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MME - Morphine Milligram Equivalents, forced to cut dose



  • grtgrandma1aneeda70, I appreciate your concern, but perhaps you've missed the part where I said I've been on narcs for 5 years - and incredibly higher doses than what I take now. My current dosing does not ease my pain - as I said, for the first time ever, I asked my Pain Management Dr for a SLIGHT increase (and she's aware of my newest MRI showing a new slipped disc, she's aware of my pain, she's aware of my upcoming surgery - but no-go on upping my meds EVEN SLIGHTLY, not even to an amount that I had recently been on (she's been weaning me down for the past 1.5 years - and this is WHY I have so many extra pills - I don't abuse them and I am doing my best to come off of them - but I'm certainly not going to refuse them nor am I going to throw them away).

    Because of the current "war on opioids" and because of issues exactly like this - increased pain, yet refusal to increase dosage, this is exactly why I have a stash of drugs. I'm not planning on selling them, I'm not taking them for the Hell of it - in fact, it's the exact opposite - my "stash" is MY stash, it's for MY use should the time come when I need more (as I recently did). In fact, I don't even like taking extra, as I look at it as an "emergency" supply" and I get very anxious when I run low. Having been on them for 5 years straight - and more on-than-off of them for the past 13 years, I do know what it's like to run out and the panic it causes me. And of course I'm addicted as well. It's not just the pain, it's the addiction aspect - which my Pain Management doc is very well aware of. Honestly, nobody is on narcs for this long without getting addicted. "Physically Dependant", to be honest, is just a nice way of saying ADDICT, does that really make anyone feel better? "I'm not an addict, I'm "Physically Dependent", so I'm perfectly fine." Anyone who truly believes that is...I'll leave that there.

    You're more than welcome to "tsk, tsk, tsk" me for taking care of myself and planning ahead for myself. Everyone has their opinion. Personally, if you're keeping yourself at an 8 pain level just because you don't want to take more drugs - AND drugs sound like they're your only option, I think you're a fool - unless you enjoy being an pain. I do not - and I have been for almost 15 years. 5, going-on-6 back surgeries is not the only thing I've had done. In the past 8 years, I've had a total of TWELVE surgeries for things falling apart (I'm 57), none of them were elective. So you see, I've got just a bit more going on than just back pain. So if I want to stockpile drugs, that's my business. I'm not breaking any laws. If I want to take extra drugs once in awhile so I can actually have A TINY FRACTION of a social life, I will. That's why I have a stockpile. And I'm also VERY well aware of my limits, I've been on 3-4 times more than I am now (not counting post surgeries).

    One more thing - exactly how is my drug stockpile affecting anyone else? I'm not doctor hopping, they're all from the same person. I'm not asking for more than I need - as I said, I just asked for an increase and was turned down because our government seems they know what's best for people living in Chronic Pain (and you're part of that problem, keeping yourself at an 8 - how's your Quality of Life, by the way?). My stockpile is because she prescribes drugs for 30 days, yet I see her every 28 days - sometimes less depending on her schedule. It's also because, as I noted, I've had 12 surgeries, so those days in the hospital, I'm not taking my drugs, I'm taking what's given to me. Yet my PM doesn't take that into account - and no, I'm not going to remind her. And one more thing - she's been trying to wean me down, and I have been doing my best. Everyday I can take one less pill, that's one more pill in my stockpile. Over a period of 2 years, that's a whole lot of stockpiling - and all of it in a totally legal way. You can question my ethics - but go ahead. The government is now telling us the max amount we can take without knowing one thing about any of us - is that ethical? And lastly, my PM doc knows that I have a stockpile, she knows that I get extremely anxious when I start running low - and she's okay with that. Does she know that I have a 2-3 month supply? Hell no. So again - how exactly is my stockpile keeping anyone else from getting pills? 

    If you're happy living your life at a Pain Scale of EIGHT, no options for surgery, the only option being more drugs which you refuse, that's totally your business. Again, I think you're a complete fool, unless you enjoy playing the martyr. But that's my opinion, your life, do what you wish - but your decision also affects other people, as the amount of drugs you take to keep you in your 8 is factored into the equation of how much drugs is enough, as well - because most sane people would NOT want to live there life at an 8 pain scale when more relief is right in front of you. Don't judge others, it's just as easy for others to judge you.

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  • MarybogieMMarybogie Posts: 46
    edited 07/01/2018 - 8:50 PM

    As a recovery room nurse I am amazed at the number of patients who have surgery after surgery. If by surgery 3 you've had no relief, why do you keep going back? Go to a surgeon and he/she will cut. It's how they make money. As for MME, it's a nice tool we use to anticipate how much medication a patient will probably need post-op. Repeat back surgery patients are a nightmare, it takes forever to get their pain under control. Opiates are not meant to be used long term, you just end up needing more and more.

  • Marybogie, yes, I have had 5 back surgeries and about to have one more. The part you may not understand is, they technically are not the exact same surgery. Surgery #1 was micro-discectomy of L4-L5. Surgeon said it would not last forever - BUT it lowered my pain from a constant 10+ to a 1, totally off narcs for 5 years. He was right, didn't last forever. Blew L4-L5 and L5-S1. Had a fusion 2011 (6 years after surgery 1). Had pain relief for almost a year, almost off narcs but pain returned so Surgery #3 to remove fusion hardware (wasn't needed) and micro-discectomy of L3-L4 due to Disc Cascade Failure (a somewhat common issue with fusions). That helped the pain briefly - surgeon referred me to another surgeon. L3 was basically sliding off L4, so an extension of fusion was needed, a special type of cage needed (going in through my side) to stabilize my spine. That was #4. #5 was the implant of my Spinal Simulator - and I SWORE I was done with back surgeries, each one hurts more and more. Now 2 years later, L2-L3 has failed. Cascade Failure does not generally happen that fast but the cartalidge in my body is disintegrating. The pain from an L2-L3 failure is completely different than the others, there are days I can barely walk. Just the pressure of my torso on my hips/pelvis from standing is intense. So I have a choice - deal with the pain (and the government isn't allowing increases in narcs even though pain is worse - even with my 13 year documentation of chronic back issues) and be immobile or have a 6th surgery.

    So, yes they are all lower back surgeries BUT they are on different parts. I've worked in medical doing patient care for 23 years. My husband is an ICU nurse for almost 20 years - and I can tell you more about narcotics than you'd ever care to know - and not just the white-washed generalization that they're teaching you. I've been on FAR more narcs in the past than I'm on now so your theory of "needing more" isn't true IF pain reduction from surgery is effective which all of my surgeries have been...until another part fails. 

    I'm so sorry if people like me, with all these back surgeries make your job harder with managing my pain. Did someone tell you that being a nurse would be easy? I'm actually a very good patient - bring me my pain meds on time and I'm never on the call light. I've worked in hospitals, I know exactly what it's like. 

    Last thing - you've obviously never been someone in chronic pain. For you to actually tell me to stop having surgeries if they don't work is rather heartless and judgmental of you. First off, they DO WORK or I wouldn't continue to have them. They're not fun and yes, there's a lot of pain for a few weeks and if going through that gives me relief for even 1 year, it was worth it. I honestly hope that you're never in any situation where you have to go through what we do. Your tune would be much different if you were in my shoes. Or do you think that I should just resign myself to be in horrible pain for the rest of my life? I'm only 57 - not ready to sit in a chair the rest of my life.  

  • dilaurodilauro ConnecticutPosts: 13,421


    We normally do not make comments like this, but your approach is borderline on being offensive to other members.  People are offering suggestions and making comments, but instead of listening, you are just retorting .    There are many many members on this site that have medical conditions far beyond what you have describe.   Yet, the first thing they do NOT do is look for an increase in opioids.  Pain medications is not and has not every been the way to manage overall pain.

    While, I can understand your pain levels, please put everything into perspective.  They have been some members here who have been dealing with chronic pain for over 20 years and still maintain a positive attitude towards their life and everyone else.

    There are also folks here with more understanding and knowledge of spinal problems, conditions, treatments and the various medications, including non-opioids that are used to help them.   Its hard to judge someone online when they are only trying to help.

    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
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  • I've had one surgery 6 years ago, a decompression laminectomy for horrible debilitating sciatic pain. My nerve was compressed by an overgrowth of bone and ligament. I had a very wise, experienced surgeon who retired a few months after my surgery. One thing he said I will always remember, there are 2 reasons for spine surgery. Spinal stenosis, and obvious nerve impingement. I will not have anymore surgeries. Do I have back pain? Every day, and my job doesn't help. Do I medicate it with opiods? No, because I know the brain physiology of chronic opiate use. As for the "war on opiods," I think that refers to the many unfortunate people who go on to heroin and other drugs. Heroin is a national energency. Cheap high.

  • nutcase007nnutcase007 United StatesPosts: 877

    For all of you that can manage your pain without any opioids, good for you!

    I am one who tried to manage my broken neck with very minimal opioids.  I ended up in the hospital with heart attack symptoms (elevated troponin levels) and spend three days in Cardiac ICU.  I had a heart catheterization performed which was clean. 

    Several months later, I spent another four days in intermediate care for full blown stroke symptoms.  Had a CT Scan looking for brain bleeding and three different MRIs looking for clots in the brain and blockages/clots in blood vessels to the brain.  Spent 80 minutes in the MRI tube for those three MRIs.  Nothing was found.  Several other tests were performed looking for neurological issues.

    I finally had my neurosurgeon demand that I increase my opioids so that my body would not shut down.  As he stated, severe and chronic pain can kill (this being after several years that ER doctors threw me out of the ER with the statement that severe pain is NOT an emergency). 

    Several months after my hospital stay for stroke symptoms, my neurosurgeon was finally able to get authorization to perform another fusion in my neck.  I had been delayed by insurance for years because they wouldn't approve the one test that would have diagnosed the need for the fusion. 

    So I can say with almost certainty, opioids saved my life.  I'm now 6 months post-op with another 12 months recovery that I might have some quality of life restored.  Tapering down on my opioids is very difficult.  Yes, I still have muscle pain, but not anywhere as intense pain as I did with multiple level failures in my neck that was caused by neck trauma 40 years ago.   


    Do your due diligence, trust you know your body and question everything if it does not fit.  Advocate for yourself and you will be surprised what will be revealed trusting your body and instinct.

  • Dilauro, 
    That's interesting that you take my posts as "offensive" after a nurse tells me I'm stupid for having more than 3 surgeries for the "same thing" (different vertebrae levels are not the "same thing" - L5-S1 is not the "same thing" as L2-L3. Therefore I have NOT had over 3 surgeries for the same thing).
    She goes on to tell me that "repeat back surgery patients are a nightmare" because it's hard to get pain under control. Poor, poor nurse has to keep phoning the doc asking if more pain meds can be given. Hey, that's what she signed up for. EVERY patient has the ability to be a nightmare over the silliest little thing. I used to work in a hospital and had an elderly woman on her call light all the time asking silly things such as "could you hand me my water?" - her water was on the table right next to her, her arm was on that same table, the water was within her reach, she merely wanted special treatment. This would be the same woman who would ask if someone would pour her syrup on her pancake - when it's sitting right there in a little carafe! THAT woman was a nightmare - and there was nothing seriously wrong with her. 
    It's odd, as all of the back surgeries I've had, the surgeon was already aware of how much pain meds I was on BEFORE the surgery, so he was able to order a Dilaudid pump for post, on top of other increased pain meds. The surgeon who did my first fusion (when I was on a massive amount of drugs) had me transferred to ICU for 2 days post surgery, JUST because he knew I'd be on even more and wanted me monitored. My point? A GOOD surgeon will have already taken that into account - it's not even up to the nurse to decide how much pain meds a patient needs, MaryBogie isn't able to make that call - ONLY a doctor (NP, perhaps PA as well).
    As for going to a surgeon and "he/she will cut" is absolutely not true. I've been to surgeons for back issues, knee issues, etc and I've been told many times "we're not at a surgery stage right now, try ____". Aside from that, MaryBogie should be thankful for surgeons - she's a Recovery Room nurse, therefore surgeons are who keep her employed. As judgmental as she is, I'd hate to have her as my nurse. The only thing is, a patient in Recovery is not likely to remember even being there.
    MaryBogie is also wrong about "opiates are not meant to be used long term". I have permanent nerve damage from Spinal Stenosis in my L4-L5-S1 area because I waited too long to have surgery. The stenosis was resolved but the nerves fused together - they are "clumped", giving me permanent pain and sciatica. I've been seeing a very knowledgeable Pain Management Dr who, in the past 2 years, has weaned me down considerably from the amount of narcs I was on after my last 2 surgeries (so no, one does not always need more and more) but she has told me that I will be on narcotics for the rest of my life for the chronic pain. So yes, people with Chronic Pain issues CAN and ARE on narcs very long term/forever.  
    And lastly, MaryBogie admits she's had a "decompression" (not the same thing as a fusion), and her "wise" surgeon said "there are 2 reasons for spine surgery. Spinal stenosis, and obvious nerve impingement". I don't think many people have spinal surgery for too many other reasons, aside from cracked/broken spinal bones or a large number of other reasons too numerous to mention. Anyway, her 2 reasons given have been EXACTLY the reason for ALL of my back surgeries (except my last, which was for Stimulator implant). This is the reason I'm having surgery #6 - Spinal Stenosis AND nerve impingement at L2-L3. She's had one minor spine surgery and says she'll never have another. HAHAHA!! I've said that after my last THREE surgeries! But when another level goes and one can't even walk through a grocery store without being in agony, I bet she'll change her tune. I'm sure someone as wise as MaryBogie has heard of Failed Back Surgery as well as Cascade Failure?
    So take my defense of myself against what I considered a stupid post and an attack on myself as "offensive" or "borderline offensive" - just as you're attacking my defense of myself. I can give my opinion and experience just as anyone else.
    I'm totally with NutCase007 - if some of you can get by without narcs, BULLY for you! Believe me, there have been times in between my surgeries when I WAS off narcs and living on NSAIDS (which can be worse on your body than narcs). I'm 56, disabled, and I still do my best to do the things I enjoy - and if it takes being on narcs all my life to keep some Quality of Life, damned right I'm going to take them.
    As for your last line, "Its hard to judge someone online when they are only trying to help." - you've got to be kidding! MaryBogie's first reply to me was NOT wanting to help, she wanted to judge me and tell me I'm stupid and a difficult patient. How is that "trying to help"? And believe me, it was ALL too easy to judge her instantly.

  • MarybogieMMarybogie Posts: 46
    edited 07/28/2018 - 9:12 PM

    Wow sounds like you enjoy deliberately misinterpreting other's thoughts. As a PACU nurse I have a lot of control over how much pain meds post-op patients get, and I am very generous, especially when I care for someone with a very high pre-op MME. I have had patients swear at me, spit at me, accuse me of not really giving them pain meds. Honestly the best thing a patient can do is to have an honest discussion with his/her anesthesiologist. There are numerous interventions that can be done during the surgery to reduce post-op pain. After 10 years of doing this, I can often tell how much pain a patient will have post-op just by who their anesthesiologist/CRNA is. I'm sure your obvious hostility worsens your pain. I knowa lot about narcotics, being both an RN for 36 years and a patient for 7. And I never used the word stupid. I guess you can't have a reasonable discussion with some people. Too bad. That's all. Have a good day.

  • MaryBogie - get real. You came out swinging, "As a recovery room nurse I am amazed at the number of patients who have surgery after surgery. If by surgery 3 you've had no relief, why do you keep going back?" Shortened version of that = you're stupid. If you meant it some other way, you certainly could have phrased that opening sentence better.

    "Repeat back surgery patients are a nightmare, it takes forever to get their pain under control." That's a wonderful thing to tell me, when I'd previously stated I've had five lumbar surgeries. First you call me some version of "stupid", then tell me I'm a nightmare patient (nice blanket statement to make about multi-spinal surgery patients). And quite honestly, my only "nightmare" with pain control was my first fusion of L4-L5-S1 - it did NOT go well, I was in ICU for 2 days, 3 more days in a regular room, then 3 weeks in a rehab center to be able to walk again. My following surgeries did, of course, hurt, but not anywhere close to the first fusion when the slightest movement caused extreme pain and spasms. Merely incision pain hurt, each one worse than before because of all the scar tissue - plus, as my Pain Manager said, after so many surgeries in 6 years (12 total, 5 were my back), my nerves are hyper-sensitive to pain and I'll feel it more than a normal person (and I'm not a wimp). I will say that my 3 abdominal surgeries were FAR more painful than my back - cutting through abdominal muscle - even small 1" and 2" cuts - EVERYTHING makes those incisions hurt. You never realize how much you use your abs until they've been cut on.

    Finally, "Opiates are not meant to be used long term, you just end up needing more and more". As someone who's been on opiates for 5 years straight and on/off a few times before that over 13 years, I have a pretty good understanding of them. What you say about needing more and more CAN be true under certain conditions, I've never had an issue with that. My PM has been weaning me down for over 2 years - it's just difficult, as every time I turn around, I'm having something else cut on. I believe I mentioned that in all my time of seeing this particular PM, I've asked for an increase ONCE, that was when I blew yet another disc and I can barely walk. Unfortunately, that was also in the beginning of the MME max and I was denied more narcs (but given 6 Tramadol a day which equals 30 MME - that never made sense to me). I don't always take my full amount of oxycodone - it depends on my pain at the time. But, as I mentioned in my last post, my PM told me I'll ALWAYS be on narcs for my permanent nerve damage - it's just getting me down to the lowest dose possible and, as a 36 year nurse, I'm sure you're aware that opiate weaning can take a very long time. If I wasn't having surgery for one thing or another every time I turn around, my choice would be the Subutex/Suboxone route I've done twice before, get completely off the narcs, and see where my chronic pain lands. Quite honestly, I would love to be free of the narcs again and it's still something I ponder from time to time

    One thing I'll never understand, especially with this big "War on Opioids", is why the restrictions on Subutex/Suboxone are still so strict. Not many doctors can dispense them, once they certify they can only have so many patients per month. Not to mention, insurance won't pay for the doctor OR drug, as it falls under "Behavioral Health", aka addiction. I swear by the stuff and it's SO much easier on your body and SO much faster than weaning. Any doctor can prescribe narcs to as many people as s/he wants, yet only certain doctors can prescribe Suboxone, and have only so many patients. It's completely counter-productive to what the government wants to do.

    Lastly, yes, if I feel like I'm being attacked, I'm going to defend myself. The quotes I posted were from your first reply to me and honestly, you can't tell me, when re-reading your post, that it comes off rather badly to me. If you weren't aiming that directly at me or if I misunderstood your intent, then I apologize. And, BTW, I'm actually a very good patient; I try to be polite and respectful, even when I'm in severe pain. I've worked in healthcare for 23 years in patient care, I know first hand how hard EVERYONE in healthcare works these days, I know employers squeeze and squeeze workers so there's no time to even sit down on 12-15 hour days. I went on total disability 3 years ago at 54 after being a Dialysis Tech for 16 years and even if I was totally healthy, I honestly don't think I could do that job anymore, the company has the techs and nurses going at a non-stop, frantic pace. Honestly, it's not safe.

    With my apologies if I misunderstood your meaning, I'll let this go. Cheers to all the hard working nurses and healthcare professionals!

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