due to many yrs of perc,oxy type meds,and now at apoint where they dont work well w/o high dosages. im wondering if fentanyl codiene or some other med might work better with a smaller dosage required ? Thanks
You may be a perfect candidate for methadone. For may PM docs this is the perfect scenario for when to switch someone to methadone. It's not at all unusual for folks on hundreds of milligrams of other opioids to switch to methadone and be fine on 1/10th to 1/12th of the previous dose. There's something about methadone where the higher the dose of other opioid, the higher the conversion ratio. You can read about it by web searching methadone conversion ratios and such. I've seen folks go from 600mg of MS Contin daily to 80mg of methadone daily and get better pain relief, and the methadone doesn't escalate. I went to methadone from high dose fentanyl patch, was stabilized on 80mg methdaone per day and needed no breakthrough medicine at all - and it stayed that way for years.
Well if your doctor has such a big problem with Methadone, which is what many seem to prefer, including mine, I wonder if he would be okay with the patch or a long acting oxycontin? seems to me if he objects to one, he might not be comfortable with the others.
Maybe you should ask to a referral to a specialist, that might be the way to go.
Hope this helps, Fabby
Last edited by Fabrashamx; 10-24-2007 at 09:30 AM.
im gonna see him nxt week to give him one more chance, you may remember the i fired my doc (should i talk to his boss) thread awhile back.hopefully
i,ll soon get the relief a sorely * thats a pun * ê¿ê. need
is the patch a LATERAL move? or the same med as contin ?
The patch contains fentanyl, a very potent narcotic, roughly 1,000 times stronger than morphine (which is in MS Contin). That's one reason why the dosing with the fentanyl patch is in micrograms (e.g. 75mcg) rather than milligrams.
The biggest differences between the two, in my opinion, are that fentanyl is less constipating and the patch is a wholly different delivery system than oral tablets. At first I thought the patch was great, no pills and lasts three days. Then I started needing the patch every two days and had lots of trouble keeping the patches on. But that's just me. I did develop tolerance to fentanyl much faster than I have with any other narcotic.
Codeine is much weaker than morphine and most probably wouldn't be prescribed for chronic pain.
I do think though, that going from oxycontin to a lower dose patch might be seen as a lateral move. But I can't see a doctor who has such a knee jerk reaction to methadone prescribing either one, frankly.
I think youve gone as far as this doctor cares to go as to meds, but if you like him you could ask for a referral to a specialist instead of just looking for a whole new primary.
IS it just methadone he wont prescribe? Have you asked him about any other meds? Hard to say, all doctors have their favorite meds, and since they are human they also sometimes will be prejudiced against a med.
Good luck and keep posting, let us know how you are doing.
I don't recall what meds you are currently on. Could you update us? I have gone from Dilaudid, MScontin and IR morphine to Methadone with good results. I stayed on the methadone for about 2 years (could have been longer...just don't remember at the moment). I was on 120 mg. of methadone with oxycodone for breakthrough pain. I did very well with the methadone until about the last 3 months of my usage. I started noticing (along with my freinds/family) that I was turning into an apathetic slug! It's not that I was just sitting still, staring out into space; but I was getting close to it. I lacked energy or enthusiasm for anything, although my pain was pretty much under great control. I did gain lots of weight, but it was a gradual thing and I don't think I can blame it on the methadone itself, but more on the lack of energy that I felt while on it. That translated into sitting around and not doing any kind of exercise. So, my doc and I decided that we would switch to the Duragesic Patch. I went on the 100's straight away and I've had off and on success with them. My main problem is that the patch itself is not adeuqate pain relief for me. I am taking my breakthrough meds of 30 mgs. of oxycodone 4 times per day...every day....thus making it part of my regular pain med regiment. The oxycodone was never meant to be an everyday thing. Also, I'm having itching, redness and blisters from the adhesive that's used around the edge of the patches, as well as to the adhesive in the bioclusive overlays that Jansenn sent me to cover the patches. I haven't been able to see a pain management doc since mid July because the one I was seeing (the director of the practice) left in early August. He assigned me to another doc in the practice who has been out on maternity leave for 6 months and returned last week. I will be seeing her tomorrow for the first time and I can tell you that I'm extremely anxious about it. Because my pain was getting so bad I had to visit my primary care physician in late September to see about increasing my oxycodone dosage from 4 30mgs pills per day to 5 30 mgs. pills per day. He ok'd the increase and so when I go to see this new doc tomorrow she may just kick me out of the practice for this increase. I really didn't have much choice though...with no other doc who could see me until tomorrow, I had to do something while waiting for 3 months. My primary care physician used to be the one to prescribe my pain meds when I first started going to this pain clinic. The first pain management doc that I was assigned to would tell m y primary what meds he thought I should have and then the primary would write the scripts. I did this for 2 years. Then that doc left the pain management practice and I got a second doc who wrote the scripts himself. I never signed a contract with either my primary care doc nor my pain management doc, but I'll have to wait and see what the consequences of my actions will be tomorrow. I want to get off the Duragesic patch altogether and substitute it with oxycontin. It seems that the oxycodone gives me the best pain relief. Anyway, I've highjacked your thread and I'm sorry for that!!!! Please forgive me. All the best - Memere (K'Mac)