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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 44326
Experience:  Board Certified Physician
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Dr Can you advise on chronic pain management and medications to ween me of 75mcg of fe

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Hi Dr
Can you advise on chronic pain management and medications to ween me of 75mcg of fentanyl every 48 hours (I'm very allergic to every brand and generic out their. I also suffer from bi polar . Emotionally unstable mood disorder acute adult ADHD a history of OD and feel it's time to come of benzodiazepines and zolidem 10mg nite and 600 mg of gabapetin. I was advised by consultant psychiatrist to change the fentanyl to MST CONTINUS tablets 60mg/d every 12 hours for 7 days, review after 7 days and increase to 100 mg/d every 12 hours but to stop diazepam 5mg (PRN gabapetin and zolidem stay on olanzapine 10mg nite and sodium valproate. He warned it will mess my sleep around and may increase pain from fibromyalgia sacralitis and new bottom spine nerve pain. But from age 13 suffered acute backache had steroids pumped into me and not any longer !!! Simple, safe, easily prescribed and administered in 3 days RX because risk of another OD. Please advise, I've tried exercise and positive thi
Submitted: 11 months ago.
Category: Medical
Expert:  DrRussMD replied 11 months ago.
HelloYour thread is cut off, and I see no questions.We do not treat here, or repace your doctors advice.We answer questions only.I will comment that stopping diazapam suddenly is not a good idea as dangerous withdrawl can occur.This medication should be tapered.Otherwise, you need to work with ONE doctor, the psychiatrist, and not find other conflicting advise to follow.You need to work with a pain management specialist.And no changes should be done without running them past your primary doctor first. OK, so you might have more questions or want to give me more information: Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent—that’s how we are paid, per rating]. If you forgot something, come back. I am here daily.
Expert:  DrRussMD replied 11 months ago.
HelloYou have not come back to give more information or ask more as instructed.Yet, you gave a negative rating which rates me bad with just answer and sees that I am not paid.Was that on purpose?Your post is not even complete, as I told you, and I expected you would take care of that.Or was your negative rating an error...that happens.What questions do you still have?
Customer: replied 11 months ago.
Not offering advise on alternative medications for various complaints.
Not the Drs fault but not the service that was sold to me. I asked loads of questions and was refereed back to my current ft not worth time or effort
Expert:  DrRussMD replied 11 months ago.
HelloAS I told you, your post was cut off.There are no questions that I can seeThis is s site problem, yet you rated me, the expert negative, and that punishes meCan you re state your questions and reverse your negative ratings with a positive?
Customer: replied 11 months ago.
Sorry no offence, nothing personal with your service, but feel it should CLEARLY state NOT FOR SECOND OPINIONS also no pharmaceutical questions or advice that COULD conflict with primary Dr. To be told that Valium was withdrawn to quick £36 when on state benefits and I hold nothing personal against Dr it should indicate questions to long AND CUT OFF point on form. Please commend dr and withdraw negative personal feedback he answers professionally and was polite and considerate but could not understand my views and T&C of just ask
Expert:  Dr. David replied 11 months ago.
This is Dr. DavidI am another expert here.I can understand your worry about converting from fentanyl over to MS Contin.it may not mess up your sleep or cause worse pain.you should stay on gabapentin regularly which can help your fibromyalgia pain. why are you taking it prn?
Customer: replied 11 months ago.
Hi Dr David
I'm taking the
gabapentin TDS
Diazepam 5mg
Fentanyl 75mcg/hr patch (extreamly alergic to the adhesive hence me wanting to change.
Olanzapine 10mg
Sodium valproate 1200mg
Ambien 10mg
Now I'm not happy with the rash and swelling and scar tissue left by every generic brand available.
My prognosis does not look good, pain getting worse and opinionated Drs working office to office. My question is what would you recommend or stay clear of ?
I have a slot in May and would be fantastic for an independent view. I would prefer to stay clear of controlled RX they treat u like s junky !!
Sir your response would make my day. I'm not acting on your opinion just getting it to put to my dr cheers Paul
Expert:  Dr. David replied 11 months ago.
you need the sodium valproate and olanzapine for your bipolarif you can exercise during the day and stretch and do some physical activity, this could help your sleep and allow you to cut down or stop the ambienyou need the gabapentin to help with your fibromyalgia. you can ask your doctor to switch you to pregabalin which could work better for fibromyalgia for you.I would work on changing the fentanyl to morphine like your doctors have recommended and slowly taper down on the morphine over timeand if your pain is better controlled, then you might be able to stop using the morphineyou might benefit from using calendula cream on your skin to help calm your skin to decrease rash and itchiness.let me know if you have other questions.if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you todaywe only get credit for helping clients after positive feedbackyou can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questionshere is my website if you need to reach me:http://www.justanswer.com/medical/expert-dr-david/Thanks for using JustAnswers.com
Customer: replied 11 months ago.
Hi Again
So you feel PO Long acting morphine is that mst extend make up ?
I agree would be great to tapper of, but my consultant said I have nerve damage together with FM and 31 years history of acute sacral elitist and the pain when I leave my bed even on fentanyl is unbearable I can't buy 2 cartons of coke home !
So, what type of morphine release would you use ? And what program to keep the new morphine replacement of fentanyl would you adapt and would I need any rescue meds. ????
So kind of you to help, thanks for the pregab advice I will ask but your lucky to get phone consultation lasting 2 minutes, so I'm doing my home work...
Expert:  Dr. David replied 11 months ago.
pain medications should be dosed with long acting pain meds for baseline and then oral short acting pain meds for break through pain.your long acting pain pills should be morphine ER or MS Contin 60mg twice a day every 12 hoursand then you should ask your doctor for MSIR morphine sulfate immidate release 15mg pills that you can take one or two every 4-6 hours if you have break through pain.if you don't have break through pain, you don't have to take them.that is pretty standard with regards ***** ***** pain managementyou would also need a bowel regimen since all pain medications can cause constipation so you want to avoid constipation.the morphine pills should also be taken with food in your stomach, never on an empty stomachlet me know if you have other questions.if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you todaywe only get credit for helping clients after positive feedbackyou can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questionshere is my website if you need to reach me:http://www.justanswer.com/medical/expert-dr-david/Thanks for using JustAnswers.com
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 44326
Experience: Board Certified Physician
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