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Old 06-09-2011, 03:10 PM   #1
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In conflict with PM Doc

I have been in PM since 2006 after the removal of my lumbar fusion appliance. The PM doc I have been seeing for 1 year will not increase the dose of my meds. I have become tolerant to the meds and need a solution. On my last visit he switched me from 180mg per day of Morphine Sulphate to Oxycontin ER 80mg per day. I did the conversion myself and it should be 120mg of ER Oxy. Knowing this and suffering from staying in a constant state of withdrawals (which I have been for the last 3 months) I am ready to find a PM doc willing to increase the dose. My question to the board is this: Is 80mg of ER OXy and 60mg of IR Oxy considered high doses of medication? Also has anyone been in a situation like this and if the meds were increased how much was the increase. How can a PM doctor who uses opiates for PM not increase the dose? And how quickly does one become tolerant and in need of dose increase?

 
Old 06-10-2011, 07:59 AM   #2
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Re: In conflict with PM Doc

My doctor as well won't increase my meds after THREE years. however, they will from time to time switch my LA med to a different one to try and keep my tolerance down but always use a conversion chart to get the equal dose. Some meds however react differently and that in itself always causes me to have a few days where I have to adjust to the change.

 
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Old 06-10-2011, 08:21 AM   #3
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Re: In conflict with PM Doc

To answer part of your questions 80mg of Oxycontin is not a particularly high dose, it just depends on the person. 60mg of Oxycodone as your BT med if you are taking this everyday is very high. You should not have to take your BT meds daily to control your pain, they are for flairs and times when the pain is just uncontrollable. As to why your doc lowered you Oxycontin when he switched you off the Morphine, it takes quite a bit less Oxycontin to cover the same pain as the Morphine 180 does. He most likely wants to start you low to see how your pain goes, so as not to over medicate you.

When I switched from Oxycontin to Morphine, it took 140mg of morphine to do what 60mg of Oxycontin was doing.

On the other hand you are having to use way to much BT med, and he should look at upping your LA med to cover your pain more adequately, I would definitely have that conversation with him soon.

Kat

 
Old 06-10-2011, 10:30 AM   #4
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Re: In conflict with PM Doc

Just as a matter of comparison, about 10 years ago, I was on 120mg x 3 daily with up to 8 x 5mg Oxy IR. Since that time, I have been on next to nothing for a couple years but now I am on 80mg x 3 with no BT meds. I've been on this dose for numerous years and am quite comfortable. So, the 80mg isn't high at all but it needs to be moved up slowly. Unfortunately, some docs are very nervous with this stuff. I'm sorry for all of us for that fact!
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Old 06-11-2011, 04:34 AM   #5
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Re: In conflict with PM Doc

My doctor is very conservative but I feel fortunate to have him. I have been on 40 mg of Opana (20 am 20pm,) with 4 .....7.5mg percocet allowed for breakthrough pain. I have been on this regimen for going on 3 years with no increase in dose. I for SURE have days where my pain is very bad, and I feel like I "could" continue going up in mg. but what then? I mean wouldn't we just become as tolerant to that dose and keep needing more?

I guess my way of thinking is, if I can "manage" and understand that I am never going to be pain free, then that is how things will always be. To help with the extra pain, I look for ice/heat, or PT. I guess I may not know what I speak of but at what point do we draw the line, and stop increasing knowing that no matter how high the dose our bodies are going to adjust to that? Am I missing something? And I say this with the greatest amount of respect for others pains and needs.

Last edited by Madison104; 06-11-2011 at 04:35 AM.

 
Old 06-11-2011, 07:58 AM   #6
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Re: In conflict with PM Doc

Count your blessings that you're getting as much as you are.

I was prescribed 15mg oxycodone every 12 hours and every doctor I have seen said it was a high dose. I was with a pain specialist about 3 years ago that was giving me 40mg oxycontin per day and was told that it was a very high dose and she wasn't really all that comfortable prescribing that much.
IMO, your doctor sounds like one of the few (and becoming even fewer) doctors that are willing to prescribe a narcotic on a long term basis.

 
Old 06-12-2011, 07:21 AM   #7
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Re: In conflict with PM Doc

hey Brokend, how are you. I am on 40mg Oxycontin and not taking it every day due to high tolerance to narcotic pain meds. My doctor also told me it is a a very high dose.

What are you going to do? going to Africa haha. Over there it is againt the law to rx narcotic pain medications.

I have been trying to take Advil for a while 200mg a day and I cannot take it anymore cause it is causing me stomach pain, not sure why. I have been taking it with food or milk as instructed but my stomach still hurts me.

Perhaps you can try Fentanyl patch, have you thought about that?

Last edited by nochange; 06-12-2011 at 07:22 AM.

 
Old 06-12-2011, 09:17 AM   #8
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Re: In conflict with PM Doc

hi D. just wondering here back when you were still taking that MS? were you taking that in divided doses thru out your day or all at one time? another thing here, if you WERE taking this in a divided dose way, would it be at all possible for your doc to rx you 40 in the am and then another 40 in the PM? this stuff just does NOT, esp this new OC, last anywhere even close to the stated twelve hours. it still even did not with the 'old' version either. if you are only taking that one dose of 80 which i am assuming would be in the am? you have absolutely nothing running thru and into your system after that 12 hours is up(which also ONLY covers your "day pain' barely and not coverage thru your nite time), so in the AM your blood plasma level would be like nothing, and you kind of are 'starting all over again' every single morning? ya know what i mean? i am taking this crap 3 times a day myself. i just had to since it was bottoming out on me at around 8 hours back when i first started at my PM back in 04.

another possible here if you can afford it is to stop the ER generic that always contains in some cases MUCH less than any brand name med just does, and thats just okey dokey with the FDA too(per FDA, any given generic version of a BN med only has to contain around 80% of the active ingredient and STILL gets called 'equivalent'). sick but unfortunetly true. i ALWAYS have had that DAW on my OC Rxs ever since the first generic came out and it simply did not work at all for me, and made me sick when i tried it just to see if i could try and save some money if it was close to equal. no freakin way was that even close to NB. and when i went back onto the name again, holy crap was there EVER a huge difference in coverage again. i am hoping you do not have to pay out of pocket for your OC here since the brand of course would cost you way more. but if you do simply have to pay a bit higher co pay here to do it the BN way(i DO pay more with co pays for this), trust me D, it IS money well spent.

i am not too certain of that conversion rate, but the one thing i did find out only when my normal BT med roxicodone/oxy IR was not availiable when ethex had to recall it a few years ago. was one 5 mg oxy is equivalent to 15 mgs of MS. they had to give me the MSIR 15 mg for BT in place of my oxy IR, and i 'assumed' it was simply going to be lower since it WAS MS afterall? i was really stunned when they gave me the new MS rx and it was actually even 15 mgs. i was told that THAT just was the same 'equivalent' to what i had been taking with only 5 mg oxy. shocked the heck outta me.

just how many oxy IRs are you allowed per day and what is the mg amount of the pills?what exactly does your pain feel like to you? depending upon how the pain is and where it is and what is generating it, there just ARE alot of other non med options availiable alsong with some med options too. i have two seperate pain sydromes that are insane to say the least that just do not at all except for one part of my RSD pain from structural damage in the knee its in respond at all to any narcotics or any of the tons of other meds i have tried. soo i have had to really work hard to try and find many other ways to just try and rein in flares and keep things somewhat livable. have you ever tried the TENS unit? that actually is my only source of pain relief from my RSD flares. there are also lidocaine patches depending, or biofreeze which i LOVE to death. those are just 'some' of the things i use and have managed to stay on the same exact daily intake of my OC i was on back in 2005. other ways are what really allows us to manage pain that narcotics cannot in some cases, or get us thru so we do not ever have to take more BTs than allowed, or god forbid, go to the OC. i only have two BTs per day myself. the more lil pain control tools you have in your chest for back up, honestly it just helps much more than you may think.

just some stuff i thought might help. marcia
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Old 06-12-2011, 11:49 AM   #9
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Re: In conflict with PM Doc

Quote:
Originally Posted by feelbad View Post
hi D. just wondering here back when you were still taking that MS? were you taking that in divided doses thru out your day or all at one time? another thing here, if you WERE taking this in a divided dose way, would it be at all possible for your doc to rx you 40 in the am and then another 40 in the PM?
Hey marcia, just thought I'd jump in and give you an answer. I assume your talking about MSContin? If so, yes it can be taken twice a day. I take 60mg twice a day, along with up to 6 percocet 10/325 for BT as needed. I also use Voltaren Gel, it's great, you have to get a script for it, but it works. And of course the Lidoderm patches, heat wraps, and biofreeze.......all the old standbys. I also get alot of relief from my Cryrocuff, which I get from the hospital after each knee surgery, I have a ton of them. I don't know if you've ever seen one, but it's basically a round ice chest that has a hose coming out of the bottom that's attached to a pump, which pumps ice cold water into a brace/wrap that goes around your knee.....after a really bad day, it's like heaven!

Hope you're doing well.

kat

 
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