What happens next when you are on 10mg hydrocodone 4X a day and Xanax as needed for Fibromyalgia and RA but it is no longer working? What is a good next step? Also on Savella and Synthroid (probably misspelled) once a day. I’ve tried injections for RA with no relief.
First, let me say, you spelled both of those correctly :) The issue of where to go next is both simple and complex. Here is the simple, as described in the appropriate chapter of my book: Tell them the plan is not working and discuss how functionally it falls short. That is, you must have a better reason then "I hurt" to say the plan is not working. What is it you are not able to do because the plan is not working? There are several examples in the book for the answer to this questions but here are a few here: A) I am not able to get dinner on the table because I need the first three doses to do (blank) and the last one to rest. B) I can white knuckle it through my work day but when I get home, I go straight to bed without spending time with my family because I have "nothing left."
Now, here is the complex part. You should have an OPINION about what might restore efficacy to your plan. Then you have to be prepared to not ask for this specific change. Instead, you ask curiously, "I wonder if adding a single dose at (insert time) might allow to meet all my obligations?" Or, "I wonder if a long acting...?"
By introducing the conversation as a curiosity, it encourages your provider to respond with their ideas, whereas if you only ask for what you think will work, you are setting up a very abbreviated "Yes/No" conversation, and it is SO much easier for the provider to say, "no, we can't do that."
You mentioned that you are on Xanax, remember that being in pain also messes up your behavioral health plan, so some of your reasons for why the plan is not working may be tied to worsening behavioral health.
Finally, do not overlook the value of a medication reset, which is to intentionally take 1/2 your normal opioid dosing for 5 days, allow yourself to sit in your pain for this period of time and then restore previous dosing - it will very often restore efficacy to your plan. This is something you can do yourself, and of course is well described in the book as well.
