Saturday, October 25, 2014

Friday, December 24, 2010 lorikeyder, Community Member, asks

Q: How many vicodin do you get/take? (in a month)

I'd like to get a feel for how much vicodin (hydrocodone/norco/lortab) average chronic pain sufferers are taking.  I was seeing a palliative care doc and she was very generous-I'm a responsible, long-time sufferer, who needs (like many) to work, etc.  In addition to an extended relief med, she gave me 240 10mg with 6 refills -- meant to last at least 6 months.  When the time was up, I just contacted her and she would call in a new script.  We met once a month to 'check-in' and it worked wonderfully.  She recently moved and I have found that docs do not want to touch me with a 10 foot pole -- if I get them to listen to me, they focus immediately on the narcotic usage instead of pain management -- usually appalled at my recent past.  So, what's everybody else taking?  The fact is that the max tylenol a day is equal to 12 of the dosage I'm on and there is conflicting data on a max for hydrocodone.  I've done my homework but I can't find a physician who can react with logic and reason instead of fear. Is there anyone else who has experience with taking/getting these types of amounts of hydrocodone on a monthly basis?  Thanks

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Answers (5)
Karen Lee Richards, Health Guide
12/27/10 6:04am

You had a very unusual doctor.  I'm afraid I don't know of any doctor who would prescribe that quantity of Vicodin on top of an extended-release pain reliever.  If you're taking an extended-release pain reliever, the Vicodin would normally only be prescribed for breakthrough pain – not to be used in that quantity on a regular daily schedule.  If the extended-release medication isn't providing adequate relief, perhaps it needs to be increased. 


It also concerns me that you're taking such a high dose of acetaminophen (Tylenol) every day.  Even though you may be within the maximum limits, that much acetaminophen every day is extremely hard on your liver.  In fact, the FDA is seriously considering lowering the maximum dosage because of that.  I hope your doctor was testing your liver function regularly. 


I seriously doubt that you're going to find a doctor who will continue giving you the same types and dosages of medications you've been receiving.  However, hopefully you'll be able to find one who will work with you to find a medication or combination of medications that will provide you with similar pain relief.  There are a lot of different options available. 


You didn't mention what kind of doctors you've been talking to.  If you haven't already done so, I'd suggest looking for a pain management specialist.  But you're going to need to be open to trying some different medications and treatments because it's unlikely any of them will rubber stamp what your previous doctor was doing.  Here's an article that may help you as you talk with potential new doctors:  How to Talk to Your Doctor About Your Pain


A pain management specialist is most likely going to require that you sign a treatment agreement.  Here is a must-read article before you do:  Treatment Agreements:  What You Need to Know Before Signing


And finally, here is a directory of pain management specialist that may help you in your search:  Doctors for Pain


I hope you find a doctor you're comfortable with that is able to help you get on a good, effective treatment plan.



lorikeyder, Community Member
12/27/10 1:53pm

Thank you for your response.  Yes, you're right.  I recognize that a) it's a lot of opioid and b) a lot of tylenol.  I do get regular labs to keep tabs on my liver, kidneys, etc.  I have been taking hydrocodone for about 12 years now (not at this level) but consistently.  You're right about the ER as well.  This time (out of breakthrough meds) I decided to increase my ER so I added the 60mg of oxycontin I was taking to the 30mg of Opana recently prescribed and today especially it's working great.  The breakthrough I do have is easily managed with breathing or stretching or distraction.  Again, that's a lot - 120mg of oxy and 60mg of Opana every day!  But, it's working.  I'm lucid, awake, able to do ADLs and am experiencing very little breakthrough.  What do you think he'll say when he hears that?


At this point in my life - I have no options as far as a permanent/surgical resolution, I'm almost 50, single, and financially limited.  I was working 3 jobs but my MD suggested I cut back.  I have good insurance but Opana doesn't come in a generic.  The ER is over $80/mo and if I took the IR of the same, another $60/mo.  I can get 240 norco for $2.  I told my doc the other day, I don't care if he puts me on a sugar pill if it works - I just want my pain managed.  I want to be able to see my family over the holidays (a long drive-my parents are older and unable to drive to me); be able to be a responsible employee; take care of the things I find important (house, pets, exercise).  I want a life and I'm more concerned about quality than quantity.  I don't think that's too much to ask.  The studies out now show that pain kills just as much, if not more than narcotics.


Thank you for the articles and the list of doctors.  I'll look them over.  I also hope I am able to find a doctor who is able and willing to help me get good, effective pain management. --L

Karen Lee Richards, Health Guide
12/28/10 12:22am

I don't blame you a bit for wanting to have a decent quality of life.  And I understand your situation of needing to be able to work to support yourself.  I'm in pretty much the same situation.  Actually, that is what has helped me most with my doctor.  I take the maximum dosage of tramadol every day, which comes out to be 240 tablets per month.  At one point a few years ago, she was hesitant to continue prescribing that quantity, but after I explained that without them, I could no longer work and support myself, she has continued to prescribe them – for which I am very grateful.


To respond to your question about how your doctor will react to the combination of medications you've been trying – if he didn't prescribe the OxyContin and Opana to be taken together, I suspect it will not go over very well.  If a patient does not take opioid medications exactly as prescribed, most doctors become very hesitant to prescribe any opioids at all.  As I'm sure you know, they have to be extremely careful because so many people abuse these drugs.


Have you ever tried the fentanyl transdermal patch?  If not, that's something you might want to discuss with your doctor.  Fentanyl is an extremely powerful opioid pain reliever and the patch provides a consistent dose for about 72 hrs.  Sometimes doctors are more comfortable with the patch since it's not as easily abused as oral medications. 


Two other options that might be worth considering as well are the neurostimulator and the intrathecal pain pump.  Both are implanted devices.  The pain pump provides much greater pain relief with significantly lower amounts of medication because the medication is delivered directly to the spine and doesn't have to be digested first.  Here are some videos that tell more about these options:  Neurostimulation and Pain Pumps

Mary, Community Member
2/18/12 4:42pm
I am glad to find someone who is experiencing a lot of The same problems I am dealing with. I too have been taking pain medicine for years and had to find a new doctor. Just as you said, the concern was not about the pain I suffer, but about the pain medicine. I too am a very responsible, sensible adult. I know what works for me, and agree with wanting more quality than quantity of life. It is very Embarrassing and insulting to be treated like A street thug. Drug addict. I am really sick and tired of having to go over my history, and the Many reasons for my pain, and explaining the need for pain medicine! If the doctors would Spend more time listening to my problems, and And understanding my condition, they would not Question the need for the pain medicine. Reply
jude, Community Member
2/10/11 4:42am

i have been taking vicodin for chronic neck pain. my doctor see s me every two months. i have gone from 60 per month to 90 per month of vicodin es and now i am taking lortab...90 per month. i still require motrin eight hundreds or i take naproxin. 240 of any kind of narcotic sounds very excessive and i can certainly see why a reputable doctor would blink more than once. there are laws governing excessive narcotic prescribing, also many folks get them just to sell them, doctors have to be very careful. some pain management clinics prescribe more heavily though, but they will want to xray and many other tessts first.

J.R.Hosuton, Community Member
3/30/11 11:31pm

I have been taking "vicodin (hydrocodone/norco/lortab)" off and on since 2000, when I herniated two disc in my lower lumbar and one in my upper that wasn't as bad. I lost baseball career for college / possible professional baseball. I was really against pills, and still don't really consider myself  someone who is very liberal about it, because of the addiction. "BUT" in some circumstances like mine, and possibly yours, I'm not a Doctor, it is necassary for daily life. I had my first lower lumbar surgery at 19 years old, yeah "WOW"! They wanted to cut on me like a "butcher that just got a load of fresh meat." The sad thing is, the Neuro Surgeon has his Bachelors from Harvard and had a pretty big hand in creating the "prosthetic disc" they now have for our backs, well special patients. It's supposed to be as good as a fusion. The fusion is my next choice, oh yeah i forgot I had another surgery in the same spot a year later, almost to the day, it was crazy. Long story short NO, I dont know anyone and that is why Im on here, trying to find if there are any doctors that have any exuse me "balls" to take care of their patients. I hate those damn clinics, which I will be at soon, because I can't make 120 Norcos last me 30 days. Oops! well I'm sorry I'm 5'11" 248 pounds, and have a huge pain thresh hold. " Oh but everyone that has surgery is FIXED and perfect, right?" Anyway, I have heard of a doctor outside of Houston, not too far that does this, but I haven't tried it yet. I hear its a hasle to get a visit, and the communication process isn't the best. " Yeah if any DEA, Police Detectives, or anyone is monitoring this, or reading this, I'm absolutely glad, because we are not all "crazy drug addicts." Some of us really need this medication. SO...I'm sorry I dont know, but if you find one please message me back and we can exchange emails. I'm having the same really really sucks that there are people out there that don't need these types of meds at all that are screwing this up for all of us whom need it.

lorikeyder, Community Member
2/19/12 9:40pm

I think there are more people in THE BOAT WITH US (real time pain sufferers) than there are 'drug seekers' but the squeaky (dead) wheel always gets the grease!  With Whitney Houstons' death, I'm afraid it's only gonna get worse.  I have been seaing a GREAT pain doc here in Denver since August after my second back surgery in May... His name is Jason Peragine at Interwest Rehab in Littleton Colorado.  I'm not sure you want to come to Colorado for pain relief but perhaps you could call the clinic and see if they know of anyone in Texas that practices like he does.  He doesn't tolerate anyone on cannabis - but other than that he has been great.  After really SUFFERING for 3 months after the surgery -- my surgeon was very stingy with the pain meds.  Right away he put me on enough meds to get me back to work and thinking life might be worth living and his entire staff is very good.

Don't give up - there are good docs out there - I know you'll find one too.

Netter07, Community Member
10/22/12 5:44pm
Try to see Dr Ronald Killam in channelview. He works out of East Houston Regional Hospital. He's prescribed me pain meds for well over 10 yrs. Hes a great Dr. Have all your surgery documentation and perhaps your old scripts. Good luck. Reply
spinal cord injuries, Community Member
7/10/12 12:38am
The only answer I can give u is I go o a pain clinic and am on fentanyl patch and I was also on 3 Vicodin a day 10/500 but they recently upped the gently dosage and cut me back to one pill a day for breakthrough , I don't know the extent of your illness but it appears as chronic pain and the best hop I had was to Dina reputable pain management clinic ,show my mri records and that's what hey gave me some seven years back and life ain't grand but , I know longer lay around in tears from pain , I do suffer from time to time and nothin helps but if I over do it it happens, so do yurself a favor look into the fentanyl pacth it's my understanding it's safer if used correctly , it's been in use for decades , I use the mylan brand as there as less skin irritations from it and the size of the patch is half the size of any others on the market and I feel less chance of damaging the medication whil I'm wearing it, yu do have to avoid high heat and long stints in sunlit and be careful in he shower ,for me I take 15 patches a month changed every 48 hours and at first I itched like crazy for the first day and then I got over it and that alll past ,an upside to it is it helped me loose weight ,after my accident I picked up a lot of weight I hadn't had ,then it slowy drifted off as my eatin habits slowed way down , at fist I tended to sweat like a horse , but that passed too in time, fenatnyl is 150 times stronger than real morphine so it's a real match for most chronic pain no tater who u are, just follow the rules and ,there are no damage to and of my body organs such as kidneys or etc , it's safe as its synthetic opioids, I do howvee have a hellacious problem with short term memory , which sucks but they pain was so bad before I ended up in the hospital 3 times a week or more , I was in the hospital 54 times in one summer prior to being on he fentanyl patch, for the majority I have no real pain unless I forget my age and my broken body parts , so please stop throwing all those pills in yiur poor body, your liver can't take it and neither can your kidneys or your arteries,I don't what stae your from or any if those things but the best thing to do is find a list of pain management doctors through your yur insurance company and the ones who are on he level and realy want to to help you are normally long time associated with the insurance companies, I'm fortunate mine went to Harvard and was also a teacher at Mayo Clinic and realizespd people like me were the ones who needed help most and started a clinic which helps about two thousand people live better lives,so the point of all this is if yiur really in constant pain as I was and ,it went way deer than pain , it was so bad it gave me IBS and panic attacks and other goodies too, but one simple pacth and few pills a month and my whole life turned around , I still am unable to work but that's mechanical issues for me, many people I know atke the same med's and worked daily jobs , but you must see the doctor once a month to get a fentanyl patch prescribed its some sort of law , it's sucks as I have to be driven 70 miles one way to get there but it beats the other life I wasn't living. Reply
spinal cord injuries, Community Member
7/10/12 1:14am
Sorry about the typos , I have super bad arthritis and I hit the keys right and the spell checker on the iPad thinks I mean something different than what I type ,it appears I'm illiterate ,which I'm not ,just badly beaten up in my joints and the iPad is a small typing area, but a lot easier than the weight of a Laptop Reply
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By lorikeyder, Community Member— Last Modified: 04/09/14, First Published: 12/24/10