Opiate dosage

[ruralhome24]

Hello- new poster just seeking advice really

I've been prescribed the following (taken daily as prescribed, no abusing meds, crushing, etc)

Morning: 10mg Oxycontin, 50mg Tapentadol
Evening: 10mg Oxycontin 50mg Tapentadol 20ml Oxynorm

but due to breakthrough pain I have increased my dosage to:

Morning: 15mg Oxycontin 100mg Tapentadol
Evening: 20mg Oxycontin, 100mg Tapentadol 25ml Oxynorm

However my doctor is concerned that it seems like a lot of opiates and won't adjust my prescription- I've been referred back to the pain clinic as even the increased dosage isn't really controlling the pain adequately...Just wondering if it is a lot of opiates to take on a daily basis or not?

 

[Ignio]

You do not state how many mg each ml of OxyNorm containes for one.

Seen from a general perspective, your dosages is not unseen and is not that high. But we can't say anything about whether your dose is high without knowing the extend of your injuries and how much pain your are in.

Breakthrough pain should be something you experience from time to time and thus requires a little more pain killers than usually. Breakthrough pain is not something that should increase your dosage for good, then it isn't breakthrough pain anymore.

Normally a doctor would give you a slow release pain medication (in your case OxyContin) to handle your pain throughout the day. Every know and again one will then experience breakthrough pain requiring some extra pain killers here and now, that is instant release pain killers. In your case OxyNorm.

The best advice I can give you is the find the amount of OxyContin required for you to be able to handle your pain and take that each day. Then you can add OxyNorm when you need it on days with breakthrough pain. Explain to your doctors that you don't feel that your pain is covered to a satisfied degree and see what they say. Normally "normal" doctors are very careful with strong pain killers whereas pain specialists are more aware of how much pain certain injuries cause.

We can hardly say anything as we lack information and as we are not doctors. I hope you find a solution. No one should live under constant pain. But you probably cannot expect that the medication will remove your pain complete if it is of a chronic nature.

 

[ruralhome24]

Oops- sorry- I take 5mg in 5ml Oxynorm. I am gradually becoming wheelchair bound and cannot walk far at all and even then it is with a stick or support. I work too so it's also difficult..

I am not expecting to be totally without pain however I do want to be at the point where I can take the edge off the pain enough that I can function however it's a really difficult balancing act as if I up the opiates then I'm so doped up I can't do much but then if I don't take enough then the pain's so severe I can't do much anyway..

 

[Ignio]

Okay. My initial thoughts is to ask to get your OxyContin dosage increased.

The new dosage you have increased to yourself:

Morning: 15mg Oxycontin 100mg Tapentadol
Evening: 20mg Oxycontin, 100mg Tapentadol 25ml Oxynorm

Is still not enough? Are there a specific reason for them giving you Tapentadol? It isn't as powerful as the other things you get. I can't see how Tapentadol should do anything when you get oxycodone.

You could start by asking to get 30/40 mg OxyContin each morning and each evening. As a side note, I also think there is a long time between morning and evening. I would think you should have a dose a morning, midday and evening.

I take 5mg in 5ml Oxynorm

So in your 25 ml OxyNorm there is 25 mg OxyNorm? I don't get why you get an instant release dosage right before you have to sleep. It would make more sense so spread the OxyNorm throughout the day and take it when needed.

I think I would ask how much more OxyContin you could get id you dropped the Tapentadol and take your OxyContin three times a day.

But again, I am not a doctor, so I should not really be giving any advice on this. This is just based on my own experience.

But just make sure to inform them that the pain is influencing your well being at the moment. You should not be afraid to not speak your mind because you want to be polite. You really need to tell them that you are in pain with our current regimen. In a longer perspective, if OxyCodone doesn't help you, you might should consider to ask your doctors what else you can get instead. For some people one kind of pain medication works more effective than other types.

 

[Raysu]

First I want to caution you that the moment you start adjusting your own doses contrary to doctors orders they will constitute that as misuse and you will rapidly lose credibility with them not to mention you will run out early and have to suffer even more waiting on the next prescriptions...and then if you get tested and do not have your prescribed drugs in your system it looks like you may be diverting and may not even need the dose you are on already. I agree too that the nucynta is a little redundant though I found it manages neuropathy a little better. Before increasing your doses and tolerance consider potentiating what you have to get the most out of it (adjusting the factors that increase absorption and metabolism of each drug, considering supplements that aid in the uptake/reuptake etc.). Have a very candid discussion with your doctor(s). These are the steps I'd suggest taking first. Good luck to you as you work towards ideal medication management.

 

[Keif' Richards]

OP, you really want to avoid taking higher dosages than what you have been prescribed, as other posters have already alluded to. This kind of use can end up getting you in trouble and jeapordizing your chance at adequate pain management. All you can really do is go back to Pain Management and hope that they give you what you require to control your pain.

That being said, your daily Opioid schedule is nothing crazy. Dosages can go much, much higher, this is not to say, however, that you require these kinds of dosages. What's going on is that in the recent tightening up of Opioid prescriptions, regular prescribers (internal med, primary care etc.) are not able to prescribe Opioid painkillers aside from low dose and more short term schedules. This is why you're being referred back to Pain Management.

 

[ruralhome24]

Yes- it is 25mg Oxynorm equivalent- I take it at night as I struggle to sleep due to the pain and also grind my teeth with the pain and I also find the other painkillers seem to take an age to kick in although I may need to speak to the pain clinic again to work out the best times for dosing..The dosages are allowed by my pain clinic consultant as he has given me additional Oxycontin & Tapentadol & Oxynorm to manage the pain when the usual prescribed doses aren't working, however my GP isn't in agreement with the pain clinic hence the re-referral to them as she thinks that they should be looking at alternative painkillers if my current dosage isn't working rather than increasing the dosage on each. The Tapentadol is given as I struggle with nausea due to my medical condition and the opiates exacerbate this- I also take cyclizine to manage the nausea however it isn't always effective. My issue is that in the last year my health has deteriorated and due to this the pain has increased hence the increase in my painkillers

 

[Ignio]

Have you attempted sleep aids instead of taking your oxynorm before sleep? After all, when you fall a sleep you might not need the oxynorm as you don't feel the pain as much. Quetiapin, Melatonin, a very mild benzo or something. Then you could use your oxynorm during the day or convert the dose to more oxycontin.

My experience with regular doctors is that they often disagree with pain specialists and say that the pain specialist prescribes too much medicine. I can't figure out why it always is so, you should think normal doctors would think that pain specialists know what they are doing. So make sure to make good use of your pain specialist.

Are oxycodone (oxynorm and oxycontin) and tapentadol the only pain killers you have tried? Sometimes people don't react well to particular types of opiats and opioids while they react better to other types. So down the line if you don't get better from oxycodone, you could suggest that you want to try other types. That could be morphine, hydrocodone, hydromorphone, buprenorphine and even methadone or fentanyl in extreme cases. But as I said, this is down the line. See if oxycodone will relieve you of your pain when you find the right dosage. Oxycodone is usually an effective pain killer.

It could also be combined with Lyrica, but that depends on the nature of your injury.

The important thing is that you as a pain patient find a reliable doctor that you get a good relationship with.

 

[ruralhome24]

I have tried melatonin but found it gave me worsened night terrors and I don't find benzo's effective for sleep. I have tried lots of different painkillers- gabapentin, pregabalin, tramadol, butrans patches among others I can't recall. The Oxycontin, tapentadol and oxynorm I've used for a few years and it's kept the pain manageable up unti last year where as I said my health has deteriorated along with the pain. The pain clinic seem quite good however they have a long waiting list so I only get to see them around once a year.