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  • Ever run out of meds early?

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    Old 10-08-2004, 08:31 AM   #1
    pain-intheneck
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    Ever run out of meds early?

    Just a question for you guys, I have fibro, take meds on a daily basis for pain, patches for the overall pain, and percocet 10's for BT pain which happens all the time, recently i moved and was stupid and helped lift things which shouldnt have done, but i ran out of my BT meds one week early due to being in more than normal pain, afraid of WD what do I do?

     
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    Old 10-08-2004, 08:59 AM   #2
    khoff
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    Re: Ever run out of meds early?

    Try to rely on the patches and either acetominophen or ibruprofen for some pain relief. I would not suggest asking your doctor for an early refill. Docs tend to frown on that and start thinking patients are talking more than needed. It may be difficult, but try to bear it out for just the week.

    Ken

     
    Old 10-08-2004, 09:28 AM   #3
    scotty12
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    Re: Ever run out of meds early?

    if you take the BT meds daily then they are not realyy BT meds.
    how many per day?

    if you have the patch you really shouldnt have any w/d.i say shouldnt because i done know how much a day you take.do yourself a favor and stick it out until your due for a refill and maybe consider talking to your doc about raising your base meds.if you need BT meds every day you may be undermedicated.

    IMO being undermedicated can cause compliance problems.once you are on a comfortable dose you shouldnt have to take BT meds every day.

    I went through the same thing early on but once we found the right med and the right dose i did not have to count pills at the end of every month.

    hang in there,you'll be fine,scotty

     
    Old 10-08-2004, 11:15 AM   #4
    vamp36
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    Re: Ever run out of meds early?

    I have Dilaudid for BT meds and I use to use them ALOT daily. I asked my doctor about this (after great advice from the board here) and he increased my Mscontin base med. Now I only need them truly for BT pain. I use to take about 4 to 6 a day. Now I get by on 0 to 2 a day. I think it's time to talk to your doctor about your base med being increased. Good luck to you.

     
    Old 10-08-2004, 12:37 PM   #5
    goddessdana
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    Re: Ever run out of meds early?

    Quote:
    Originally Posted by pain-intheneck
    Just a question for you guys, I have fibro, take meds on a daily basis for pain, patches for the overall pain, and percocet 10's for BT pain which happens all the time, recently i moved and was stupid and helped lift things which shouldnt have done, but i ran out of my BT meds one week early due to being in more than normal pain, afraid of WD what do I do?
    DON'T ASK for a early refill!!!! Youre just gonna have to rely on youre patches till youre refill time. When you go to your doctor I do suggest you let him know the BT pill is not working as well. Since youre taking more then you usually do, I would ask for something else for bt pill that don't act like it's helping anymore. Good luck.......

     
    Old 10-08-2004, 12:59 PM   #6
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    Re: Ever run out of meds early?

    Hi PIC, It really depends on your BT med use and what proportion they are of you daily intake. What patch strength and how many BT meds a day do you take. A decrease in daily intake of 20% or less wouldn't cause severe enough withdrawal to risk loosing everything for non compliance.

    I'm sure you know opiates for fibro is still controversial and loosing a doc that beliefs in using duragesic for fibro may be tough to replace. The duragesic withdrawal would make the Percocet withdrawal seem like a picnic, that is if they aren't half your daily opiates and being used as part of your base med routine rather than using them for true break through or incidental pain.

    Personally, My daily amount of BT med use has never been more than 20% of my daily opiate intake and never prolonged at 20%. If I averaged the days I take 1,2,3, or 4 for real break through it probably works out to be about 10% of my daily daily opiates. Ive gone over a week without having to use BT meds and never experienced withdrawal and I'm probably what most would consider a high dose patient.

    Intrathecal doses are harder to ocnver to opiates and even methadone which is highly underestimated in strength is hard to show a comaparison.

    But when taking 600 mgs of kadian a day, I was allowed to take 2 30mg MSIR or 2 4mg dilaudid or 2 30 mg roxis twice as day PRN. So even if I took 4 pills every day it's still only 1/6th of my dose so going a week with 1/6 less isn't a big deal especially if you can remember when your pain wasn't treated at all or remember when it was grossly under treated every time I switch meds, they start the conversions low. So I've gotten several good reminders of what uncontrolled pain was like.

    I would agree with Scotty and say ride it out. Not every doc gives second chances and BT meds are prescribed for the situation that caused the flair. It's a way for us to stay out of the ER where treatment of CP patients is poor.
    If the meds become a daily routine, same dose, same time every day, They are just a part of your base meds and have nothing more to offer than the previous days/weeks/months before.

    Because of the way PM patients are treated, It's important to use your BT meds as needed, not every night at 7 and 11pm. Without them you will find docs and dentists believe we have the means to manage whatever complaint brought you to the doc. I had a toothed pulled a couple weeks ago, and was given nothing for pain. The doc assumes I have enough meds at home. Fortunately I had my evening bolus changed and an overall increase previous to the extraction.

    Samere thing with the pump implant. The anesthesiologist that is certaifified and used to do the implants is so swamped he farms out the actual implant. I came home with no meds for post op pain 20 hours after the implant. Fortunately I Because I use my BT meds for incidental pain rather than extra pain relief as part of my daily routine, I had meds to manage post op pain.

    I've seen to many stories abut people having surgery and coming home with no additional pain meds and even not having additional meds post op in the hospital. They think that patch or pump is going to take care of you and have little understanding of BT pain.

    It's something to think about and talk over you post op pain management anytime your having surgery.

    The only bad thing about tolerance is you aren't given much sympathy should you break your ankle, go to the dentist and sometimes having major orthopedic procedures can be horrendous because the think a large base dose will manage any and all pain. Surgeons are so used to take 2 percvs every four hours, they don't know what to do with someone already taking 3,5 and 10 times what they normally prescribe for major surgery. All 3 surgeries and the last was a 6 level fusion I came home with the 2, 5mg percs every 4 hours.

    Now I try to be clear and say just because I have a pump or take X and Y doesn't mean I do party tricks and stick my hand in the fire. I do feel additional pain. The meds help my back and keep me walking, they won't manage a lot more than that. They might mask a tooth that's turning bad a couple extra day but other than that. The meds given have a specific use and don't make us impervious to pain.
    Unless the percs were a significant part of you daily opiate intake you can drop 10 or 15% and not feel miserable. The times you would normally take BT meds may be more uncomfy but is it worth the risk of loosing your doc over a weeks worth of BT meds.

    My doc has everything spelled out. We sign a new contract each year and there is an enlarged copy of the contract on the wall. I haven't seen the new one yet but every offense ends with "the pills will not be replaced and the patient will be terminated from the practice.
    If not for the tight control people would be moving 6-8 times a year. LOL Just kidding. I believe you moved and increased you pain. I've been with my doc long enough to know what to do for increased pain. I either use my BTT meds or make an apt. They don't make adjustments over the phone. They don't call in any med. I guess someone was doing that. It will prevent diversion by letting pharmacist and patients know no meds are called in.

    Be prepared at each visit. It sounds tough, But when the alternative is so horrific, It's really not hard to be compliant. Those 28 compartment pill planners do make life easier. You can lay your pills out for the month, Even your BT meds for each day and you can see if you took a pill or not and you can see where your going to pay or go without if you take extra. Or se that you have saved BT meds and had a good month, put em away because you never know when it comes to dentists.LOL

    Honestly I think you would be fine unless your taking 8-10 perks a day plus increased for the move and now your out. Like Scotty said if you need that much BT your base dose is wrong. Or if your taking 2 10 mg percs at a time, replace it with the 15 or 30 mg Roxicodone. Those 10mg percs, even generic are expensive and the generic versions of Roxicodone are 3 times the mgs for your dollar.

    But I think your doc would want your BT meds proportionate to your daily dose. 20-30% is usually enough and very safe to make a dent in additional pain. IN the day time a half a 30mg pill works fine for BT for me, at night I may take 2 at a time or nothing at all. I've never experienced withdrawal from skipping days of using BT meds.
    Good luck, Dave

     
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