Otter66
08-05-2007, 07:20 PM
Hi Everbody,
Although I have seen pain-med conversion charts, I have to admit that I am a bit confused how to use them. I am going into my Pain doc next week, to talk about changing the dosage on my break-thru medication. My LT medication is Kadian, which I take 200 mg/3x day. For breakthru med, I take 2 10mg percocets, 2x/day. I have been on this same dosage (both meds) for about 3 1/2 years, and the percocets don't seem to help me much when I take them when I am am really hurting. What I wanted to know was, what percentage is my breakthru meds vs my long-term? i.e. Are the 2 percocets 5% of my Kadian? 10%? Any help would be greatly appreciate. Here's wishing all of the board readers a pain-free week:)
Although I have seen pain-med conversion charts, I have to admit that I am a bit confused how to use them. I am going into my Pain doc next week, to talk about changing the dosage on my break-thru medication. My LT medication is Kadian, which I take 200 mg/3x day. For breakthru med, I take 2 10mg percocets, 2x/day. I have been on this same dosage (both meds) for about 3 1/2 years, and the percocets don't seem to help me much when I take them when I am am really hurting. What I wanted to know was, what percentage is my breakthru meds vs my long-term? i.e. Are the 2 percocets 5% of my Kadian? 10%? Any help would be greatly appreciate. Here's wishing all of the board readers a pain-free week:)
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mudbone
08-05-2007, 08:13 PM
I dont know the percentages, but if your hurting then I would get the base med raised, or if you just want the BT med raised I would go with Roxicodone in either 15mg or 30mg. If you have to take BT meds everyday they become useless as your tolerence increases so they should be reserved for "have to" situations. Thats why I would suggest looking into your basemed dose. There are plenty people here though that do kno what percentage you are looking for though. Good luck!
Otter66
08-05-2007, 09:14 PM
I dont know the percentages, but if your hurting then I would get the base med raised, or if you just want the BT med raised I would go with Roxicodone in either 15mg or 30mg. If you have to take BT meds everyday they become useless as your tolerence increases so they should be reserved for "have to" situations. Thats why I would suggest looking into your basemed dose. There are plenty people here though that do kno what percentage you are looking for though. Good luck!
Thank you for your response. That is exactly what I have ended up doing. I have to take both the LT and the break-thru meds everbody, and then when the pain gets really bad, I have nothing more I can take. I am going to sw the Doc this week, and (hopefully) something can be done. I'm tired of feeling like I'm being stabbed in the back over and over, and can't make the pain stop with my meds!! :mad: :mad: You know, I've had one of the Doc's assistance tell me that there is no such thing as tolerance, and that with LTerm meds, you should've have to raise the amount you are taking. Anybody who has a comment about that, I would love to know what you've been told
Thank you for your response. That is exactly what I have ended up doing. I have to take both the LT and the break-thru meds everbody, and then when the pain gets really bad, I have nothing more I can take. I am going to sw the Doc this week, and (hopefully) something can be done. I'm tired of feeling like I'm being stabbed in the back over and over, and can't make the pain stop with my meds!! :mad: :mad: You know, I've had one of the Doc's assistance tell me that there is no such thing as tolerance, and that with LTerm meds, you should've have to raise the amount you are taking. Anybody who has a comment about that, I would love to know what you've been told
mudbone
08-05-2007, 10:39 PM
I also had a dr tell me tolerence was in my head. I left his practice for a pain managment clinic. And by what I understand, if you need to use all your BT med everyday then your LA med is not high enough dose. Hence raise the LA med so you dont need the BT all the time and for when you do, its ok to use, just not everyday, or you will build tolerence. Ask him to raise your base med and see if you still need the BT med as much. I bet you dont..;) Hope it works out for ya, Good luck!
Donorpanc
08-06-2007, 11:15 PM
I'd like to see this conversion chart myself. My doc. has switched me around so many times, and I can't figure out how he comes up with this stuff?
Shoreline
08-08-2007, 04:44 PM
Hey Otter, I haven't seen a chart for BT meds but have read enough text to remeber the formula that's considered the standard of care. It's a simple and reasonable method for calcualting what should be a large enough increase in serum level proportianate to your base med to make a difference. If your PM doc is an anesthesiologist, he has done this daily to calcualte bolus doses when patients are already on round the clock meds. having your GP manage your pain may be conveinant to some, but they loose that expertise and clincal practice a specialist has.
Anyway, the formula for BT dosing is take the daily dose, devide it by 2 and use 25-30% of that for BT. This should increase serum levels enough to treat BT pain. It's not designed to take all pain away or even drop you below what the base dose manages, just bring things back to normal. If short acting meds are used every day, 4-6 times a day, they aren't BT meds. They have become a supplement to the LA med and part of your daily regemin.
The manaufacturers reccomend re evaluating the long acting dose if a patient requires more BT meds than twice a day on a regular basis. That's whay 60 pills a month or two doses a day is also the standard of care in PM. That's a little different interpretation than increasing if a patient takes all their BT meds. The short acting med will loose it's effectiveness long before the base med when over used and If it's a large enough percentage of your daily use skipping days or doses induces withdrawal. That's something most docs want to avoid.
Printing out charts,and showing them to your doc to proove he's wrong isn't the way to comunicate with your doc that the BT med doesn't help when you need it.
Good luck, Dave
Anyway, the formula for BT dosing is take the daily dose, devide it by 2 and use 25-30% of that for BT. This should increase serum levels enough to treat BT pain. It's not designed to take all pain away or even drop you below what the base dose manages, just bring things back to normal. If short acting meds are used every day, 4-6 times a day, they aren't BT meds. They have become a supplement to the LA med and part of your daily regemin.
The manaufacturers reccomend re evaluating the long acting dose if a patient requires more BT meds than twice a day on a regular basis. That's whay 60 pills a month or two doses a day is also the standard of care in PM. That's a little different interpretation than increasing if a patient takes all their BT meds. The short acting med will loose it's effectiveness long before the base med when over used and If it's a large enough percentage of your daily use skipping days or doses induces withdrawal. That's something most docs want to avoid.
Printing out charts,and showing them to your doc to proove he's wrong isn't the way to comunicate with your doc that the BT med doesn't help when you need it.
Good luck, Dave