Shoreline

Hi Kit Kat, It's completely normal for a doc to start low when switching to a new med, It took 6 months and 16 adjustments to get my pump to provide equal relief that oral meds did. It's a case of better safe than sorry and there is no absolute when it's a drug you haven't had the level of exposure too or a different route of delivery.

This chart was created specifically for Duragesic and it looks like your at the high end of the scale to meplus you have potent SA oxy.
http://www.globalrph.com/narcotic.htm

The thinking when switching meds is that CP patient have lived with intracatable pain so long, taking a few weeks or months to fnd the right dose is well worth it in the end. The charts and tables are just guides to safely get you in the ball park. Even folowing a chart doesn't gaurentee patient response. All you can do is give each dose a fair try and report any need for adjustment, make an apt, requests over the phone are seldomly done. The docs needs to evelauate your condition, like BP, drowsiness, basically see the whites of your eyes before increasing a long acting med that could potentially be lethal.

The BT meds are also part of the equation and if he plans on replacing some of the BT meds with long acting meds it makes perfect sense. Having to still take SA meds every 4 hours dosn't free you from clock watching and defeats the major advantnage of LA meds. But it looks to me like the dose should be fine aside from some fine tuning.

The other factor when switching meds is when you change the class of opiate you may loose certain characteristics or an opiates ability to bind to specifc receptors. There are more than 3 opiate receptors aside from the Mu , Kappa and Delta, each class has several sub classes of opiate receptors. Fentnyl is somewhat unique in it's Kappa activitry, and oxy has minimal Kappa binding ability. That loss can cause differential withdrawal. Oxy doesn't have every characteristic that fenetnyl has but fentanyl has most of the major characteristcs that oxy has. So you can experience minimal problems swtiching to durageisic, but experience some withdrawal when switching away from he lack of Kappa receptor acticivity. Experiencing this kind of withdrawal won't be cured by an increase in Oxy, it will simply increase your tolerance to oxy and not relace the lost Kappa activity, you have to ride out the loss of Kappa activity or go to a variable taper . Decreasing one med as you increaser the other. Most peoplle can gt through this without having to do that because people simply don't die from opiate withdrawal , [particluarly whn the dose is really in he right ball park. Adding a 12.5 pacth ntill you figure all this out may help a litle but I wouldne't want to spend the time and the nuber of visits and copays to do a weekly vairaiable tapoer. "decreasing the duragesic as you increase the oxy".

Fentanyl and meth are the two drugs that have unique opiate receptor activity and switching away can be somewhat unpleaseant, but taking more of a drug that doesn't replace the qualities fentanyl and methadone have and oxy doesn't won't help differencial withdrawal.

The dose looks like the right ballpark, you may have to make adjustments depending on your response, but at that dose, my guess would be any withdrawal symptoms are related to loss of particular qualities that Fentanyl has and oxy doesn't. Docs know transition from one drug to another is really their best guess and should expect to hear from your more often during a med change. Allowing the doc to determine if you need and increase to manage pain caused by too low of a dose or meds simply to eleviate some of the symptoms of withdrawal from loss of Kappa receptor activity is something only he can determine. Basically if your feeling sick or ligt headed, an increase in oxy may not to do the trick, the better choice may be clonodine or phenergan or some other drug.

You need the lines of comunication open and don't worry about the charts. If docs and people based their pain relief on what a chart says than no doc would ever deviate from a chart, If the one they use says that's the right dose, then that would be it. But we don't want to be treated that way. Charts don't acount for indivdual response, tolerable side effects and different qualities from one opiate to the next.

An increase is not an effective way to manage differencial withdrawal when the only real cure is a bit of time. 2 or 3 weeks of increased pain or feeling whoozy isn't a huge price to pay for an increase in pain relief when the process of switching meds is complete. Keep your eye on the long term goal rather than the imediate effects of switching from one med to another. I've switched to meds at one fifth of the final dose, but knowing my doc will contnue working with me is more important than taking a risk of ODing, unmanageable side effects or finding your alergic and dying from tryng to hit a hole in one on the firt shot. It rarely happens.

It's normal to be concerned, but You are being treated which is better than what many of us experienced when a request for vicodin got you labeled a drug addict. Hang in there. If you have problems, ride them out as long as you can if it's not an emergency, if it's more than you can manage after a few days make an apt to see the doc and have your dose adjusted or restart a small dose of duragesic and cut back the oxy.

If the dose is completely off, it will show in your vital signs and the need to go into great detail explaining how bad you feel, will be eliminated by measured BP of 160 /90 or a pulse rate of 128 or throwing up on the docs shoes.

Don't worry about the number of mgs, It takes what it takes. I would expect some mild withdrawal from the change in class of medication but knowing what's going on makes it much easier to except and endure. You may even find that you don't need as much BT med, or the OC dose needs to be reduced. It can go either way on a conversion.

Good luck, Dave