Ok, Ive been seeing a CP dr for over 2 years now. Im currently on Morphine ER, however, my question is this -Is it a common thing, that theres a max dosage they will do, and not do BT meds?

Currently, im on the highest dosage he will do 30mg, 3 x a day. He wont do BT meds, which is becoming a bit of a problem

Do you mind me asking what brand of ER morphine he has you on? The only ones I know are either 12-hourly or 24-hourly preparations. Of course, you may find that they do not last as long as they are supposed to last, but the product licence will be a 12-hourly or 24-hourly dose, so he's maybe feeling he's being a bit 'generous' there.

Does he also have you on NSAIDs and APAP, or any other analgesic, oral or topical?

Its the purple ones. Id go look, but Im lazy and dont wanna get up. (i will if i have to) so im honestly not sure if its 12 or 24 hr.

Nope, nothing, just the morphine.

I really would like to go get a new dr, but it took SO LONG to get into see him.

*sighs*

Thanks for responding Nephro

Ok, decided to not be lazy. Its manufactured by mallink pharm is 30mg extented release morphine. As far as if its 12 or 24, i have NO clue.

from what I can tell it is 12 hour

ok, thank you stevo1. I wish it really HELPED for 12 hours. Not even half that. *sighs*

Maybe a good approach with your doc would be to ask if it's worth trying APAP and NSAIDs; at least he'll think you are interested only in pain relief, which is true of course. Then you could go back in a couple of weeks and say that the morphine is lasting barely 6 hours. He might then be more receptive to increasing the dose or including an IR med for breakthrough pain.

Yeah, I did that last time, and told him I had been taking Tylenol. His max dose of morphine for ANY patient is 90. And he doesnt do BT meds, he doesnt believe in them. Ive known that from the beginning. Its just frustrating.

Ty for your help and advice

It's exasperating when doctors don't seem to follow logic. At my last appointment at the pain clinic, I asked my doctor if Taiwan uses the WHO analgesic ladder. He said "yes, of course we follow it, but we don't use opioids unless the patient is dying." So, basically for the rest of us in severe chronic pain here, it's NSAIDs and paracetamol with perhaps a few adjuvant drugs thrown in - no opioids unless we are terminally ill. He only prescribes me Temgesic because he says I am a 'special case' (I assume because I'm a foreigner who's been prescribed opioids long-term from another country) and every time I go to see him he always goes on and on about how addictive opioids are, and checks to see if I have a runny nose or anything else he calls 'signs of addiction'. I've already made it abundantly clear that I fully understand the advantages and disadvantages of opioid therapy, not to mention the difference between addiction, dependence and tolerance (I sometimes suspect he doesn't, to be honest). He told me that he doesn't like prescribing morphine because when it ceases to control pain effectively there is nothing left to use. I told him I was aware that there is basically no analgesic ceiling with morphine and many other opioids, and mentioned stronger opioids such as fentanyl. He then told me that they have fentanyl patches here, but - get this! - the pain clinic can't prescribe them! Only a psychiatrist can prescribe C2 drugs, apparently. I always leave the clinic with my head spinning... maybe I should see a shrink!

Milvis, maybe your Dr. needs to see a shrink. Your pain Doctor is obviously lying about what they can prescribe. It's a pain clinic for God's sake.
I hear you loud and clear. I'm going through the same craap with my PM.

It's like "NOTHING MORE FOR YOU, BYE".

I guess we have to be we have what we got and fend for ourselves elsewhere.

Seeing a psychiatrist for c2 drugs instead of the pain clinic really blows my mind.

Milvus- OMG..im so sorry! I guess i should feel fortunate then! That makes, NO SENSE. Also a Psych can prescribe C2s, but not a PMC? WTF!?

Tazlover - Yes, I guess we do need to be happy with what we got, and fend for ourselves elsewhere.

It just gets very, very tiring. Too much at times.

*hugs to ya'll*

I know, the psychiatrist thing sounds crazy, doesn't it? I'm seeing another neurosurgeon soon, so if I find him receptive I'm going to ask him if he can recommend a better pain management specialist. The doc I see now is a nice enough guy, and I believe he is genuinely trying to help, but opiophobia is so widespread over here, and he is no exception when it comes to the general disapproval and ignorance regarding opioid drugs.

It's very frustrating. Every appointment follows a similar pattern: instead of asking how I am, whether the medication is controlling my pain and I whether have any new symptoms, he goes into a monologue about how addictive opioids are and how they don't use them over here except for terminally ill patients. There are many things he has said to me over the last year or so that I know for a fact are simply incorrect, but at the moment he is my only source of the only medication that has helped relieve my pain to any significant degree, so I don't want to antagonise him by contradicting him too blatantly. I do feel uncomfortable going to appointments, though. It's causing me extra anxiety and actually makes my pain worse, at times! Ironic, isn't it? The only alternative is to find a more enlightened doctor over here, or move to another country, which isn't an option at the moment.

Another thing that has puzzled me is that this doc has mentioned injections several times, but in the end he said it would be too tricky because I am too fat. I'm 'a bit' overweight at the moment (I gained about 10kg over the last few years from diminished activity), but I was unaware having extra body fat was a concern where injections are concerned. Anyone here know anything about this?

@milvus- What kind of injections are we referring to? As in like cortisone, or?

That all does sound very frustrating. I wish I had a solution for you (as I like to solve things for people) ..however Im no where near where you live, and thought things were bad here in the states. Guess not!

*huge hugs*

I have been reading up on injections for several years now - boards, med sites, etc ... and I have never heard of this as a concern. He could just be an [censored], or if that gets censored, let's go w/jerk.

The doctor referred to the type of injection as a 'caudal block' and said he would inject steroids. I haven't had any kind of spinal injections before, so don't know much else about them, I'm afraid. Time for me to do some research...

This doctor has also mentioned radiofrequency nerve ablation as a possible treatment option, but from what I've read of people's experiences with it, it seems very hit-or-miss. I get the feeling the doctor is a bit frustrated that he can't really do much for me. He's been showing my MRI to other patients with back problems as an example of how bad things can get, apparently (he told me I have the dubious honour of having the worst lumbar spine he's seen in his clinic) so obviously he knows I'm in pretty bad shape.

Thanks to both of you for your concern (and hugs). ;-)

milvus, seeing as you are in east asia, is not easy just to find a pharmacy to "get" it from. I guess my question is asking whether the stories about buying meds otc are true, even something like perduretas etc.

every doc is different

go to a diferent doctor.

No, you can't buy any opioid-containing medicines over the counter over here (Taiwan - I don't know about other countries). Everything is tightly controlled nowadays, and has been since the mid-90s. Before that, you could walk into a pharmacy and buy all kinds of stuff: codeine (pills and syrup, with no other ingredients), Ritalin, diethylpropion, ephedrine, and just about any kind of benzodiazepine. I remember one time I went to buy some Robaxin for my back and instead the proprietor tried to persuade me to buy a bottle of Rohypnol (this was before all the 'date rape' stuff came to light). When I first arrived here I remember seeing Doriden (glutethimide) and Luminal (phenobarbital), and Quaalude (methaqualone) had just been banned due to increasing abuse and suicides associated with it.

Strangely, though, you can walk into a pharmacy and buy any seizure or antidepressant medication.

Milvus, that is really weird. I will NEVER understand why certain things can be bought, and others cant. Oh wells.

Id have to agree with Zeny28, and say maybe go to another CP doctor, if you can.

i would have to agree also, another cp doctor is the way to go, or maybe even the psychiatrist, it seems like you are just wasting money if you continue with this route without relief. Also if I were you I would do some research on maybe going to another part of country or maybe even on to the mainland. I cannot imagine that the entire region is like that. IE, where I was living in South America, it was like that, so I just took a $200 plane ride to a better country once ever 3 months. Maybe Hong Kong, how much would that be, dont they have cheap prop flights?

Thanks for the suggestions, all. At the moment I am being treated and receiving the medication that I need (I should have made that clearer) - I was just pointing out some of the odd and frustrating aspects of pain management in Taiwan. I would rather continue with the Temgesic/Tramadol/diazepam that I'm used to, rather than switch to fentanyl, which is the only other alternative over here (the only other strong opioid they have is morphine, but that is Schedule 1!). If my pain worsens or the doctor stops prescribing my Temgesic I may have to look elsewhere, though.

The worst thing is actually the uncomfortable feeling I have at every appointment, which is every fortnight (even Schedule 3 drugs can't be prescribed for more than 2 weeks at a time here). I just wish he would focus more on my condition and how to control it rather than endlessly repeating all the bad things he's heard about opioids. In future I will try to steer the conversation away from that. At least I don't have to pay for anything, as I have health insurance (he said I'm his most costly patient - apparently Temgesic is pretty expensive). Thanks again for all your thoughts and advice. ;-)

Milvus, I know what you are going through I think. My PM doctor is strange. I'm only in there for maybe 15 minutes and most of the time he talks about past patients who abused their pain meds. He has several stories every time I go. Some are the same because he forgets who he tells what to. He calls those patients that abuse "Criminals". Really he does.
For example:

He said a lady was given a script by him for 4 hydro's a day. She called his nurse 2 weeks later and said she was out and asked for an early refill. He said, "She is criminal, I told my nurse to have her come in that day and I fired her. No more medicine for her, she criminal". He is foreign and that is how he talked. The more he talked, the upset he got.

I've never asked for anything like this. I do was he says. But I get the same craap every time I see him. I hate it.

So I feel for you. I am going in on the 27th for an epidural injection. It seems like because i turned it down, he does not trust me completely even though my MRI shows 3 bulged disk. I'm only doing to satisfy his questions of every time I see him, he always brings up that I declined the injections.
Once again, the doctor wins.

I'm sorry you seem so have such an uncompassionate doctor. Have you asked people in your area for a better recommendation? It never hurts to ask around and try to find more suitable help.

Taz, if you don't mind me asking, what are you currently Rxed?