What do I tell my pain management peopke

[MrE51]

Started Pain Mgnt. IN October. They reduced my hydrocodone from 180 pills a month (10mg/325) my primary Dr was prescribing as they no longer helped without taking more than prescribed ( which is why I went to pain management) they reduced me to 60 of the same pills ( Norco) but only twice a day plus a 15 Mg morphine pill which did absolutely nothinh but cause my pain to stay at a very uncomfortable level. Fyi, I hate the pain rating they ask. It varies based on medication
Anyway, after telling them it was no help but worse, they had me start on 25mcg fentanyl patch which it too did nothing. No change in pain diminishment.
Why have they not tried percocet  10/325? I had them once in between doctors, my primary and the one who did my shoulder replacement. It worked unbelievably. Why is it morphine does nothing, fentanyl patch ( which I hate the process plus the repercussions should Any advice?
my grandkids touch one that doesn’t stay stuck on or my dog eats it)

[backhurtz]

For fentanyl patches- there are cover tapes called tegaderm or opsite that you can place over the patch which helps keep it in place. It is also important when placing them that you choose an area of little muscular movement- shoulder blade, upper arm, lower calf muscle- and hold it firmly in place for about a minute.
I think you may be confusing not ‘feeling’ the onset of the medications and misinterpreting them as not ‘working’ because you aren’t getting that feeling many get from immediate release meds.
Because extended release deliver a steadier blood plasma level as you continue to take them and once you reach the steady plasma levels- there is a noticeable decrease in overall , every day pain.
The norco now appears to be used only for breakthrough pain- and either the morphine or fentanyl is your main pain medication. The nice thing about the fentanyl patches is once you adjust to them- you’ll come to enjoy not being tied to a pill bottle all the time and the overall pain control is far more stable and less.

[backhurtz]

Hydrocodone is an immediate release medication- meaning that most ‘feel’ it kick in after taking its within half hour/1hr.  It is also short acting- meaning  as 4-8 hrs pass- those using it notice the effects lessen over the time frame.
Morphine ER is an extended release- most taking it don’t feel it ‘kick in’ like the immediate release options and often believe because they don’t ‘feel it’ it’s not working. Extended release meds are meant to deliver a steady blood stream level of medication over its dosage time.
Fentanyl is hundreds of times MORE POTENT and powerful than other opiates and is absorbed through the skin- over three days. When using fentanyl patches- you won’t feel it immediately since it takes time to reach a steady blood plasma level - for new users- typically two or three patch changes.
With extended relief and medications like fentanyl- instead of noticing it kicking in- most patients notice an overall decrease/more consistent leveling of pain.
IMPORTANT- NEVER allow anyone to touch fentanyl patches and once removed- put used patches in coffee grounds or used cat litter to prevent someone from using or touching them.
There is a VERY real danger of accidental overdose for someone to come in contact with fentanyl or opiates they are not prescribed.
I think you need to give either the fentanyl or extended release morphine a longer trial period before discounting them as ineffective. Both medications are the most potent available.

[MrE51]

I had a major surgery 20 years ago. A nurse came in my room and injected something into my IV. Shortly after, the surgeon came in and ask how I was doing. I told him Ivwas still hurting. He looked at the nurse and asked and she told him she had just given me a morphine injection. I asked him how long does it take to start working. He said immediately.
Two years ago I went to an ER due to severe pain in my right shoulder which my shoulder had to be replaced ( reverse arthroplasty), at the time in the ER they gave me a Fentanyl injection. Nothing happened. The pain never let up. I was told that it happens occasionally.
I have what was called degenerative arthritis in my lower back, lumbar region and having IBS ( since I was a teenager) tylenol, ibuprofen, etc cause very irritability in my stomach, thus I was first put on tramadol which caused my body to itch like crazy, so they put me on what was then called Lortab, now called Norco ( hydrocodone)
After many many years on it, my body has built up a tolerance of sorts and taking two pills caused the pain to subside but my doctor felt I was abusing. He was not the original doctor but a new one.
I understand the opioid issues but being in my 70’s, hurting is not fun and living on an acreage I stay very active in taking care of it. Mowing, weedeating, tree trimming etc plus I have 14 years of martial arts in my past which I started at 35 and was told to quit at 50 due to the arthritis pain.
Had my left hip replaced in 2020 due to deterioration of my ball & joint, then my right shoulder in 2021 for same reason, arthritis deterioration.
Now having knee issues requiring surgery soon but no one will administer anything that works other than 4-5 days worth.