Ryen asked
I've had fibromyalgia for 25 years and I'm only 59. I'm currently taking Norco 10/325 for mild pain and Oxycodone 10 for severe pain ( when the Norco doesn't work). Neither is relieving the pain any more. What's the next level of pain meds my doctor needs to prescribe? Also, the Tizanidine 4mg isn't working. Is there a higher does of that too?
Answer
Both oxycodone and hydrocodone are semisynthetic opioid drugs and are certainly considered to be some of the more potent options out there. Typically, when the current dose of an opioid drug is no longer effective, the dose is either increased or the medication is switched to something else.
The doses you are taking certainly have some room to be adjusted... but if there has already been adjustments with no effect, a change in drug may be warranted. There aren't necessarily any 'set in stone' guidelines as to what an appropriate drug change may be. There are many other opioid and non-opioid drug options that may be more beneficial to you and that would be at the discretion of your provider (and you of course).
You mentioned that you are treating fibromyalgia but oxycodone and hydrocodone are not the typical drugs used to treat that, at least initially. Very often, prescribers will try drugs that work on a neurotransmitter known as norepinephrine, which is thought to be involved in nerve type pain. Some examples of these drugs include:
- Nucynta - An opioid type drug that also works on norepinephrine.
- Lyrica
- Gabapentin
- Savella
It may be worth talking to your doctor about these options, especially Nucynta as it is involved in the opioid pathways as way as norepinephrine.
In regards to tizanidine, a muscle relaxant, it is often used to potentiate the effects of opioid drugs. The maximum daily dose of that drug is 36 mg per day so there is certainly so room to adjust that dose to something that may be more effective for you.
