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Too low of a dose for BT med?

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Posted 12/29/2012 10:26 PM (GMT 0)
Hey all, just had a question and wanted some opinions on it. So since June of this year I have been on a 75 mcg/hour fentanyl patch every 3 days (10/mo). However, after being as patient as I could, I finally called my doctor last week right after Christmas and told them I needed something for BT pain.

I went in to the doc's office and talked to her and she was really understanding. I kindly explained to her that while the patches worked fine most of the time, that there were a few times a day (namely first thing in the morning, late afternoon and in the middle of the night) when I had severe BT pain that the patch wasn't handling. She said she understood and gave me a prescription for 40 oxycodone 5mg tablets to be taken 2x daily, 1 tablet each time (so 2 tabs a day as needed). I also told her that the patches don't usually last past 2 days instead of the 3 days and she said that was one drawback with the patches but the oxycodone should help.

Now it is day 3 since I filled the script and I cannot for the life of me take just 1 tablet 2x daily. It does nothing at all. As of today I decided to try more so I have taken 2 tablets this morning and just took another 2 (6 hours in between doses) and will probably need 2 more tonight at some point to handle the pain.

My concern is that I only have 40 tablets and if I have to take 6 a day (which honestly still doesn't seem to be working but its better than just 2 a day) I will run out in about a week give or take. Should I call my doctor again later this week and ask what I should do? I don't want to get into trouble for taking more than what was prescribed but my doc told me that she was giving me the lowest possible dose. I'm just stuck because I appreciate her finally giving me something for BT pain to go with the LA med but I don't want to seem like I am just trying to get more pills that I don't need, because I really need them.
Posted 12/29/2012 10:38 PM (GMT 0)
Call your doctor and explain that the BT meds are not working well enough. If your doctor has 2 cents worth of sense then she will know that the dose and/or med prescribed is a starting place for BT pain control.

BTW: You really need to stop taking more than prescribed. I don't know your doctor but I do know many doctors get quite upset when their patients take more pain meds than prescribed because they feel they are abusing them. It is quite common for doctors to kick people to the curb for this. Doctors may forgive someone once for this but few will forgive twice. When it comes to pain medications the adage of it being better to seek forgiveness rather than permission does not apply.
Posted 12/29/2012 10:46 PM (GMT 0)
Thank you. I understand completely about not taking more than prescribed. This is the first time I have ever done so and I will try to call the doctor first thing Monday. I am not trying to abuse them by any means but when I tried taking just 1 tab 2x daily it was like I wasn't taking anything at all. I don't sleep well at night because of the pain and its just really frustrating when I get in bed at 10pm and don't fall asleep until 5am and end up waking up at 9am every night.
Posted 12/30/2012 1:28 AM (GMT 0)
Sorry your having such a time with your pain. Optimal would have been for her to change your fent to 48hr change but she oopted instead to go for low dose b/t.

However you decided the dose was not doing anything and took 3 times the amount she ordered. I would not do that again and I would not tell her you did. I would call her asap and tell her that the 5mgs absolutely made no change in your pain levels. At this point she can do several things,up your b/t,change your 72hr to 48hr fent or nothing at all.

As Jim said this is a big no no with most PM docs and violates contracts which to them is unforgivable offense. I have been with my current Neuro for 5 years and he would certainly "kick me to the curb" the 1st time.

Good Drs are so so hard to find when treating CPrs you cannot afford to lose too many.

Some of us have been around these forums long enough to have seen this happen time and time again, not trying to be hard here and certainly understand hurting and having a means to stop it and how frustrating it is to not be able to use. Doing so can have consequences alot of us cant afford.

Please call as soon as you can and hope your pain levels out soon.

Posted 12/30/2012 2:30 AM (GMT 0)
Thank you for the responses, I appreciate it. Its just that I have never had this sort of thing happen and didn't know how to proceed. I will call Monday morning and hopefully get an answer.

Earlier this month they tried to put me on methadone instead of the patches but it made me very sick to my stomach so I called back 4 days later to report it. I went in and talked to her about it and she switched me back to the patches and gave me a script for them immediately.

I am only worried that they may not be open or have any openings to see my doctor until after New Years, since I have my 3 year old son visiting me for part of Monday and part of Tuesday. I only see him a few times a week and want to be able to play with him like he wants me to, but the pain is so bad at times that trying to keep up with him seems impossible. :(

Note: I edited my signature with my official DX from my visit with interventional pain doctor since it has been a few months since I have posted here and realized I should update my signature.
Posted 12/30/2012 4:58 AM (GMT 0)
Hi outtammo, sorry you're having so much pain that isn't getting under control. I'm afraid I have to agree with the others, you really need to get your doctor's permission before upping your dose. I know how terrible it is to have pain that you just can't escape, but it would be far worse to have no medication to fight it with, than to need a stronger dose. Just my thought here, but if two percocets aren't getting you in much better of a spot than one, why take the second? I know there are a few people in the forum who get better pain relief from hydrocodone as a BT med, than oxycodone, this might be something to ask your doctor about. But everyone is different.

Another thought here, is there an on-call number you can use to get ahold of someone from your doctor's office? If you could get ahold of them, they might give you permission to go ahead and double up, and they might also get you on the schedule to see the doctor.

Anyways, I hate to hear that you're in so much pain, but none of us hear want to see something really bad happen, where you got booted from the doctor's practice. Any time I'm in so much pain that the split second thought comes to mind of trying an extra BT med, I just try to remember what the raw pain is like without anything. I certainly don't want to run out, and I don't want to stop getting any at all.

I hope you're able to get this taken care of soon, and get something that works better, I know how precious our time with our children is, 2 years ago, I didn't get to see my son at all for Christmas, my ex wife just left town with him, without telling anyone, and I didn't get to see him for two weeks. It wasn't fun. Take care, and keep us posted on what happens.
Posted 12/30/2012 5:05 AM (GMT 0)
Matt:

I took the second one instead of just one simply to see if it would help any more than just the one. I am not one to abuse my meds and I agree with you that not having anything would be much worse than having too little. It was just that I got fed up with just the one 2x daily that I may as well have had nothing at all.

I will try to call the doctor at the hospital, as I am sure there is an on-call doctor there. I never really thought about that, thank you for the suggestion. I was going to wait until Monday but they usually never get me in to see the doctor the same day if I call so hopefully if I can talk to someone tomorrow morning then I may be able to get in on Monday before the holiday. I will let you all know. Thanks again.
Posted 12/30/2012 9:11 AM (GMT 0)
Hi Outtammo, sorry to read that you are suffering so much.You know thats the tough part when dealing with CP is getting the right medication and dose in line to help with the pain. From the way it sounds you would be much better off getting the patch changed at 48 hours to achieve the best pain control. It is not unusual at all for patients to have to change the patches every 48 hours rather than 72. When I was on Fentanyl patches they never lasted 72 hours, in fact the last day was mostly horrible because I was in severe pain and had some withdrawal symptoms going on too.

If this is a PM dr she can tell you to bring your meds in for a pill count, some do this monthly to make sure the patient is taking their meds correctly. That is another reason to take your meds as directed. No one here is judging you we don't want to see you get kicked out of PM. When that happens its difficult to get another dr to take over your care. I sure hope you can talk to your dr.

Take care.....Susie
Posted 12/30/2012 10:18 AM (GMT 0)
Go easy on yourself and the parenting thing,its quality time versus quantity here. As for the methadone it didnt really have a fair chance to work in 4 days and usually the side effects go away after a bit. I still have to take a nausea med if I have to increase for any reason but only for a day or so. Just a tip in case you have to try it again. And please dont think we were being harsh as Susie said what if they said bring in your meds? They do that alot and what if you had to go to E/R as they always want to see them. One bad mark in your record and treatment becomes more difficult as those records follow you to every Doc.

Good luck
Posted 12/30/2012 12:47 PM (GMT 0)
This may be a silly question (first cup of coffee here), but have you tried adding an over the counter NSAID like Motrin or Aleve? They can help with inflammation, which could maybe take things down a notch, unless you are on them already. Even if you've taken them before, taking them in this combination could be significant.

Just a thought.

And the suggestion about not telling the doctor about taking it is wrong. I'm sorry, it's wrong. It's the holidays, lots of offices closed, you were miserable, you tried something to make your life bearable, you need to be honest with the doc about it. Tell him when and how many extra you took. If it was 1 (one) extra dose over a 30 day period, then maybe that would slide. That could be chalked up to a mistake or desperation on a bad day. Just about any doc would give you that leeway.

I've doubled up my night meds before. Couldn't remember if I took them or not, (I usually take them at the same time every day) and had to wait 2 hours to see if there was a difference, there wasn't, so I took them again, then they hit me like a brick. Now, at the time I was close to 300 lbs and had a high tolerance, so it just made me groggy. I have one of those pill minder things now. Slept well that night, but the ex-wife was freaked out and kept nudging me every hour or so to make sure I was still breathing. Glad I was off work the next day too.
Posted 12/30/2012 12:53 PM (GMT 0)
I'm so sorry to hear what your going thru. I don't know if it will help but I'll share my experience wi Fentanyl patches. Rx 50 every 3 days. 1st day pain 2nd day glorious relief 3rd day withdrawal that I didn't know was withdrawal. Kept the patches on just adding & adding. Bad idea. Couldn't think . thought I had a stroke. Finally talked to a drug counselor. Figured it out. Finally what works: 25 & 12 on alternate days. keeping the old patch on so wearing 2 at all times. That meant big time reduction. Took a year before getting over the withdrawal. Like sweating thru 3 t shirts per night. For me its a fine line between being able to use my brain while controling the pain. Sounds like a song. For me, a small amount every day with a carry over keeps an even level of medication in my system. I don't know if a more level amt in your blood stream would be helpful. Just a thought. Good luck Puppy love from InventingJoy & the Furry folk
Posted 12/31/2012 4:25 AM (GMT 0)
My breakthrough is 15mg roxicondone and I split in 2 with my dr approval. Occasionally I take both halves. Most important is ur dr needs to know what you do.
Posted 12/31/2012 4:40 AM (GMT 0)
they had to change my fentanyl 75 from 72 hours to 48 hours,, it made a big difference with me and my cancer pain. that would be an easy thing to ask your doctor for starters

david
Posted 1/4/2013 10:06 PM (GMT 0)
So I finally went in a couple of days ago and the doctor said they don't want me to be on any percocet if I don't need it so they changed my patch from 72 hours to 48 hours. However I was not thinking when she told me that they were going to give me 3 more patches to last until my next refill. The problem with this was she thought I had 5 patches left so 3 more would last me when I really only had 1 patch left when I received the 3, and since I was replacing them every other day I had less and I think she did the math as if I used them every 3 days.

So I realized this today when I went to put my new patch on and saw that I only have the 3 remaining and that would only last me until next Wed when my refill isn't due until the 13th or 14th. I called the doctors office as soon as I realized this and left a message with the PA there as an emergency call. I can last until Tuesday night/Wed morning but after that I will be all out.

I am glad they decided to change it from 72 hours to 48 hours but now I feel dumb for calling back 3 days later to report that I will still be short. If the doctor does the math correctly and knew I was changing them every 2 days since the 14th of Dec., then she would obviously know I will be out sooner than later.

Thank you all for your comments. BTW I can't take NSAIDS as I am allergic to them.
Posted 1/4/2013 10:14 PM (GMT 0)
I'm a bit confused so I apologize....So you started changing the patches every 2 days instead of 3 on your own before you went to the Dr.s and got their ok?

Do they know this part? If so and they were ok with it then I think you should be fine with her redoing the math and giving you the amount you need.

If they think that you just started doing this after your appt. then you may run into issues with them expecting you to have the extra patches...

Do you have any of the 40 Percocet they gave you? I couldn't quite tell what date you got those and they were for 2 a day to last for 20 days so you should have some of those left as well to help until this gets worked out...I hope you didn't go against the prescription every day and take 3 times the amount of 6 of them....Or did they say this was ok to do?

Not trying to accuse just trying to sort out what the situation is...I just really caution you (and others) to never take more than prescribed unless and until a Dr. has ok'd this...

Post Edited (Snowbunny21) : 1/4/2013 3:17:44 PM (GMT-7)

Posted 1/4/2013 11:01 PM (GMT 0)
I told them the problem I had with them not lasting 3 days and they told me it was fine that if they did not last 3 days then change them when needed or when I started to feel sick when they weren't working. I told them this back in October.

I told my doctor when I saw her last that I was still having this problem and I told her I was changing them every 2 days not 3 since the instructions say to replace your old patch with a new one if it stops working or falls off, and she was okay with this. My problem now is that her math was off or she did the wrong math completely and I will be 2 patches short of my refill date. I only ask to get enough to last me. I am awaiting a call back from the doctor now. I will let you know what she says.

No I do not have the percocets as they wanted me to return what I had left to the office when I got 3 extra patches on Monday. This is just their rule. If they want you to use something else then they ask that you return what you have of your old med. I had to do the same thing with the methadone when they switched me back to the patches from that.
Posted 1/4/2013 11:14 PM (GMT 0)
I too hope when you saw the dr you told her you changed the patches early. If you didn't do not be surprised if she declines to call in more patches to last till the next refill. I would worry more about her kicking me to the curb than anything. You have to understand with all the new guidelines in place for PM these drs do not want the DEA breathing down their necks and the DEA does monitor drs on how many scripts they write per month for narcotics. My drs happens to write more scripts than any other PM doc in our state. She gets regular visits from them for her records to be audited. A lot of drs are scared and intimidated of the DEA visits and afraid of having their licenses take away. My dr is not, she says she would rather deal with them any day rather than the state board. But, not many have her attitude either when it comes to the DEA.

I hope you get this worked out.
Posted 1/4/2013 11:39 PM (GMT 0)
It seems you should be fine then and nothing to worry about if they know you have been changing them early for awhile now....You have enough for 6 days so if it takes them until early next week to figure things out you will be ok to pick up the other prescription for the remaining ones..
Posted 1/5/2013 12:20 AM (GMT 0)
I just spoke with my doctor and they have bumped up my next appt from the 14th to next Monday. Like you said I have enough to last me through Wednesday so I am not too worried but I would prefer not to have to wait. 5 days is a long time to go w/o any pain meds.
Posted 1/5/2013 12:36 AM (GMT 0)
Oh...I was thinking that you could easily drive by there on Monday or Tuesday to just pick up the new prescription for the remaining patches since I thought you just had an actual appt. with them.

So, that is great that they were able to get you in this Monday....I wonder why they have to schedule an appt. just to get the prescription? Maybe I am missing something why you go in more often than every month?
Posted 1/5/2013 9:10 PM (GMT 0)
Normally I go in once a month. Its just that this month I have gone in a couple of extra times. Once to get a BT med and the second time was when she changed my patches from 3 days to 2 days. I have only been with this doctor since June 2012 so I am guessing that is why I need to go in monthly.
Posted 1/5/2013 9:27 PM (GMT 0)
Thanks for explaining more..

And now that you have the early appt., you don't have to worry about the count as this will be your regular monthly one and start the clock ticking again.
Posted 1/5/2013 9:54 PM (GMT 0)
Outta, a lot of the docs require the patient to come in once a month when there are opioids being rx'd. In my state if a dr writes a script for them, then she has to actually see you in the office for a appt.

Take care....Susie
Posted 1/5/2013 10:41 PM (GMT 0)
That's the way it is here also - the doctor has to actually see the patient in order to give the prescription. The doctor my fiance sees now (was my doctor for over 7 years) has pain patients come in twice a month. I had one other doctor that had this same policy.
Posted 1/5/2013 11:36 PM (GMT 0)
I think it may be as Susie mentioned, a state regulation, as I am only required to come in every 3 months and there is no difference in my treatment than many here with being on opiates along with other meds and modalites.
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