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  • Breakthrough meds that arnt?

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    Old 06-12-2008, 01:25 PM   #1
    aussiejono
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    Breakthrough meds that arnt?

    I see a lot of posters who have to take their breakthrough meds ona regular scgedual to obtain acceptable pain releif.

    To me, that means they arnt breakthrough meds, that they are part of your baseling analgesic...... and leave you nowhere to go on days where the pain does spike.

    Whats the concensus on breakthrough meds? I would have throught that if you continualy needed them more than say once a day, it would be an indication that your baseline needed increasing, or having a sceond drug added, so that you still can have a breakthrough med to take when the pain spikes.

    Do your doctors allow for examply, a double dose of breakthrough med on bad days, or anything else to help?

     
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    Old 06-12-2008, 02:12 PM   #2
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    Re: Breakthrough meds that arnt?

    I need my breakthrus pretty consistently; however, I do have a few days that I don't need all of my daily alloted amount so I put them aside and use them on a bad day or to build up a stash in case of an emergency. Everytime I needed an extra pill, I was emailing my doc, asking if it was okay and I think he was getting tired of it so I quit emailing him and now I just do what I have to do and stay within my monthly allowance.

    I have never had a pill count or been asked to bring my meds in but if I had to I would have enough meds. There is no way that I would ever be caught without the proper amounts on hand. I will not jepordize the loss of my medications.

    I agree 100% with your statement:

    To me, that means they arnt breakthrough meds, that they are part of your baseling analgesic...... and leave you nowhere to go on days where the pain does spike.

    This is sometimes a problem which is why I always have an extra stash just in case. I know this is probably wrong but not having meds for over 2 weeks has made me a little possessive over my pills and if the pain is severe enough I will self medicate if necessary.

    Last edited by ms_west; 06-12-2008 at 02:13 PM.

     
    Old 06-12-2008, 02:53 PM   #3
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    Re: Breakthrough meds that arnt?

    I totally agree. If you use BT meds daily what do you use when you have a pain spike. Most manufacturers recommend if your using BT meds more than twice a day 2 or 3 days a week, the base dose should be adjusted. However some docs also believe that if they give the patient 2 doses a day they will take 2, if they give them 6, they take 6.

    I haven't been to an ER room in 15 years because my doc gives me BT meds for BT pain and that's all I use them for. What is an ER going to give me that's stronger than 30mgs of oxycodone at a time? Not to metion spending 6 hours in an ER to get a shot that lasts 4? My BT pain would pass before I got back home from an ER.

     
    Old 06-12-2008, 02:57 PM   #4
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    Re: Breakthrough meds that arnt?

    Tose were my thoughts shoreline, that if you need your BT through meds regularly, then the doc should realy up your baseline analgesic, so as to still leave you somthing for spikes in pain.

    Damn doctors!

     
    Old 06-12-2008, 04:05 PM   #5
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    Re: Breakthrough meds that arnt?

    That sounds sensible and reasonable.

     
    Old 06-12-2008, 04:55 PM   #6
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    Re: Breakthrough meds that arnt?

    I agree the BT meds should be used for just that. If you are using them as part of the regular then they are not BT anymore.
    Fred

     
    Old 06-12-2008, 06:08 PM   #7
    aussiejono
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    Re: Breakthrough meds that arnt?

    I dont think its through choice, its through undertreatment as baseline.

    My sister is astmatic, she has a preventative inhalar, and a releiver inhalar

    She has been told that if she needs to use her releiver more than once a day, she's to increase her preventer.

    I see pain in the same way, if you need to use your breakthrough meds every day, the doctor should up your baseline, either through upping your original LA med, or adding a second LA med to your regime.

    However, it seems some (most?) doctors dont see it this way

     
    Old 06-12-2008, 06:36 PM   #8
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    Re: Breakthrough meds that arnt?

    Quote:
    Originally Posted by Shoreline View Post
    I Most manufacturers recommend if your using BT meds more than twice a day 2 or 3 days a week, the base dose should be adjusted. However some docs also believe that if they give the patient 2 doses a day they will take 2, if they give them 6, they take 6.
    I've read/heard the same thing. However, interestingly enough though, my PM Doc said he'd rather increase one's BT meds (qty) than LA because the BT meds are in/out, while the LA raises your tolerance (because it's 24/7) and thus stronger BT meds are needed to fight the flare ups.

    I guess this kind of thing is what makes PM so difficult....Many different theories out there.

    Ex

     
    Old 06-12-2008, 10:56 PM   #9
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    Re: Breakthrough meds that arnt?

    I totally agree, Ex! My last doctor had fully 1/2 my meds as 'breakthrough' meds, my new doctor says he doesnt believe in the concept at all, and if you need more meds, your baseline LA meds need adjustment, not a supplimental.

    If it were up to me, I would prefer to have it as Dave does, where you have those few in your arsenal for the really bad days, but if you need it more than 3 times a week, its time to look at the baseline dose.

    My doctor is one of those that firmly believes that if a pain patient is given say 30 oxys a month for breakthrough, they will take all 30 and want a refill every month like clockwork. I dont know if he has just seen this happen so often he switched his thinking, or if from the beginning thats what he assumed would happen.

    Hope everyone is having as pain free a day as possible!
    Hugs, Fabby

     
    Old 06-13-2008, 12:20 PM   #10
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    Re: Breakthrough meds that arnt?

    This is certainly a very difficult field. I think one can make good cases both ways. My Doc said that his concern with high LA meds is that they establish a new "set point" and then that becomes the "norm"...And you eventually need the full arsenal of BT meds. Something to think about.

    I just wish I could rub the side of a bottle....Have a genie pop out and cure me once and for all!

    Ex

     
    Old 06-13-2008, 04:04 PM   #11
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    Re: Breakthrough meds that arnt?

    My personal belief is that regular use of SA meds causes a much more rapid rise in tolerance than do LA meds. The reason being that when relying on many SA doses, the resulting highs and lows put you on a never ending search for relief much sooner than with LA meds, causing an ever rising escalation of SA doses."

    Agree totaly, esoecialy at a psychological leval, it has a very reinfircing effect "if i dont have a pill dead on time I will be in agony"

     
    Old 06-13-2008, 09:33 PM   #12
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    Re: Breakthrough meds that arnt?

    Good post, Jono and one that I have a lot of questions about. As you know in Aus, things are much more stringent in regards to bt meds - no such thing as getting 60 + to see you through the month. I'm lucky if I get 20 - 40 endone because drs agree with your theory. I do too but it's hard when, on days like today, I'm in massive pain and I've run out of bt meds completely because I'm having a bad time (have major surgery in less than 2 weeks and stress is not helping).
    I only use my bt meds as exactly that - one or two 3 - 4 times per week but what happens when this doesn't cover it? I'm really stuck at the moment and because drs rx to this theory, I don't get enought bt to cover me in times of stress or when things are bad. The other difficulty is - following this theory, my pain is bad enough to require regular bts at the moment so should the dr increase my LA meds? But if he does that, what happens in 3 months when my pain is manageable again because the surgery is over - does that make sense?
    I'm finding the whole thing confusing and upsetting and although I think the Aussie system is great (we are treated with more respect, generally), I wish that sometimes drs were a little more generous with bt meds.
    Can I ask another qn here - should start a post but the qn was for Jono anyway (you know aussie meds) - what can I do to boost the effects of my oxy? I take panadol, have mobic or neurofen on hand, have neurontin, have propanalol, xanax...hmmm, think that's it Just wondering if you can help me out.
    Great post, thanks.

     
    Old 06-14-2008, 12:27 AM   #13
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    Re: Breakthrough meds that arnt?

    Your doc needs to give you more Endone or whatever your BT med is, or up your LA stuff.


    "But if he does that, what happens in 3 months when my pain is manageable again because the surgery is over - does that make sense?"

    Back it off again, same as would happen if he gave you a swag of Endone to see you through. The dose can be reduced when the crisis is over. Or, as it is a short term need, give you more Endone now, wither way on the strict understanding that it will be for a month only or what ever, while you heal.

    Noone should be left in unmitigated pain, but I think that if you are needing breakthrough painreleivers every day, then they are nolonger breakthrough meds, and your baseline should be upped.

    You could also add a little chlorpromazine to your regime, at bedtime. As well as helping you sleep, it healk releive stress and tension, and greatly improves the analgesic given by narcotics.

    After surgery is a little different, you have your baseline pain, plus pain from the surgery.

    Short term, try taking two Chemists Own Strong Pain Tablets, and three Nurofen Plus, every 6 hours. (This will give you 1gm Paracetamol, 400mg ibuprofen and 60mg codeine, optimal doses of all theee drugs. The Oxford Analgesic leauge Tables have shown that high dose NSAID's consistantly outperform oral narcotics after surgery

    Last edited by aussiejono; 06-14-2008 at 12:44 AM.

     
    Old 06-14-2008, 04:40 AM   #14
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    Re: Breakthrough meds that arnt?

    Thanks - largactil isn't something i can see my gp rxing - he's very conservative. I asked about the nortriptyline and he wasn't too keen on that either because it's not used as commonly as amytriptyline. I shall ask him though cause I'm not getting any sleep at all - until the morning when I can sleep for a couple of hours. Not very practical.
    I shall ask about more endone on Monday - I'm going to go mental without doing something. This is not usual bt pain though, this is something else entirely. Am maxing out on panadol and nsaids but hadn't thought about adding in codene. Thanks.

     
    Old 06-14-2008, 05:58 AM   #15
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    Re: Breakthrough meds that arnt?

    Quote:
    Originally Posted by Juliet31 View Post
    Good post, Jono and one that I have a lot of questions about. As you know in Aus, things are much more stringent in regards to bt meds - no such thing as getting 60 + to see you through the month. I'm lucky if I get 20 - 40 endone because drs agree with your theory. I do too but it's hard when, on days like today, I'm in massive pain and I've run out of bt meds completely because I'm having a bad time (have major surgery in less than 2 weeks and stress is not helping).
    I'm sooo sorry....This is very sad. IMO, the under treatment of pain and the suffering consequences are just terrible.

    Forget all the discussion on tolerance & etc.....You're in pain and suffering, and shouldn't be. With the full arsenal of meds out there, surely more can be done.

    Again, I'm sorry.

    Ex

     
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