First, I would like to say, I am a patient of Dr. Forrest Tennant. His research results in him prescribing Human Chorionic Gonadatropin (HCG) along with Taurine, DHEA, Pregnenolone, GABA Amino Acid, and Glutamine at least in my case as a woman. You have to have a blood test done of your hormone levels at 8:00am. He is in CA, just outside Los Angeles. He has a few colleagues around the country that follow his protocol. He can be reached at 626-919-1323. However, his office is not open every day of the month. He runs a pain clinic week once monthly to care for all his patients. He is wonderful. This may be a direction you want to look into. The results are not immediate and involve self injecting the HCG up to three times weekly. Before seeing him, he agreed to issue blood test orders for me to avoid an extra trip as I live in CT. Currently, I am off his regimen as I need to follow up with him. It did help however. But, it was used in conjunction with my opioid regimen. It is well worth your time to download and read Dr. Tennant's Intractable Pain Guide regardless.

My opioid regimen includes 400mcgs of fentanyl patch for long acting pain relief, fentora...fentanyl buccal tablets for breakthrough pain, and methadone at 120mgs per day (30mgs four times daily) for my nerve pain. This combination is a very high dosage of opioids. I have RSD/CRPS along with other chronic pain conditions which preceded the onset of RSD/CRPS, including back problems in the same area as yourself. I have had back surgery, however. I also have other areas of my back and body involved with the chronic pain. I have lived with pain since age five. I am 41 now. I also use a topical compounded cream which has morphine, ketamine, flexiril (spelling?), ketoprofen, and procardia in it to rub on painful areas. the lidoderm does not help me.

In the meantime, the methadone was added when I had terrible side effects from neurontin and four other anti-convulsants. I do not know if you have nerve pain, but if you do, perhaps you can try an anti-convulsant to help add to your pain control. Personally, I only get nerve pain relief from methadone, even if does hit the other receptors. The improvement from it was marked and immediate. Perhaps it will work for all your pain. It comes in two dose types, 10mgs and 100mgs. The lower dosage is for chronic pain. The higher for former heroin addicts. Yes, it is cheap. I read some comments about finding cheap meds in the thread. My dosage started at 40mgs per day and has risen to the present dosage as stated above. If your doctor says he cannot prescribe methadone as only drug counselors with a special license can, he is wrong. He needs to write, "For Treatment of Chronic Pain," under the rx for methadone.

I personally love fentanyl as it has no highs. The only side effect for me is possible tiredness from a breakthrough dose. The patch makes it so I am not tied to the pill bottle as I was, beside BT dosages. The OxyContin you are taking is fairly high, but there is room to go higher. It does not work for me at any dose. There is also dilaudid which is stronger than the OxyContin. I do not respond to that either. Perhaps your OxyContin dose can go up, or dilaudid can be prescribed instead.

As for your breakthrough medicines, you are on medications that are much less strong than your long acting medicine. There are many options there from morphine sulfate instant relief (MSIR) to oxycodone. Some docs are hesitant to prescribe the oxycodone however. The ultram you are on is not an opioid, but an opioid agonist and is related to the nyucenta you mentioned. As far as Opana, it is a newer form of long acting morphine. As for The Percocet, it may work if it is increased.

I think it is important to understand, there is no formula that works for all. Everything I mentioned are just options to alter your current regimen. Adding methadone may be the cure all for you. Maybe not. Pain Management is really in its infancy still. Did you know that doctors receive about three hours of training in pain management in all of medical school. Have you asked your doctor if he thinks there is a procedure like a nerve block or a epidural which may benefit you? Procedures along with acupuncture and minimal exercise...walking...can be highly beneficial. I also use meditation as a form of pain control. Meanwhile, back to what I was saying about no cure all. It may take quite a bit of time before you find the right combination of therapies. You may even need to consult another doctor if this doctor is unwilling to work with you. Pain is a beast much like an ape running free and crazy through the streets. It needs to be reigned in and put under control. Doing this involves getting you on a sufficiently high dose of long acting pain medicine to where breakthrough meds are not being relied on beyond the dosage prescribed. it sounds like your regimen needs tweaking. it may be unrealistic to get to a pain score of three everyday. I have learned to live at a 5/6. You just must be willing to work with the doctor and find a doctor willing to work with you. I think keeping a strict pain diary at this point is important for you as it will reveal a pattern your doctor can work with to help abate the pain based on when you flare and when things subside. Doing your part shows the doctor you are a patient in pain trying to work with the doctor to help find a solution.

I wish you all the best in finding the best relief you can. If I am completely honest, I have to say it is not an easy road to follow. You will have ups and downs. Being open to some alternative treatments in addition to medication will surely benefit you. The worst that happens is a particular therapy does not work. At least you know you tried everything you can. I he this post helps you and clarifies some of the confusion as well as elaborates on other things people mentioned. Feel free to private message metaker his site. take care and be well.