Hi
72daywmn,
Quote:
Originally Posted by 72daywmn
1. Is it the baseline med (Oxy) that needs to be increased so I require less BT meds? Or do I need stronger, more or different BT meds? Or do both the baseline and BT meds need adjusted? I just don't know exactly how to explain the pain and situation to discuss it with the doc. In the past, he has just had me show him a chart of when I take my meds each day and the pain levels throughout the day, but I'm not sure that this is getting the correct treatments.
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These are decisions for your doctor to make after you describe to him your pain and the effect it has on your day-to-day life. Review the articles that come up Google:
talk doctor pain
The chart is a good idea for all chronic pain patients, whether their docs request/look at it or not.
Quote:
2. What is the strongest OxyContin ER dose, and what might be considered "average" or normal for my conditions? Like I said, I feel weird needing to go up in dose all of the time- it makes me feel strange because of the stigma associated with taking narcotic pain meds anyway, and though I've been going through this for more than 3 years, it is still hard for me to accept that I am only 39 years old, and will be in this condition and requiring pain meds for the rest of my life, (barring divine intervention or major medical or surgical breakthroughs). I also worry that at this rate, I will be at the maximum doses of everything soon, and there will be nothing else I can take, and then what will I do. Has anyone else dealt with these feelings? Why am I afraid to take the medications I clearly need? I think it's the need part that scares me. 
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With most opioid medications,
medically there are no upper limits.
Politically, however, is another story; some states (like WA) have actually legislated how much pain a person is "allowed" to have/be treated for (by legislating maximum levels of medications that can be prescribed). Let's not get me started...
The largest dose of oxycontin mfd. is 80 mg. They used to make a 160 mg., but again, politics stepped in and eliminated that. Doctors may still prescribe higher when medically justified. There are also other options, like fentanyl patches, implants (medication and/or electronic). (BTW, have you tried accupuncture? Google it for
chronic pain). Another option is switching to methadone. Methadone carries some different risks than other opioids (requiring even closer monitoring during the phasing-in period -
mrsD &
I have both posted articles concerning benefits/risks of methadone) and unfortunately may also carry some stigmatic risks, however it's also different in how it works on pain control in the brain.
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Pain can be divided into two types of physiological explanations: nociceptive and neuropathic. Nociceptive pain is generally caused by tissue injury (somatic pain) or injury to internal organs (visceral pain). Neuropathic pain is caused by injury or insult to nerves in either the central nervous system or the peripheral body.
We are blessed with opiate receptors in our brains that allow our bodies to respond to opioid pain medications. The majority of these receptors are classified at mu and delta receptors and a smaller percentage are NMDA. Nociceptive pain is primarily mediated by the mu receptors and neuropathic pain by delta and NMDA receptors; morphine binds to mu receptors only, while methadone binds to mu, delta and NMDA. Morphine does an excellent job of treating many types of pain, but because of its ability to bind to 100% of opiate receptors, methadone may do it even better.
http://dying.about.com/od/opioidpain...doneVmorph.htm
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Methadone is also extremely inexpensive.
All that said, while there are no upper limits with opioids, the higher the dose, the higher the risk for/of accidents and incidents. Vigilance and monitoring are imperative; opioids are never to be treated lightly (not implying you do).
There is one other thing I can think of at the moment that I think is worth looking into, but that your doctor may not be familiar with yet, and that is the depleting/suppressing effect intactable pain and opioids have on adrenal hormones. When patients with these hormones suppressed from pain or medications have them supplemented up to normal levels, they have reported up to a 50% decrease in pain levels, and that their medications work better again. I've been posting a lot about this subject in past months. It comes from
Dr. Forrest Tennant, whose
Handbook for Intractable Pain Patients you're probably already familiar with.
As for the WC, you're paying an atty for advice there, and I don't feel comfortable commenting on that.
Doc