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    Old 06-06-2005, 10:25 PM   #1
    sadies mom
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    Need advice with pain meds

    I've been on the boards before but not in a while~I am still having issues with chronic pain and the meds I am on. The doc has me on oxycontin 30 mgs bid and then percocet 10/325, 1 or 2 for btp 3 x day. I don't like taking that much percocet but, the oxycontin isn't helping. What is the average dose of oxycontin for people like us with CP and a tolerance to meds?? This doc is a physiatrist and not a pain mgmt doc~I know I need to find a good one, but~where? Thanks for any replies. Sadies mom

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    Old 06-07-2005, 04:31 AM   #2
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    Re: Need advice with pain meds

    Hey Sadies Mom,

    Sorry to hear that you are having so much pain ): I am not sure exactly what your condition is, so I can only tell you what i know so far. If I were you I would seek an actual pain management doctor that specializes in chronic pain. I am surprised that a physiatrist is actually prescribing you those meds. Never heard of one doing that. Especially those types of meds. Now, with your OXYcontin problem. You said you were taking the oxy 3x a day that's 90 mg's of LA oxycodone and on top of that you are taking up to 60mg's of SA oxycodone a day. So on an extremely bad day you are able to take up to 150mg's of oxycodone in one 24hr period of time. To be honest with you, that is starting to get up there. However, there are A LOT of people out there with double that dose of meds. So don't worry about it too much. If I were you, I would ask your doctor that you are experiencing increasing pain and that your meds need to be upped. You should try to get your base med (Oxycontin) upped to a level that's comfortable. The BT meds are just for spikes of pain. It shouldnt be taken every 4 or 6 hours. If that is what is happenin to you, that means that the Oxycontin dose is not high enough. Taking those BT meds everyday every 4-6hrs is defeating the purpose of breakthrough meds. You should just use them at the time when you have spikes of pain. ANother thing to think about is maybe changing meds. THere are other meds out there that are great. I switched from Oxycontin to Methadone and I will tell you that my pain decreased soo much with this med. I didnt take any BT meds and it last much much longer than Oxycontin. Talk to your doctor and tell him what you are going through. As well, think about seeing an actual pain doctor, they might know a little bit better about managing your pain with medications...

    Good Luck to ya,

    Old 06-07-2005, 05:27 AM   #3
    sadies mom
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    Re: Need advice with pain meds

    Joe~ you wrote: You said you were taking the oxy 3x a day that's 90 mg's of LA oxycodone and on top of that you are taking up to 60mg's of SA oxycodone a day. So on an extremely bad day you are able to take up to 150mg's of oxycodone in one 24hr period of time.

    That isn't exactly right. I am on Oxycontin 30 mg Twice a day(BID). For a total of 60 mg. And regular old fashioned Percocet for breakthrough pain~10mg tabs~up to 3 tabs a time for a total of 30 mg of percocet once or twice a day. I know it's confusing and this is still a lot of meds I guess.
    What I need to know is if the Oxycontin dose is low compared to what other docs preescribe. You are right though -I do need to find proper pain mgmt doc.
    Thanks! Sadies mom

    Old 06-07-2005, 05:42 AM   #4
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    Re: Need advice with pain meds

    Hey Sadies mom, There really is no such thing as an average dose of pain meds for chronic pain. A big part of what most physiatrist do is pain management, Just because the dose your on isn't effective doesn't mean he's not a PM doc. There is no such thing as going to med school to be a PM doc, there is no such progrom to specifically train PM docs. Any type of doc, Internal med, physical med, neurology, psychiatry, Rhuemy's or anesthesiology may practice PM and may even do an internship at a PM clinic run by the physical medicine or anesthesiology dept at a hospital or medical school. But there is no such thing as a fellowship or Board certified pain management doc or even course selections to prepare docs to become PM docs in medical school.

    Anesthesiologist are trained to do more needle work and more interventional procedures but I have seen plenty of Physical med docs that feel comfortable doing Epidural injections, nerve blocks and trigger point injections.

    Personally if you want near my spine with a needle you will be an anesthesiologist that's done thousands of epidurals on a maternity wing or thousands of blocks during surgery, that's where they get there experience in pain intervention procedures. I don't want to be some physical med docs 12th epidural they have ever done.

    Your physiatrist is prescribing more meds than most othorpedic surgeons use for post op pain for hip/knee replacements and spine surgery. However chronic pain and acute pain are very different and tolerance is rarely an issue in acute pain scenarios, or at least hasn't been prior to the invention of Oxy C. Before 96 no surgeon would have met a patient taking more opiates than they use post op. But since the PM revolution, docs are seeing patients taking 10 times the standard 2 percs every 4 hours used for post op pain.

    If the dose your on doesn't work or the med doesn't work, you either need to learn to convey how disabling your pain is and ineffective the meds are to find a medium both you and the doc are happy with. But you can't pull out a book that says under 120 mgs of oxy is low, 120-240 mgs is moderate and anything over 240 is considered high. It just doesn't work that way.

    Many PM docs don't use opiates at all, some physiatrist don't use opiates, some PM docs use them selectively, so your question doesn't have an answer and your Physical med doc is acting as your PM doc. What would seperate this doc from a "true" PM doc if there is no such thing as a PM fellowship or acredidation in PM. They can join The american pain society or other organizations for a fee but that doesn't make them a PM doc. Any doc can hang a sign up proclaiming they are an advanced PM doc when they have no more specialized training than your physiatrist.

    If your under the impression a doc that calls himself a PM doc is going to see what your doc prescribes as minimal, I think your wrong. Some will agree it's not enough if your still unable to function, some will think your headed down the road to addiction. Some will have views on opiates anywhere in-between the two most drastic points of view, from no opiates to having patients on very high doses of meds Whatever very high actually is.

    The DEA seems to be the one drawing the line as far as what a high dose or excessive dose is, not PM docs. PM docs all have their own opinion where the DEA is the only organization counting mgs and number of pills prescribed each month.

    Most manufacturers due have prescribing guidelines as far as rescue medication and needing BT meds. 3 times a day is a bit excessive for some, some docs don't use any BT meds at all. Most manufacturers of LA opiates like OxyC will suggest if you need more than 2 doses of BT meds per day the overall dose of LA med should be reevaluated.

    The PM clinic I go to has an anesthesiologist/DO that does most of the interventional procedures like ESI, neuroablation, test blocks and pump and SCS implants. The physical medicine docs do plenty of trigger points , Botox injections and Robaxin and Lido infusions as well as med prescribing, The head of the place is a Psychiatrist/Neurologist that also does TP injections,nerve blocks and minor procedures and medication management. All in all, they have more physical medicine docs on their staff than any other specialty, so a phyical med doc is as much a PM doc as the neurologist/psychiatrist or anesthesilogist.

    If you left your present physical med doc you may have to see a half dozen PM docs all with different specialties before you meet one that will reinstate or use the same meds your on now. So communicating better with your present doc, perhaps with a pain diary, might be the key to finding better relief. If they aren't already balking about what they feel is an extremely high dose based on their experience with rehabbing a broken hip or TKR.

    You really can't compare what I take and say I know someone taking 10 times the dose for the same condition as me. CP is a unique experience for each person. Who is to say we have the exact same amount of pain simply because we both had the same surgery or have the same DX.

    There is no journal of American pain management that says what a high dose is and what a low dose is.
    It all comes down to does it work, are your expectations reasonable and is your doc comfortable with what you require.

    Good luck, Dave

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