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Old 12-18-2009, 08:25 AM   #1
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Angry Post-Op Pain Medicine

[SIZE="3"][FONT="Arial"]I was sent home from the hospital with Norco 10/325 3x's a day. These pills are just like the Vicodin my PCP Rx'd to me for 8 years, and as my back got worse, the pills became less effective. I have been suffering day and night because Norco is doing nothing for my pain. Even the anesthesiologist told me I would need stronger meds. The neurosurgeon said that Norco is the strongest meds he can prescribe. I would have to go to my PM Dr. for stronger pills. My PM Dr.only administers my ESI Injections. My PCP controls my pain meds. I'm just curious to know what meds did any of you receive post-op. This is nonsense. I know I am supposed to feel pain for at least a year after this type of surgery, but I cannot even rest because I'm in tears because of the extreme pain 24/7.


PLIF L5-S1 and Discectomy 12/09/2009[/FONT][/SIZE]

 
Old 12-18-2009, 09:08 AM   #2
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Re: Post-Op Pain Medicine

the thing here is, number one, that NS is outright lying to you about what he can and cannot Rx to you for post op surgical pain, and he simply OWES you 'appropriate' pain management for the level of surgery he did on any patient. if ANY surgeon can actually Rx norco, they can also Rx oxy. you just ARE HIS responsibility here when he first cut you open, you know what i mean? i would seriously either see him in his office or ask to speak to him or his trusty NP or PA which they all have and tell them how bad your pain levels really truely are, and the tolerance issues you had even going into this surgery. one way or another tho, that Rx for anything above hydro would have to be picked up in person since it IS a class II narcotic.

if you absolutely CANNOT get thru to this stupid surgeon, THEN and only then would i see the pcp about this situation. you would have to pretty much stop getting anymore Rxes from your surgeon tho if your primary is willing to go above this idiots head and Rx you the more appropriate oxy at the very least. it could 'appear' wrong in certain lights if you just kept on accepting Rxes for a weaker med from the surgeon WHILE your primary is Rxing something else, stronger? just do not get yourself into THAT particular situation, K?

if you have a really good ongoing relationship with your primary this may just work. your primary doc IS your main care coordinator afterall, and should be also advocating for you IN these types of situations too. but do try and see what you can get the stupid surgeon to just do, like his job? before you even go to the primary, or you could just call or see your primary for help with the surgeon too? believe me, in just having over six surgeries done since 2001, my primary DID have to go to bat for me with one particular surgeons office, and he DID help me tons. this is just what your primary doc is supposed to help you with, this stupid kind of treatment by specialists who think they are freaking god or something.

i do hope you can get the "appropriate meds" for your pain. just DO attempt to exhaust ALL possibilities with the surgeon before asking the primary to actually really Rx you anything at all narcotic, K? please let me know how things go, marcia
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Old 12-18-2009, 09:26 AM   #3
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Re: Post-Op Pain Medicine

[QUOTE=feelbad;4145810]the thing here is, number one, that NS is outright lying to you about what he can and cannot Rx to you for post op surgical pain, and he simply OWES you 'appropriate' pain management for the level of surgery he did on any patient. Please let me know how things go, Marcia[/QUOTE]

You are right. I didn't believe any of that crap the NS was saying. I called my PCP's office yesterday and told them what happened. It was close to the end of the day, so I knew they weren't going to call me back that day. I called their office twice this morning because I didn't want to go through another weekend of horrific pain. I just spoke with my PCP-not a Nurse, and he's writing a script for oxycodone 3x's a day and my hubby is speeding over there to pick it up because the office closes at noon today.[SIZE="3"][FONT="Arial"][/FONT][/SIZE]
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PLIF & Discectomy 12/09/2009
Emergency Cesarean Section 04/21/2008
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Right Wrist Arthroscopy 08/2001
Tonsillectomy/Turbinectomy, 09/2001

 
Old 12-18-2009, 09:34 AM   #4
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Re: Post-Op Pain Medicine

Something doesn't sound right with all of this...are you sure your PM doc isn't suppose to be covering your pain? I was thinking your surgeon is just a jerk but I can't believe he would expect you to recover without pain meds on board ......you are entitled to have no pain. In the health care system we are in the surgeon will prescribe pain meds for up to 3 to 6 weeks after surgery because who better would know of what your level of pain would be at those critical times however just routine office visits for check up we have to go to the primary doc for pain meds. you do have a PM doc perhaps you are misunderstanding and you are suppose to tell you PM doc to now prescribe you some adequate pain control meds. Call him right away to find out. You can't heal properly without relief of pain. good luck

 
Old 12-18-2009, 09:48 AM   #5
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Re: Post-Op Pain Medicine

[QUOTE=AnnD;4145827]Something doesn't sound right with all of this...are you sure your PM doc isn't suppose to be covering your pain?[/QUOTE]

I like my PM Dr. He only performed my ESI's. I wouldn't use him for meds because he does random drug tests (which I don't have a problem with). So if you are randomly chosen for a drug test, you have to pay $30 for it, plus your co-pay. If he wants the test, he should pay for it. I have nothing to hide.[SIZE="3"][FONT="Arial"][/FONT][/SIZE]
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PLIF & Discectomy 12/09/2009
Emergency Cesarean Section 04/21/2008
Right Foot Bunionectomy, Flat Foot Reconstruction 05/2001
Right Wrist Arthroscopy 08/2001
Tonsillectomy/Turbinectomy, 09/2001

 
Old 12-18-2009, 10:13 AM   #6
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Re: Post-Op Pain Medicine

Something sounds terribly wrong. You are not getting enough meds. Even oxycodones 3x a day isn't enough. Let me tell you what I was on after my first fusion, it's a lot so dont be shocked!
I was allowed 2 oxycodone's every 3 hours. (This oxy had no tylenol in it).
1 Oxycontin twice daily ( went to 1 1x daily after a week and a half or so)
1 valium every 6 hours
and then neurontin and I cannot remember the dose.

Now they started weaning me off everything after a week and a half or so. After 2-3 weeks I was just on oxycodone and neurontin.

You absolutely MUST had adequate pain control after a surgery like this. It is crucial for your healing. You have to be able to walk so you can heal, and if you are in terrible pain the you can't walk very well.

Good luck and I hope you get some relief!

 
Old 12-18-2009, 09:06 PM   #7
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Re: Post-Op Pain Medicine

Most PM doctors have you sign a contract and do random drug tests. But it's worth all that to get the right medications at the right level. I've not had one urine test thus far but did sign a form saying "I'll pay for the urinalysis if the insurance company does not". Think of it this way, would it be worth $30 to be in less pain? If so it seems like the cost vs. benefit would lead you to the PM doctor.
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Old 12-19-2009, 04:25 PM   #8
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Re: Post-Op Pain Medicine

If I read your post correctly, you (pre-op) were taking vicoden for pain relief. Post op from the fusion, you were given 10 mg/325 Norco, which is a higher dosage of pain medication than what you were taking pre op. In most cases, it is assumed by the surgeon that if you have a pain management doctor, that the surgeon will send you home with enough meds for one week, during that week, the patient is supposed to contact their PM doctor for any increase in medications or change in them. Unless your surgeon's office tells you that they will handle your pain medications for a certain period of time, it is done just this way with the patient dealing with their PM doctor for medications.
The reason for this is because of the contracts that most of us in PM have with our doctors, that we will only get meds from one doctor, and only fill at one pharmacy. This surgeon may have made the assumption that you would contact your PM doctor for more or different medications if they were needed, unless you discussed your pain management post op with him, you can assume that is what he did. I know that before both of my surgeries, I had to discuss post op pain management with both surgeons and my PM doc as to who would handle what and when.
It is left up to the patient to clarify those things before the surgery. If it was not discussed with the surgeon or your pain medication doctor, they operate under the assumption that it is taken care of.
As far as being undermedicated goes, that depends entirely on the patient and the pain they experience. Some are able to do rather well managing their pain taking 5 mg of oxycodone and others not so much. It is not a good idea to tell someone that their pain is being undermedicated, when they may not need a stronger dose than what is currently prescribed.
And you won't be in pain for a year. The worst of the pain will subside in the next month or so and then decline from there on out. Hopefully , within the next three months, you will see a steady decline in pain and won't need to worry about pain meds in the future.

 
Old 12-20-2009, 09:04 AM   #9
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Re: Post-Op Pain Medicine

hi BH, while i do totally agree with what you are saying here about speaking with your PM BEFORE the surgery gets done(crucial actually). what realistically occurs with anyones surgery and the post op meds that are needed really does come down more to who decided to actually take that responsibility. and anything and everything while in PM just HAS to be communicated as well, that is NOT an option here. no communication is what gets any PM patient into trouble down the road.

the thing is, with my two knee surgeries, an aneurysm coiling(produces horrid headpain post coiling) and also my rotator cuff repeair all being done while i was in PM? it was actually left to my surgeons to take care of ONLY the added post op pain with my PM continueing to rx me all my regular meds which the narcotics were oxycontin and roxicodone, but only two per day with my PM. the thing is, with that 'new' acute pain being added, you just DO need that extra to help keep that not yet accomodated in the brain pain under the best control. my surgeons were just 'in charge" of the post op pain area and they did Rx with the full total knowledge of my PM too(when they stopped, that was told to them too).

this is just how things are done with 'my' particular clinic. every clinic/surgeon does things their own particular ways. but EVERYTHING done with any narcotics just has to be completley out on that table at all times, with everyone on that very same page. if i rememeber the initial poist here? the only thing this person actually saw the PM for was injections? it did not sound from what was stated that the patient was actually getting any narcotic rxes from them at all so no contract was signed. i had to do this very same thing wayy before my spinal cord surgey screwed up my body and my life. i was referred to a pain clinic ONLY for trigger point injections when needed. there was no Rxing or seeing their staff at all, just the anesthesiologist who eventually DID become my own PM years later,doing the injections. my primary, as i think this person has too, did any narcotic rxing for me, which was pretty minimal back then. now of course it is very different with me having been seeing the actual PM for about six? years and i did sign that contract too. what really dictates what anyone can have done for them post op really comes down to what was simply discussed before hand when in PM. who is going to take the responsibility for the added post op pain?

i just cannot imagine that someone who had even been on only hydro,even at a lower dose,could realistaclly get a good amount of relief considering the type of surgery from 'just' the very same type of med being given post op when it is only hydro. despite the fact that hydro is considered to be a 'weaker' med. what anyone actually responds to and their particular pain and what is generating it, that really dictates whether anyone would get better relief from the hydro or ty 3s even vs oxy based meds. in certain instances, certain types of narcotics can just be much more effective with certain people than what someone would 'think' would just be less or not enough.

it just appears rather obvious that this particular person,and what they have stated is just not really getting the best possible relief from hydro only. and that really IS something that the surgeon just should realistacally address since not all people just will naturally respond to any real given meds in the very same ways. we are all just very very unique and different physiologically, ya know?

it all kind of comes down to suffering thru a post op period and just being at a much more tolerable level so a person can relax and heal properly. that just IS part of the surgeons responsibility here to 'appropriately' treat a persons level of pain, espescially when it is a more invasive type of surgery that does just cause much more trauma and inflammation to the patient.

its just kind of a scarey world out there when you just need a surgery and you are also in PM. it can be an easy thing to do or become very very complicated. communication and preplanning are really the most crucial part of the dang surgery in some cases. its just anytime things are simply NOT well communicated in any PM situation, thats when the bigger problems start, ya know? i have just been wayyy lucky in that i do have a really great PM clinic and doc and a wonderful ortho surgeon who just really does understand chronic pain and my RSD too. and also a VERY much freakshow body that just comes from SCI. i AM thankful. marcia
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 12-21-2009, 09:07 AM   #10
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Re: Post-Op Pain Medicine

[FONT="Arial"][SIZE="3"][B]To clear up any information I may have left out: Pre-surgery, the NS told me that he would be handling my pain for the next 12 weeks. After that, I could go back to whoever was controlling my pain before I had surgery with him. When I told the NS that the Norco wasn't working, he said that's the strongest thing his office could supply. After he told me that, I called my PCP who usually Rx's my pain meds and he wrote me a script for 20mg Oxycontin 3x's a day. I don't really feel a difference in this medicine either, but if we can't figure out something that will work, I guess I will have to see my PM for meds because he might be able to treat the pain better. I just feel more comfortable going to my PCP because I've been with him for 10 years and he's in the same city as me. The other Dr.s are about 30 mins away and the PM (even though he's nice) wants money for copays and drug tests. I cannot afford all of that right now. I'm trying to get my disability, so I have no income, and tons of appointments and Rx's to pay for.[/B][/SIZE][/FONT]
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Old 12-21-2009, 10:10 PM   #11
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Re: Post-Op Pain Medicine

Stressed,
It is going to hurt and badly for the first two weeks, and then will ease. The best thing that you can do is rest, walk as much as you can tolerate each day and rest some more. I am not sure why your neurosurgeon says that he can only write a script for 10/325 Norco, but it may be his opinion that he fixed whatever was wrong so now, you need to deal with the pain for a bit. Not fair I know. It is not that I am unempathetic to you, I've had that surgery twice, so I know it is painful. If your GP is the one prescribing pain medications for you, then you will need to discuss your pain relief with him. Oxycontin is a long acting medication, which means that it releases part of those 20 mg right after you take it and then the remainder over the course of the next 12 hours or so. It may be that he may need to add some immediate release oxycodone/percocet type pain meds to give you the additional pain relief in the immediate time and then the oxycontin as a base med for now.
I hope that you feel much better in the coming days.
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Old 12-22-2009, 07:00 AM   #12
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Re: Post-Op Pain Medicine

Yes Oxycontin is a long acting narcotic, and should last about 12 hours. But it does sound like you need something for break through pain as well. Like I said before, I took 1 oxycontin every 12 hours and then oxycodone in between. Have you been taking the narco in between (with doctor approval of course)?

I disagree with the fact that you should have to suffer this much. It is painful but you deserve to be as comfortable as possible. It is so important for you to get some exercise you that is hard to do when you are in excruciating pain. For every surgery I have had, I was told that keeping your pain under control is important for healing.

I think you need yo clarify between all your doctors who is going to be in charge of managing your pain for right now. Doctors don't like it when you are getting narcotics from more than 1 source.

 
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