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I ran out

dilaurodilauro ConnecticutPosts: 9,856
So many times we hear those words in terms of the narcotic pain medications.

This should never ever happen. It is wrong for it to happen and when it does happen, you run the risk of being dismissed by the doctor that is prescribing those medications.

And it gets worse, you could be added to a 'black list' if you wanted to have you medications filled too early.

Yes that is the pure negative aspect if taking more medications then the dosage allocated.

Shame on you.....

Can it happen? Yes, Does it happen? Yes Has it happened? Yes

Anytime you find yourself needing to take more than your normal dosage of pain medications, it is so very important to contact your doctor to discuss it with them. They may offer a higher dose of that medication or perhaps want to see you as soon as possible.

So folks may not want to call their doctor to tell them they took more. But you are only hurting yourself. Because while taking more, you will run out sooner. And when that happens, sometimes the price you pay is much more than you can bear.

Be honest. Yes, there are times when the pain levels go up and you need more. But those are the exact times you need to communicate with your doctor.

I've run into this myself. I contacted my doctor because the 5mg Oxycodone IR was not enough for breakthrough between my Oxycontin. The doctor and I adjusted the plan, decreased the time between the ER medications to see if that helped, and if not, increase the dose of IR as breakthrough.

That is the way it should be handled.
Ron DiLauro Spine-Health System Administrator
I am not a medical professional. I comment on personal experiences
You can email me at: rdilauro@veritashealth.com


  • breakthrough medications as well. One of the biggest issues that we see over and over is the incorrect usage of breakthrough medications. Too often, patients are prescribed breakthrough medications with a dosing schedule of 1 tablet every 4-6 hours or some such direction on the bottle....
    To the patient , this is often translated to, take the long acting medication on a prescribed dosing schedule of 12 hours for example......and then they take a breakthrough medication dose on a regular basis....often as they see the directions written on the bottle........this is WRONG!
    The proper use of pain medications is this.........Long acting or extended release medications are usually dosed twice a day, for most of them. You take it in the morning and usually 12 hours later. These extended release medications are meant to manage your all day, every day, baseline pain levels. Once you and your doctor reach a dosage that manages most of your every day pain, you have reached the correct dosage that allows you to manage most of your daily activities.
    Breakthrough medications should only be used sporadically at best...... never taken on a regular basis. They are a "rescue" medication only to be used when you have a significant flare up of pain, caused by overactivity or a sudden worsening of pain that you can not control or bring down by other means. Rest, first and foremost is your best defense, followed by ice or heat, whichever helps you more......over the counter anti inflammatory medications do wonders for increased pain......stretching can sometimes ease the pain , or a warm bath or shower. Distraction also helps at times.
    IF those things fail, then and only then should your next option be to use the breakthrough medications. What I do is start with half of a tablet, and wait for an hour, if the pain is still significantly more than I can handle, then I try more ice, and if that doesn't help to ease the increased pain, then I take the other half of the breakthrough medication.
    If you take the breakthrough medications with any kind of regularity, you do two things- one is increase the tolerance issues, because you are only increasing the normal amount of opiates that your body is accustomed to having.......which means that when you run out of breakthrough medications or don't take them, your body goes through a mini withdrawal . The second thing that occurs is that when you do have a significant flare up of pain, you have nothing to take to ease it......
    Of course, it is the best course of action to discuss how exactly and in what scenarios you should use the breakthrough medications given to you, with your medical doctor, but generally most pm offices want you to use them as little as possible to give you something on hand to handle flare ups, and if you use them with any regularity, you leave your self in a bad situation.
  • sandisandi Posts: 6,343
    edited 09/18/2014 - 4:50 AM
    If a prescription says " Take 1-2 tablets every 6 hours" it does not mean that you should be automatically taking 2 tablets every 6 hours. It means that you are supposed to start with one tablet every 6 hours, and if there is a significant flare of pain that isn't relieved by the one tablet, it allows you to take a second if absolutely necessary during that 6 hour time frame.
    The quantity is given on the bottle, and if you divide that up by 30 days, that tells you how many tablets you are permitted per day......maximum. Some doctors include a notation on the bottle or prescription that gives something called a MDD ( maximum daily dose) . That gives you the total amount of pills you are permitted for a 24 hour period for that prescription.
    Patients are expected to ask any questions regarding their prescription and directions while at the office. If you are taking the medications as prescribed, then you should never "test light".......It appears that you need to discuss the proper dosing instructions with your doctor. It sounds like you misunderstood how he wanted you to take the medications.
  • Quite right.

    Sherrie Sweets
  • No, no misunderstanding on the when, how n why. It's very difficult. I will leave it at that.
    Thank you for your feedback :);):)
    Sherrie Sweets
  • my doctor has recently retired and we had a very good rapport I was always honest with him and he was flexible with me and this system worked .unfortunately.the replacement doctor is not as obliging and has very little idea of intractable pain sometimes its not the patient its the doctor and the doctors persecution of the patient .we all feel pain differently and some doctors understand this others don't and this is where problems can start trying to get 20 years of pain and all it entails over to a ;;new person . can make one sound ;;desperate or even aggressive .when all the person in pain wants it the pain killers .I know because I am going through this process right now .its purely a paper exercise because all my notes are there and all my request for pain meds are there and have all been signed off by a senior doctor but because he has left I now have to ;;jump through hoops just to get the medications that I have been on for many years .even my consultant said if I even require an advocate that he would vouch for my requirement for continued powerful medication .as there is nothing left for me now just pain killers .some of us have very little left and painkillers are the only thing available when all else has failed .its just more stress that's not needed but rules are rules ..sometimes common sense trumps rules because when it come down to it I will get my meds but I will just have to go through the mill for them .its a shame my doctor has retired not just for me he was a good doctor for many and will be missed by many as he helped many people in his 45 years .so ,my battle to get what I already have .starts
  • One of the hardest things to hear is that there is nothing surgical or procedural left to help your chronic condition.
    I think it is unfair to say "this is how breakthrough pain meds need to be taken" in a forum for pain. All pain is different from person to person based on ones tolerances. Words like 'this is what really worked for me' or 'I've tried this, and it was successful for my current condition' is a bit easier to relate to. Doctors treat pain differently from patient to patient. Prescription pain medication works differently from person to person. I respect the opinions posted here. But pain management is not black and white... My humble input.
  • I have now found out that I have to attend a pain clinic I have been through the pain clinic system for 10 years and I had a wonderful anaesthetist that did all she could for me mostly injections various ..but I did not get any relief ,we tried many different drugs but only narcotics made my life bearable and I have been on them ever since ,the doctor that's left was the decision maker and the doctor that's left is not as confident even though she has had around 30 years experience .I am not a suitable candidate for a SCS due to the location of the damage in my spine and my consultant {who installed the SCS wanted to fit one at first but when he opened me up he was glad that he had not ;;broke the seal on the unit ;;! ..his words ,,because he said that this guy is in enough trouble a SCS would only add to it ,on my last visit he said that I am one of his failures ...strictly from a pain relief point of view .even though fusion don't always help with pain he was hoping that in my case it would but seeing the post op MRI scan it showed nerve damage even more visible now that he had removed the damage around it .and on the last scan there was evidence of scar tissue and facet joint hypertrophy .the next step is to see what's causing the inflammation in the lower legs and feet its not cardiovascular related he thinks its peripheral nerve damage .or worse vena cava impingement because the problems only happen when I bend and it feel like someone standing on a hosepipe you can feel the pressure above and below the scar where the ALFI was done and this problems started immediately after the ALIF although not painful ..its a worry ,I think regardless of how a patient looks .if they are in pain they should be given pain killers if that's the only option left and has been backed up by very eminent medical professionals .but pain clinics are notorious for trying to get people off painkillers and I know that I would have no life at all with out them to me they are essential and I am sure that I am not on my own with that one .good luck to anyone else in a similar position
  • I am total agreement with you. I am not at end of things that could help with my pain but all of them are invasive. The medications keeps my pain levels at 0-3 so why would I want to switch. I have talked to a few back surgeons who stated they could fix my fusion. When I ask will it lessen my pain they all said no or it could make my pain worse. Why would I ever take that kind of risk unless I was going to lose my bowels or/and bladder. Yes there are risks with opiate medications that may include death for those who abuse them. But it seems with backs the more surgery's you have on them the worse the problems. My medication allow me to have a better life and never take more then prescribe. I wonder how many people are having spinal surgery done because of pain that could be well controlled with long term opiate medication. I have never heard of someone who had back surgery and may have some pain relief for a few years not ending up in pain again somewhere alone there spine. With a fusion this a given because now the discs above and below the fusion are stressed and break down. Spinal surgery's should be the last choice not moderate or less pain medication that is not being abused.
  • When a doctor does not tell a patient how to use the medication they prescribed the patient goes by what the bottles says. By the large amount of new people who come to this site and do not know how break though medications should be taken it really shows the lack of communication that is happening between the patient and the medical staff. Is it because the patient does not remember what the doctor said, or is it because the doctor did not mention it, or maybe the patient did not understand and felt embarrassed that they may be viewed as stupid or did the patient not want to delay the doctor who was halfway down the hall before the patient could open their mouth. Communication is key to good care but seems to be lacking in today's doctors. So the next time you visit your doctor write down your questions on a piece of paper and bring it to your next visit. (I am still working on this. I have the questions written out but I just keep forgetting to bring the paper that they are written on). Finally, don't let the doctor leave the room until he has answered all your questions. However with some doctors you may have to tie them down on the exam table first. :-)
  • There does seem to be a lack of clearly communicating how the medications should be taken, but there is also an assumption made at times that the maximum dosage and the shortest time frame between doses is the first option to follow......that's why I repeatedly state that the patient has to ask when things aren't clear. I think that most of us, at one time or another have had dosing instructions that were less than clear, and I just don't want to see someone get into a problem with their doctors because they failed to clarify things before they have taken a bottle of medications that should have lasted a month, but only lasted 2 weeks because of unclear directions.
    Sometimes on the bottle or the written prescription you may see a MDD notation- that means maximum daily dosage so that might help to clarify things........if someone is given 120 tablets of a medication, and the notation is MDD qty 4 , the prescription is supposed to last 30 days, so the maximum daily dose is 4, even though the prescribing directions may say 1-2 tablets every 4-6 hours......The person should only be taking 1 tablet every 6 hours.......
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