Posted 1/22/2010 11:13 PM (GMT -7)
Yes, I heard this from my PM just about one year ago. He announced this to me after he had spent almost two year ramping up my Fentanyl from 0 mcgs to a 100 mcgs patch changed every 48 hours. For breakthrough, I was rx’ed first (1) Actiq 200 mcgs a day to at the end (5) Actiq 1000 mcgs per day. Even with all of this medication, I continued to have pain. In fact, my pain was increasing. Then out of know where, comes the opiod hyperanalgesia diagnosis. WOW – this hit me like running into a brick wall. Here is the conclusion:
1. YES, I did indeed have opiod hyperanalgesia caused by HIS incorrect prescribing of narcotics.
2. After 2 years of what I consider his mismanagement, he was now tossing around rehab.
3. I immediately changed PM’s.
4. Once my new PM stopped those horrific doses of Fentanyl, my pain decreased by at least 50%.
5. We decreased the pain medication until we were able to establish a new baseline.
6. My new PM started me on low dose morphine. He explained the Fentanyl was not the drug of choice for all over neuralgia types of pain. Morphine, in combination with Cymbalta or Lryica, usually did a better job controlling this type of pain. Lyrica did nothing for me. HOWEVER, the morphine and Cymbalta did wonders. I felt like a new person.
In summary, I absolutely believe in opiod hyperanalgesia. The cause is usually having a PM that continually increases the dose of the pain med you are on, month after month, rather that reevaluate HIS medication choice. I have now been on this new regimen of morphine and Cymbalta, with (90) 4 mg Dialaudid tablets per month for breakthrough pain for about one year. This plan works for me. I really need medication increases, and when I do they are minimal bumps up. Now I am on a realistic amount of narcotics that I can maintain for a lifetime, without worrying about maxing out due to tolerance.
Moderator for Chronic Pain and Epilepsy
Rare neurodegenerative /movement disorder called “Multiple System Atrophy”. Mobility issues,, neuropathic pain, spasticity, myoclonus, central apnea, collagenous colitis, joint and body pain, swallowing and respitory involvement, Implants: intrathecal pump & neurostimulator. Extra features: O 2 & wheelchair.