Hi Marry, %0ugh would be right on the line as to whether or not to increase or not, Most likely they would start at 50 and increase from there. There's no poinjt in using 75 if the 50 works.

As far as BT meds, It not a matter of being fair, it's a mater of getting your base dose correct. The bggest problem I see of BT meds is the misuse. Brewakthrough means pain the patc can;'t handle. If a doc gives a patient 4 oills a day and say to use when you have BT pain, the average person is going to use 4 pills each and every day, If he 6 pills a day people would use 6 BT doses every day and so on.

What happens when you fall down the stairs and you need additional meds for true BT pain and your completely used to taking the max amount every day. Those same 4 or 6 pils will do nothing more than they did every other day you take the max amount. It's not unfair to expect you to learn other methods to deal with minor BT pain so you can reserve BT meds for true BT pain. If your taking short ating meds to do nothing more than suplement your long acting dose , these meds aren't truly BT. I you truly need to take aditional meds every 4 hours, why wouldn;'t increasing the dose or dose frequency be reasonable? Because it's not what you want? PM isn't about giving every patient the drug and dose they read about simply because it's available. The clinic I use limits BT meds to 2 doses a day and doewants to see a few extra at the end of the month. Trust me, having those extra and nott using the max amount every day, is what willkeep you out of the ER and keep you from asking for an increase everytime the weather changes, you slip or twist your back. He gave you 40 extra mgs of oxycodone, that's equiveklent to 60 mgs of extra Hydrocodone. So all he did was replace ne for the other. You weren't using BT meds as BT meds, so how do you know your going to miss them. If it's possible, take 40-20 -40 and save a 20 mg Oxy to use if you neee BT pain. But if you use every pill that's given every mionth, you won't have anything to deal with any additional pain. All he's doe is use the LA meds coretctly.

It's not unreasonable to use alternative methods to manage incidentalpain. Even with DDD and being tolerant to Oxy, Motrin and tylenol will still add something to the mix. These meds still work for headaches , toothaches,sprained ankles etc. If someone gets in the habbit of increasin their dose or taking kmore and more pain meds every time they have a bad day, In a year you willbe taking 160 mgs 3 times a day and still complaining of BT pain. If you set a base dose to manage your worst pain and then use BT meds to manage any increased pain, do you never have a good day where theweather is nice, and you feel a little beter and can get by with taking less.

I think it;'s an honest concern of your docs when your not benefiting from long acting meds because your still dosing short acting meds every 4 -6 hours. The idea of LA meds is to allowyou to escape living your ife in 4 hour increments, where you wait for a short acting med to work, squeeze evrything you can do while it's working and then wait for the next dose. Using BT meds every 4 hiours doesn't free you from clock watching, you still get the rush they try to avoid with LA meds and it drives your tlerance up even faster. On the right dose, if you can mange 50% of your pain 80 % of the time, your likely taking enough meds that you can find alternatibeve methods to deal with any other inccidental pain. Giving up those SA meds and the freedom to dose whenever you want, is a problem thPm docs are trying to over come. You ay not see it as a problem, but it's hard to justify taking the LA eds. Why not save money and just take 15 or 30 mgs of oxycodone every 4 hours and save a bucket of money.

It's not unreasonable to expect you to use some other method to manage pain in conjunction with ppiates, otherwise we train ourselves to simply reach for a bottle of opiates everytime we have any sort of increase. It teaches you to cope my increasing your dose of pain eds even when you may seem happy with the present dose or are restricted by side effects and can't increase that dose due to a side effect like Nausea, sweating, drowsiness or urinary retention. The more you take now, the faster you will reach the ppoint where your body and mind simply can't tolerate the additional side effects from moran increase. What do you do when you can't tolerate more side effects, what will you do if you blow the discs and a fragment is compressing ya nerve root or your cord. What can they give you in addition to the meds you already can bearlty tolerate.

Using BT meds in that fasion will get you to that point twice as fast as if you use LA meds alone along with other modailities to manage pain. If someone can truly use BT meds for true BT pain it they won't be part of their daily routine, you can skip days of BT med use and not eperience withdrawal and use the max dose when you truly need it.

There ar dozens on non opiate PM methods and modalities and if you haven't been tought anything other than opiates, the docs are doing you a greater diservice than replacing your BT meds with an increased dose of LA med. The goal isn't to get as comfortable as medicinally possible. It's comfortable enough to function and work on your self to increase strength,endurance,flexability and function.

Doping somone up so they have no motivation to do anything more than wait for their next dose and veg out isn't Paii management, It's pain obliteration. Whether using Ice, heat, TENS,TINS, medrol dose packs, Advil, acupuncture or biofeedback/self hypnosis or guided imagry., Unles your terminal, you have to learn to live with what meds can't do and meds can't elliminate all pain in all circumstances, certainly not chronic pain. It's setting somone up so that the meds do more harm than good. It doesn't free you from clock watching and drives your tolerance through the roof.

My Pm group uses 60 doses of BT meds per month for those that use them responsably. So it doesn't sound unreasonable and likely nobody ever explained the proper use of BT meds.

Good luck and try to give the increase a fair shot, if you can get buy with one pill instead of 2, just a couple doses per week, you will have additional meds to take beyond what you take every other day of the year and they will be more effective.

Good luck, Dave