to pharmacist steve

[dag_FL]

I would like to know whats the right amount of pain medicine for my condition, I am in my mid 40's and have arthritis in my feet, hips, knees, and back, my left foot has already fused right in the center and I'm getting some pretty painful injection in that foot, rheumatoid nodules on my right foot. The pain is slowing me down to where it is becoming very hard to work and really no social life. I've been in pain management about 9 years and worked my way up to about 200mg per day oxycodone and 24mg diluadid for bt, I've been at this level about 6-9mo but now when I'm going to work its really jacked up my pain level, I was ok if I don't work but I want to work, and my Dr. dosn't seem to want to give me an adjustment, is this some kind of high dose I'm on, or a law or something. when I take enough meds I can pretty much get full relief and I guess I feel really frustrated by this situation, thanks:confused:

[Pharmacist.steve]

While the total amount of opiates that you are taking is rather high... in theory there is really no upwards limits on opiates. You are taking equivalent to 400mg of morphine/day which is the same/similar to using 100mcg Duragesic patch. While the Duragesic 100mcg is their highest single patch... it is not outside the possibility for a patient to use more than one patch and be using > 100mcg/hr. There is no magic formula about how much a particular patient needs.. it is all based on clinical observation and patient feed back of pain management and side effects.

I suspect that your doc is concerned about the recent DEA actions against docs providing high doses of opiates to individual patients. Your need for increased opiates may be a tolerance to the drug or progression of the disease - or both. Rotating to a different opiate may help the tolerance problem... at least in the shorter term... Have you discussed an implanted morphine pump with your doc??? If a pump trial is successful ... a patient can expect there opiate consumption to be 1%-2% of what they are talking orally.. with better pain management