed, and blood is monitored, the patient should be okay.

This combination worked for me for about two years, until a few months back when I was finding that it was far more difficult for me to move each day. Now that I'm in my mid-forties, I'm finding that age plus dislocations is a difficult combination. The xrays showed that I've got several sockets that are shrinking, and that isn't allowing me to recover from the bone and joint issues as quickly. My doctor and I discussed other options, and I'm scheduled to see a rheumatologist, but in the meantime, I'm now on an Immediate Release version of the Morphine, which I take every few hours between the long-term dosages. Because I've grown a strong tolerance for the drug, the idea that a similar formula should work well seemed logical.

But that does not take into account the renewal of side effects. In the first few days, I noticed a remarkable change in pain relief, but I also noticed that some of the issues that appeared included nausea, loss of appetite, and an almost PMS-like feeling just before the next dosage is due. In a few days, I should develop enough tolerance of this new form that this reaction will abade, but in the meantime, it's the miserable feeling between then and now. My doctor is working to find the correct long term dosage so I don't have to take any more break-through pain medication again. This will be a welcomed relief, eventually.

Today's questions- What do you find has been your greatest relief in building up tolerances to medications? How do you handle the initial side effects? What medications would you rid yourself of if you could?

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