Does anyone have any advice on what to do when your doctor will will not revise a too low doseage?
- 19 Sep 2011 by frustmom
- 19 September 2011
- fentanyl, injection, pharmacy, herniated disc, doctor
My 21 year old son has been on every drug available for his inoperable herniated discs. Including injections. Finally a doctor put him on these patches last month. The pharmacy instructions on the box were unclear so I read the enclosed material and looked up info. online. I applied 2- 25 mcg/hr and it was a miracle. They lasted the full 72 hrs and allowed him to resume pt twice a week. Long story short I was only supposed to put 1 patch on. When the doctor told us this at his next appt. and would not refill the prescription it was horrible. When we did get the refill one patch barely made a dent in his pain. When told this his doctor said he would not change the dosage. He is on a low dose of lortab and gabapentin. I am at my wits end. I cannot go against the dr. and increase the dose myself but he is in constant level 7-8 pain. If anyone has any similar experience i would appreciate any advice.
It is unfortunate the Dr wont budge on this as it sounds like 50mcg/hr is the dose he needs to be on but I'm betting it has to do with his age. He is only 21 and he is going to have this issue for a lifetime. I assume these are Fentanyl patches and Fentanyl is a very powerful drug. If he starts now at a high dose-where will he be in 10 years?-20 years? They want to keep him at as low a dose as possible because he will build tolerance to drugs as time goes on and will need higher and higher doses. Pain medication, in chronic pain patients, is designed to just take the edge off so it is possible to do the things we need to do and have to do, not to make us pain free. If he does do the 50mcg/hr he may be pain free for a time but as tolerance builds it will get to where 50mcg/hr is not helping and he will need 75 or 100mcg/hr. Sooner or later NOTHING will help him and say he is only 30 when this happens-what then? So does that help you see where the Dr is coming from? On the other hand, pain is pain whether you are 20 or 70. Why do they say the herniations are inoperable? Is it just that they are inoperable now? Actually surgery is rarely indicated in disc herniations. Most improve with time on their own without intervention. Surgery is usually only indicated if there is instability in the spine or if nerve impingement causes progressive weakness in the legs or if a person loses control of bladder or bowels-cauda equina syndrome. Some Drs will do a fusion if the pain is severe and doesnt get better after a few years. This may or may not help and it can make it worse!
You and your son need to read up on back pain and educate yourself. the National Pain Foundation has an excellent website. He needs to concentrate on exercising the core muscles in his abdomen, sides and back. This will allow the muscles to help the spine in carrying the body. He may also want to try applying ice and heat to his back. Has he tried any chiropractic manipulation? I find it helps me a great deal. He has to adjust his expectations on pain. More than likely he will not be pain free. Again, pain management is to keep you at a level you can tolerate not to be pain free. You might have him keep a pain journal. They have examples of how to do this on the NPF website. Let the Dr know what activities of daily living his pain prevents or interferes with as well as how pain affects his relationships and ability to do things he wants and needs to do. Perhaps if he does this he can convince the Dr to go with the higher dose. It might be beneficial for him to try Cymbalta. It is an antidepressant but has been shown to be effective in chronic pain. It doesnt work like opioid pain meds. It often takes 6-8 weeks before the full effects are felt so he must be patient with that one. What dose of Lortab is he taking and does it help the pain at all using it with the patch? Has he tried any muscle relaxants? Sometimes if the muscles are not so tight it can help with the pain. I find that massage is very helpful too.
I, too, have herniated discs and also disc degeneration so I know how painful this condition is.
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