Question
Dear Doctor.

I am a 43 year old male. I suffer from kidney stones which I pass on the average of one to two a year. I also have been diagnosed with idiopathic neuropathy.  I do not have diabetes. For my pain regarding the neuropathy I take 30mg oxycodone every 6 - 8 hours.  On a scale of 1 - 10 with 10 being the worst, without the oxycodone my pain can go as high as an 8 or 9. With the oxycodone my pain averages a 4. During the times I am passing a kidney stone, the oxycodone does nothing for my kidney stone pain. My urologist prescribed me .25 microgram fentanyl patches which don't work but I don't want to tell him that because I don't want it to look like I am "drug seeking".   Anyway, tomorrow I am going in for a nerve / muscle biopsy. I will be receiving general anesthesia and was told I would have to be off of my feet for 2 - 3 days. The area in which he will be taking these nerve and muscle samples is already an area with a considerable amount of pain. My concern is that after the surgery the pain may be more than normal and because I have been on the oxycodone for over 2 years it may not help with this "new" pain just like the oxycodone does nothing for my kidney stone pain. My question to you as a professional in the area of pain is, would there be a medication I could take for 2 - 3 days that would work along with or better than the oxycodone?  I was thinking maybe he could prescribe me something stronger than the oxycodone for 2 - 3 days and during those days I would not even take the oxycodone.  I understand you are not my doctor and anything you say is just an idea or "advice". I am getting a little anxious and would appreciate any "ideas" you may have.
Thank you for your time.

Paul DePietro

Answer
I understant your concerns.

Let me first say that you are (obviously) anxious and that you are setting yourself up to be hypersensitive of whatever pain you do have.  I would ask the doctor for a short supply of something like valium that would help alleviate the anxiety portion of this equation.  Just be honest with him and tell him you are scared and anxious about the surgery and the recovery and is there something he could give you just for a few days after the surgery.

Re: Kidney stone pain ~ some pain is simply too powerful and accute (meaning happening suddenly) that it can cut through any pain control medications you are on.  Short of being in a checmical coma - or in a hospital where they can used IV narcotics to really dial in the pain control there is nothing you can do about severe acute pain like that.  I wish I had a better answer for you but I have seen patients litterally screaming in pain with a PILE of meds onboard and there is just sometimes that there is nothing more that can be done (outside of going to be admitted to a hospital for IV pain drugs).

Oxycodone is a powerful medication AND the pain from the proceedure is less like kidney stone pain and more like chronic pain.  That being said there are a couple of things I would suggest.

1) If the fentanyl patch isnt strong enough you need to be honest with you provider and tell him - you can even tell him you havent mentioned it because you were scared of looking like a drug seeker.  You need higher dose long acting medications if the Oxycodone is needed that frequently and only brings you to a 4 on the pain scale.  YES - there are risks to doing this and it is only a recommendation - he might freak out - some doctor are gun-shy (unfortunately) with schedule 2 drugs.  That being said I dont believe people should suffer in pain while the options for its control are available. Ultimately if he cannot or will not give you a stronger patch or something else as your pain gets worse (which it almost always does over time) you may need a new provider :(

2) The oxycodone is a good short acting pain reliever AND you may need something to help it along for the immediate recovery period - realistically it could be something weaker than Oxy just to push the pain control back down - a prescription from the doctor for several days of Norco 10/325 should be enough to make the difference.  There is also the option of just asking your doctor if (for those 3 days) could you take more Oxycodone - like 1.5 each dose instead of 1 per dose.

Hope that helps - let me know if there is anything I else I can do for you.

Dr. Joshua