I have heard this fact and was wondering if I should tell my doctor about it just in case he doesn't know. I am on the fentanyl patch 50mcg and 4 Lortab 5/500 per day along with 2 50mg Ultram per day. So I guess that would be apprx.

4 x 5/500 Lortab = apprx 10-15% of the 50mcg patch

2 x 50mg Ultram = apprx 3% of the 50mcg patch

Total would be 13-18% of the 50mcg patch for BT meds

If I am calculating things right but I would welcome anyone else's calculation. I was figuring a 50mcg patch would be equal to 20-25 5/500 Lortab. Anyone else on BT meds found this fact to be true for the 10%-30% rule and what is yours?

Brian

Brian:

I don't mean to come across as harsh, and I LOVE the fact that you are a researcher, I am too. You always offer AWESOME advice to others that is well thought out, and very helpful. But IMHO, you are OVER researching at this point. Why do I say this?? It seems that you are always searching for some new med that will help in your pain management. You made a statement in another post along the lines that you tend to over diagnose yourself anyway.

We have to trust our docs to do their jobs. If we can no longer do that, then IMHO, it's time to find another. I think the key in GOOD PM care and treatment is two-way communication. I know you have been in pain over the last few months, pain that it escalating. You have to communicate your pain needs to your PM doc in a way that he can understand how it is limiting you, and then together, come up with a plan to reduce that pain.

Personally, I have no clue about conversion tables/charts, or what percentage of BT meds I'm on. (I do know I can run here though, if I ever need help :D) I can tell you, that if my meds weren't doing the trick, I'd communicate that to my PM, and I feel he'd work with me to reduce it in whatever way he felt appropriate. I just have to trust that he knows what he's doing. When I feel that he no longer has a clue, (LOL), I guess that would be the time to stop.

I was figuring a 50mcg patch would be equal to 20-25 5/500 Lortab.

If my PM ever gave me that many Lortab, I'd fire him, and run for the hills. :D

In my experience, my PM usually stays with meds that are alike for BT. For example, when he changed me to avinza, he changed my BT meds to MSIR.

When I was on the Fentynal patch, I took percocet for BT meds. (I know those are not "like" medications).

I guess my point here is, I leave my diagnosing and Prescribing to my PM. Now if you are with a GP or some other doc who IS NOT a PM, then I can see sharing info with him. But if someone is going to be in this game of CP for life, why not see a specialist. I understand when there are not any docs in the area, etc.

I'm not trying to put you down or anything like that Brian. Like I said, you offer GREAT advice to others BECAUSE IMHO of all of the research (as well as life experiences) you do! But, having said that, please remember what you said in another post, that your (addict) brain can play tricks on you thinking and telling you that you require more and more meds. You are only 33. You have a VERY long life ahead of you. I really respect you, and hope that I have not offended you in any way, that SO was not my intention.

Blessings and Peace!

A couple of thoughts:

(1) If you want to, you may ask your Doc something like this: "I read in an article that your BT meds should equal......." Is this accurate...Just curious. You may want to even bring a copy of where you found it.

(2) Although there may be guidelines for things like this, every patient is different and due to tolerance levels and etc., what works for one patient, may not for another.

(3) If you're on the fent patch, lortabs are baby aspirin in comparison. I think I may have mentioned this in another post you had somewhere....Can't remember. The whole purpose of BT meds is to pack a PUNCH when the LA meds don't control your pain. Lortabs have no punch to fent....not even close. You need something MUCH stronger....Probably either percs, liquid oxy, or Actiq. All would do the job. Plus, you don't need all that Tylenol that's in Lortabs.

Hope this helps.

Ex

Thank you everyone for the advice and suggestions. I definitely do tend to overanalyze, do too much research, and try to play doctor. I guess from the VERY BAD EXPERIENCES that I have had in the past, I feel that I owe it to myself to become as educated as possible. I caught my doc off guard when it came to a medication interaction and I was like "no, I think your wrong about that" so he checked his PDR or whatever and came in and said "you were right". That made me feel good. As you may well know I am bi-polar and I tend to ruminate, which means constantly analyzing things over and over and over to the point of making myself get anxious and overwhelmed. I even realized this last night and told myself "dang you already know nearly every med available for pain managment, what they do, the generic names, the doses, what interacts with what, the side effects. I figure I should put this to good use, besides helping everyone out on here. I want to go into the health field but I don't know what to specialize in or how to go about it. Plus, I let my low self-esteem, recovery issues, and limitations from chronic pain prevent me from doing anything. I do need to focus on:

What is my current pain level?
What is my average pain level?
What medication seems to be helping the best?
Am I getting enough BT med protection?
When am I going to be satisfied at my level of pain reduction?

I know that my pain level will never be 0 although there have been minor occasions when it has been close, although my average is around a 4 or so. I guess that I tend to overanalyze, catacrophize, get overwhelmed, have anxiety, depression, and self-esteem issues. I appreciate all of you getting me back on the right tract instead of constantly veering off the path.

Brian

Brian- Don't be defensive......More patients should be like you and learn as much as possible about their condition and their meds. I believe it would make for a much better experience all the way around. The key to doing research I think is being informed so you can ask the right questions with your Doc, but not come across as being a backseat driver. Your overall good knowledge only helps your condition.

I do think your problem is the weak BT meds, but you know your condition and your reaction to our meds best. Good luck.

Ex

I'm not trying to be defensive, I am just frustrated at myself because sometimes my "manic" behaviour takes over and you see what happens, the hyper ability of researching over and over (ruminating), worrying about all of the what ifs? that don't even really need to be thought of. UGGHHH sorry guys I am just stressed to the max and not getting good sleep. I did take that Ambien CR last night which thoroughly knocked me out (10-11 hours). I will ask my doc for the 6.5mg dose instead. That stuff kicks my butt.

Brian

You bring up a good point about sleep....Getting a good night sleep is critical for everyone, especially PM patients. I've always thought that if you get a good nights sleep, you can handle just about anything in life. However, if you don't sleep well, or much at all, then sometimes the smallest things can really throw you a curve ball.

PM patients already have a lower resistance threshold due to chronic pain meds...Meaning that your more susceptible to colds, flu, infections & etc. Add in the lack of sleep, and your resistance gets even lower.

Good luck.

Ex

Thanks for not getting too mad Executor, it definitely wasn't you and I guess that I was really pouring my emotions out into that post to try to explain to others just what exact "thoughts" are churning through my head. I definitely inherited it because my grandmother, mother are all the same way. I always tell people I get the "best" of both worlds with my mom's side (mental illness) and my dad's side (alcohol/drug problems). No wonder I'm so messed up but being crazy is not illegal as I always say (hee hee) kidding of course:D

Brian

"Being mad" NEVER even remotely crossed my mind....Just glad I can be of some help.

BTW, what do you think of my theory that your Hydro is too weak of a BT med? Just curious since you know the situation best.

Ex

That could definitely be true. You know the weird thing is that I am "afraid" of possibly asking for Percocet due to me being in recovery. How flippin crazy is that I am on one of the strongest narcotic available (the patch), Lortabs (narcotic) and even Ultram (weak narcotic). He even gave me the samples of Ambien (C-IV). I have been hurting worse today but it is due to the BIG storm on the way. It is predicted that we could get 4-10" of snow, sleet, freezing rain starting tomorrow morning & continuing through Saturday night.

Brian

I understand....I think just about everyone in PM is afraid or reluctant to ask for more meds or a higher dose. I know I am!

I think the way you go about it is to tell him/her that when you have your "flare ups", the hydro just isn't working....That you take it and it doesn't feel like you even took it and consequently, you're in a lot of pain and/or suffer. See how he/she responds and then if the Doc just sits there or looks at you in a way for more feedback, maybe you could say something like "is it possible that the patch is just a stronger med, thus, the pills just don't work"?

Keep in mind, that all Docs try patients at the lowest possible dose/med to see if it works....Then, they move from there in response to feedback. Very few Docs reach for the big guns right away, unless it is very serious (like cancer).

Conversely, I think if you go in and say that you need some Oxy for BT, that may send up a red flag for any patient.

Ex

Brian:

I hope my initial post didn't offend you either. I agree with Ex that it's a good thing to be as informed as you are, just was trying to make a point in not letting it get away from you, since you are already aware that you tend to over analyze some situations.

About the weather....I feel your pain (literally too)! There is a cold front coming through with a chance of some sleet and snow down here, and THAT just never happens. My migranes are out of control today, and my RODS from my fusion are killing me!! :mad::( Will Spring ever get here??

Feel better soon buddy!! Take care!! Stay warm!

Huggles,

How did you figure that? Could you do mine.I take 2x30mg msc and 3x15mscI have heard this fact and was wondering if I should tell my doctor about it just in case he doesn't know. I am on the fentanyl patch 50mcg and 4 Lortab 5/500 per day along with 2 50mg Ultram per day. So I guess that would be apprx.

4 x 5/500 Lortab = apprx 10-15% of the 50mcg patch

2 x 50mg Ultram = apprx 3% of the 50mcg patch

Total would be 13-18% of the 50mcg patch for BT meds

If I am calculating things right but I would welcome anyone else's calculation. I was figuring a 50mcg patch would be equal to 20-25 5/500 Lortab. Anyone else on BT meds found this fact to be true for the 10%-30% rule and what is yours?

Brian

Hey Brian,I know I have told you before but I wanna tell you once more how much I appreciate you doing the research and answering my questions.;)

How did you figure that? Could you do mine.I take 2x30mg msc and 3x15msc


I would think that would probably be around 25% with the BT meds, just guessing though.

Brian