I could really use the help of anyone who might know about pain meds.
Currently I'm wearing a patch called DURAGESIC which has fentanyl and I wear 2 patches at 100mg each, for a total of 200mg and apply new ones every 2 days. Also take 30mg ms contin 2x aday. I weight 150 lbs. I know the patch is for a 3 day, but my Dr. has told me to wear it for only 2 days.
Aside from asking the Dr. giving me the meds, how can I find out how much of a drug is too much to be taking??? Is there a guide line for doctors to follow when giving out the dose to take? I know some people will say that the dr will set a certain dose and change it until it works for you but this cant be totally true because thats like making it ok to overdose people...so I would think there should be a set amount of meds based on the body weight and etc, no?
The first thing that jumps out at me is that you are taking two long acting meds. Both the DURAGESIC patch and MS Contin are sustained released meds.
Usually, Cp'ers are given one long acting med and one short acting med for breakthrough pain.
For example, I had been taking 100 mcg DURAGESIC with 30 mg Roxicodone for bt. Now, I still use the Roxicodone for bt but have replaced the patch with 60 mg Kadian, a sustained release morphine, twice a day.
Last edited by HBMod07; 06-26-2006 at 10:26 AM.
Reason: Diagnosis is irrelevant to medication. Do not compare your diagnosis and medication schedule to someone else.
First, I'd agree with wolfmarket on this one. It is strange that your doc has you on two LA meds. The dosages are not a concern, but the two LA meds seem strange.
It is true that using different opiate meds, effect different receptors, thus creating better pain relief. But that is generally done by using an LA med like Duragesic and then a BT med that is short acting.
As far as mg/mcg's, this is really of no concern as everyone is different and responds differently. For some your dosage would put someone in a coma, and for others it may not effect them that much. For you it works, so forget about the mgs/mcgs and focus on pain relief. If 200 mcg's of Fentanyl works for you, then there is your dose.
But you are right, many docs will look at dosage or mg's and determine that you take too much based on that. That is a bad way of doing PM because everyone responds differently. If more focus is applied to pain relief, then Mg's really have no bearing for meds that have no ceiling. Now, if you are taking Tylenol or a product that contain Tylenol, then Mg's come into play. But as far as Morphine or Fentanyl, whatever works for YOU is the right dose.
I would assume you have been taking meds for a while to get to that dose? Fentanyl is the strongest prescribed med available, so I would think you have been taking it for some time and have developled a tolerance to these meds which is completely normal.
If you don't mind sharing, could youo tell us about your Diagnosis?
Hi Jon, Too much for the patient unless your dying is when it hinders you ability to function rather than helping. There is no such thing as too much in the sense that nobody that weighs 150 should take more than X, Y or Z of any drug. As long is the dose is approached safely and the side effects aren't too bothersome, it may take 5 times what your taking in 5 years and be perfectly safe. If you if you were adjusted upwards in a safe manor, 25-50% can be done every week until you reach a point the individual is having side effects that canít be managed or can't be tolerated or your too doped to function. If your dose was slowly increased if you had a progressive problem that couldnít be stopped or corrected, you could end up with 10 patches on and taking several grams of morphine a day, not mgs but grams. If a doc doubles or triples your dose and your already having respiratory problems like low BP, shallow breathing, repeat lung infection or reduced heart rate then increasing becomes dangerous. Huge jumps are dangerous, switching from one med to another that you haven't been exposed to at high doses can be dangerous so they usually start low. But your dose doesn't shock me , It's just a number.
How it effects you should be more concerning than a number of mgs or mcgs. You could increase to the point where you nodding out and can't walk or drive but it doesn't mean your going to overdose. Tolerated dosages are different for everyone and your weight really has little to do with it at the level of tolerance your already at.
From a docs point of view, he has to be able to justify the need to prescribe based on diagnostics, physical exam, psychological exam and failed previous attempts to provide increased function and pain relief.
For Alan, There really isnít a guideline for you doc to follow as far as diagnosis equating to dosage. He may have his personal opinion on a patient that has not had back surgery Vs a patient that has had multiple surgeries. Thatís really not a gage of how much pain someone is in or how much medication they require to reach optimal function with acceptable side effects.
Every doc is going to have a different comfort level with each patient. It only seems natural for a doc to feel more comfortable with a well-diagnosed and documented case than one that is a mystery that another doc might think the meds are excessive and may be preventing a diagnosis or the proper treatment from being given. Simply masking a problem that needs to be addressed is not doing anyone a favor. There is never a good time to have a major injury or have surgery. People that want to put something off untill they are vested in a retirement plan or until kids are in school or out of school or the house is paid off , are taking a huge risk that those years where the pain can be tolerated with higher and higher doses of pain meds may find the opportunity to correct the problem are long gone by the time it's a good time to have surgery.
Everyoneís situation is different, everyone responds differently to meds and each person must live with the consequences of their choices. I've seen marriages end over the use of opiates, jobs lost, families writing members off because they don't agree with someoneís use. Those things don't usually happen due to the number of mgs someone takes but the way it effects the person taking it. Someone can justify themself right into sedation every night which may not be tolerable for a spouse. Sometimes it's complete ignorance and the mere fact that opiate use is equated so readily to addiction that creates those feelings in our friends and family regarding opiate use..
MY general rule is when the meds become more hindersome than helpful. I have a wife that wouldn't put up with me nodding out all the time and a child I don't want coming home to a passed out parent they canít waken. Therefore I must live with a lot more pain than I probably would if I were single and lived alone. What would be acceptable might be a little different. As far as safety, after the last 6 years with my doc and what I know, an overdose isn't going to happen unless it's done intentionally. If my doc told me to increase my dose 400% and sent me home that would cause a problem. Whether I was used to taking 100 mgs a day or 2000 mgs a day, it would be just as lethal. It's the percentage and how rapidly an increase is made that causes an overdose.
There is no defintive answer as to what is safe for you to take. Your opiate tolerant and that tolerance can safely grow if your dose is increased slowly. You will reach a point where you can't take more without causing side effects that you can no longer tolerate. It may be something like Urinary retention or it may be over sedation.
Good luck and I'm sorry your still having such a rough time Allen. It's a shame someone won't be more aggressive or offer a solution.
I first want to thank everyone for truly taking the time to help out with some great advice.
Alan, you do sound like you are being under treated but I'm no professional. Also sounds like your back issue is much more painful then mine.
As for what's wrong with me...I had a Disc herniation, with a crafted bone fusion which didnt work the first time, so the next one was done with some screws and bone from my hip. I can thankfully say the pain is gone from that part of back, but have pain from my lower back and was told it is due to an old operation I had and some disc degeneration (spelling, sorry).
The problem I think I may have, is with the effects of the drugs. Dave, you mentioned about breathing and etc. Also about falling asleep to all be used as a possible guide to see how the drugs are effecting your body.
Well, there was a point when I was on all the drugs mentioned before and I was falling asleep at the wheel, falling asleep in the middle of the day and not being able to keep my eyes open while waiting in the dr.'s office. I mentioned to a different dr. about taking 'adderall' which is used for ADD and ADHD. Once I was on this drug, it was a huge help to keeping me awake and able to function. But...
I'm concerned now, after reading everyone's post because I wonder if I may be masking a problem. Is it possible that the effects of the painkillers is really too much and because I'm taking the 'adderall' no one will be able to tell?
Can you also tell me if there are any tests that your doctor performs, every few months or so, to make sure the painkillers are not damaging...say your liver or kidneys???
Hey Jon, Sorry to hear about the multiple surgeries, that's something you can't undue and your just left wth the reults. Personally I wouldn't let anyone but a surgeon give me a surgical opinion or make the call as to whether they think surgery could relieve your lumbar pain. I would get several opinions from both Neuro and Ortho surgeons.
As far as the opiates harming internal organs they really aren't known to do this, not the ones you take. I'm not sure what the amphetamines are doing, Adderall is extremely potent stuff but the veiw or stigma atached to amphetmaines has been greatly reduced by their use on children to treat ADHD. Unfortunately it hasn't been a standard of care long enough to see what the long term effect is going to be on the kids that are medicated.
These drugs alter our brain chemstry and endocrine system which would more likely manifest symptoms in mood, personality and hormonal problems more than they are effecting any oher body system once your at a stable dose and accomadate and the rsisk of OD is gone.
Are you still working? It's a very thin line, I guess if taking enough stimulant to take a high enough dose to kill my pain was offered, I would want to now if they would make a difference for me. I had a heart attack 3 years ago so I doubt any doc can prescribe them without the fear of killing me. they really just don't know exactly what the long term effects are other than studying methadone maint patients that have been on meth for decades and continued to abuse.
At least the pump has brought my BP down but I'm at a point where increasing opiates to mask the pain I'm in would just sedate me more. Using amphetamines isn't an option because I had a heart atack on my 36th birthday. Most likely from spending years where my BP numbers combined were over 300. Even with the pump and 30 mg Roxicodone I can still only tolerate being on my feet an hour and more meds would just mean more urinary retention, lowere levels of testosterone, ED and extreme constipation.
Drowsiness isn't the only side effect people will run into that can prevent increasing a dose. The exact effects are unknown other than knowing they do effect brain chemistry which effects personality/mental status. Sexual and urinary function, Endocrine/hormonal/metaolism and bowels are all system effected by opiates but there isn't a test for all of these other than what you are willing to tolerate.
It's really a balancing act but everyone needs lines they won't cross if it's just a matter of being a little more comfortable. Honestly I would love to have a tank of Nitrous by my bed, there are times I would love to just knock myself out or spend 24 hours pain free. However my wife wouldn' t go for it and I wouldn't want my daugter to see it. I know if I were single some things would be more exceptable.
As far as your doc doing tests to make sure your OK. Your GP or GYN should run standard blood work and do UA's during anual physicals that would detect kidney or liver damage. The markers for damage are tested for whether it's from alcohol, tylenol/ Ibuphrofen or a disease process. It's the brain chemistry and other effects that are harder to detect by a test. Hormonal levels can be tested but only you know how you feel, how happy you are, what your outlook is like, your psychological state, what your labido is like and what hormonal changes you feel. Unfortunately there is no quality of life test and if someone has crossed the line from dependent to addict, they are going to be even more willing to put up with the side effects a rational person wouldn't.
the dr should NOT take into account the mg/mcg in titrating the correct dosage.
i have been taking 2 100mcg and 1 50mcg patch every two days,along with 6 400mcg fentora for bt pain.
for the last 6 months i have been telling my dr that this dose isnt at its most effective, as i can sit nowadays,,but walking or standing for more than a few mins,,and my pain jumps toa 8,9 or10.
they tell me their afraid of me getting addicted,of overdosing, or that some people no matter what the amount of medication,,more of it wont change a thing,therfor they wont change my meds.
i tell them that instead of worrying about the amount,,how about titrating me slowly untill i either have some kind of bad effect,or the pain is under better controll.
nope,they say,,we cant go higher with your meds,,"you take more meds than anyone else in our clinic" i say what does that matter? if i leave here and go elswhere,,then the guy that takes the second highest dose will be "taking the highest dose of anyone in here".
so none of their logic makes sense.
i wish the law would get involved,,i believe that under treatment of my pain,or anyone elses is malpractice. the dosage rules are on both the pakaging of the fentora and the fentanyl,, and the def of "titration" is the same no matter where you look. but acording to both makers,and the fed gov,,this clinic didnt "titrate" me, they gave me meds and stopped with no medical reason to do so,,that i think would constitute malpractice,,and if a few dr.s caught heck, for it (lawsuit),,then i bet there would be allot less pain sufferers out there, needlesly having a crumby way of life. all i can do is sit or lay down on the couch.this has been going on for 10 years,its depressing. last month i told the dr "it would be nice if i could have the dishes washed to help my wife when she
comes home from work,instead of her having to do everything,thr trash,cut the lawn,snowblow,rake leaves,go to the dump,,,,everything. im sick of it,but when dr refuses to titrate medication as law says they
should, but their oath also tells them to ease pain and suffering,,,,
there must be a law they are in clear violation of,, we just need to find it.
then let them have it with both barrels.
Some people say that there is no max on the opiod/opiate medications as long as one can tolerate the side effects. However, the docs and insurance companies will put limits on them. I think that you would be a good candidate for the pain pump. It uses much less medication than taking meds orally or using the fentanyl patch. And don't worry about using them every 2 days because I do as well and many other people since they don't seem to last the full 3 days for most of us.
You should ask your doc about the pain pump or look up Medtronic pain pump online and see what docs in your area provide them. good luck and keep us posted.
i've just read your message and your sssssssooooooooooo right, i also have been suffering from chronic pain for the past 10 years and have also been told that they won't increase my (surposed to be) pain releif medication. its an outrage, if these pm dr's suffered only a bit of the pain that us chronic pain sufferers have, then they'd soon up our doses and help to releive our pain and help us to become the people that we once where!!!! I hope you get some effective pain releif soon x