We met the Pain Management Specialist today!

First of all, I must say that the pain management specialist (Dr MC) is a really nice lady! She made us go through a very thorough de-brief on what has been happening to date, plus all the info about what meds Husband is on now, which, as I told her, are as follows:
- 9am : 20mg Oxycontin
- 3pm : 2xUltracet, 1x200mg Celebrex
- 9pm : 30mg Oxycontin
- 3am : 2xUltracet, 1x200mg Celebrex

She says there are several options to try, starting with the most straight forward and working our way up to the most 'complex'. In fact, when she heard that Husband is already on Oxycontin, she said that already ruled out the simplest meds, as that would have been her first options. So, we have gone straight to the slightly stronger options: For now, she has put Husband on liquid morphine, to be administered as necessary, 5ml initial dosage. If not enough to kill the pain, then another 5ml when the pain breaks through... Which also means that subsequent daily first dosage could then be 10ml. If the 5ml makes him 'high' and hallucinatory, then reduce to 2.5ml. In addition, she recommended that we continue with the oxycontin I am already giving him (20mg at 9am, 30mg at 9pm), discontinue the Ultracet, but continue with the 200mg Celebrex ONCE a day at 3pm. If he can handle more pills, then to take 2 normal Panadol at every meal (4 times a day) - though, given the choice, Husband does not want to add MORE pills unnecessarily to his overall dosages! She has also prescribed something called Amitryptilline, HALF-tablet to start, to be taken at night, before sleeping. If he handles it well (ie, he doesnt wake up the next morning feeling like he has had a hangover), then increase the dosage to ONE tablet nightly.

She wants me to adjust the opiate dosage till we find one that suits him, at whatever interval that suits him (eg, she said if 5ml works perfectly, but only works for 1 hour, then take another 5ml every hour.). I dont think it will come to that frequency, but I have a feeling that it will be at least 4 times a day, once we find the right dosage. I know that the Oxycontin only seems to work for about 6 - 7 hours, which is why I had the Ultracet/Celebrex combination dosage set for 6 hours after the Oxycontin! So if the morphine is similar (since they are both opiates), then 6 hourly might work well. We will have to see how it goes. So far, since we got home, it seems that the 5ml dosage keeps Husband going for TWO hours. I will continue with the 5ml dosage for the rest of the day, till he goes to sleep, and tomorrow morning, start with an increased (10ml) dosage to see how long that can keep him going. Dr MC did warn us it will be all trial and error, as every single person responds differently.

What are the other options open to us? Not a lot more actually. One other drug is methadone, but that is, apparently, somewhat difficult to get here.

Final possibility, if we find that the opiates just make Husband too "woozy" and hallucinatory, would be to put an epidural (a very very fine tube) directly into the spine, with the other end of the tube connected to a "port" (somewhat like the chemoport he already has implanted in his chest for chemo infusions). This port would be embedded below the ribs, and would be used for direct opiate injection 2 - 3 times a day, into the spinal fluid - thereby bypassing the gastric and blood systems, which means it won't cause constipation and won't cause hallucinations or dizziness - and directly targetting the spine which is where all the pain is concentrated. The port could also be used for continuous infusion - where the opiate, diluted in some solution, is administered over a period of time. In such a case, the solution+opiate would be in a small bag, which can be clipped to a belt, and then connected to the port for ongoing infusion. Which also means that Husband would not be restricted in his movements, and would not need to be in hospital.

That's it for now. We are due to see her again on 30th Dec, though I can always pick up re-prescription of the morphine earlier IF required. Please continue to keep Husband in your thoughts and prayers that this change of painkiller will work, and that we will be able to quickly work out the ideal dosage to relieve him from pain on a continuous basis.

So, till next time, remember... stay safe, stay HEALTHY!