I currently take 4 60mg MS-Contin and 6 10/325mg endocet for chronic back pain. I have been on this dosage 3 1/2 years. I have been having to go to ER to get shots of Dilaudid up to 3 times a week due to unbearable pain that my meds are not controlling. The ER Doctor suggested I talk to my PM Doctor about changing me to Dilaudid and Oxycontin as it seems I have a tolerence to my current meds. What would be a correct dosage for the Dilaudid and Oxycontin?
No one here is your pain management doctor and therefore it wouldn't be wise or prudent for any of us to suggest a dosage for you. That should only come from your treating physician. He or she is the one who knows your medical condition, your level of function and your past and current medical history , all of which impact your dosage needs.
If I were you, I would definately discuss the multiple trips to the ER for pain relief with him and together you and your physician can come up with better ways to manage your pain levels, in addition to making any necessary changes to your pain meds.
Do you also use other modalities to help reduce the pain? Heat, ice, physical therapy, TENS, spinal cord stimulation, swimming etc? There are many other avenues to managing pain in addition to using oral medications, all of which used together, help keep pain levels down and avoid unnecesary trips to the ER for high pain levels.
One thing that you may want to keep in mind, many, many PM doctors do not want their patients going to the ER for treatment of increased pain levels. And in the event that you do go, they want to be notified the very next business day, especially if you are given treatment and or prescriptions. Otherwise, if you are under contract, it can result in your being dismissed from their practice if you don't follow the rules in your particular contract, if you have one.
I would ask the treating doctor what he would like for you to do, if you haven't had that discussion with him yet, when you have increased pain that your pain meds aren't controlling at home. That way, you protect yourself and don't find yourself inadvertantly breaking your contract.
Are you taking your endocet regularly? If you are, all that really does is increase your baseline medication level, and won't work to relieve "breakthrough" pain levels. I also am allowed to take my breakthrough meds up to 6 times per day as well but only take them when nothing else works and they usually do a good job of bringing down my super high pain levels so that I can handle them.
Best of luck to you,
Last edited by backhurtz; 07-16-2012 at 05:11 PM.
Reason: to add additional information
I know not getting the pain control you need for your situation is horrid. But I will tell you that you should talk with you pain management doctor. The people on here all pm patients. None of us would be able to tell you what dosage you should be on because what one person dosage is may not work well for you. May not be enough....or too much. If I were you I would call the pm doctor and tell them that you are not getting proper relief. Tell them that you have had to go to the E.R. a few times for relief. Maybe you can get in sooner than your scheduled appointment. When you do talk with the pmp make sure you are honest and tell him that the meds that he has you on are not giving you adequate pain relief. I would strongly suggest against going to him and asking for a specific pain med by name. That is a big red flag to pmp. Even though it can be completely innocent. Good luck to you. Hope you get things straightened out. Muah!
I definitely agree. I'd tell your PM doctor you've been needing to go to the ER three times a week (if they don't already know) and that your pain has been out of control, then see what they suggest. Don't mention meds or doses by name, unless they ask what has worked in the past for you, or you are telling them what it took at the ER to get it under control, etc. I don't know any doctor who would think its acceptable to go to the ER that often, nor do I know many patients who could afford that. I hope your doctor is helpful.
By the way, I see no reason why the ER doctor should have thought you would do better on certain meds than others. Your dose of the MSC could be increased and you could be given any number of stronger breakthrough meds, you could be switched to any number of long acting meds, etc. I think it is out of line that they told you to ask your doctor about two specific meds. Also, I think the fact that your doctor is prescribing six doses of breakthrough meds a day (unless you take more than one pill at a time) says that your long acing dose is too low. Thats a decent amount of acetaminophen.
You are very lucky you even got pain treatment at the ER (often they treat pain patients like drug seekers), especially after the first couple times...they could have easily said you have been in here X times in the last couple weeks and you need to follow up with your doctor.
If you have any doubts in your PM doctor, I urge you to seek out a new one. A good way to do this is continue to scheudle appointments and get meds with your current doctor, but schedule consults with other PM doctors. If you find one you like, make a follow up appointment to coincide with your next prescription due date, then cancel any contract you may have with your current PM doctor (a certified letter is a good way if you can't do it in person).
Be sure not to get any meds or sign a contract with the new doctor until cancelling an old contact. I'd hope that your PM doctor continues to try you on non opiate options like injections, adjunct therapies, and adjunct meds, unless all those have truly been exhausted. Often one doctor does not have all of the options in mind and it can take several doctors and many years to do this. Hope you have better pain control soon. Best wishes.
constant head pain, fibro, and other fun!
chronic pain established in 2006
Thanks for the replies. I guess i didnt explain everything very well but yes my pm dr knows when i go to hospital for the shots and gets a report from the hospital on my er visits. I do use stretching exercises, pt and ice on my back. My PM Dr has suggested using Oxycontin before but I have always been afraid of the Oxycontin. But i see from your posts that i need to voice this concern with him. Sorry am new to this but thanks.for your help.
Yes I would definitely encourage you to speak up that your pain management is inadequate. I am quite shocked your doctor knows how often you have been going to the ER and hasn't almost automatically upped your meds. Mine has me fill out a sheet each time I come in asking about my pain levels and how my meds are working, so that is a good starting point for conversation. There are other options if for some reason you do not want to try Oxycontin, but unless you personally have had a bad reaction to it (I think not since you are on Percocet), there isn't a reason to be scared of it...yes some meds will have a bad rap in the news (Methadone is another one for example).
Some folks would be scared to take morphine as for some reason it gets touted as being very strong (when it is in fact one of the weaker meds). There are other meds besides morphine and Oxycontin though. Might be better actually to not switch to Oxycontin as it has Oxycodone, the ingredient in the Percocet, which you already have some tolerance too. All you can do is give whatever your doctor suggests a try and report back. Do keep in mind if you switch meds things could actually get slightly worse for the short term as they have to do a conservative conversion to be safe, but most often they schedule you for a follow up quite soon after (such as two weeks) and may even give extra breakthrough meds, or you can call for a sooner appointment. Best wishes.
constant head pain, fibro, and other fun!
chronic pain established in 2006
No reason to apologize. That is what the board is for...questions and concerns that you may have. It is relief for me to come on here sometimes and know that I am not alone in this wacky world of pain. I agree with tortoisegirl when it comes to your pmp not doing anything about your pain control after knowing you have been in the er that many times. Please be very careful. I know that your pmp know that you are going and getting the shots but the E.R. docs may start to get very cautious if you continue to go in so much. I only say that so if there is a time where you really need to go I don't want you to be turned away or put in your chart those 2 words that us pain patients hear that makes us cringe...."drug-seeker". Hope that you start to get the pain relief you need. Muah!
I am very sorry you experiencing so much pain dear person, but I have to tell you something based on my own experience.
I wonder how come your PM DR lets you go to ER 3 times a week to get shots - period!!! Usually with most PM Doctors this would never happen. Do you think your DR is carrying and takes good care of you?
If they answer is yes, why than instead of agreeing his patient goes 3 times a week to ER to change either the doses or medication?
First of all, this is very unusual that one can be on same drug, on same dose for 3 1/2 years and still have good results. Unfortunately due to tolerance, drugs stop working and what you are going through clear prove that they stopped working for you. Than why nothing is done? Do you communicate well with your PM?
I remember one time I woke up at 3 AM with severe pain. My PM gave me his cell number just in case which I never used before. I called him and even though he is in NYC, and I am in NJ, he called ER car for me and was the rest of the night and next day on call with doctors from local hospital until everything he ordered was tested, until my pain went under control.
When I came home, his assistant called me saying that even though I see my PM every month, he wants me to come this time in between to discuss new "cocktail" for me. Unfortunately my tolerance is very high by now and I am lucky if I can stay on same drug or same dose for more than 3-4 month. He discussed with me what happened and what caused such inflammation and changed my drugs and doses.
I have to tell you that I really know Good Doc - Bad doc, had such experiences! So become very smart and careful about it. Especially when it comes to PM DR. Communication, trust, honesty is the key. I strongly suggest you discuss your situation with your DR. Does he know that you go every week 3 times to have the shot? I wonder how they do it for you at ER for so long? I thought they are so strict nowadays and careful but they still do it? Wow, I am shocked that your PM, if he knows of course this, lets it happen.
And why are you afraid of Oxy? Lets face it, there no good opiates, they all bad. But I found Oxy as LA drug brings more relieve than many others. Of course if doses are right.
Have to agree with Moldova!!! That is what i am concerned about. The doctor knowing all those visits to the er and your getting shots each time. Then I would be concerned about the doctor using this to be a reason to drop you. Trust me I have heard it on here so many times...."The doctor knew I went to the hospital and the next visit he refused to see me. I don't even know why" Also I don't want you to get a rep at the hospital er. Trust me the nurses and doctors put alot of things in your records that they don't tell us. Before I was put on disability I worked in a doctor office as a medical assistant. The er docs don't like returning pts coming in multiple times a week for shots. They want you to follow up with your doctor. I am shocked the er doc didn't ask you why haven't you followed up with your doc yet. I am shocked your pmp haven't said lets change this around right now! Like I said before all narcotics are ugly. But as long as you keep that in mind and take it as you are suppose to then you will get the benefit of it and hopefully it will help you. Good luck! I hope you get some results before it's too late. Muah!