My history is traumatic brain injury from a fall which compression fractured my cervical and thoracic spine at age 22 while on active duty.For the sake of brevity I fast forward to now. I have completely eliminated all pharmaceuticals except 45 milligram equivalent of oxycodone each day. Rapid tapered at VA after my private doctor passed from cancer from 90 mg equivalent to 45 mg equivalent. I am finding that I cannot engage in the activities necessary to improve my functionality and quality of life because of the high pain which is poorly controlled by the relatively low dose of Oxycodone.Also the oxy lasts 2 hours and 40 minutes after taking 40 minutes to work yet Rx continues to instruct to take every 4-6 hours. My desire is to increase the oxycodone to 75 to 90 mg equivalent per day. Using the RIORD tool which I have become familiar with and other general assessment of risk I find that my only risk on the RIORD tool is that I take oxycodone and that I have sleep apnea. I score an eight on the test. My CPAP machine is well tolerated and I wear it every night. This makes my RIORD score even lower. How do I advocate with the VA to increase my pain meds so that I can engage in the functional rehab expectations do the mindfulness exercises etc. Additionally I have quit smoking I’ve lost 40 pounds my heart risk has been reduced significantly my cardiac health has improved significantly. I am 63 years old and in an otherwise good health except for the chronic pain. At one point in my journey I had over 23 of the 34 symptoms on the mind body syndrome list. I have successfully reduced and or eliminated many of those symptoms and I’m left with chronic pain which flares significantly when I try to engage in physical activity. I know that with my experience with opioids for many years now that oxycodone is a medication that has very few side effects if any for me and continues to be helpful and I don’t and have no history of trying to reach higher and higher doses. What are my chances of Finding a doctor that would work with me to find optimal dosing for optimal pain relief to optimize my function. Thank you very much for your time.
Chuck, Theses are all great questions. The obvious simple answer would be to switch to extended release oxycodone as either OxyContin or Xtampza. If your doctor is unwilling to place you on that and titrate your dose, it is likely you would respond better to a lower than equivalent dose of methadone. Methadone not only offers opioid agonist activity, but it also blocks reuptake of norepinephrine and inhibits NMDA receptors. Anothet potential option that docs are less squeamish about prescribing (if they are willing to learn about it), is tapentadol. I think it would be good to have a frank conversation with your doctor about these options. These meds also have certain drawbacks, particularly methadone, so you may or may not be a candidate for either.