Handbook for Mortals : Controlling Pain : Doses of pain medicine

Over-the-counter medications are taken in the same doses as recommended on the label. When medications such as aspirin, acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®, etc.) are included in prescription medications, the total dose of these should still not exceed the maximum recommended daily dose on the over-the-counter labels, so be sure to ask your doctor or pharmacist what the maximum dose would be.

"What is the usual dose of morphine? Isn't mine too high?"

The right amount of opioid medication is the amount that relieves your pain with minimal or tolerable side effects. There is no usual dose. Some people need small doses of opioids, while others need much larger doses. The amount of medicine that you need for pain relief is not related to how well you tolerate pain or how well you are coping with your disease. It is not a weakness to take large doses of medicine if that is what you need to relieve your pain.
Just as there is no usual dose, there is no maximum dose of opioids. This is unlike over-the-counter medications, which do have a maximum dose (and have serious side effects if you take too much). For opioids, you increase the dose if your pain increases. Also, there is no ceiling effect - no point when increasing the dose won't work anymore to reduce the pain. Some people worry that they will get so used to the medication that it will not relieve their pain anymore. There is always a dose which will overcome any tendency of the body to be "used to" opioid drugs.

"My husband says he won't take more pain medication - he feels like he's giving in to his disease."

Some people do not want to take medication for pain because they feel that doing so is giving in to their disease. Remember, though, that living well is often the best revenge. Trying to ignore your pain will not make your disease go away. Ignoring pain will only make you even more aware of your disease, and will detract from the time you have left. Treating your pain will keep your disease from controlling your life more than it already does.
Some people look at the amount of pain they are in as a measuring stick. They judge whether their disease is getting worse by how much pain they are having. Although pain may worsen as some diseases worsen, it is not a reliable indicator of disease activity. Sometimes a small injury or change hurts a great deal. Some people have a lot of pain with less disease; others have little pain with advanced disease.

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Handbook for Mortals book cover Copyright © 1999, 2006 by Joanne Lynn. This extract from the Handbook for Mortals by Joanne Lynn, M.D. and Joan Harrold, M.D. is used with permission.
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