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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Narcotics For Pain Inspite Of Having Opiate Tolerance

I have just been told I have Reverse-Hill Sachs lesion and a chronic reverse Bankart lesion with denuded cystic degeneration of the posterior glenoid rim, both of the labrum and the osseous glenoid with mild posterior glenohumeral subluxation and patulous ventral aspect to the glenohumeral space(all in keeping with prior dislocation). Subscapularis strain and partial tearing. I was originally referred to our local orthopedic surgeon because of progressing bone spurs in my lower back along with chondrosis in my hips and knees. I started lifting weights when I was 12 . I have been on hydrocodone 10 mg with 325 mg of Tylenol for almost a decade. What would you suggest for a narcotic pain medication that might work for me because of my opiate tolerance. My normal Dr. put me on oxycodone 10 mg every 4-6 hour. That was before they knew all of the damage. I have to take two of these at once to get the main edge off the pain. I have had 3 children without any help from drugs so my idea of a 1 - 10 pain scale equals how many centimeters my cervix would be during labor.
Mon, 20 Jan 2020
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Addiction Medicine Specialist 's  Response
Hi,

Good scale for pain. the location and movement of a pain gives clues as to what is going on. But the key point here, is that the pain often has some either inflammatory or nerve components. These are better treated by non-narcotic medications. Tolerance can be overcome by time off from narcotics and/or on a narcotic blocker. Otherwise you're just stuck going with just higher doses. As these things go, 50 mg a day is the border between doses that are not going to cause problems to doses that might get progressively more of a problem.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Matt Wachsman, Addiction Medicine Specialist
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Suggest Narcotics For Pain Inspite Of Having Opiate Tolerance

Hi, Good scale for pain. the location and movement of a pain gives clues as to what is going on. But the key point here, is that the pain often has some either inflammatory or nerve components. These are better treated by non-narcotic medications. Tolerance can be overcome by time off from narcotics and/or on a narcotic blocker. Otherwise you re just stuck going with just higher doses. As these things go, 50 mg a day is the border between doses that are not going to cause problems to doses that might get progressively more of a problem. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Matt Wachsman, Addiction Medicine Specialist