KathyMac a question for you - Pain Management Message Board

catnap · 01-07-2006, 03:55 PM

by KathyMac

Quote:

If you are already at the maximum amount of pain meds on a daily basis for chronic pain, then there is no where else to go when the pain increases after surgery.

I was just curious to know about what you said in your post about being at a maximum amount of pain meds. I would think that 180 mgs. is about midline as far as low and high doses go. I have never found a "maximum dose" of any kind of narcotic. I alway read that doses are adjusted individually as needed until pain relief is attained or to the point of sedation.

Have you found a chart for maximum doses of all the opiates/opiods? If you have I would like to know, because I have been searching for that particular thing and have not been able to find it. I would like to know if the docs go by anything that says they should be givine xx amount for back pain, xx amount for neck pain, headache, etc. At my visit to my new pcp the pa said something which made me think that is what they are doing. Plus the fact he said I am the "highest dosed" patient in their clinic.

A long time ago I asked if I should every have to go in for surgery what and how would they treat me for pain. My pcp in 1999 said they would treat me as usual. My daily pain med would be used and I would be given more to control the pain.

Thanks,
Carol

BrittleBones · 01-07-2006, 08:28 PM

Hi Carol - the reason for my statement about "highest dose" was in response to what my pain doc said as well. His statement exactly was, "We need to get your base meds down before surgery or there will be nowhere else to go when the post-op pain gets worse." I took it to mean that he thought that any higher dose would put me at risk for respiratory problems. I do remember that the last time I had a hip surgery the pain docs at the hospital were meeting every day to debate the advisability of going any higher with my PCA pump that had dilaudid in it. Because of that I feel I suffered needlessly most of the time I was in the hospital. Maybe it has something to do with my being a woman who is rather small in stature. They don't seem to think that I could possibly handle the amounts of dilaudid and methadone that it takes to get me out of pain. Because of what the surgeon said, I've gotten myself down to 120 methadone from 180 and about 8 mg. of dilaudid a day for breakthrough pain. I'm very happy about it because I realize that I can get good pain relief on less meds and wouldn't have known that if I hadn't tried to titrate down. And to answer your other question....I'm pretty sure that there are no charts that say: If you have a headache take ____ amount of percocet; if you have a back fusion take ____ of morphine, etc. It is to our benefit to be on the lowest amount of medicine that will get our pain numbers 50% lower than where they started. At least that's what I've been told. I hope that clears up my post a little.