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Re: Dr. Whitworth/Oxycontin dosage levels & complications

Re: Dr. Whitworth/Oxycontin dosage levels & complications

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Posted by Michael L. Whitworth, M.D. on February 09, 2000 at 04:54:27:

In Reply to: Dr. Whitworth/Oxycontin dosage levels & complications posted by Angyl on February 08, 2000 at 07:37:24:

: I suffer from a rare chronic painful disease called Hidradenitis Suppurativa. I constantly have multiple, huge breakouts of boils in my groin area. Have been seen pain mngmnt for one year now. Currently taking 80 mg./3 X day for 6 months now. Worked well, but no longer. Complications due to 3 rear-end collisions recently--9/10/99 & 1/3/00--both serious (hit from behind at highway speeds while at stop lights (totaled car and neck and back), minor collision on 1/26/00. Oxy is just not helping. Pain mngmnt dr. refuses to treat severe neck and back pain due to not original reason for treatment. I'm in agony, even with the meds. Have to change pain docs anyway due to change in insurance. Have apt. w/new neurologist/pain mngmnt specialist next week. Where do I go from here? Docs think dosage levels are already too high. All I want is RELIEF--I'm losing my mind, not to mention sleep. Advice?
The next step beyond oral opioids is an implantable intrathecal infusion pump, but I use this only when opioids are causing significant complications. Your dose of 240mg/day oxycontin is high but there is a 20 fold difference in responsiveness to opioids in chronic pain, so I have patients on much higher doses when indicated. As long as side effects do not preclude usage, there is no ceiling to opioid dosing. Side effects however usually intervene at higher doses such as sedation, phasing out, intractable constipation, severe headaches, swelling of the extremities, nausea, and skin lesions. As long as you are monitered there should be no problem. The acute on chronic pain problem is a bit more complex...we also do not treat acute injuries, however once a patient has had them 3 months or more, we will treat such injuries and perform the appropriate diagnositics. Good luck with your new pain doc.

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