Some of these dishes are very old- and not relevant to the MME dosing used today.
More opiate doesn’t always equal better , more consistent pain management- but there are increased risks of respiratory suppression and accidental overdose.
Pain management is not about eliminating pain - an impossible idea since it is chronic- but getting a patient to a tolerable level that permits activities of daily living.
Comparing your medication dosages to someone else’s is useless and not a real comparisilon since we all have different conditions, severity and tolerance to pain.
I can’t BELIEVE the amounts of opiates people can still get! I have different for years it is so strict here in Hawaii. The max MME you’re allowed by law here is 120 MME equivalent! I came here is oxycodone 10mg 4x a day and 15 mg morphine 2x a day. Morphine doesn’t work for me no matter how high the dose. I have spondylilothesis (compressing my spinal cord btw) scar tissue on l5s1 nerves from previous spinal fusion ame spinal stenosis. I also have plantar fasciitis and root scoliosis. When I told them morphine doesn’t work for me at my new place in Hawaii all’s they did was take me off of it and didn’t give me anything to supplement it. So I different for a year until she increased me to 5 10s of oxy a day. Their neuro misdiagnosed me with post laminectomy syndrome and told me I needed a spinal cord stimulator. I knew in my gut this was wrong. I did the trial which helped but cancelled the surgery after reading and talking to tons of people that had been paralyzed from it. Once I got to the top neurosurgeon in the state, he said no you need old hardware out and new fusion to correct instability and curvature (he was like DUHHH!) when I had canceled my SCS surgery, mt pain place got mad because their anesthesiologist was going to do the surgery! My PA lowered my dosage back to 4 a day as punishment with no medical reason at all. I have ALWAYS used every topical lidocaine, cbd, ice, heat, tens, acupuncture, massage, PT…you name it I do it. Absolutely nothing helps and I’m left constantly unable to walk. My pain is BARELY reduced. I also use kratom and cbd to alternate so I lower my bodies tolerance and receptors to the oxy so I don’t become too tolerant. That is literally the only thing that has seem to help me. So basically the only relief I’ve gotten has been because I have had to help myself. The DEA needs to get out of pain practices. Their data was wrong ans what they are doing is criminal and medical negligence. I can’t believe you people are complaining. I have endometriosis, fibroids and cysts and I barely notice that pain because my spine pain is so horrific. Ibuprofen helps with pelvic pain. How are you getting like 4 times what I’m prescribed? I’m 36 and have kids that depend on me and work Pt. What a joke.
For me going from 20mgs of oxycontin to 18mgs of Xtampza wasn't much of a difference. But it doesn't matter now since I got into it with my doc. I was requesting an increase of 20mgs a day for a year and he wouldn't budge. So he decided to let me go "because I was always wanting More and More!" I left with 80mgs of oxy daily. I asked to make it 100mgs. I feel he was being very unreasonable for the pain I had. So I'm in search for a new pain doc via my new primary doc. This governmental over-reach and intrusion is over the top! It's like what I read about happening in Nazi Germany! Soooo sick of all of it!
I’m still battling this. I had an appointment with my doctor & we discussed all of the alternate meds which are covered by my insurance. We settled on one (which required a PA) and they outright rejected it - at least in the dosage necessary to replace my current regimen. I’m in a situation that is untenable and think the only way to reconcile it is to file a complaint with my state’s insurance commissioner. I’ll be doing that very soon. I thank all of you for your suggestions and comments.
Btw, I’m no longer taking Xanax and have switched to Lunesta. I don’t sleep well but I’m at least no longer taking a benzodiazepine.
Conversion from one opiate to another is never a 1:1 conversion. Even in pain management practices, when converting from one opiate to another there is a reduction in dosage with the new medication. Cross tolerance issues are considered, since even in long term chronic pain patients- they typically need less of the new medication to achieve equal or better pain control using a lesser dosage. The new opiate uses different receptors and that’s why. Secondly, in order to avoid side effects , accidental overdose , drug interactions -a new medication is reduced.
A typical reduction is 20-30% of the previous dose- so it appears your doctor is doing the conversion exactly right.
Xanax is not recommended for use with opiates, since both cause sedation and respiratory suppression. I’m not surprised they don’t want you taking the amount of opiates you are on and the Xanax as well.
Trazadone can be titrated up in dose safely and effectively if the current dose is not working.
For good or bad (and I understand often bad), pain management and especially with oxy is under heightened scrutiny. There really is that whole situation of managing your chronic conditions while dealing with the fact you are likely addicted to the meds you've been taking. So, the idea of changing is, I'm sure, terrifying. We get psychologically wrapped up in our routine and it works, so why wouldn't we? I understand how you are feeling. I think the best you can do is to try what they are asking. And if it doesn't work, there will be the time of re evaluation. Totally stinks to have a month or a bit longer that may not be like you usually are in terms of keeping the chronic issues at bay. But they are saying you have to so I would try to fight the fear and try with an open mind. Chronic pain patients are being taken off meds around the country. Xanax is a little bit different. Xanax is not really a treatment for insomnia. It really just numbs you. There definitely better treatments for insomnia than that. That one may be harder to continue for an insomnia diagnosis. But you do need proper pain management. Trazadone is usually a good choice for insomnia. I'm sorry that isn't working for you. Maybe the dose can be tweaked. I'd say it is unlikely you'll get put back on xanax with this doctor. Again, try to be open minded as to 'what else' you can do.
I doubt your doctor wants to fire you. Most doctors really do want to help you. hugs