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MME - Morphine Milligram Equivalents, forced to cut dose

I made a post about this a few days ago but it was really long, so this is short and sweet:

Has anyone recently been denied an increase of pain meds (Schedule 2 narcotics - morphine, oxycontin, percocet, fentanyl, etc) OR been told that they MUST cut down to a certain amount by their Pain Management Clinic?

I was taking 90-95mg Oxycodone per day for chronic pain after 5 lumbar surgeries (including 2 fusions) did little to nothing. I've recently blown another disc and my pain has worsened so I asked 2 visits ago for a slight increase (I've never asked for MORE narcs in 2 years). I was told no. They are under close supervision by CDC/FDA/whoever and nobody with chronic pain - unless they have cancer - can take more than 120 MME. 80mg Oxycodone/day = 120 MME (there are websites with MME calculators). So, not only could I not have an increase, I was told I had to DECREASE my dose to 80mg from the 90-95mg I was taking. Pain, withdrawals - nothing else matters. Everyone with Chronic Pain is now lumped into one category and it seems that the "CDC has determined that anything above 120 MME will not help with pain". I was given 300mg of Tramadol to help me compensate for the difference. 300mg of Tramadol is 30 MME, but Tramadol, being a Schedule IV drug, doesn't seem to count towards the total MME value.

I live in Arizona and I'm REALLY curious who else has been told this recently. Anyone?



  • Denied an increase, no, not yet, but told a out the MME dosing yes. In fact, we did reduce my meds, but my PM doctor just increased them back to my original dose.

  • Yes I've been told. I also had been searching for a new pm. Had alot of doors slam shut for me once they saw I was on fentanyl. These are sad times for chronic pain suffers 

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  • Boo,

    I was on fentanyl for about 2 years this last time. I wanted off because of summer, being in the sun and pool...I switched to oxymorphone ER and it worked well.

    You may want to consider something similar.

  • I have not been denied any med.  That being said, I had a genomic DNA test done five years ago which can determine which medication will work best given your biochemistry make-up.  The report concluded that in my case hydro nor oxycodone will do any good for me.  My body eliminates it without working.  It also states that it will take a higher than normal amount of morphine to get a therapeutic change.  My doctor had has me Oxymorphone which works well, but I have to take six (6) tablets a day.  To minimize how much I take, my PM is switching me over to Methadone which stays in your body much longer than typical opioids. 

    I will say that the Methadone is working pretty darn good.  My pain level is decreased considerably.  There is a difference in the methadone addicts get versus what chronic pain patients get.  I was worried about the social stigma of being on Methadone, but my PMP explained it to me.

    I am beyond fortunate to have the doctor that I have.  He fully get's it.  Plus, he uses common sense which is a dying trait in medicine these days. 

    I would suggest that you speak with your doctor about getting the DNA testing so they can see what will work and what wont.


    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • I keep seeing people speak about the DNA test. I pretty much figured what it's for by the post but would love more info on it . If someone can send me a link...and Sandi I've been on fentanyl since 2005. Was on 125 till June 2017 been weaning down now on 12. I'm changing PM Drs soon and had a time finding one once they heard the word fentanyl next word out of their mouth was sorry we don't take anyone on it.

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  • Boo - I just sent you a message regarding the Genomic testing.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • This is happening across the country primarily due to those who abuse their medications and those that use opiates recreationally to get high and then wind up overdosing. Thanks to that crowd true chronic pain patients are being looked at as a liability by their doctors and the politicians. That's it in a nutshell and nobody will convince me otherwise so a big THANK YOU to those that we now have to suffer for!!

    Here in Oregon the state "recommends" to family practice docs that chronic pain patients they treat be given no more then the equivalent of 100mg of morphine daily. Now if a pain management doc and if warranted you can exceed the 100mg mme if warranted. Howwever, from what I see, know and hear even pain management docs are very leery to exceed that. I have been with the same pain doc for over 20 years and at one time was on 800mg daily of morphine. That was after my pain pump failed so believe me my case is extremely well documented. I have never abused my meds and would pee in his coffee cup at a moments notice if asked. Currently, I'm at approx. 120mg mme and still have pain, but I'm not going to push the issue.  My [ain doc is very good at rotating meds which really does help. Bottom line is, we are as they say,S.O.L. as chronic pain patients.  This is a real issue and is not going away soon. I'm waiting for someone with the nerve and the money to go to court and challenge these rulings.  In my mind the state/feds/whoever has absolutely NO business in telling a doctor especially a highly trained specialist what he/she can prescribe but it's happening.  Should they shut down the so called pill mills and go after those doctors? Absolutely but leave those who have legitimate practices and are providing a high standard of care to patients.  Nuff SaId!!!

  • MrNyleMrNyle Posts: 109
    edited 04/29/2018 - 2:12 PM

    Yes, my doctor won't let me go above 30 MME no matter what.  They actually said that if I ask for an increase then I'll be dismissed.....

  • DenSanAZDenSanAZ Posts: 23
    edited 07/02/2018 - 1:53 PM

    It's been a few months since I made my original post regarding MME and, after discussing it more with my PM doc and my pharmacist, I feel somewhat better about it - [edit- political discussions not permitted, please read forum rules]

    I originally stated that nobody was supposed to take more than 120 MME/day. I was told that has actually now been lowered to NINETY MME/day! I mentioned that PM gave me Tramadol, which has 30 MME/day (300mg/day) and was corrected that yes indeed, Tramadol's MME DOES count towards that 90 MME. For now, PM isn't pushing the issue of lowering my narcs (even though I'm at 150 MME/day), as I'm scheduled for my SIXTH lumbar surgery (Fusion Revision #3 - original was L4-L5-S1, then L3-L4 was added, and now 2 years later, L2-L3 is going to the fusion as well. Quite honestly, I'd prefer my surgeon to just do L1-L2 at the same time, as it's failing - but not quite bad enough yet. The "Cascade Effect" force is strong in me, so it seems. I may also be needing a revision knee surgery as well as a lower left arm surgery to remove a 1" x .5" bone growth from my humerus that's been causing me great pain for some time. Until these are addressed, there's no point in lowering my narcs if I'll be back on higher amounts after a few more surgeries.

    Apparently, the Powers That Be are somewhat "grandfathering in" some cases where people are on higher amounts than the allowed 90 MME. What they're really pushing for is for physicians to stop giving narcs out to begin with, and, when necessary, only giving out a few days worth and lower doses. DUH!!! Good heavens, do people think that I just went to the doctor one day and he immediately put me on 100mg of Oxycodone and 30mg of Oxymorphone a day? That took quite awhile - a few years, actually. And I've been on far more than that in the past as well.

    I don't understand the CDC/FDA/whomever's logic in "deciding" that 90mg MME /day was enough for all chronic pain sufferers. My PM told me "they" decided that more that that actually did NOT give any patients more pain relief - it simply enabled them to adjust to higher amounts, then need more as they grew used to it. Wow, AMAZING how that works. Groundbreaking scientific research. (yet why does more and more narcs help advanced-stage cancer patients?). I can say for a fact that more works better. Last week was a VERY bad week pain-wise, yet I needed to do a 90 minute drive round-trip, park, walk a distance, then sit for a theater performance for 2 hours. The only way I got through this was to take 3 times my normal narcs for 2 days to recover. I've been on narcs long enough that I have quite a stockpile - so I can "self-medicate" when needed. I rarely do it but having 2-3 months extra narc backup is, to me, comforting as money in the bank is for others. Stockpiling is one sure way to get discharged from a pain management practice

    Indeed, it is a horrible time for anyone to be a Chronic Pain Sufferer! It's just amazing how they lump EVERYONE together - a one-dose-fits-all approach. This is what happens when non-medical people, or non-suffering people make the rules. As much as I'd hate to see anyone go through what I do, I SO want these people to know what we go through. 

    Comments entered by Ron DiLauro,  Veritas-Health Forums Manager

  • [Deleted User][[Deleted User] Posts: 1,095
    edited 06/30/2018 - 6:18 AM
    The user and all related content has been deleted.
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