Discussions that mention requip

Pain Management board

Hey ken, If you went from 120mgs of morphine, which isn't a large dose, It doesn't really make sense to give up that early. But 90 mgs of oxy should prevent withdrawal if you can maintain somewhat of a steady serum level. Pppersonally I would try using a pill cutter and turn your 30's into 15's and take 1 every 4 hours. Because Oxy is stronger than morphine and a 30 mg 120 mgs of kadian or avinza is no no different than taking20 mgs of morphine every 4 hours, the 15 mgs of roxi should quell any withdrawal.

If your doc won't g above 120 mgs of morphine a day, and it's not relieving your pain,. He obviously has some menatl limits on what he's comfy prescribing, low doses and no OxyC.

I would be looking to change docs and expalin you don't feel you were given a fair chance with morphine products. Why not increase the morphine untill you get relief or the side effects are too bothersome. Morphine des cause more drowstness at the beginning of use and at each higher dose but that wears off quickly, especially when your in pain.

When you boil it all down, If you were to take 120 mgs of Kadain a day for a year, you will still become physically depoendnet, so if you have to pay tis enormous price, being dependent, why not use a dose that works. I hate it when I see docs end a titration at their comfort level and state this obviously isn't going to help. When I switched to kadian from meth, they started me low, 200 mgs a day, low compared to the 120 mgs of meth aday I was taking, so over the next six weeks we went from 200-300 then 400 and finally 600 and I found great relief and a clear head at 600 mgs where 300 didn't even begin to touch my pain. 300mgs a day would also make you physically dependent, so really, what's the difference between 120 240 or 480 mgs. It takes what it takes, The price you pay is the same as far as dependence, It just boils down to the docs discomfort treating high dose patients.

I just switched back to generic Roxi made by Amide, I bought a pill splitter and it cuts them perfectly. I this way I can adjust my BT dose to whatever level I need at the time.

There are also ways to prevent the jerks from eth, Without insurance meth was my only option so manageing the side effects was my only option. I tried Niacin, then requip , then miripex and finally found Klonopin worked well on the herky jerks.

It just sounds like this doc isn't going to be the one to treat the high dose patients in the area. We have the same situation here, There are docs tha will use low dose opiates but when you reach their comfort level your told obviously you don't repond well so there is no point in continuing the titration which is hog wash.

If you feel your PM docs are limited or you just are not being guided to the right doc that can mange higher dose and higher levels of pain.

Use the old medtronics back door method, and ask them for a list of docs in your area that do pump implants. This should get you a list of names of docs that believe in the use of opiates. Although you certainly shouldn't be ready for an implant having only used low doses of meds, hopefully the implant doc list will lead you to a practice that has more to offer than your present doc without the mental restrictions on doses. Just because Avinza highest strength is 120, that doesn't mean that's the max dose. Morphine doesn't cause organ damage, you can become aconmadated to most of the side effects aside from constipation and likely reach a dose that works. It might be twice the 120mgs or it might be 4 times that dose. But once physically dependent, is the "cost" of using morphine any greater based on the dose. IMO NOT.

It may be time to art waves, I wouldn't burn bridges but I would certainly seek another opinion if one doc isn't able to manage your pain. Rememeber it's only one docs opinion and it absolutely seems based on his own comfort level of prescribing rather than your comfort level and ability to function.

Suggesting a change is easier than it sounds but there are other docs out there.

The group of docs I see now are pretty much the top guys in the area, they can offer any modality and the take the harder cases. The definitely cover their buts as far as being able to defend their prescribing practices with rules regs, contracts and no call in meds or bumps over the phone. If you need something you have to be seen, everything documented, a new treatment plan is devised and an explanation of why it''s neccesarry. Avinza could be your wonder drug if you ever got a chance to reach a dose that worked.

The AAPM has list of dpm docs in your area, The APS also has list in your area. If you have a good relationship with your pharmacist he may be able to recomend a doc.

The crazy thing about the doc I presently see is, They have always been in my own back yard, But while in the comp system and then an HMO, no GP or surgeon would refer me to these docs because of their own beliefs in the use of opiates. They know who uses opiates and who doesn't and if they keep steering you away from the guys that could do the job because they don't believe in their methods, it's tough to get in with them. It may require a change in GP's if he's unwilling to get yu where you need to be as far as a PM group that will continue to work with you untill you have reached a point of max benefit or intolerable side effects. For 7-8 years I sufered and waited to see PM docs thet the referring docs knew wouldn't use pain meds. So once I found they have ben around for longer than I have been in pain I was a bit upset with my GP nd surgeons that kept telling me you have to learn tolive with it, or it's in your head or your just a drug seeker because I was folish enough t sk for pain meds to treat pain. Silly me.LOL
I would give your presnt doc another chance and explain that just because 120 mgs of avinza or kadian doesn't work it doesn't mean thet 240 mgs wouldn't work either. IMO Kadian is a great med when taken twice a day. With roxi as a BT med I had the lowest pain levels I have had in years. That's why I just switched back to Roxiand hope I can achieve the same results with IT morphine and Roxi.

Once you reach a level that works, the proof is in he pudding, If you stabalize, stay at that dose for some time and can show the positive benefits, return to work, increased function, weight los from that ncrease in function, It's hard to dispute that your dose is too hgh. Too high compared to what. There will always be one patient that takes the highest dose. Although my numbers may sound high, they have been by far the highest doses I have seen or my doc uses.

But start lining up a back up list now, even before you see the doc to give him one more chance to titarte morphine, If things don't work out with your present doc, I would never burn a bridge should something happen. "Just in case"
let me know what you think or if you have any thoughts on th e whole titration process. Do you think you gave avinza or kadian a fair triall or was it yanked before you got relief or the side effects were too bothersome.
Good luck, Dave