This peeves me to no end...
All scripts are written pretty generic for everyone...
1 tab x times daily, 1 tab every 6-8 hrs...ect.
***??? Are we not all different sizes, weights, ect? My hubby and I can have the same med prescribed, the same way. He is 6'6 and Im 5'9. Not even pain meds, but any med.
AND especially a med, such as a pain med...it does make a huge difference!
Is this the way its going to be forever??? How fair is it to dispense meds to a whole range of ppl the same way? We all have different needs and wants.
Does your doc take in to effect that you have different needs?
I know my doc tries to accomodate me, but they have their "guidelines."
THE PROBLEM IS THEY HAVE THE SAME GUIDELINES FOR EVERYONE...
Something needs to be done, I feel...so many ppl suffer from the same "cookie cutter" and "generic" dispensing instructions.
Does this bother any one else but me???
Please feel free to share your thoughts...Sorry, I just got home from a long flight...Hope this makes sense.
xoxoxox,
IZZY'SMOM
Re: How Scripts Are Written....the Same For All???
I feel your frustration! My wife is a whopping 98lbs and the doc gave her 5mg percs for a little side pain while he has me on a 5mg hydro for severe and chronic back and head pain!? What the heck? Doesn't make any sense to me. Sorry I had to vent about that. I just don't understand the logic in that!
Re: How Scripts Are Written....the Same For All???
Scary....and what about kids taking all of these medications that have never been tested in children...because who wants to test drugs on children....but it is all quite frightening when you think about it.
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undiagnosed lung and back pain after pneumonia in '03, tmj, migraines,(two failed surgeries for) Kienbock's disease
Re: How Scripts Are Written....the Same For All???
I agree with the generic script thing but i gotta tell ya'.....My niece who is 14 and weighs about 100 pds.had 1 wisdom tooth pulled about a week ago. They gave her 7.5 mg hydro 2 tabs every 4 hrs. Same thing they gave my hubby who is 6'3" and weighs 240 pds. when he had his last 4!!!! teeth pulled for his dentures. I get 10 mg hydro every 6 hrs. for DDD, fibro, severe osteoarthritis throughtout my body, and CMP. It's really messed up. I think they hold back on chronic pain patients for fear of them getting addicted. I do not want to dispute that my niece and hubby needed those meds because they did but what about us who live in PAIN everyday? God Bless, morgyporgy
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God Bless everyone and pray for a pain manageable day. morgy porgy
Re: How Scripts Are Written....the Same For All???
I actually had a chat with my PM about this a few years ago, when my daughter had her wisdom teeth pulled. She was prescribed 10mg. hydro every 4-6 hours. At the time, I was taking 5mg hydro as my BT med.
He explained to me that when a person is Rx'd narc pain meds for something acute, it's looked at as just that...acute. In these cases, usage is not expected to last more than a few days or weeks, so there isn't as much concern about abusing or addiction. In chronic cases, there has to be some wiggle room, especially in the beginning, because usage is expected to be long term or permenant. This way dosages can be changed or increased as time goes on and conditions worsen, etc.
I do agree, though, that when 2 people are chronic, and have equal pain, but not equal size, this doesn't make sense. I didn't discuss this with my PM, because I was referring specifically to my daughter's situation. Very good question Izz. Do the 2 of you have the same PM? Do the meds you and he take give different results for each of you? Maybe it's a tolerance thing. I really don't know. If you talk to your doc about it, I'd be interested in what he/she says.
Take care and I hope you are resting up after your flight. cmpgirl
Re: How Scripts Are Written....the Same For All???
I'm not sure which ones, but I do know that not every pill is measured out by the weight of the patient, some have to do with brain size, which can change very little from person to person, even babies.
Maybe Shore or Jon or Steve knows what I mean and can elaborate.
Also, just FYI, not all pills lose strength as they get older, some of them actually gain strength the longer they sit.
Interesting subject, good post, op!
Re: How Scripts Are Written....the Same For All???
IZZY'S MOM,
A girl friend and I had the same conversation the other day.We both have MS and we were discusing the dosage of our injectable meds.We are both about 5'2 and a 110 pounds.Why would they give us the same strength meds as a 250 lb man.We beleive one size don't fit all.
The 44mcgs make us sick but the 22mcgs we are fine with.
When I was hospitalized last March for a MS attack,I had severe pain,the DR. gave me a 100 mcgs of fentynal patches,oh LORDY was I sick.At that time I only took vicodin when needed.You wanna talk about shocking my system.
I had this talk recently with my neuro,I ask him to start the dilaudid out at a low dose versus shocking my system.He agreed with my weight it should be taken into consideration.
He had prescribed methadone,that made me so sick it put me in the hospital.The methadone was a big jump from oxycodone.Now hopefully my neuro understands that one size don't fit all.
Hoping when I go to the pain clinic they take all this into consideration,but it is one of my questions I have wrote down for the PM DR.
I'm hoping he doesn't dismiss me day 1 for all the questions I have.
Re: How Scripts Are Written....the Same For All???
Hi Dut, nice to meet you!~
Any doc worth their salt wouldnt be put off by the questions you have...Be honest, and say your piece, and Im sure you'll be just fine.
You dont have anything to worry about...You are a very well spoken patient with legit issues. Good luck, and Im sure it will all work out wonderfully~
xoxoxoxo,
IZZY'SMOM
Re: How Scripts Are Written....the Same For All???
Well I dont know about your doc but my pm doc has adjusted my meds just about every month since December to find the right combo as well as the amounts, however you are right but only because the pharmacutical companies suggest doses and the doc's almost always go by that. What they adjust are the quantities and types. Hope this helps.
Re: How Scripts Are Written....the Same For All???
Hey Guys, Someone already touched on the answer, Most every drug used in CP or to treat acute pain whether it's an opiate, muscle relaxer, anti anxiety med or anti siezure meds works on the nervous system. The nervous sytem of a 250 lb man isn't twice the size of a 100 lb woman, therefore twice the amont of drug isn't needed.Few drugs need to be disperseded systemically but in those cases like anti biotics, Paralytic agents, steroids, etc, weight, blood volume and size are factors that need to be considered. But an opiate naive patient is the same whether they way 250 or 100lbs.
There is cetainly a plecebo effect if someone is large and believes they need more or will be in pain, but if the patient wasn't given the info on the actual dose or the patient doesn't have the abilty to convert say a dose of IV dilaudid into an equianelgesic dose of a drug they are familiar with, that effectively takes expectation of relief which is a proven factor in pain management off the table. By removing the psych componant or expectation of relief that may be telling a larger person it only makes sense they would need more of a medication than their 100lb partner people can can stop lookng for reasons whay their meds fail to live up to their expectation and then ned to justify why they need more than their tiny wife recived from a different doc for a complately different condition. Your no longer comparing apples to apples and buying into misinformation.
Re: How Scripts Are Written....the Same For All???
Hey Dave.....I thought one's BPL...Blood plasma level was akin to say one's BAC, which is weight and metabolism driven?
My PM Doc, an anesthesiologist, has made comments before about UA's and how one has to be careful when dismissing patients because metabolism and muscle to fat ratio is so important. While body weight may not be the only criteria, I thought it was a factor. Am I wrong?
Re: How Scripts Are Written....the Same For All???
Hey Juliet....Thanks for joining the discussion....Sounds like your experience can be of some value here. What you say makes perfect sense. So, in your opinion, does body weight and metabolism become a factor?
Re: How Scripts Are Written....the Same For All???
Izz,
this question bothers me too - i thought about it many times...
When my PM told me (after I met him first time) about "custom made meds coctail for me" I smiled... He explained that this is the way they work.
This was so new to me, my old PM never even asked how much I take, is it working or not,he just called to pharmacy with prescription.
I wish every DR find time to listen to their patients and prescribe "custom made"
treatment for them. I bet it would be better results in treatments and pain mgmt.
Re: How Scripts Are Written....the Same For All???
Hey Ex,
No worries, I can only comment on what i know though and I'm certainly not a dr. Yes, metabolism is a major factor - weight is less of an issue and tied in with metabolism anyway. For example - if you have more muscle you are likely to metabolise a drug faster and the onset of action will occur earlier (this is for pain meds and is general, of course), the drug may also leave your system earlier too as there is more active tissue (muscle) working to get the blood around. Have you ever know a really fit person (marathon runner or bodybuilder) that has no alcohol tolerance and gets drunk with 2 drinks? This is what I mean. Therefore the opposite is also true for those of us who can't exercise as much. One dose (or 3 or 4) in pain medications really does not suit all, or even most people and Maldova is correct in saying that pain management should be custom made for each individual.
Also taking your medication on an empty stomach tends to hasten the onset of action and being constipated may mean that the drug cycles through your system for a longer period of time. Taking drugs together usually increases the action of one and possibly (though it's usually the other way around) decreases the action of another - especially if they travel the P450 through the liver. It's really very complicated and I hope that my answer has helped rather than confused you
This site is great and I think it's brilliant that everyone is so supportive.
Re: How Scripts Are Written....the Same For All???
Much of the effectiveness of meds and how they s/b prescribed has to do with how they are distributed throughout the body, as Shoreline wrote.
Take, for instance, anesthetics. Ever look at the prescribing information for these meds? They are almost always given according to weight and/or body mass. Sometimes they read something like 10mg/kg. These kind of drugs are often lipophylic, or dispersed into the bloodstream directly but distributed in body fat too. Fentanyl is like that when used an an anesthetic. So are other injectible anesthetics and inhalants. This is why it's so important for an anesthetist to know your weight and overall body fat & mass measurements.
So, IMHO, I think CP drugs that are lipophylic s/b prescribed in similar fashion, and this would include fentanyl and methadone. The other meds are prescribed as Juliet describes. And they always shoot for the lowest possible amount with the least possible side effects that is still effective theraputically.
Acute pain and chronic pain are very different and s/b treated differently. Acute pain requires higher doses over a shorter period of time.
Ex - I think "fast" and "hasten" mean essentially the same thing unless you are referring to how quickly a med goes into and out of the central compartment.
Re: How Scripts Are Written....the Same For All???
Right on, Steve...anasthetics do work differently although it's the paralytic agent that is fat mass dependent. Metabolism still makes a difference with these drugs though - this is why your bp, pulse and heart rate are monitored so closely...even with the right dosing of these meds, some people have been known to wake during surgery - I was briefly awake during my back surgery (although I was paralysed and eyes taped shut - I could just hear the surgeons talking and a hand on my shoulder) because they bring you back a little during longer surgeries if your bp is too low or something like that - as soon as they noticed my pulse come up, they put me back under properly. It wasn't at all scary at the time but did give me nightmares for a while. The reason that I gave this as an example is that I'm small, low fat mass and was quite fit - therefore, based on the anasthetic dose used - I shouldn't have woken up. As you say though, drs must prescribe (to begin with) at the lowest dose available that provides a result, this makes it pretty hard for those people that have a natural high tolerance to certain medications - and why pain management is so difficult for all parties involved. At the end of the day there has to be an element of trust between dr and patient for correct PM to be met. Difficult.
Ex, yup, sorry I did mean that an empty stomach tends to make drugs work faster. Didn't mean to confuse you.