Re: Increase Neurontin First Before Increasing Pain Meds?
I think that I would be inclined to say that your neurologist chose the dosage of neurontin and Cymbalta carefully to control your toe pain and that you don't want to change anything as it would make sense that your neurologist wouldn't like you changing the doses that he prescribed. Neurologist beats NP every time. I don't think he'd be happy at all. You could even get his office to fax a copy of the dosage of neurontin and Cymbalta that he would like you to stick to - why change something that's working?
I think that NPs do this because they can do it without consulting the dr - in other words, it's easier. I'd ring your neuro and explain your fears - that you might lose the toe pain relief that you've finally found because she's changing your meds. Once the neuro has made it clear that your neurontin dose should remain stable, you can bring up better pain relief through increasing your pain meds - I'd probably actually say 'I think that I need that increase in pain meds that you suggested for after I had my injection' and put it back on her.
If you don't want to go to your neuro, I think that the NP would take you seriously if you just told her that your neuro wouldn't like you changing around your neurontin doses now that you've finally found the right dose to work well - without increased side effects. If you've found the dose that works, why raise it? I feel your pain. My old gp (years ago) was terrified of pain meds and used to throw masses (like 400mgs +++) of tramadol and 3600mg neurontin at me each time she saw me. It was insane because I couldn't tolerate tramadol which I'd told her time and again, it wasn't until I had to go to hospital for massive pain (and seretonin syndrome from the tramadol!) that the hospital changed me to Oxycontin and she was finally comfortable to keep writing it (because the hospital had made the first move). i also had major thoracic surgery too.
i hope it all works out, I'll be thinking of you, so please let me know what you decide to do. I'd be inclined to ring your NP today or Monday and say that you 'remember' that your neuro put you on those doses specifically and as they worked, wanted you to stick with them. Just see what she does. Good luck!