As Annette introduced into this discussion, it is insurance companies that have instituted the 200 mg/day of morphine or synthetic opiate bio- equivalent to 200 morphine .
It has nothing to do with the Managed Care Act ( the correct name for "Obamacare"), nor the DEA, or FDA.
If an MD doesn't comply with the insurance company regulations, the insurance company can opt out of it's contract with the MD.
Anyway, the 200 med ceiling is concerned with opiates only.
The Neurontin, muscle relaxers, or any other meds that are not opiate, aren't a problem. The dose isn't part of that 200 mg, as they're not opiate meds.
If you take a PRN opiate, or "breakthrough med", the full dosage is added.
For example, if you're prescribed Percocet 5/325 three times a day, as needed. Even if you don't take it every day, or if you take one or two most days, the entire three per day is counted into the 200 mg/ day total.View Thread
If this gentleman, just ONCE, left a patch on and put on another one.
It was a mistake.
Whilst it could have been tragic, he is in no danger now.
The solution seems quite simple:
Have another person present during the patch change.
As I wrote, why did this gentleman go through addiction rehabilitation when he is not an addict?
Something is not okay with the narrative.
Transdermal fentanyl therapy has made many persons- with- pain's living hell a lot less intolerable.
Upon occasion, when my SCS battery has been dead, I have seriously considered having it explanted and using the Duragesic/ fentanyl transdermal (patch) again.
For me, fentanyl was the only med that came close to the pain management of the SCS.
Of course, SCS isn't the right pain management modality for all, but it has been amazing for me, as my pain is 100% neuro- genic.
There is reason for hope that modalities like transdermal delivery and neuro modulation will only become more advanced, offering us, persons living with chronic pain, better and more options to live with some sense of satisfaction in out day-to-day existence.View Thread
I apologize as I had meant to get back to you, but have been I characteristically busy.
Pain management is, as you know, a specialty practice.
Pain management MDs do not diagnose your problem that is causing your pain; they work with your PC and existing diagnoses and treat pain.
Please don't be afraid. This is a positive step in treating your pain.
The goal is to reduce your pain to a manageable level, to achieve comfort to participate in more life that has been restricted due to pain.
Usually, the first appointment will involve a lot of questions and answers designed for the MD to get a baseline of where your pain is located, the intensive at its worst and best. What has helped and what you've tried that has not helped.
The physical exam is limited to the area or system that is painful.
Regarding pain medicines: the goal is to find the lowest dose that is effective for you.
Therefore, most MDs start off with a lower- than- therapeutic dose. It's easy to increase dosing if it's not high enough. It's not so easy to reduce dose, especially since excessive amounts of opiate I the system can cause dire consequences.
I'm telling you this so you won't lose faith if you are prescribed a med and it doesn't take away as much pain as you'd like. I'd recommend asking the MD or RN/ PA if you can call after a few days to report how the med is working.
I'm addition to opiate analgesia, some other medicines that are useful for chronic pain include SSRI antidepressants, anti- spasm meds, anti- inflammatories, and other classes of meds based upon your pain pathology.
Your keeping a pain journal is a good thing. Please bring this with you to your appt.
Okay, now we must discuss the injectables.
With many disc and other soft tissue pain syndromes, inflammation is a huge problem. Injectable steroids can be very helpful in reducing the cause of the pain.
Some people get months of relief, some get permanent relief, others get days of relief, and yet others get no benefit at all.
Epidural steroid injections for disc syndromes have reduced the incidence of surgery for thousands each year.
No one likes needles.
Trust me, surgery is much more distasteful than steroid injections, so if there is any chance that you could get pain relief with this treatment, please consider moving forward with this relatively- non- invasive treatment.
Some PM MDs will use anesthesia, or conscious sedation for patients who just cannot tolerate this sort of injection.
The more information you can give your MD, the better care you'll get.
I'd you have more questions, or if I can help you in any way, do ask here, or, if you'd like to talk in private, click on my name or little picture.
You'll see it take you to "My Story". At the bottom of my story, you'll see my email address.
Feel free to write to me, however, please alert me that you'll be sending email, as my SPAM filter is high security and in- recognized email addresses go directly into my JUNK file.
If I know that I'm expecting email from you, I'll check my JUNK file daily.
Try not to worry.
Some people like to have "second set of ears"- ie a friend, come along for support or to be sure that you don't forget things.
Personally, I've never wanted this, but many find this a good thing.
Good luck, best wishes, and do let us know how it goes.
There have been numerous studies about the safety of spinal cord stimulation.
"It has been suggested" is a lot different than "scientific studies have proven"
An electrician told you that you could get cancer from a SCS? I don't think an electrician should be making medical statements to you.
Ask your surgeon and, even better search for academic papers regarding spinal cord stimulation. I'm NOT talking a out reading peoples opinions, but actual academic papers
CAT scans with contrast are a fine diagnostic tool.
If you have cancer, there isn't any reason to have your SCS removed.
Really, where did all of this anxiety come from?
Were you not allowed to ask questions before implantation?
I suggest you ask your MD all of the questions that you have, read up factual scientific research , and pay less attention to things like, "it has been suggested" ( by whom, btw) and what an electrician says (regarding medical procedure)
Most of all, of SCS helps your pain become manageable, enjoy the pain reliefView Thread
I'm trying to disentangle all about which you've written.
Lots going on with you, I can see.
First, your daily med protocol is somewhat uncommon, and slightly bizarre. Before we go on, can you clarify if the following daily (or is it three times a day?) meds are as follows:
Percocet- 14 tablets
Vicodin- 12 tablets
"Muscle relaxers"- name and dose unknown
Valium - "to sleep"
Ibuprofen- 800 mg
MMJ- ad lib
The first two issues that jump off the page are concerning the bizarre combination of oxycodone plus acet and hydrocodone plus acet.
Fourteen Percs= 70 mg of oxycodone plus 4,550 mg= 4.5 GM of acet.
I'm unclear if your schedule is thirty opiate- based pills per day, or these same thirty pills divided over three times- a- day schedule.
Please clarify this, if you would.
Twelve Vic= 60 mg hydrocodone plus 3,600= 3.6 GM of acet
So, if this schedule is thirty pills spread out over a 24 hr dosing schedule, you'd be taking 8,100 mg= 8.1 GM per day of acetimophen.
Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death.
Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4000 milligrams per day, and often involve more than one acetaminophen-containing product.
This, before we can even enter into further discussion, if you're prescribed this regimen, you're taking more- than twice the amount known to cause liver failure.
If you're taking the Perc and Vic three times a day, as you stated, then your daily dose of acet would be almost 25 GM of acet, and you'd probably be dead.
There would be no reason for your MD to prescribe Vic and Perc, since their indication is the same, hence this alone would lead one to believe that you're getting meds from more than one source.
It is also contraindicated to take a benzo, such as Valium, with an opiate.
It is also contraindicated to take a "muscle relaxant" along with a benzo, so this would also indicate that you're getting meds from more than one source
When prescribed MMJ (I am in a 420 legal state, too), the common practice is to reduce the prescribed opiate and "muscle relaxant".
This combination of benzo, "muscle relaxant"( of unknown name) would also indicate that you're getting meds from more than one source.
Oh yeah, did you tell us what is the problem with your back that is giving you all of this pain? What is the surgery that you had performed in 2005?
Again, lots going on with you, your son for whom you got MMJ so he won't get addicted to pills (?), "other family members", including your mother, getting MMJ, plus your lethal acetaminophen,
Add to this lethal combination - 800 mg per day, or three- times a day of Ibuprofen.
If you are using ibuprofen every day, paradoxically the medicine itself may actually be contributing to headaches through a process call medication overuse headache, which is one of the most common causes of daily headaches.
High doses of ibuprofen can also lead to liver disease.