AncientTowers
04-13-2004, 04:30 PM
Ok, I'm writing on my moms behalf this time. Mom has fybromyalgia/cronic pain/DDD. This is her deal...For years she has been on 190mg of methadone HCL a day. Well, her Dr. had to cut her, and others, as a patient...we can only guess that he's been getting heat, so to speak. So she saw a new Dr. at a pain clinic. He had no objections to keeping her on her Methadone/morphine 30mg BT 1 a day. But he said he didn't want to write a Rx for so many Meth. He want to make it 140-150mg's a day. And that 40mg diff, really makes the cake when it comes to efficacy. But my question is this. What would scare a dr. to be uncomf. to write a certian amount of drugs. From what I've read in the past, Opiates aren't toxic and we motabalize them normally. That there is no ceiling w/ opiates(iods). That humans can tolerate how ever many mg's they need to do the job, if their tollerable to them, which she is. Please, someone shed somelite on this for me...she has an appt, Monday...want to be able to tell her what I've dug up. xoxo thanks,
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Shoreline
04-17-2004, 11:50 AM
Hi AT, It seems the docs that are having the most problems are having it due to the quantity of pills they prescribe.
For instance, a doc that prescribes 3 30mg Roxicodone a day would not draw as much attention as the doc that prescribes the generic 5mg tabs but you have to take 18 a day to get the same amount of medication. So a monthly script for 90 30mg Roxicodone draws less attn than a script for 540 5mg oxycodone tablets. Good god, 500 pills a month.LOL Most people can't get passed the number of pills regardless of the potency of each.
It's not funny, But 90 pills doesn't draw the attn that 540 would even though the daily dose is exactly the same. Perhaps if your mom used name brand Dolophine in the 40mg diskettes the doc would be more comfy prescribing 150 40mg diskettes a month rather than 570 10mg methadone tablets because it draws less attn. Maybe 500 pills is somehow the magic number that docs are leary of exceeeding?
Her other option may be to investigate the implantable medtronics pump. Treating fibro with opiates is contreversial and honestly your mom has been lucky to find such agressive treatment for an invisable illness.
It's a problem that anybody with an invisable illness that you can't put your finger on goes through.If her doc was being investigated, how do you prove the patient truly needs these meds other than patient reporting and hopefully family reporting to back what the patient says is true. But there isn't a test they can give her to distinguish between a true patient that suffers and somebody completely faking. Press on 11 points and yelp and your DX is Fibro. It's hardly a test that can't be faked? I know the 11 points and could easily yelp when they are palptated, If it's that easy to fake, It's easy to understand docs being more conservative and 190 mgs of meth per day is not conservative treatment.
I'm not sugesting your mom or any fibro patient is faking but docs want to be able to protect themselves. This new doc, by decreasing your moms dose is saying, see I have control of my patients and I determine the dose, not the patient. Based on the docs clinical expertise.
You also have to look at the visit when the decrease happened. If you mom said her present dose was perfect and relieved 95% of her pain, that could cause a doc to decrease her dose. No PM doc shoots for 95% pain reduction. It's rarely possible and if your mom claimed to be getting that much relief that may worry a doc who may think now she has to maintan this patients level of relief which may be quite difficult to do. reducing 40-60% of the pain is a realistic goal, But 95% isn't. Were you at that apt to know if something like that went down?
My first PM doc would prescribe LA opiates for failed back patients but not for Fibro. Treating fibro with opiates is contreversial so perhaps her doc isn't willing to go quite as far out on the limb with a fibro patient. I'm sorry your post got over loocked and I hope no fibro patient is offended, I'm sure they are well aware of the problems of finding treatment for an invisable DX that has no way to confirm or denie validity.
Headache patients go throug the same BS. IF it can't be seen or proven it does make finding agressive treatment harder. It's not because of any of my opinions, It's just the way it is. Sorry, I would need more info to do anything more than speculate.
Good luck, Dave
For instance, a doc that prescribes 3 30mg Roxicodone a day would not draw as much attention as the doc that prescribes the generic 5mg tabs but you have to take 18 a day to get the same amount of medication. So a monthly script for 90 30mg Roxicodone draws less attn than a script for 540 5mg oxycodone tablets. Good god, 500 pills a month.LOL Most people can't get passed the number of pills regardless of the potency of each.
It's not funny, But 90 pills doesn't draw the attn that 540 would even though the daily dose is exactly the same. Perhaps if your mom used name brand Dolophine in the 40mg diskettes the doc would be more comfy prescribing 150 40mg diskettes a month rather than 570 10mg methadone tablets because it draws less attn. Maybe 500 pills is somehow the magic number that docs are leary of exceeeding?
Her other option may be to investigate the implantable medtronics pump. Treating fibro with opiates is contreversial and honestly your mom has been lucky to find such agressive treatment for an invisable illness.
It's a problem that anybody with an invisable illness that you can't put your finger on goes through.If her doc was being investigated, how do you prove the patient truly needs these meds other than patient reporting and hopefully family reporting to back what the patient says is true. But there isn't a test they can give her to distinguish between a true patient that suffers and somebody completely faking. Press on 11 points and yelp and your DX is Fibro. It's hardly a test that can't be faked? I know the 11 points and could easily yelp when they are palptated, If it's that easy to fake, It's easy to understand docs being more conservative and 190 mgs of meth per day is not conservative treatment.
I'm not sugesting your mom or any fibro patient is faking but docs want to be able to protect themselves. This new doc, by decreasing your moms dose is saying, see I have control of my patients and I determine the dose, not the patient. Based on the docs clinical expertise.
You also have to look at the visit when the decrease happened. If you mom said her present dose was perfect and relieved 95% of her pain, that could cause a doc to decrease her dose. No PM doc shoots for 95% pain reduction. It's rarely possible and if your mom claimed to be getting that much relief that may worry a doc who may think now she has to maintan this patients level of relief which may be quite difficult to do. reducing 40-60% of the pain is a realistic goal, But 95% isn't. Were you at that apt to know if something like that went down?
My first PM doc would prescribe LA opiates for failed back patients but not for Fibro. Treating fibro with opiates is contreversial so perhaps her doc isn't willing to go quite as far out on the limb with a fibro patient. I'm sorry your post got over loocked and I hope no fibro patient is offended, I'm sure they are well aware of the problems of finding treatment for an invisable DX that has no way to confirm or denie validity.
Headache patients go throug the same BS. IF it can't be seen or proven it does make finding agressive treatment harder. It's not because of any of my opinions, It's just the way it is. Sorry, I would need more info to do anything more than speculate.
Good luck, Dave