How did you approach BT Pain Management with your PM doc?

[Pamster]

Just curious because I haven't discussed it with my PM Doc and am worried it might seem like I am complaining about the meds I take when he thinks what I am on is enough. As I have said before I take lortab 10/350 (its called lorcet though but its the same thing, only less APAP) and robaxin in place of soma. I do have pain about three hours after taking them and it's just something I have lived with. Does it mean I should ask for something to cover BT pain? :confused:

I wasn't even aware that you could get something for breakthrough pain and that they would be open to such a thing. So tell me, if I am hurting three hours after taking it and HE hasn't brought up BT pain so how should I or really should I even bring it up? It's not on a huge scale, it's about 4-5 as opposed to 8-9 with no meds that I had before starting on the Pain Control path and that's about how I feel when I wake up. Any advice is welcome, thank you all for your awesome support! :D

[juniee]

Hi Pam,
What you are taking is commonly used for breakthrough pain as it is short acting....they like to put you on a timed released med like oxycontin or kadian and use hydrocodone or percocet for BT. There are many more different options but these are the most common.
HTH

[Boopers]

Hi Pamster,

Yes, what you are taking are BT meds!! Just tell your doctor that your pain meds are only lasting three hours and if he could put you on a long acting pain med and use what you are taking for BT pain. I take hydrocodone, methadone, neurontin and oxycontin. That way I have long acting and BT meds. The combo works great for me.
Sorry you are in pain and hope you talk to your doctor about it.
Good Luck,
Linda :)

[Spiney]

I would keep a pain journal for two weeks before my next appointment and give that to him. I have no problem with my pm doc when I just stick with the facts. I let him know when I am having the pain, how it is effecting me and what I am doing to reduce the pain besides the meds............hot showers, heating pad, stretching and range of motion exercises etc.

[erfan]

Most of us CP'ers get 2 meds every month from the pm doc. We get a long acting med and a short acting med for bt.

The lortab is a short acting med that would be used for bt pain. What you need is a long acting med, like the Fentanyl patch, OxyContin, MS Contin, etc.

The long acting meds are your base meds. They idea is to keep the serum levels at a fairly constant level so that you don't experience the peaks and valleys and clock watching seen with the short acting meds.

Since you already are getting a short acting med, if you complain about breakthrough pain it would seem a little unusual because outside of Actiq, there really is nothing more suited for bt than the short acting meds.

[BrokenBladder]

Hi Pamster!! Just wanted to confirm what everyone else here is telling you. Lortab is a BT med and you need a "base" which would be a longer lasting med such as Oxy contin. My rhemy manages all of my pain medication and it wasn't until I let her handle it that I started feeling any relief. Granted I still have pain that shoots up to a 7, but for the most part it's at a manageable
4-5. I hope you can get some relief soon!! I was taking only the BT meds for a while so I know what you're going through......not fun.

[Pamster]

Hi everyone! Thanks so much for all the replies, I had a feeling I was taking short acting meds, I wonder if I can do what you suggested and keep a pain log and see if that can't help him to help me a little better. Now do I understand it right that break thru pain is pain you have before the next pain pill right? So like it sounds, it's breaking through the pill you took say at noon-and it's like 3 pm and you aren't due to take another one until 3 more hours? Is that the way the PM docs look at BT pain? Sorry to have so many questions, but I had a feeling what I am taking is BT pain meds already and I am wondering how to approach getting a better base to work from then just hydrocodone. I don't want to come off the wrong way with this subject since I know it's easy to get looked at/labeled as a seeker these days. :(

[Pharmacist.steve]

Trying to control your chronic pain with a short acting opiate - like hydrocodone -in not going to work... you will always be chasing the pain.. Proper chronic pain management involves a long acting opiate - like MS Contin or Oxycontin - which is taken every 8-12hr... or Avinza - which is taken every 24 hrs... Once you are controlling - or attempting to control your chonic pain with one of these meds.. and the pain returns before the next dose .. then you are experiencing breakthru pain.. at which time a short acting opiate would be appropriate. Typically pain is better managed when the patient stays on top of the pain... rather than wait until it is goes to the higher end of the scale and trying to back it off.

Pharmacist Steve
www.chronicpainresourcecenter.com

[BrokenBladder]

Pamster I would suggest that you talk to your doctor very frankly about your pain. I would explain that you are part of a support group and many of the people in that group have the same illness as you. That's what I do. If this board gives me good information, which you guys always do, I tell my doctor that I received some suggestions from my support group. I don't even mention that it's over the internet. My doctor listens to what I say and then we go from there. Always remember that each doctor is different and some don't like to prescribe OxyContin or MS Contin, but you deserve some relief!!

[Pamster]

I wonder why this was the way he went about treating my pain? He's an anesthesiologist *spelling?* and treats a lot of people in my area, his office is always full of patients and they don't look like they feel any better then I do. I kind of have a feeling that maybe they put me on short acting meds because they think that is all it takes to take care of my pain, but it's leaving me hurting after about three - four hours after taking them.

Thanks for the reply Steve, as always your words of wisdom are greatly appreciated. :) I will just have to think about how to handle this...still not sure how to approach it. :confused:

Thanks BrokenBladder, I think I will mention the support group and not mention it's over the internet unless he asks and see if I can't get something better for managing my pain. I think that there has to be something better then lorcet to help manage my pain. :cool:

[Kira]

My situation is a little different. I have a disorder that fluctuates a lot from day-to-day... I have a background level of chronic pain, but I also have a lot of acute pain superimposed on that.

I just started with the PM doc, but what we are doing is MS contin for the long-acting med and then I have oxycodone IR for what I was calling "breakthrough." But it sounds like what I am calling "breakthrough" is maybe something different... for me, "breakthrough" means my bad days, when the MS contin just wouldn't be enough. I have noticed that my pain gets worse before it is time to take the next MS contin, but I have just started with this doc and am still at the lowest dose, so I figure we will have room to adjust things when I see her in two weeks.

The way I talked to her about it was pretty straightforward. I said "So the MS contin is for everyday, not just the bad days?" and she said "yes" and so I asked "what is our plan for the bad days?" and she gave me the oxycodone IR for that.