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What is a breakthrough med?


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Old 06-26-2017, 08:05 PM   #1
teddybearhero
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What is a breakthrough med?

Stupid question I know. I thought a BT med was to be taken when the regular med didn't stop all the pain that day. Then why am I prescribed enough to take two pills a day for the month? Are you suppose to take them regularly if needed? Wouldn't that be the same thing as increasing your dose and if it showed up in your urine test you would be violating your contract?

Just don't understand this pain clinic. Wish my pcp could handle pain meds again.

 
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Old 06-27-2017, 05:00 PM   #2
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Re: What is a breakthrough med?

You should discuss with your doctor as far as how they expect you to take them.

By my definition: It is something to be taken when the pain spikes above the treated baseline, with the goal of bringing it back to the treated baseline. It isn't to be taken on a schedule. It may not be needed every day. Two doses per day is usually the max I read of which is still considered a true breakthrough med (more than that and you'd nearly have enough for around the clock). My doctor gives me one dose per day. I have some days I take none, some days I take 1 dose, and some days I take 2 doses. My doctor would allow me to use up my entire month's supply, or not.

I am not expected to have my BT med on a UA (they ask when I last took it), although if every UA doesn't show the BT med, then the doctor may start to question it. I also wouldn't be in trouble if it did show up in my UA (as long as it wasn't in higher amounts than prescribed). I have heard of some doctors having a patient bring in any extra BT med and reduce their next prescription by that much. My doctor has never done that. Some months I have extra, some I may take extra I had left over. My doctor has discussed this with me and given me lenience as long as I don't exceed a certain number of pills every certain number of hours, and don't ask for an early refill.

Therefore in my opinion, if you felt you needed it, you could take both doses every day. However, I think if that was necessary it would also be a good idea to discuss your long acting med with your doctor, as often they would want to increase the long acting dose if the short acting is needed too often. Some folks need that much BT med but don't need that high of a dose all the time, so it can make sense to have multiple BT doses. Others like me can get multiple days in a row of high pain where I need a higher dose, but other times my baseline dose is ok. Most BT meds last 4 hours at best, so even 2 doses per day is only 8 hours, 1/3 of that covered by a long acting med.

It doesn't matter what I think though. Its important to understand what your doctor/clinic expects. For example: Could you take more than 2 per day if you had taken less than 2 per day on other days? Are you expected to use them all, have extra, or somewhere in between?

What were you previously given for breakthrough, if any? Interesting a pain clinic would increase it, especially in this anti opioid climate.

Pain management isn't expected to stop all pain by the way. You should discuss your goals and whether they are being met with your doctor. 50% pain reduction is a typical reasonable goal.

I think in the long run most patients are significantly better off with a good pain doc than with a primary doc. Pain docs have the expertise and experience with treating pain, keep up on the latest treatments, etc. I feel more comfortable with a pain doc as far as the fear of them getting busted by the DEA and me getting cut off. When I was seeing my primary doc for pain management, he ended up tapering my dose up too high too quickly. I got to a dose that several pain clinics wouldn't even take me as a patient. It hurt me in the long run as down the road I had to taper down to a sustainable dose. Best wishes.
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Old 07-07-2017, 11:32 AM   #3
Kylekat
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Re: What is a breakthrough med?

Your Dr. prescribes breakthru meds based on what you've told them about how well your pain is controlled and what type of flares you have and how often. Everyone has a different dose/schedule for breakthru meds. When your Long Acting med doesn't handle a particularly bad pain flare the breakthru med combined with your normal LA med might handle the increased pain.

No, you should not be taking your breakthru meds on a daily basis every day because then they just become part of your daily pain management program. Breakthru meds are PRN and your Dr. gives you enough so that you can cover any flares during the month. I'm allowed to take up to 6 of my breakthru meds on top of my LA pain med, but I don't have to do that everyday, there are many days when I don't use my breakthru meds at all. As for your UA they know that the meds they RX will be on it, and they know that BT meds won't be a constant, so that shouldn't be a worry.

 
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