Question: My spouse has been under the care of a pain management clinic for three years. She had spinal fusion surgery and has been relegated to their whims ever since. They led her to believe that increasing doses of Fentanyl and Oxycodone were the precursors for determining if she would be a candidate for a pain pump. Well, after getting her up to 75 mcg Fentanyl patches/72 hrs. and 60 mg Oxycodone/day, her doctor said, "you are too young to get the pump". At age 47 and wanting more than ever to become productive and enjoy life again, this was contradictory. It begged the questions, "If I am too young, how old do I have to be? Do I have to be so old that I am beyond being able to work, be productive, and have no hope of being a wage-earner again?" This made no sense, since the whole idea of getting the pain pump would be to be able to return to some semblance of a normal life without dependence on oral medications that saturate the bloodstream and turn one into a virtual vegetable. After that revelation, my spouse rightly told the PM doctor "no more". They have started a tapering program over supposedly three months that seems much too rapid in some respects starting out and the process of dosages reduction over time has not been fully disclosed. Although they have related the Fentanyl dose would decline as 75/50/25/12.5/unknown over two-week intervals, they have initially decreased the Oxycodone from 60 mg/day to 20 mg/day in the first two week period, which is causing problems - both pain-wise and mentally withdrawal-wise. There is no doubt my spouse will continue to need adequate medication of some sort to continue to manage her extreme pain, or approval to receive the pain pump at best, but the uncertainty and distrust of this tapering process, given the level of non-disclosure, is leaving my spouse stressed out and enduring emotions and uncertainty that, at least to me, are unwarranted from doctors if they really cared about the patient's well being through the process. What course of action, to mitigate a process of tapering not really tailored for the patient and to get them into a more effective program of treatment for their pain would be recommended?

I believe you may have somewhat misunderstood, since my question did not inquire about risk. The patient has begun tapering off the two medications. In the first two-week period, Fentanyl patch went from from 75 mcg to 50 mcg and Oxycodone went from 60 mg/day to 20 mg/day. It is the sudden drastic cut in Oxycodone that is the concern, which brings into question the whole tapering process which should cause as little discomfort for the patient as possible. I know the patient should seek out another physician of some sort to pick up managing the pain in some way as these other hard narcotic medications decline, but just who or where that would be while this tapering regimen is going on is the question. So, what best course of action should the patient take (meaning who and where should the patient seek out) to continue adequate pain management during and following this tapering process?