Information for patients who feel they are stable on their pain medication
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While every individual situation is unique, there are some general guidelines we can give you as to what to expect based upon your history with pain medication. Our goal is always to use the least amount of medication that gets the job done. In some cases this means continuing the dose you are already on, sometimes it will mean reducing or even weaning off of the medication. If you what to understand more about why we would want to reduce or even stop pain medication, please read the Core Series on Dr. Whiting's Blog.
Patients on pain medication are strongly encouraged to make use of additional options for reducing pain. We offer several effective treatments in the office including a maintenance program of treatment designed to keep your pain at a manageable level. There are also many community resources including gyms, physical therapists, chiropractors, counselors, etc.
If you were only recently started on opioids we will in all likelihood strongly encourage you to let us get you off of them. Again, check out the Core Series if you have questions about why.
If you have been on opioids for years, then how we approach your situation will depend in part upon your dose. Dose is expressed as Morphine Milligram Equivalents which is explained best by reading this flyer from the CDC.
Low Dose Patients: Those taking 50mg daily or less. These are the patients who do best in our program. We encourage them to take their medication in a flexible manner - to look for the days when less medication is sufficient so that on the really bad pain days they can take just a little more. Patients on higher dosages are rarely able to exercise this degree of flexibility.
Even with low dosages it is important not to rely just on medication. Low dose patients still benefit from treatments such as massage therapy and the other modalities we offer in the office. And all pain patients should strive to be as active as their condition allows. Regular physical activity is the key to living well despite chronic pain.
Moderate Dose Patients: Those taking between 60mg and 90mg. Patients on this much medication may be stable, but they are rarely satisfied. The medication changes the chemistry of the brain and tolerance is the inevitable result for almost every single patient on dosages above 50mg. They may be able to take the medication as prescribed, but they invariably are watching the clock and eagerly anticipating their next dose. They have nowhere near the flexibility that low dose patients have.
Patients in this group are strongly encouraged to sign up for one of our maintenance therapy plans. They should consider pool therapy or at least be regular attenders of their local gym. If they will avail themselves of these other forms of treatment it is very possible that we can reduce their dose slowly and gently and bring them to the point where they have flexibility in their dosing and less pain overall.
High Dose Patients: Those taking more than 90mg. Again, patients on higher doses of opioid are rarely truly satisfied with their treatment. There is no flexibility - a missed or delayed dose brings misery. These patients take upon themselves significant risks including at least double the risk of dying compared to those on doses below 50mg. These patients will have to agree to weaning in order to be a part of our program, and will need to be actively engaged in some form of non-medicinal treatment. Weaning is always done slowly and gently. Dr. Whiting has weaned hundreds of patients and without exception they do better in the long run with less pain and more flexibility.