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    What causes persistent pain while on Dilaudid?

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Posted on Fri, 30 Jun 2017 in Pain Management
Question: I'm on Dilaudid 8 3x a day and my chronic pain is not relieved. It is mostly relieved and I feel I need at least 1 more a day but can't get my Dr to prescribe it. I've been on Dilaudid 8 for more than a year. My pain management Dr says she needs to fly under the radar. What does that mean and how can I get her to increase my meds at least 1 more time a day?
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Answered by Dr. Matt Wachsman 48 minutes later
Brief Answer:
several points.

Detailed Answer:
First it might be nice to look for some treatment other than narcotics:
1) a treatmetn for the underlying disorder (unlikely in most disk disese) or
2) nerve dampening medicines such as lidocaine, capcaicin, anti-epileptics and amitryptilin.
second, narcotics work to change the perception of pain by methods that are by their nature not separate from ones own internal wiring. Several points on this: most important is that relief of pain narcotics are quite good at but removal of it is not something these drugs can ever do and thinking that a bit more will change this is sadly deluded. Furthermore, they do not work differently than other non-narcotic modalities such as physical exercise and conditioning.

Then, "fly under the radar" is making it the doctor's preference rather than either legal entities such as medical boards or plain good sense that at some level narcotics are dangerous and should not be increased beyond a certain dose. Certainly with a fatal cancer this does not apply. Otherwise continuing to escalate dilaudid is likely to eventually be a fatal disorder. At some point it is just a bad idea to increase the narcotics.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

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