PA Lady is correct. He may have been trying to see if the increase in the methadone dose would better treat your pain than giving you an increase or even just staying at the same dose with your break through meds. The goal is to have the patient using the ER release meds to cover most of their pain, and only using the BT meds infrequently and only in severe exacerbations of pain. If you are taking your BT meds daily or even most days in a month, adjusting your baseline med (ER) makes more sense than it does to give you more or different BT meds.
As far as your insurance goes, PA Lady again is exactly right. Your insurance refused to pay for both meds at once so now your doctor either needs to increase the med you are on already ( which he did) or you can call your insurance and ask them what you need to do to get the Opana approved while you are titrating down on the Methadone.
You know that Methadone is an extremely long acting medication and given that he just increased your regular dose 30 extra milligrams, he may not have wanted to take a chance of you overdosing by giving you the regular dose of BT meds that you were on previously. The NP may have had the same concerns once she understood what you were there for, which is why she offered you oxycodone at 5mg.
You may do very well with the increase in your regular dose of Methadone and the 5 mg oxycodone might have been just enough to bring the increased pain levels back down given that increase....you should have given it a try.
Most PM's when they change a dose of you ER meds will either lower or withhold your BT for a bit to see if the increase in the ER meds are going to work.
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.