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Re: Dr. W.

Re: Dr. W.

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Posted by MLWhitworth, MD on March 27, 2000 at 20:41:43:

In Reply to: Dr. W. posted by John V on March 27, 2000 at 11:38:12:

Wow!! What a complex history!
Pseudoaddiction may have had some place in your history. Certainly drug holidays do not work and the old theory that opioid receptors reset themselves has been disproven.
The way to demonstrate conclusively the pump catheter position and continuity with the pump is by a myelogram through the pump. The pump has either a separate access port or separate chamber accessable via special needle that allows this. By withdrawing the morphine in the catheter through this needle then injecting contrast, it will be readily evident the pump-catheter system is still connected and in the proper place.
Your doc may be correct about the scar tissue, but I doubt it...usually there is very little in the subarachnoid area unless you have arachnoiditis. Another option is adding bupivicaine and/or clonidine to the pump.

: After reading the last few posts of everyone, I am more confused than ever.

: My original pain doc, who has since retired, told me when he put me on methadone that I would probably be taking it for the rest of my life. He also made pyschological counsling mandatory for continued treatment. After seeing the shrink for about 6 months and learning all the extra ways of dealing with chronic pain, the shrink told me that I would only have to see him when I felt the need. When the pain doc retired, after treating me for about 3-4 years, I was taking 60 mgs of methadone daily and doing fairly well.

: The new doc that I was referred to, right away started telling me that I needed to take a "drug holiday" and then lower my daily dose. One month after having my fourth spinal fusion he was insistent on taking the "holiday". I was just as insistent that I would get another doctor.

: The next doctor told me that she thought that 20 mgs of daily methadone was enough for anyone. However, since I was already taking 60 mgs, she would keep me there as long as I knew that was the limit. She also said she doesn't believe in the "drug holiday". That was fine until the 60 mgs was not doing enough anymore.

: I knew that I could get no more methadone and I was taking about 70-90 mgs a day. There was a few times that I went through withdrawal symptoms when I would run out days before my new script, not to mention the increase of the pain I was being treated for. It was at this point that I started questioning my sanity. I thought that maybe I was inventing the pain in my mind just so I could justify (to who?) taking the extra meds.

: When I finally admitted to the doc what I had been doing, she told me that I needed to go to NA. I agreed to go if she insisted, but stressed that I didn't think that addiction was my problem. She agreed to have me see a neurosurgeon before I tried the NA approach.

: The neuro said he saw all the problems in my spine and that surgery was probably not indicated due to my medical history. It was he who suggested the morphine pump. I agreed because I thought that if I took the ability of the patient (me) out of the equation that I would get the pain relief without the worry of what I could do about the amount of meds.

: It hasn't quite worked out as well as I had hoped. I have had problems with the dosage. I feel like right now I am not getting the pain felief I need (is the pain real or imagined?) or that there is a problem with the pump. Recently, while I had the pump and it was operating (20mg/ml, 1/2 cc daily intrathecal), I was hurting(?) real bad, so I took two methadone pills that I still had. I finally felt real(?) pain relief.

: In the last few days, I have had x-rays and a CT scan so the docs could make sure that the catheter is where it needs to be. All of them, so far, have been inconclusive. According to the docs, this may be due to the amount of scar tissue and the amount of hardware that I have in my back (wire, screws, stimulators, etc.). While I wait to have another CT scan, the doc prescribed Lortab 10/500 and made it clear that she expectsw me to take no more than 4 a day. I am trying to force myself to only take the 4 a day just so I know I can do that, but yet the pain(?) increases and I feel worse each day.

: That is kind of my history in a nutshell (good choice of words). Psuedoaddiction? I have no idea.

: The neuro has suggested increasing the morphine to 30mg/ml. You say this is high compared to your patients. I was taking 60 mgs of methadone daily. You say this could have been increased, but my docs made it clear that it could not have. I do know that if I could have been given a bigger daily dose of methadone that I would not have had the pump implanted.
: The way it sounds though is that would have been just putting off the problem, that eventually the methadone wouldn't have been enough. Maybe the pump was in my future no matter what I had done.

: My docs say that stress increases pain, which I agree with. The stress is inevitable.

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