Second full visit to PM (3'rd overall)
It started with a UA after signing in. This is the second UA I have had with him; the first time I had taken Norco and Xanax within 12 hours of the appointment, so I assume I was positive for both. I have a somewhat recent script from my previous doc for Norco, but my Xanax script is several years old. The lab tech asked what meds I was on, and after I finished listing them he repeatedly asked about any Klonopin, Ativan, Xanax, etc I might take - I assume since I was probably positive for Xanax the last time. I hadn't had anything other than Norco that day and have precious few Xanax left so I told him no to all those.
After the UA (which tests for everything imaginable) I was taken to the exam room and the tech took my vitals and left. When the PM came in he asked how the Neurontin he put me on was working, and I explained it didn't really, and that in the past it had taken 2-3 times the dose I was on to give 5-10% relief. He then shocked me by asking how effective each medication I have taken over my life for pain worked for me - including ones I never mentioned I had taken. After explaining that Norco at fairly high doses (Norco 10/325 tt PO Q4 - which is 12 Norco a day) worked fairly well but not at lower doses, he completely caught me of guard. He asked if I had ever tried Morphine, and offered MS Contin / Kadian etc with Norco or MSIR for breakthrough pain. Since I haven't taken MS Contin before and couldn't speak to the efficacy he asked if I thought BuTrans might help, knowing I had taken buprenorphine sublingually before with great effectiveness until it began causing violent intractable nausea and vomiting. I though tat sounded fine, so he wrote the script for that and asked about BT options, mentioning MSIR, Norco, and a few others. I told him I still had a few Norco from my previous doc and was comfortable using them until my next visit which he thought was a very respectable and responsible idea.
The BuTrans is working somewhat well, though I have some moderate pain still and have needed Norco a few times for BT pain. I have another follow up in about 2 weeks and my plan is as follows:
[LIST][*]Ask to increase the BuTrans dose to the next higher dose.[*]Ask for BT meds in the form of MSIR, Opana, Dilauded, or OxyIR in that order of preference (Norco is just not strong enough).[*]Request something for the insomnia caused by the BuTrans and my severe chronic anxiety, preferably Valium as it will treat the anxiety, insomnia, and muscle spasm allowing me to avoid using Soma.[/LIST]
I know he will bump the BuTrans, am 98% sure he will give me one of the prefered BT meds, and relatively certain he will put me on a benzo or at least a Z-drug like ambien for the insomnia considering he knows I have been on Klonopin for years, as well as Valium, and Xanax before that.
Crossing my fingers for another good visit