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Pain doc changes all of my meds...I don't understand why..

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Posted 10/4/2012 8:56 AM (GMT 0)
Last month around Sept 10. I received a call from my pain doc and she told me I was approved for Exalgo 16mg's and she would add 8mg dilaudid for breakthru pain.. So I was put on 64mg's of Exalgo once daily and 8mg of dilaudid IR 3x a day..

I waited until my next appointment and told her I didn't feel that I was getting the same type of relief as my previous meds. Before changing to the long term and IR dilaudid I was taking 90mg's of methadone daily- 15mg's of oxycodone up to 4-tabs a day and nucynta 100mg's up to 3 tabs a day. So I thought I would just go back to this regimen of med's but she told me I was to only take 60mg's of methadone. 30mg's twice daily and no breakthru med's. I just don't understand. I asked why was I being cut down so much and she told me that the morphine equivalent was just to high to go back to my previous doses. I have had a great relationship with her for almost 5yr's and at one time I was on 200mg's of methadone.. This just doesn't make sense. She mentioned my lung problems but I've always had this problem. It's what caused my orthopedic problem..to much prednisone.. Any help would be appreciated..Thanks Randy

Posted 10/4/2012 10:34 AM (GMT 0)
Hi Randy, I'm sorry that you're having problems still with you're meds. I've heard a few people around here say that switching from methadone can make anything else seem ineffective for a while. I hope you're able to maintain some kind of control of your pain. I don't understand your PMs reasoning for the change, but I would think that cutting down on the methadone would help transitioning to another medication a little easier. Do you get any relief from ice or heat, or something besides meds that would at least give a little boost to their effectiveness?

I really don't have any other suggestions that I can offer, I know that the prednisone is a two edged sword, my grandfather has to take it, among many other breathing treatments, and has 5 stress fractures in his back from it. One of his kids asked my grandmother once why he couldn't just stop taking the prednisone, and her reply was "well, we can put on his tombstone that he had good bones."

Take care, and good luck. I hope you and your PM are able to find something that works for you.
Posted 10/4/2012 4:27 PM (GMT 0)
Hey Randy...I remember responding to a few of your recent posts about the Exalgo switch but I never saw a reply about the reason your Dr. wanted you to go off the Methadone in the first place if it was working so well and you weren't having to go up and up in dosage?

I'm not sure I understand what she means about the morphine equivalent was too high? You aren't on any morphine.....Did you mean to type the "methadone" equivalent was too high?

The other issue could be is that it is unusual for a patient to be on two short acting medications in such high dosages as you were on.

When a chronic pain patient is on a long acting medication, like your Methadone, then the short acting one they give is meant for "breakthrough" pain....it's meant to be taken once in awhile but not the max amount every day...

From what you have written, am I to understand that you were taking the 15mg Oxycodones 4 times a day, every day? As well as the 3, 100mg Nucyntas every day?

Because the states have been getting tighter in their laws/regulations and the DEA in their monitoring of especially short acting ones....this could be one of the reasons she is freaking out and has dropped all these meds.


But obviously this was not done in a proper taper. That is why I am asking if she knew that you were taking the max amount of Oxycodone and Nucynta each day? Maybe she thought you were using them once in awhile for BT meds and thinking that maybe you were already weaned when switching to the Exalgo and Dilaudid..

Either way, I would certainly speak with her more about this...can you email her your questions? Some Drs. are very good about this in between appts...

And I'm sure the answer is no...but have you had any issues lately with calling in for early refills of anything?

Just trying to brainstorm some reasons on why the big switch in the prescriptions...

Unfortunately we have seen this with a few members here lately when a Dr. has been prescribing things differently than most, that because of the more strict laws and pressure lately....they are having to scramble and now change the prescriptions for their patients to match more the "norm" which is one long acting med and one short acting for breakthrough...

Again...just throwing out some ideas...I would think you are going to go through some major withdrawals if you have been taking the max of all those meds....but because you had already switched over the last month to the Dilaudid....maybe it won't be as bad in regards to that?

May I ask what else this Dr. has you doing for your pain issues besides opiate medication? Do you take any nerve pain meds or a muscle relaxer? These can be very helpful to supplement the opiates for specific type of pain relief. I know I would be lost without my Flexeril for my spasms..

How about a TENS unit, daily exercise, aqua therapy, acupuncture, ultrasound massage, physical therapy, ice, heat, biofeedback, etc...

Again..just trying to help with some other ways to help with your pain...

Sorry that all of this came without knowing why...I hope you can speak with her by phone or email and get more answers...

Post Edited (Snowbunny21) : 10/4/2012 6:11:28 PM (GMT-6)

Posted 10/4/2012 7:01 PM (GMT 0)
Randy
I am so sorry that the meds arent helping you. It is always frustrating to change dosages and change meds to. When a doc dances around answering questions that is always an issue to.

hang in there and keep us updated on your situation.

Betsey
Posted 10/4/2012 11:38 PM (GMT 0)
Snowbunny, I just wanted to correct something. If I read his post correctly, Randy said that his Dr. wants him to take only 60mg (30mg 2x/day) of the methodone and nothing else - no breakthrough meds and no nucynta. That is a huge reduction from what he was originally on.

Randy, you definitely need to have a serious talk with your Dr. Even if she thinks you were on too much medication, it was obviously working and due to the tolerance you must have built up by now, there is no way the dosage she wants you on is going to put a dent in your pain levels. At the very least she needs to allow you to taper off. She can 'tinker' with the dosages/medications until a level of pain relief is found that she is also comfortable with prescribing. Good luck to you.
Posted 10/5/2012 12:10 AM (GMT 0)
Splash....thanks...I will correct my post as yes, I misunderstood the one sentence thinking he was still given Oxycodone for BT but only two...

And yes..this is all a huge drop from what he was on before he tried the Exalgo and Dilaudid last month I hope he can get some answers!
Posted 10/5/2012 12:24 AM (GMT 0)
Honestly my suggestion would be to stay with the exalgo and hydromorphone and give it more time (it may be less than perfect but it is probably better at the dosages you described than methadone 60mg; personally I never found breakthrough meds worked very well with methadone)......but whatever you decide to do, good luck.....
Posted 10/5/2012 12:43 AM (GMT 0)
RCNE...that is a very good suggestion for Randy...

Randy...is your Dr. willing to go back to the Exalgo and Dilaudid? I would think that would provide better pain relief if that is the only choice besides the one now.
Posted 10/5/2012 7:58 AM (GMT 0)
Thanks for all of the reply's ,
When I went in for my appt. my doctor told me she was only going to have me use 60mg's of methadone..No breakthrough. I couldn't believe what I was hearing and was upset but I have such a good relationship with this doctor I just didn't want to make waves..

This is what she told me and the reasoning behind the drop in medication. she told me they measure all opiate use to the amount of morphine. So 60mg's of methadone equals 225mg's of morphine according to the calculations they use from this site. http://www.globalrph.com/narcotic.cgi and according to them that's enough medication.
She also told me because of my shoulder replacement surgery in the next couple of months My pain would be easier controlled with my decrease in meds. But when I had the chest surgery and the other hip and shoulder replacement this didn't come up and they were able to control the pain with me on the 90mgs of methadone and oxycodone for breakthru. I really think someone from upstairs is making my doctor decrease the amount of meds being prescribed and this is from the fallout from the Florida fiasco and all of the problems with the Oxy's..Thanks Randy
Posted 10/5/2012 1:58 PM (GMT 0)
I answered on the other thread...It may be helpful to try and keep your updates to one thread if possible as it may get confusing with two going at the same time.
Posted 10/5/2012 6:05 PM (GMT 0)
Hi SB,

I was just about to do that. I started calling around to Duke and Univ of North Carolina hospitals and was going to fax them over my release form for my records,But I decided I would call my doctor and just lay it on the line.. I called ther office and within 5-minutes she called me back and wanted to know what was going on. I told her I was very uncomfortable with the present medication regiman and could you change it. No problem. Back to 90mg's of methadone and 5mg of oxycodone 6x's a day for breakthru and no Nucynta which was fine with me. I really didn't think the nucynta was doing anything but making me tired.

A very unusual 2 weeks between the Dilaudid ER and IR plus the Methadone and oxycodone. I have to stop by the office Monday morning to pick up my new scripts.. I don't know if it had something to do with the Board of Medicine or Pharmacy or maybe the DEA the AMA Who knows.. Sometimes these agencies want to see that I was tried on other medications and what the results were. Thanks for all the help.Randy
Posted 10/8/2012 9:31 PM (GMT 0)
My experience with methadone is that you are STILL dealing with the methadone withdrawal, only mostly hidden by the hydromorphone, and you need to give your neurons more time to adjust to the change. Switching from methadone straight to *anything* else is challenging, regardless of dosage, and the new med will be made 'artificially' less effective by the methadone withdrawal. I speak from considerable experience with both these medications.

Also, if you ever have to go off of it....hydromorphone's vastly shorter half-life makes it VASTLY easier to taper off of, in my experience. It took me about 6 months to get down from methadone to other pain meds, then another 3 months to get off of those in turn, about three years ago.....my more recent experience going directly off of Exalgo and Hydromorphone IR (Lannett brand) took me less than 9 weeks, not 9 months! I was aggressive, to be sure, and had lots of things to help me with (enough so that now my main challenge is to get off of all of *them*!) the withdrawal, but just like with the 9 month taper, the final step-off at 1-2mg sublingual hydromorphone was almost anticlimactically easy. I can't say that about methadone or its somewhat similar cousin, levorphanol -- despite both of their advantages, on paper, as long term chronic pain medications.
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