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Old 02-13-2007, 12:04 PM   #1
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EndoFybroGyrl HB User
BT med question

Hello everyone! This is my first time posting but I have been reading posts through this healthboard for about two years now. I just wanted to say before I state my problem that I appreciate any input and all advice. So here is my problem:
My PM doctor has me on Kadian 60mg and Morphine Immediate Release/MSIR 15mg. I have stage 4 endometriosis, fibromyalgia, and recently underwent a rectal resection that was botched. Most of the time my pain is manageable but the break through pain is getting worse and worse. The only time I have the breakthrough pain is when I use the restroom due to the botched rectal resection. The last time I brought this up to my PM doctor he just upped my Kadian from 50mg to 60mg, he said it's not the BT med dose but the LA dose. It didn't help much but did take the harsh stabbing edge off my pain. I know I will never be pain free but I have heard that your BT meds are suppose to be half the strength of the LA meds.I have an appointment on Friday with my PM doctor and wanted to know if anyone had advice on how I should go about telling me doctor that the BT meds aren't doing the trick ? If you have any other advice on what I should do please feel free to speak your mind.
Thank you for your time!

Aryiana
Stage 4 endometriosis
surgery 1 (laproscopic)-1998
surgery 2 (laproscopic)-2000
surgery 3 (laproscopic)-2002
surgery 4 ( rectal resection)- 2006
Fibromyalgia

 
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Old 02-13-2007, 12:22 PM   #2
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Re: BT med question

Hi and welcome to the pain boards! Im sorry you are suffering. Most doctors feel that if you are needing to use your break through meds on a regular basis, they are no longer break through meds, they are just part of your regular regimin. The answer to that problem will always be to increase your LA meds, to reduce the need for breakthrough meds. he may want to only up your LA med a little, and then offer you a stronger BT med and see how that works. But the main idea is that you should have days when you dont need your BT meds at all, and certainly not on any kind of regular basis. Im sure others will come with better and more specific advice, but I hope I have answered a few of your questions, anyway! Again, nice to meet you and welcome to the PM board!
Your Friend, Fabby

 
Old 02-13-2007, 01:04 PM   #3
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Re: BT med question

Hi Aryiana...Welcome to the boards. What Fabby has said is true. The breakthrough meds are just that, for breakthrough pain. If you need to take them on a regular basis, then your base med is too low. The 10 mg. increase you got in your Kadian is obviously not enough. True, your BT meds may also need to be increased, but the base med is usually increased first. Do you take your Kadian in divided doses? If not, that may help you to not have to rely on your BT meds as much as you do now.

I'm on Methadone, 180 mg per day, and I don't have any BT meds at all. When I first started on it, my doctor started me low (this is normal for Methadone) even though I had been on high doses of opiates prior. After the Meth gained full blood serum strength (about five days) he titrated me up until I was able to get by with the Methadone only.

Check with your doctor and see if you can get an increase in your Kadian, so you won't need to rely on the BT meds so much.
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Last edited by RetiredDirector; 02-15-2007 at 09:42 AM.

 
Old 02-13-2007, 02:00 PM   #4
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EndoFybroGyrl HB User
Smile Re: BT med question

Thank you for the fast responce. I'm sorry I did not clarify how frequent I was taking the Kadian. I am taking Kadian 60mg twice a day and the MSIR 15 mg as needed. I don't take the BT meds every day, only when I use the restroom since it causes so much pain. So maybe once or twice every 2 days. The Kadian is find until I use the restroom, then it's another story. I feel like I am being ripped apart and my husband often has to ask if I am alright. I had this surgery May of 2006 to repair an area in my rectum that was closed off due to the endometriosis and now I regret it since the pain is now worse then it was before I had the surgery. I will let my PM doctor know what is going on this Friday when I see him. I had just heard before that if you take a LA med then the BT med should be half the dose of the LA med in order for it to work properly. Thanks for your responces and I look forward to hearing more!

 
Old 02-13-2007, 02:03 PM   #5
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Re: BT med question

Hi EFG, Fabby is absolutely right about the use of BT meds and it's not like you can predict a BM and take extra meds to be ready, If anything, the morhine is a catch 22 beause it prevents BM's by way of stopping the normal contractions of the bowels that move things along. The more you take, the more you will strain the more you will hurt. There have been pleny to times I thought I was going to croak like elvis on the crapper from an anurism from straining.

Your somewhat right about there being a forumla for BT meds, but the formula was created before the invention of Kadian and avinza, 12-24 hour meds. One of the the standards that your doc either believes in or doesn't, is to use 25-30% of the BID dose. Meaning if your taking oxycontin twice a day, you would use 25% of a single dose, If your taking MSContin 3 times a day, add the total dose , divide it in half and use 25% of that figure. If your taking a once a day med, you would divide that in half and use 25-30% of that.

If you were to turn the 60 mgs kadian into short acting meds, it would equate to 10 mgs every 4 hours, by taking 15 mgs of MSIR on top of what the kadian provides, you would be more than doubling the serum level that 60 mgs of kadian once a day creates.So he's already well above 50% and closer to 150% increase in blood serum level. You really can't argue with your doc about a fact or figgure or what someone else is doing. You have to find what's right for you.

You don't want to be on a dose so high it completely removes the urge to have a BM by prepairing for a BM by taking extra morphine daily to double your serum level, This isn't BT pain, It's moe like having a broken ankle and calling walking on it, BT pain.

It would seem making the BM easier would be the better aproach to easing the discomfort, Yakima fruit paste is a recipe Hospice facilities and caregivers use for high dose patients and it does work, It's just a matter of finding the right dose of paste or senna tea. BTW, your not a high dose patient, but your BT meds certainly increase your serum level by more than twice what your base dose creates.

Your calcualtion isn't a valid argumant. 60 mgs of Kadian doesn't sustain 60 mgs in your system, The entire pill only contains 60 mgs of morphine and that is spread over 18-24 hours. If you wanted to convert the Kadian into a short acting med, you would divide 60 mgs of morphine into 6 equal doses spread 4 hours apart. That would be the same as taking 10 mgs of MSIR every 4 hours. So the 15mg MSIR creates a 150% increase in serum level and may actually be making the pain worse by paralyzing the bowel even more.

Yakima paste works because the most active ingrediaent is the Senna tea that's used as a base for the paste.A box of 200 senna tee bags is about 1/10th the cost of any OTC med to soften or move things along. If you want the actual recipe to run by your doc just ask, but the tea works and actually warns about consuming more than 2 cups per day. You should really run the senna tea idea past your doc before starting any new plan.

It's just logical to look at controlling the degree of constipation caused by the meds you take for pain to resolve what your calling BT pain.Particlularly when the meds you take for pain paralyze the bowel. There probably isn't a med other than time that will ease that pain after you have had your bowel resected. The meds that do ease pain are going to cause further complications by inhibiting parstalsis "the normal contraction of the bowel that move things along".

Math and percentage wise, you are already beyond what you heard the norm is for BT med strength and that may be part of the problem. Morphine is one of the most constipating meds there is. Something delivered by patch like durageasic or if they ever get their oxy patch FDA aproved may be a better way to go as trandermal meds seem to cause less interference with normal parastalsis.

Good luck, Dave

Even using 120 mgs a day, that would be the same as taking 20 mgs of MSIR every 4 hours, adding 15 mgs of MSIR is still beyond a 50% increase in your serum level the 120 mgs of kadian creates.

Last edited by Shoreline; 02-13-2007 at 02:17 PM. Reason: Adjuted the dose to 120 mgs of kadian a day.

 
Old 02-13-2007, 02:21 PM   #6
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Re: BT med question

Hey Dave (Shoreline)...I just finished reading your post and you used the 60 mg of Kadian to figure the BT med. I had asked her about her dose, etc and she posted again and she's taking 60 mg BID and 15 mg MSIR, PRN. Based on that, she's pretty well covered, as far as her med dose goes, don't you think?

I think you are right though, in solving (or least making it easier) before it occurs. If she can make things easier for a BM, then she would be much better off, than increasing the meds.
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Old 02-14-2007, 04:30 PM   #7
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Re: BT med question

Quote:
Originally Posted by EndoFybroGyrl View Post
Hello everyone! This is my first time posting but I have been reading posts through this healthboard for about two years now. I just wanted to say before I state my problem that I appreciate any input and all advice. So here is my problem:
My PM doctor has me on Kadian 60mg and Morphine Immediate Release/MSIR 15mg. I have stage 4 endometriosis, fibromyalgia, and recently underwent a rectal resection that was botched. Most of the time my pain is manageable but the break through pain is getting worse and worse. The only time I have the breakthrough pain is when I use the restroom due to the botched rectal resection. The last time I brought this up to my PM doctor he just upped my Kadian from 50mg to 60mg, he said it's not the BT med dose but the LA dose. It didn't help much but did take the harsh stabbing edge off my pain. I know I will never be pain free but I have heard that your BT meds are suppose to be half the strength of the LA meds.I have an appointment on Friday with my PM doctor and wanted to know if anyone had advice on how I should go about telling me doctor that the BT meds aren't doing the trick ? If you have any other advice on what I should do please feel free to speak your mind.
Thank you for your time!

Aryiana
Stage 4 endometriosis
surgery 1 (laproscopic)-1998
surgery 2 (laproscopic)-2000
surgery 3 (laproscopic)-2002
surgery 4 ( rectal resection)- 2006
Fibromyalgia
HI. I MUST USE ALL CAPS. SORRY. JUST BE HONEST AND STRAIGHTFORWARD WITH YOUR DOC. YOU HAVE TO BE YOUR OWN ADVOCATE. I AM A NEW MEMBER. I DONT KNOW WHAT A BREAKTHROUGH MED IS. PLEASE TELL ME. THANKS! EILEEN123

 
Old 02-14-2007, 06:24 PM   #8
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Fabrashamx HB User
Re: BT med question

Hi Eileen, and welcome to the pain boards! A breakthrough med is medication given in addition to a stronger (usually) long acting pain med, for instance people might be on the fentynl pain patch, and also have a breakthrough prescription for percocets to be used when the pain flairs or 'bleeds through' the long acting medicine. Sometimes people are given the exact same medicine, but in a short acting lower dose to take when the pain breaks through the long acting one. Hope this helped, and again, welcome!
Your Friend, Fabby

 
Old 02-14-2007, 09:57 PM   #9
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Re: BT med question

I always find it interesting when someone asks how they should tell there doctor about the problems they have been having and what to do. Go into your doctor and tell him exactly what you have told all of us non-degree, non qualified people, what you should ask your doctor. Not being mean, just I always wonder why they can't go into the person they hired, yes HIRED, for their pain problems and say "Hey, this isn't working well, I need to try something else". Is it because we people are trying to sugar coat and find the best little phrase or saying that will convince the doctor to give them stronger meds? Is it to find out how to go in and say the exact sentence to make the doctor do or prescribe something they would not normally do or prescribe just because you had the most amazing sentence or story prepared? Just wondering. When something is not working or feeling like it should, I walk in to my appointment and say exactly what is happening. Hmmm, maybe people are afraid of their docs. Maybe their doc's are put in the corner and don't want to take the next step, and they think if they go in with convincing evidence, the doctor will all of a sudden be educated beyond the 8 year or more of schooling and then do as the patient asked.

Tell your doctor what is happening people. Tell them straight forward just like you tell us...

Chris

 
Old 02-15-2007, 11:25 AM   #10
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mzpain HB User
Re: BT med question

People usually feel scared because at one time or another in their pain experience they DID just tell it like it was and the doc somehow got the wrong idea, acted suspicious and then either treated them like crap or simply refused to give them a try on what might/would work. A person gets treated like that so many times (maybe once) and they are going to try and be careful of what they say especially when they didnt do/say anything wrong that first time.It is basic "when you get burnt you DONT put your hand back on the red hot burner"
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