Shoreline

Hi brian, I think I asked before what the big deal with discontinuing Ultram. It seems your gaging your dose of duragesic based on whether or not you need the weakest oossible BT med available. If I shhot never to need BT meds, I would over medicated 60 % of the time. It may also lead to thinking if you need anything extra ypu will need your dose increased, The ultram is nothing compared to the fentanyll and it's already almost killed you once. If you were replacing 60-90 mgs of BT morphine a day with an increase in fent, it would make sense to increase. But the goal isn't complete relief all the time.

As far as effecting neurotransmitters. All I can say is my shrink whos oneof the best neuro pharamcologist in the area, hates the stuff. He's seen folks prefectly stable on psyych meds thrown into a veryy bad posion from fent. He's admitely against it. Not ot metion is is an NMDA receptor binder which is believed to cause rapid tolerance, decreased pain threshold and several other neuro chemical reactions. Fentnyl is hardly harmless compared to utram and back to a dose that could have killed you 4 months ago seems pretty rapid and based on the desire to DC all BT meds seeems a little unrealistic unless you pain is always constannt, meaning never worse at night, after activity, after working, in the am, etc. Btmeds allow you to keep your base dose to a minimum if used corectlty and responsably. They aren't always an indicator for an increase,and even if they were, it doesn't meet the criteria bassed on strength anor frequency. NMost docs would love to prescribe ulrtram rather an 30 mg Oxycdone or * mg didlauid for BT pain. I guess I don't understand your goal or coralation to ultram.

Just a different perpective than increasing based on what? Tolerance, poor pain relief, Bt pain? Where will you be in 2 years and what's going to keep you from being at 200 mgs as fast as you tolerate respirtory supression. If you start dipping into a stash of ulttam, it doesn't mean it's time for an increase. The first sign of toelrance is duation, and Ultram will ghardly carry you fan extra 12 hours whe you on the patch. Eventually everyone wil reach a level where the side efects ar no longer tolerable. It may be drowsiness for one person, urinary retention or impedence for another. Yes we an develop tolerance to any dose and it won't kill us, but it doesn't mean we can function normally at it. Tolerating and functioning are two different things, I guess i really don't get the Ultram thing.

I hope you can think about it without a quick response where you feel I'm questioning you., I'm trying to give you a different perspective and something to think about. No attack is intended, I just don't get the logic or how it takes 3 months to taper off Ultram. My post is simply meant to get you thinking about what your shooting for and your expectations. If there wrong, someone nees to point it out. The right dose of duragesic isn't one that requires no BT meds. That's just my opinion. I'm sure some docs believes the opisite, some would agree and others think you need to find other ways to manage BT pain like meditation, self hypnosis, bio feedack, stretching. Non opiate methods that can be tought and learned.

CP is a life long problem for most that need these meds and you have to look down the road.
Take care, Dave