Oftentimes the answer to that maybe two folded. One may be that your disease may be progressing so if a particular type of pain medication or particular dose of medication may no longer be effective because your disease has progressed into something worse. The other possibility, oftentimes it happens specifically with opiate medications is that you may end up becoming tolerant to it so no matter who is taking opiate medications weather it’s me, myself, my staff member, a priest, a pope, anybody if they’re taking the medication on term your body starts to reset itself regularly that you are opiate receptors so that a particular dose of medication is no longer effective and you may feel like what was helpful before is no longer helpful and you may need a more stronger dose or a more frequent dose.
The determination of the type of medication, the frequency of medication, the strength of medication is going to be made after we perform a thorough physical examination a thorough history after discussions with the patient and then we come to a mutual understanding as to what type of medications are we going to use, the strength and the frequency as well as what we should be expecting out of the medications in terms of decrease of overall pain levels and increased functionality.