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Old 12-28-2004, 11:02 PM   #1
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Can't control the pain anymore...very depressed, need dosage advice

I am having a very bad pain day. I took the last of my lortab on christmas day, so now the tmj is flairing up again. I'm loosing hope. My wrist is doing fine. I do not want to have any kind of surgery on my jaw, though. There is noting wrong, I think. I think it is muscle spasms.

anyway, I have a few questions;
1. I've been taking 400mg of ibprofen, 500mg of tylenol and 150 mgs of ultram three times a day. I am worried that this is too much and I am damaging my liver. on bad days I up it to 800 mg ibprofen, 1000 mg tylenol and don't keep track of the ultram. Sometimes this makes me nausous so I take phenergan. Also still taking the prozac and the doxycyline for the lyme disease. On really bad nights I will drink a glass of wine. I am not much of a drinker, but I get so upset I cry and the alcohol seems to help me stop crying. I know that is a no-no but I am at a loss as to what to do. Am I ruining my liver? BTW, when I can get a script for hydrocodone, I do not have to take anything but the prozac and doxy.

2. I can't afford another doctor that may or may not be covered by insurance. Does tmj fall under dental insurance or med. insurance? It seems both think the other should cover it. I don't want to waste more money when they are not going to prescribe anything. I've been to chiropracter for my carpal tunnel, it didn't work. I had 5 cortisone shots in my wrists, I swear those made the ct worse. I think I got ripped off. Wondering if I should just try and buy meds on the internet. Can't afford them, but don't know if I want to risk seeing a nother doctor.

3. I don't feel like I am thinking right when I am in a pain flareup. I become paranoid and cannot stand to be touched by anyone. This only happens when the pain is severe. The things I've read about lyme disease say it can cause "neurological problems" what does that mean and is that what is happening. I feel suicidal when in this much pain. I am having terrible nightmares as well.

4. What should I do? Go to a pain mgtr center? A shrink? My PCM, who thinks I am a drug seeker? The ortho surgeon who was kind enough to give me a little lortab before (I'd have to ly and say it was for my wrist)? I don't know what to do, and I feel too bad to do research.

Thanks for listening, I think you guys are the experts on pain.
Dawn

 
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Old 12-29-2004, 07:22 AM   #2
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Re: Can't control the pain anymore...very depressed, need dosage advice

Hey Dawn, Your definitely not lone, A far as buying meds on the internet, If you want to go through the hassle, It's not much cheaper than buying them from the street. A friend who needs a hip replacement has no ins and has used these internet services which can be totally legit if you find the right Internet doc willing to practice telemedecine.

At best, using one doc or service, how it worked was he would contact the web site, there was a local GP that did a brief physical exam and looked at his Xrays from 5 years ago when he was told he neded a hip replacement and then after the local consult, he would recieve 60-90 Lortab or vicodin ES or sometimes Norco. Although the bottle said to take one pill every 4-6 hours and that makes a script for 90 pills a 22 day supply and cost him 300 dollars. However after a month had passed, he tried to get a refill and was told that it was too soon, those 90 pills were a 90 day supply?? Huh???

So that site red flagged him and he wasn't even allowed to enter the site untill after 90 days had passed, which pretty much forces you to doc shop on the internet if you need more than 1 pill a day and are willing to pay 300 bucks a pop. By using another internet site to obtain the same meds for the same roblem, that is the definition of doc shopping, using more than one doc to supply opiates for the same condition. It's not commonly prosecuted or taken to the point of a trial or jail, But you do have your name in Database at that web site as a customer. Should they be busted for over prescribing or not following the rules of telemedicne, which is legal, you can use a doc in another state, have a consult over the phone where a complete history and medical file is created, documented by the local doc who gets her 50 bucks out of the 300 for doing the exam to keep it legit, It still left him short all the time and cost 300 a month. Not exactly a good deal.

I had my first back surgery in 93 then again ion 96 and again in 99. during those 6 years I saw a dozen different PM docs, and went to 3 pain clinics, one was a week long 8 hours a day, one was a month long 5 days a week 8 hours a day, and one was 2 weeks long , 8 hours a day.

They simply didn't use opiates back then or more likely, my docs that I needed a referral from were not going to refer me to a doc they knew used opiates to treat pain.
One of the more depressing times was 6 months post op from the last fusion, I had done 3 rounds of PT at 3 locations, My insurance fnally said I was no onger recieving benefit or making improvement and denied any further PT, It did help, but I had definitely plataued to the point that this is as good as it will get. I could get stronger on my own by excercising and even going through the apeals process, writing my congress man, having my doc write letters, having PT write letters, calling my state ambudsman, some nurse at the HMO determined I would no longer benefit from PT.

She flat out said I don't care that your surgeon thinks you would benefit from more PT, You haven't made range of motion progress, pain levels had gone as low as possible wich still left me bed ridden except when I would have someone drive me to PT or the Voodoo PM docs.

I waited 3 months to see the head of the physical med dept at the local med school. A nice intern came in and took my history, then the doc "professor" came in and the first words out of her mouth were we don't use pain meds to treat pain, no different from the previous 11 but having already waited 3 months just to hear this while bed ridden any hopes of help were smashed that day after a very long and hopeful wait. They offered acupunture and antidepressants at the Med school pain management dept and I had either tried every med they use or had a negative response to every med they wanted to use, she said she didn't think acupuncture would help me, which was her specialty and she referred me to a PM clinic that did use opiates selectively.

It was another 2 month wait but I did find a PM doc that ran the program was more compassionate and did use opiates as a last resort and I was at the end of the line by this point, 3 failed surgeries, no other surgeon would touch me and I was bed rdden. So they did start me on long acting pain meds.

I jumped through every hoop and every non opiate pain relieveing technique you can name, Most was a crock but I tried to take something useful away from each experience.

If you have chronic intractable pain, Intractable meanng there is no other interventional option and nothing else had worked and therer was nothing else to try other than LA opiates. So I was started on Oxy C. That was in 2000, 7 years after all it started and by then , because the only options offered and needed were to repair broken hardware and failed fusions, Those failed too.

I had no other choice than to roll the dice with crappy odds hoping each surgery would be the answer. Unfortunately each surgery gave a whole new meaning to 10 level pain. What I thought was once unbearable and unimaginable had become reality.

Things aren't quite as tough now, It wouldn't be hard to find some pill pusher or some block shop that would do as many blocks as I and my insurance would allow, But I lucked into the right program and got outside the loop of docs I had bee stuck in for 7 years.

My surgeon was apauled by me taking OxyContin, didn't even want to know what dose or what it took to manage pain which was tehe end of the relationship with that surgeon, He called my fusion a success up to 9 months out but hasn't seen the recent Xrays that show broken and toggling hardware and no fusion at all at L5-S1 and all the gaps every where else.

Pm is out there. You may find a doc that has no problem prescribing pain meds, then again you may have to jump through every hoop I did before a doc decides your only option is pallative care, "pain management with opiates"

I know when your the person that's been in pain for a year or longer or even 6 months is enough to break many people. Obviously you are strong, you have endured and you are still looking for answers. I think the answer is in PM docs and clinics that do believe in the use of opiates for the right patient, not a doc that prescribes opiates to all, there are different levels of pain management and you start with the mild stuff like relaxation techniques and anti depressants, anti seizure meds and basically a legit doc is gong to document every tried and failed method to manage pain before he can safely prescribe what I needed without worrying about my case being audited.

I tried everything else so opiates were all that was left. Not everyone has to try everything else, and you may start with opiates just to allow you to make a decision not driven by pain and desperation , and then start working on adjunct meds and modalities to help.

PM isn't about reducing your pain level to 0, It would be nice but not possible in most cases. They shoot for 50% reduction and that allows me to be mobile and take care of the house, myself, wife and daugter. It was complete reversing of roles and becoming Mr mom. But with the right meds, having just 50% of the pain relieved is lke having a mountain removed from your shoulders. Pain mnagement is about function and quality of life. If they doe someone up to the point the meds are hindering you more than the injury, they have gone too far, But finding a balance you can live with is realsistic and there are docs out there that can do this.

There is a great trade when opiates are your only option. Physical dependence is inevatable, it doesn't equate to addiction but many people and docs don't understand the difference. I would start calling around, first to the PM clinics your GP provides and flat out ask, what methods do they have to offer when you have already tried X, Y and Z. Most will give you an idea of what there clinic is about and then you consult and consult with PM docs untill you find a method that works.

You can hang in there. There probably insn't one of us that hasn't thought about taking the easy way out but that's such a bad option when the solution may be just around the corner.

Hang in there, and start talking to docs and trying different methods of pain management. A practice that offers a multifaceted aproach to PM is likely going to be the best opton and be able to help the most people. You can't take every CP patient and treat them all with the same meds, dose and modalities and expect positive results with everyone. It's like taking square pegs and hammering them through round holes and calling it a sucess.
There s doc out there and ways to find them that we can get into further a little later.
Good luck, Dave

 
Old 12-29-2004, 08:00 AM   #3
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Re: Can't control the pain anymore...very depressed, need dosage advice

I couldn't add more much than what Dave has already advised. He's such a well versed individual.

The biggest problem with meds on the net is that it is not cost prohibitive and it is illegal. The FDA is shutting down sites left and right yet some remain open for a very long time. There's some real interesting articles and even legal documents regarding this on their actual web site.

I do know that sometimes we have to do what we have to do to manage the pain short of doing stupid things. It is the direct result of drug seekers and uneducated doctors who cause the end result of us not being able to obtain the medical treatment we deserve.

Don't count on a Ortho giving out meds, they know one thing and one thing only, surgery. They too are frightened by the fear of addiction and do not want to be responsible. Initially yes they'll help you out but never long term. It is rare to ever find a Ortho or any doctor outside of a PM who can help you long term.

There are new laws coming into effect that are lowering the restrictions on prescribing narcotics. I'm not sure when it will happen, I only know it can't happen soon enough.
As far as TMJD goes, it is and should be covered by your health insurance, not your dental. It is not a problem of the teeth, it is, as you know, a problem of the jaw which is a different entity. I've had my TMJD work billed via health insurance.
Oftentimes if the TMJD is severe enough they will operate on it, there's no need to live with a destructed joint for any reason.

It took me over 5 years and several tries at finding a doctor willing to give me anything above ultramn or darvocet (which I was on for some 15 years believe it or not). Even now with a reduction in meds I'm suffering miserably but have to believe relief is coming soon.

You aren't any different than most of us when it comes to high pain levels. Most folks don't want touched or often times just want to be alone to rest. Part of that is, I believe, that we don't want others to feel either sorry for us or have to see the real level of pain we live with each day.

I'd look for a PM or clinic, if there's none available then I'd shoot for a nuerologist. Unfortunately most of these types of doctors can mean a several months wait before getting an appointment but once you have one you at least get a sense of relief drawing near.

I'd be careful with the acetominophen etc, it will cause liver damage and with your current condition it's surely not a good thing.

Best of luck
Barbie

 
Old 12-29-2004, 08:45 AM   #4
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Re: Can't control the pain anymore...very depressed, need dosage advice

I think all has been said, we have such wonderful "speakers" here and the knowledge is so helpful.

Do try and find a dr or better yet a dentist who can help. I get a 90 day supply of Norco for only $7. To give some net dr $300 is such a shame.

I suffer from tmj myself. That is what I am being treated for in long term pain care. My dentist took it on himself, but I know the hoops you have to jump through to get treated seriously for pain when it comes to tmj. Here is a good way to start..........First you have to find a caring, knowledgeable dentist, that is the only one who is capable of treating tmj and the only one who is going to doll out pain meds for it. Second, and this is what I did, I just flat out told my dentist on my first visit the amount of meds I was swallowing just to try and function. He was flabergasted. I had written it down on schedule for about a week, so when I went in, he could see just how many pills I had to take to get around. He took me seriously and he also knew that taking 4 or 5 opiates a day was FAR less dangerous than taking 14 ibuprofen and 6 Toradols a day. He told me up front that he would be interested in treating me long term for pain, he said he knew I was in danger of hurting my liver and kidneys.

Please find someone who can help you out. Are you being treated for tmj?? you can hop over to the tmj board and get some wonderful advice, or just post back here and I will see if I can help ya out. I have been doing the dentist dance for 14 years and just this last year have gotten some real help and made some progress.

Please keep us posted,
Karen
another bit of advice......no wine with tylenol. That can be bad news quite quickly. Also, it won't show a medical professional that you are responsible with meds and they won't even consider giving out opiates. best of luck

Last edited by angel47630; 12-29-2004 at 08:47 AM. Reason: forgot some information

 
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Old 12-29-2004, 11:46 AM   #5
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Re: Can't control the pain anymore...very depressed, need dosage advice

Thanks for all the replies. I don't know how you guys have been able to live for so many years with this pain. I get such a desperate feeling at times. I am going to call around today and see if I can find a PM clinic that can help. I am scared of the whole internet thing, it sounds too expensive and too good to be true. I live near oklahoma city, if anyone happens to know a good doctor in the area.

Dawn

 
Old 12-30-2004, 10:09 PM   #6
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Re: Can't control the pain anymore...very depressed, need dosage advice

Dawn ..Im in OKC....my PM is GREAT ! ...If youre still interested , let me know !

 
Old 12-31-2004, 02:25 AM   #7
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Re: Can't control the pain anymore...very depressed, need dosage advice

Deana,
I am VERY interested! I would love to find someone who is willing to work with me long term to help my pain problems. What is their name? Did you have to wait a long time to see him/her?
Thanks so much,
Dawn

 
Old 12-31-2004, 06:03 AM   #8
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Re: Can't control the pain anymore...very depressed, need dosage advice

Hey Deana, I'm not sure this allowed but it's worth a try. We can't post email addys for everyones protection from people that pray on others desperation. For example, If I lived in OKC I could say I know a doc, just give me your addy, then I contact you and offer to sell you meds at street prices. Reasons like that are why we can't post email addys, But if you contact the head mod and ask is there any way to forward the name of the doc or post the name of the doc, get permission and ask for help from the mods as not to get banned for doing something you shouldn't.

I wish it were as easy as posting your docs name and addy but you must run it by a mods and be sure you are not breaking the TOS which will get you banned and your post deleted. Mods are human too and hopefully can arange a private message to be forwarded to OKC. Let me know if your able to make contact and forward the name, If not, I can explain a legit way to find a PM doc without breaking the TOS "terms of service" of the forum.

Hopefully Deanna can help and this will solve your problem. As far as being dental vs medical, I would bet it comes down to who is treating you and obtaining prior authorization to get it billed through your medical insurance. A PM clinic would obviously be medical, But a dentist willing to help manage pain may be dental. Been down this road with my wife. Dang, I've been down too many roads. We were able to get most of her TMJ problems billed through medical but there are some things like splints and bite blocks made by dentists that do get spendy.
Take care, Dave

Last edited by Shoreline; 12-31-2004 at 06:10 AM.

 
Old 12-31-2004, 06:06 AM   #9
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Re: Can't control the pain anymore...very depressed, need dosage advice

All of my TMJ treatments and surgeries have been covered by my medical insurance. I live in the right state. I beleive there are 16 or so states that mandate medical insurance covers TMJ. I will try and check on the states and let you know.

Mommy

These are the states that mandate TMJ treatments from their medical insurance. I am not sure how completely accurate this is though. And it does not mean your individual insurance company won't cover you. A phone call to your insurance co will answer that.

California, Florida, Georgia, Illinois, Kentucky, Maryland, Mississippi, Nevada, New Mexico, North Carolina, North Dakota, Tennessee, Texas, Virginia, Washington, West Virginia.

Last edited by mommy2scl; 12-31-2004 at 06:23 AM.

 
Old 12-31-2004, 08:26 AM   #10
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Re: Can't control the pain anymore...very depressed, need dosage advice

Dawn...his name is Randall Henthorn in OKC. He has his own clinic, not in with other Drs and takes his time with his patients. He doesnt act like hes in a hurry to get to the next room. I just love him !. You do need a referral from a phycisian ( I spelled that wrong) and it took me abt 6 weeks to get in. Luckily my other dr who referred me , gave me enough pain meds to last til I saw him.
Hes really great !

 
Old 12-31-2004, 09:38 AM   #11
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Re: Can't control the pain anymore...very depressed, need dosage advice

Thank you so much! I will call my PCM for a referal on monday.

 
Old 01-01-2005, 10:13 AM   #12
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Re: Can't control the pain anymore...very depressed, need dosage advice

I went to a highly recommended PM doc. He agreed with my primary doc that i indeed had fibro that wasnt in the mild category. I thought good, finally 3 verifications, and now i would be taken care of with pain meds. WELL this highly recommended PM doc asked me how old i was. I said 50, he then proceeds to state: I cant , and i wont prescribe any drugs for you except guafenesin because youre still young (???) and i wont be responsible for turning you into an addict at such a young age. FIFTY years old???? and hurting like hell, for YEaRs and he was worried about turning me into an addict??? I HAD NO LIFE as it was!!!

He then proceeds to say, "i cant for the life of me understand how you people can cope with so much daily pain in your lives. Theres no way i would be able to cope with fibro pain everyday". So i asked him then cant you prescribe something to make me more comfortable?? He said if i did youd have to take it all your life and that would turn you into an addict. THATS the part i just dont get. If i need them, if i have a legit reason to take them, and i need to take them for the rest of my life, what the hell does becoming dependant or addicted to the meds have to do with ANY of this??? He said no i wont be responsible for that. You can find another doctor who can easily prescribe those meds for you with your condition. I left there in tears and angry , since i had waited two months ( waiting list) to see him to be told i cant or wont give you drugs.

So my primary doctor said no problem i just thought hed give you something new or heard of something better. So she has given me norco, plus soma taken together. Also propoxy and tramadol for breakthru pain. So shes taken pretty good care of me and gave me cymbalta also, that has given me some energy. The tramadol (ultram) and the propoxy (darvocet) i take only maybe a few times a month. I trust her more than i did the PM doc. Never went back to him after the 3rd time.
Jen

 
Old 01-01-2005, 12:23 PM   #13
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Re: Can't control the pain anymore...very depressed, need dosage advice

Dawn, Let me know how it goes ! ..I hope you can get in quickly !

deana

and Shoeline...thanks for your info !..( abt how to post a dr name w/o getting banned)

 
Old 01-02-2005, 08:46 AM   #14
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Re: Can't control the pain anymore...very depressed, need dosage advice

Jenetti,
That is a horrible thing that happened to you! I can't believe a doctor would let you suffer so much knowing your condition just because of your age. I too have been told before that I am too young to be taking strong medication (at the time I was on lortab 7's) The soma I am taking now is really helping. I don't know if my dentist will keep prescribing it though. I am trying to get into a tmj specialist. I wish I didn't hve to go to so many doctors. One for tmj, one for carpal tunnel, one for (suspected)lyme disease. I do keep them all abreast of what drugs I am taking. Sometimes it seems like honesty Doesn't pay. One more days worth of soma I have left, and then its back to calling the dentist for a refill. I can't believe how much this medication has easied my pain. I can acutally leave the house!!! The reason I asked about med/vs. dental insurance is because the dental ins. said they would pay for a splint only if it WASN"T for tmj. Crazy! And the co-pays are different too. Oh well, at least I have hope. At least with the soma I am not a zombie. I feel so much better, not high or anythying, just normal, like before this all happened.

 
Old 01-02-2005, 09:50 AM   #15
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Re: Can't control the pain anymore...very depressed, need dosage advice

dawn, that is how I feel. The soma is wonderful See, now that I have been on the soma, I realize how much of my pain was muscle because the muscle spasms being under control has kept most of the pain under control.

I hope you can get your soma refilled. There is no reason why one couldn't take soma long term. They also make a soma compound that I have. It works wonders for one of those really stubborn headaches.

I have really been able to cut back on my pain meds with the soma, I am glad you found the same kind of relief. It is a shame we both had to wait so long to try it. That is such and old medicine.........why do we have to wait to try it? Do you know how many anti depressants I was handed instead of a simple script for soma? Geez, makes no sense.

Karen

 
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