Expert: Crystal - 7/11/2009

Question
I have for years now used oxycontin time release 20 mg tablets for severe low back pain left over after surgery. I have used Methadone, and it was too weird on my body, so I weaned myself off with vicodan, and got on the oxy.. Now, I have a new doctor who will not prescribe Oxsycontin, but time release morphine instead. My nasty problem is this:I can not fall asleep at night on the morphine. I end up taking an oxycontin just to sleep. During the day no problems. Do I need to see a pain management specialist? I so want to be free of pain, but the morphine is not quite strong enough. I have kept my oxycontin use at one 20mg pill twice a day, and just suffer the rest of the time. Is there a way to get off oxycontin while taking morphine. I am so very careful with these drugs, and do not want to end up strung out addicted to both

Answer
Rick,

This is a difficult question to answer because you have been on a wide variety of pain medications all the way up to methadone, the body builds such a tolerance once introduced to a higher and somewhat different substance that it makes the body and the brain go haywire. I think you have reached a point where you need help to get real pain management because you are right, you are at a point where you could very well make some bad choices and end up addicted. However, that doesn't have to be the situation. Go back to your current doctor and request a referral to a pain management specialist or find one on your own and see what they have to offer.

Yes there is a way to come off the oxycontin but that is very difficult to do since you have been taking it for such a long time. The body becomes adapted to taking these meds and then without them it is hard to function because of the dopamine changes it causes in the brain. It stops the body from producing its own pain relievers, which is what dopamine is. Make sense? This is probably why you aren't sleeping at night now and having a hard time throughout the day now. Your body is to a point detoxing right now even with the morphine because it is used to the oxycontin.
What you need is one doctor who can address this in whole with an open mind and not a mindset on addiction but I can't stress enough that this too must be done with caution. You need a doctor to help with the sleep, the pain, the tolerence and the side effects that all these meds can cause and you need a doctor who will listen to all of your concerns. Does your insurance have a PPO or HMO? Can you just find your own doctor or do you need a referral? Answering these questions will allow me better tools to helping you find the right direction.