Methadone dosing question

  1. I work in an inpatient setting, so sometimes we get patients who are managed by a pain specialist for a previous problem and then come in to the hospital with an acute injury. Naturally, it is challenging to keep their pain under control safely.

    Recently, we had a pt (middle-aged male) who had been in a "pain management program" for years due to an old orthopedic injury to one extremity (not the neck or spine). His home doses of meds included 60mg methadone per day, >20mg hydromorphone PO per day, a benzo, and a healthy dose of pregabalin.

    Here's my question for those who specialize in pain management: are those doses normal for a chronic pain patient? I realize we can't change his history at this point and we worked with the doctors to get his pain under better control, but when I saw those doses I honestly thought "what kind of provider ordered this stuff for him to begin with?" No previous patient that I've seen has been taking meds like that (including cancer patients, fibromyalgia patients, etc...).
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