how long for tolerance to build w/ meds?

Discussion in 'Fibromyalgia Main Forum' started by sweetbeatlvr, Feb 23, 2009.

  1. sweetbeatlvr

    sweetbeatlvr New Member

    i know everyone will be different, but am just wondering what the general consensus is.

    i have been on hydrocodone 7.5mg, 3x/day for a little over a year, along with flexeril, 10mg 3x/day.

    usually it has always worked well to keep my pain and muscle stiffness manageable.

    lately though, i am having more periods of discomfort. my muscles don't seem to be getting any release from the horrible tension, and my pain med only lasts for about 3-4 hours, so i am having more pain in the evenings (making sleep worse than it already is).

    i'm not sure if it's from tolerance or possibly because i have been working more hours?

    i go to my doctor in a few days and want to discuss it with her, but i am always hesitant to discuss pain meds, because of the bad stigma of them, and also because of the bad treatment i've gotten from other doctors, concerning them.

    if you could share your experiences or have any advice for me, i would be very appreciative. thankyou.
  2. Janalynn

    Janalynn New Member

    Don't be hesitant to talk to your dr. about increased pain. Your doctor has obviously already prescribed pain meds for you - so you're past the point of discussing for the first time. To put it bluntly- forget about the stigma.

    It is not uncommon to need more after a year. BUT you may just be experiencing more pain. Sometimes we go through periods where we do have more and our normal regime doesn't work.

    I would definitely tell her that your pain is not under control. Ask about what other options are available. It might be changing the dose or quantity. You're on a very low dose, so I wouldn't be worried about it.

    How is the Flexiril working for you? That is one thing that didn't work for me. That might be something you'd ask to explore different options of as well. I even had a pain dr. who has Fibro tell me that Flexiril didn't work the best for her either. I take Soma which works much better than Flexiril ever did for me.
    Maybe you'll want to ask about that.

    If you don't ask about other options and be honest and upfront about your pain, then there's no chance of getting any help.

    Just be totally honest and maybe even say something like "I don't understand why my pain is much worse or why I'm not getting relief from the medication I'm currently taking, but can we discuss what other options are available for me", then tell her how the pain is effecting you....'I can't sleep because of it" etc. I've found that saying how it effects me as opposed to how bad it is gives them a better idea of what I'm dealing with on a daily basis.

    Good Luck - remember, this is your body that you're trying to take care of. =)
  3. satchya

    satchya New Member

    I was taking 10 mg vicodin 3x a day for about a year before I noticed it wearing off faster and faster, and not working as well. I brought it up with my doctor and she was totally willing to prescribe it for 4x a day, she also wrote it for pills with less acetemenophin in it so I would be less likely to have bad side effects from that.

    However, she also brought up whether I would be willing to try adding gabapentin in. I had been very, very resistant to the idea in the past. After about a month of taking the increased dose of vicodin and still not having significant pain relief, I went ahead and filled the prescription for gabapentin that she had written. I've been taking 900 mg of it a day for about three weeks now and it's made a huge difference. I've already been able to cut back to Vicodin 3 x a day again (less pain, plus it helps the opiod medicine work better), and I'm hopeful that by spring and summer, when my pain is usually much less, I will be able to cut back to 1 or 2 times a day.

    Talk to your doctor about the increased pain and see what she says. You obviously have a relationship of trust with her already or she wouldn't be prescribing you pain medicine. Also, I would suggest being willing to try other ideas she might have to help the pain. Life's too short to live it in pain. Good doctors don't want to see their patients in any pain they don't have to be in.

    I know I was very upset and worried ahead of time when I knew I was going to ask my doctor about increasing my dosage, because of exactly the stigma you described. I was afraid this was just the first step down a slippery slope before I eventually had a "Heath Ledger" or "Anna Nicole" moment. If it helps you feel any better, now that I am in less pain, it has been easy to cut back on the vicodin. If you're truly taking it for pain, there should be NO shame in that. That's what the dang things were invented for ;) And when you're in less pain, you WILL be able to cut back. Trust yourself.
  4. monica33flowers

    monica33flowers New Member

    It very well could be the Flexeril not giving you the relief you need at night. I had a lot of problems with different muscle relaxers --- none worked. Then they gave me Tizandine aka Xanaflex. This stuff knocks me out at night. Sometimes I'm sleeping so sound I don't even get up to go potty at night.

    Also, gabapentin or Lyrica gave me a lot of relief. The problem I had with both of these meds was the weight gain. In a year and half to 2 years I gained 70 lbs.

    I would give the gabapentin a try first, before the Lyrica. That did work the best for me for quite a while. The Lyrica worked well also but I had a lot of nerve pain and the gabapentin worked much better for that. Plus, the Lyrica also added to my fibro fog. Actually, a few of my close friends said they can see a huge difference since I stopped taking the Lyrica, as they say, "I was out of it" and I took the minimum dose of 150 mg per day.

    Good Luck at your next visit with the dr.
  5. sweetbeatlvr

    sweetbeatlvr New Member

    and for your suggestions, you've given me that extra nudge i needed to discuss this w/ my doctor.

    i've tried both gabapentin and Lyrica, and neither one did anything for me (the Lyrica gave me more pain in my legs (weird) and also caused me to gain weight, blah.)

    i really do think it's the flexeril not doing it's job. if i was getting more muscle tension release, i don't think there would be a need for more pain meds.

    i have been through a hefty list of muscle relaxers, including soma and zanaflex, neither really helping. although the zanaflex was one of the 1st ones prescribed for me and at the lowest dose. it did not help. i wonder if a higher dose would help? does it need to build up in your system to work better?

    i was thinking of asking to try something like Valium. when i had to go to the ER for my FM pain and muscle spasms, they gave me that, and it worked wonderfully, no muscle tension.

    i've also been having the feeling alot (especially at night, waking up from sleep), like my body is on "high alert", feeling like my body is buzzing inside (from my own research of symptoms, i believe i have a form of dysautonomia), and i wonder if the Valium would help with that?

    thanks again for your responses, i truly appreciate it.
  6. Janalynn

    Janalynn New Member

    That might be a great idea!
    When I visited a rheumatologist - one I see every 6 months for follow up- he suggested Klonapin. I wasn't sure why exactly at the time - but I do believe it's for the overall relaxation it provides.

    I really don't take it very often - but on bad days, it does help. On the weekends, I get out my heating pad, favorite blanket, take a Klonapin if it's a bad day (which lately they've all been) and find myself very relaxed which is wonderful!!

    Great idea!!

    When do you go to your Dr.?
    I wish you luck - don't walk out of there without feeling like you've been given some help! =)
  7. sweetbeatlvr

    sweetbeatlvr New Member

    i go back to her on Monday.

    she really is open minded, and definately believes in Fm, which is a big relief.

    she knows about the "high alert" thing that's been going on, and gave me a 24hr holter moniter test at my last appt. it came back normal. i think she was doing it to make sure there wasn't anything wrong w/ my heart.

    i will let her know, i am still having these feelings though, and also about the need for more relief of my muscle tension. i also a have a great article about dysautonomia and the relationship with FM, that i want to give her, to see if she may agree that this may be what's going on.

    hopefully she is as open-minded as i believe she is and will be willing to give my suggestion a try.

    thanks for your replies.=)
  8. monica33flowers

    monica33flowers New Member

    I just wanted to let you know that Tizandine aka Zanaflex comes in two doses. Their is the 2 mg and the 4 mg. I take 3 of the 4 mg at nighttime. I hope that gives you a better idea of maybe you had a really low dose. This medication was given to me from my migraine dr. to help with all the muscle tension in my neck. Therefore I couldn't sleep at night.

    I do think a lot of the people here do well with Klonopin. Unfortunately, it did absolutely nothing for me but that could have been the low dose as well not sure.

    But what it all comes down to is what works for you. Everyone is different.

    I also want to say how "proud" I am of you for continuing to work as a waitress. I did this for many years myself and my hat goes off to you for all your hard work!
  9. sweetbeatlvr

    sweetbeatlvr New Member

    that was very nice of you to say, as you know how physically taxing this line of work can be.

    i am very grateful that i am able to continue towork (although i may complain about it from time to time!=)

    i believe that working is actually "helping" me right now. when i stop moving, i hurt more. as i've noticed on days that i am off, i have to do things at home, to keep my mind off the pain, i guess.

    i hope that this continues to work for as long as possible, as i know some people w/ FM come to a point where this just doesn't work anymore, for those, my heart goes out to you.<3

    thankyou for explaining Zanaflex. i was on a very low dose then: 4mg 2x/day. i will bring up the possibilty of maybe trying this again too, in a higher dose, and see what my doctor thinks, although, i definately don't need to be "knocked out" during the day (at night, would be bliss, though.=)

    thankyou for your responses, i appreciate you.=)
  10. sweetbeatlvr

    sweetbeatlvr New Member

    and it turned out really well.

    i told her i was not getting the same relief from the meds, and i believed it was from the flexeril not working for me. we went over the list of muscle relaxers i have tried.

    i told her how when i went to the ER, when they gave me the Valium it worked really well to relax my muscles, and she agreed to let me try it.

    i have been getting wonderful relief from it, and feel no need for an increase in pain meds, yay!

    turns out, my holter moniter was not "normal", there's something happening to my heart several times a day (and night), but my heart is making up for it.

    also, when i was in the office my heart rate did that weird thing i was telling her about, where it just starts pounding, then slows, w/ the dizzy feeling, and sweats. she ended up putting me on a beta-blocker also.

    turns out, i had brought info with me on dysautonomia, which she agreed is the cause of these other weird symptoms.

    she said we're gonna learn together, and i told her how thankful and appreciative i am to have her, that she will be able to help other patients, like me, in the future.

    what a wonderful doctor (nurse practioner, actually).

    i pray everyone will get the same treatment from their physcians eventually.
  11. loto

    loto Member

    Hi sweetbeatlvr. I just a week ago started taking the same mg vicodin as you currently do. But my doctor prescribed it to me for "take 1 - 2 tablets up to 4 times daily", and I definitely need 2 tablets 4 times daily! Anyway, before that I was on 5-500 mg vicodin for about 2 years. So, the 5-500 definitely wasn't totally working for me anymore. But I have a question for you. This new mg is making me more tired/sleepy than normal. Does it make you that way? Or does your body gradually get used to it and not make you feel that way anymore? And, so far, this mg doesn't help with the pain that much until I've had 3 of the doses in me! I have had more pain lately though.
  12. brightsidedone

    brightsidedone New Member

    I was diagnosed with FM in 2003-04. My "primary care" physician happens to be a rheumatologist specializing in Lupus. I believe that I "had" FM long before I was diagnosed, but obviously, this is a relatively, new science. I had three horses and a "farm" when I was diagnosed. I was placed on Ultra-cet because Ibupropen was upsetting my stomach. I was also placed on Neurontin for depression, Klonopin for leg spasms, tried Flexaril which didn't work and was given Ambien to make me sleep. In addition, the court mandated that I seek a clinician for my depression, which I did. My doctor insisted that I maintain a certain level of physical activity on the farm and that I continue riding the horses, as much as possible. Riding in a car, however was almost intolerable.

    Now, I take Wellbutrin, Tramadol which doesn't do a thing, a lower dose of Klonopin, Ambien, Baclofen. I was diagnosed with breast cancer this time last year and have since undergone a bi-lateral mascectomy. Prior to that, I had a complete hysterectomy which I attribute to the FM. From time to time, I have bouts of IBS and still experience, insomnia but it doesn't last long.

    My body definitely has played "catch-up" with meds. I had almost none of the side-affects they thought I'd have with the chemo. The Taxol brought on 2 months of piercing pain around the crown of my head and even since the chemo ended, when I have a flare-up, it begins with that symptom. In fact, everytime I have a flare-up, I have a new symptom and that symptom seems to be added onto the existing list. My flare-ups "usually last" for two weeks and begin about two days after a significant change in my daily routine.

    My husband is now convinced that "medicine" is responsible for the terrible health issues I have and that annoys me to no end, because I am the one dealing with all of this. I am looking for something concrete to share with him; something that will give him some peace of mind and me, some "peace".

    I attribute "everything" to my personality type and that is "A". I don't handle stress well and in the past have simply "handled" as much of it as I was able. Since the cancer, I fall apart without warning, so I know that I cannot place myself in those situations any longer. I wonder though, just how much personality type plays a role in the development of FM.

  13. sweetbeatlvr

    sweetbeatlvr New Member

    as your body adjusts to it.

    i do not feel tired anymore when i take mine.

    a jump from 5mg to 15 would definately make you feel a little more tired, it should go away soon.

    i am the opposite with the needing more doses to get effectiveness. I find i get more relief from my first dose, and the effect goes down with the rest of my doses.

    i hope you find the relief you need.<3
  14. vivian53

    vivian53 Member

    Hi brightsidedone. I am sorry you have gone through so much. Don't let anyone blame it on your personality type though. We "type A's" might hold our selves more rigidly and therefore have tightened muscles, but it didn't cause our FM. Does it make it worse, I think so. I will liken it to the bad experience I had on Provigil. It hyped me up so much I felt like I was on Speed. I had clenched teeth and couldn't relax for the life of me. It increased my pain because I was so tense and rigid.

    Even people that suffer from the old Histrionic Personality Disorder can't truly cause themselves to have a physical disease, they can only display the symptoms. Just my opinion. FM isn't caused my mental or emotional factors or even personality types.

    Hope that helps answer your question and hope you have a pain free day.

  15. Janalynn

    Janalynn New Member

    I agree, once you get used to it, the tiredness should go away.
    Sweetbeatlvr, I'm just like you - I find my first dose is really the most effective of the day. - that part kind of stinks, because early evening I'm in pretty bad shape and sometimes get very little relief at that time of day.

    Maybe it's because it hasn't been in our system for 12 hrs or so. ( at least in my case).

    I literally have to write down when I take my medication or I'll forget because sometimes I can't tell at all that i've taken it.
  16. shari1677

    shari1677 New Member

    sweetbeatlvr - please don't be hesitant to discuss pain medicine with your doctor. In my opinion, if your doctor is educated on fibromyalgia, he/she will prescribe pain medication without much hesitation.

    All I have to do is call my doctor's office and he will refill it over the phone. I am extremely lucky!

    Oh and BTW - I'm surprised the meds you are on now have worked for a year. I build up a tolerance alot faster than that.