Jennelle -

Let me join the chorus on this one. You are being done wrong.

And for what it's worth, the same issue came up for me at an appointment with my pain mgt. doctor on Friday, but he handled it in a completely different way. I went in complaining that my 20 mg. Oxycontin tablets were just not enough anymore: they were lasting all of 90 minutes as opposed to the advertised 12 hours. So I asked for an increase in my prescription, which was quickly turned down on the grounds that the drug was simply not working for me anymore (I remember years ago when the same thing happened with Vicodin) and to increase the amount of the dose would be simply to invite something called Hyperalgesia or "abnormal pain sensitivity manifested as increased pain from noxious stimuli and as pain from previously non-noxious stimuli." Opioid Guidelines in the Management of Chronic Non-Cancer Pain, Andrea M. Trescot, MD, et al, Pain Physician, 2006; 9: 1-40, at 17, http://www.rsds.org/2/library/articl...sician2006.pdf

Instead, the answer according to my doctor lay in the long settled concept of "opioid rotation." See, Pharmacotherapy Principles & Practice, Marie A. Chisholm-Burns et al (McGraw-Hill Professional, 2007):

Opioid rotation is the switch from one opioid to another to achieve a better balance between analgesia and treatment-limiting adverse effects. The practice is often used when escalating doses (greater than 1 g of morphine per day) become ineffective. In some settings opioid rotation is utilized routinely to prevent the development of analgesic tolerance. [at p. 497]

See also, Opioid therapy for chronic noncancer pain: practice guidelines for initiation and maintenance of therapy, Coluzzi F., Pappagallo M., Minerva Anestesiol. 2005 Jul-Aug; 71(7-8): 425-33, at 428-29, http://www.minervamedica.it/en/freed...2Y2005N07A0425

So what my doctor suggested instead was that I switch all the way to methadone, which, in addition to being a strong relatively opioid is also an antagonist of NDMA (Nmethyl-D-aspartate) receptors, as is ketamine and Namenda (memantine), among others. [Trescot et al at p. 14.] Having said this, I understand that methadone poses unusual risks to people with cardiac arrhythmia (which I don't have) and obstructive sleep apnea, which I've got. But where the latter is well controlled with the use of a BiPAP machine (an advanced and more comfortable version of the CPAP) I am prepared to see how I react to it.

But the purpose of this post is not to extol methadone, but the virtues of opioid rotation.

Bottom line: it may not be in your best interest to ask for an increase in your prescription dose, as much it would to simply switch meds. And the list of potential choices is large, even if it winds up being something as relatively benign as Tramadol, which may be helpful to CRPS patients due to “its concomitant serotonin/norepinephrine re-uptake block.” RSDSA Complex Regional Pain Syndrome: Treatment Guidelines, Section 3 Phamacotherapy, R. Norman Harden, M.D. at p. 29, June, 2006, http://www.rsds.org/3/clinical_guidelines/index.html

Perhaps worth discussing with your doctor, or a new one.

Mike