Shoreline

Hi Linda, I can't think of any pharmacological reason to discontinue BT meds but from a pain managemnent standpoint. There isn't a negative drug interaction, one drug doesn't cancel out the other. It's more likely he wants to manage your pain with the right dose of your base med. With 3 times a day dosing of methadone and 4 times a day dosing of BT meds, it becomes one of those situatons where "when aren't you taking something for pain".

With long acting meds, which meth isn't exactly, the idea is to free you from clock watching and the constant focus on pain and relying on that next dose to get through the day. If your taking a pill every 3 hours for pain, that wouldn't be doing much better than simply managning it with SA meds round the clock.

IMO It has more to due with psych issues and learned dependence on frequent dosing and feeling that need to dose whether you may need it or not. If you are fairly new tometh and discontinuing the Percs came at the smae time as an ncrease in meth, then most lkikely he is simply trying to manage your pain and allow you to live a life where you aren't waiting to take your next dose. IF meth is going to b e your only pain med and it's not doing the job, eflected by the ned for frequent BT dosing, then I would simply work at getting the meth dose correct and managing the bulk of you r pain. Needing T meds 4 tims a day would mean your base dose is too low by most long acting med manufacturers, most suggest if you need BT meds more than twice a day you need an adjustment in base dose. I took meth for years and although it has a long half life, I could never get by with TID dosing . 6-8 jours was just too long betwen does for me. It took tim to titrate to safe level and safe interval. would bet a 4th dose would eliminate alot of the need for BT meds. You might want to aporach it in more of a carefree attitude where you don't cae if it's pececet or meth as long as the med is doing it's job. Nerve pain is much toughe to manage, with oopiates alone./ You could double your meth dose and still feel most of that nevre pain. If he increased your meds to a dose high enogh to manage that erve pain you would likely be severly over mdicatd and te meds would be more mpairing than your ondition or the pain.

I would continue to titrate your dos if he replacd 4 percs with an extra 10 mgs of meth, Tha's not eacatly an equitable trade particluarly when your struggling between TID doses.If he's more willing tomake adjustment to ythe meth , more fequent dosing will likely deminsh or eliminate the ned for BT meds. Ya have to show th e doc yourtrying o work his pogram, if he doubled your dose and you still requeted the dame BT meds, It wuld likel cause more concern than ncreasing your dose of meth and then reinstating the meds for a specific purpose. Like incedental or activity related pain. Once the meth dose is woking as best it can on yourback and nerve poain, if you still have significant pain when you wake up and need soethign faster acting to get moving, or have significant pan after activity that can't be avoided, like car trips, grocery shopping, etc. He may be willing to reinstitute the BT meds with less frequency. Bottom line is "manage your pain," it shouldn't matter with what, as long as it works and isn't causing intolerable side effects or more impairment than the DX he's treating.

I've talked to my doc about this same thing at the beginning of my tretment, he basically said that so many people, by the time they arive at his clinic have been so mismanaged and are so used to taking something every 4 hours it's a hard habbit to break even when he's prescribing 3-4 times the dose of short acting meds and replacing it with long acting meds. There really is no explanation as to why a patient would still need BT meds ever 4 hours after a 2-3 fold increase in overall meds regardless of what form.
Good luck, Dave