Executor

Great question.

Unfortunately, there isn't a standard answer....It depends on what type of pain you have. For example, if one has a type of pain that is "nagging" or a consistent type of pain...Maybe a hardware issue in their back where it hurts all the time....Then, a higher level of LA, or an emphasis on LA meds, would be appropriate.

With many CPers who fall into this category, they normally don't need many BT meds. BTW, I prefer to call it "rescue" med as I think it more clearly defines what is going on. Unless someone in this situation does something they really shouldn't, or gets too active, then they normally don't need a bunch of rescue med, assuming they are dialed in correctly on their LA med. IMHO, the biggest issue with this group of CPers is learning what they can do or can't....Which then influences how many rescue episodes they have. Too much activity, or activities outside their comfort zone would result in needing rescue med & etc.

On the other hand, if one's day-to-day pain isn't consistent, or if the flare ups are the main issue, then an emphasis on BT meds would be appropriate. In this situation, one's flare ups are usually unpredictable and typically very bad....Large spikes in pain...Say a bad migraine or some type of really bad flare up of some sort. In these situations, no amount of LA med would probably prevent them, or address the pain, so raising the LA med would probably be futile and only increase the tolerance.

I think of a BT episode as a little fire that starts and one has to extinguish it with rescue med. The more little fires you have, or the more a little fire turns into a big brush fire, the more rescue meds you need. IMHO, raising LA meds in these situations only increases tolerance and one's "set point"....And everything has to be raised from there at some point. My rationale is that the flare up is gonna happen regardless, thus rescue med will be needed. Increasing the LA med only increases the tolerance, which then increases the amt of rescue med you need.

In these type of situations, the flare ups are most often out of the CPer's control....The BT episode is from external stimuli, like the weather, or some other type of unpredictable force.

Lastly, complicating matters is that some PM Docs subscribe to the theory that one should only have a set # of BT doses per day (4 is the most often quoted number), and if it's higher than their pre-determined #, then they automatically think the LA med should be raised. I don't necessarily agree and my point is that it's very individualized. It also doesn't help by the fact that insurance will also often jump on the # of doses bandwagon as well, in terms of what they'll pay for.

Hope this helps a bit.

Take care,

Ex