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Old 12-04-2005, 12:00 PM   #1
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Pain med inneffective what should I do?

I have been on tylenol 4's for about a month, and usually I take four and it will last for around two hours, the last few days, four pills don't do a thing. I don't know what to do because I am just getting into finals at school and I can't sit for more than fifteen minutes without pain killers. I don't want to take five or six because it will just create a cycle of taking more and more to do the same job. So what can I do to make four pills have the same effect they used to? Should I stop taking them for a while to get the resistance down, or should I take one more pill until I can get into a doctor? Should I ask the doctor for something stronger or just stay on the meds I am on? I am sorry for all the questions, I am just worried about addiction, but I need something to get me through the pain, so I am really confused, any help would be greatly appreciated.

 
Old 12-04-2005, 02:06 PM   #2
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Re: Pain med inneffective what should I do?

I was seeing a pain management doc, but it didn't work out, so now I am waiting to see another pain management doc but the wait will be about two months, so I just have to see my regular doctor for now, and he has been very hesitant to give me anything stronger, and I'm not sure I want to be on anything stronger. He has put me on neurontin to try to stop the pain, but they haven't worked very well. I am worried that if I tell him I am building up a resistance to these meds that he will think I am addicted or abusing the meds. So I am kinda stuck between a rock and a hard place.

Last edited by cptpooface; 12-04-2005 at 02:09 PM.

 
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Old 12-04-2005, 02:55 PM   #3
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Re: Pain med inneffective what should I do?

you should try many alternative types of treatment before excalating opiate use. Some find TENS machines help, Acupunture, Meditation, Massage, Physical therapy etc etc. It might not help you with exams to up opiate dose right now as it could make you a little more foggy minded.

Be frank with your Doctor about how you feel though, I've always found that the best approach.

 
Old 12-04-2005, 11:45 PM   #4
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Re: Pain med inneffective what should I do?

If you are taking finals i assume you are pretty young, at least young enough to be in college. I am 19 and am in college myself. I had to take a quarter off bcuz of my pain though. I am going back in winter and am kind of scared bcuz i dont know how i am going ot deal with things. Anywayz, if you are younger it is alot harder to get meds. Cuz there is that stigma that, "nobody dies from pain, so why get addicted so young". But at some point you have to chose to get relief. And when you have chronic pain, and are on any oppiate for long periods of time, you can get physically dependent. But there is a HUGE difference between physical dependence and mental dependence. WE all at some point get physicall dep. bcuz we take the meds for such a long time it is unavoidable. But if taking stronger meds will increase the quality of your life you have to make a decision. Thats my 2 cents, if it helps or not...
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Old 12-05-2005, 07:18 AM   #5
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Re: Pain med inneffective what should I do?

Hey CPF, Nice handle LOL
Without knowing what your problem is it's hard to make a recommendation about other therapies that might help aside from simply increasing the opiates every time you have to increase your work load.

Taking responsibility for your own actions, like staying up all night and cramming and then not being able to manage the pain because you haven't slept and spent too much time sitting or sleeping with your head on your desk, really isn't a medical problem, It's a lifestyle problem. Opiates arenít a solution to lifestyle problems. There will always be important things that must be done. If you choose to self adjust your dose, you won't be able to keep a doc that prescribes anything and you won't even have to ask what should you do. If you can make time to search and post a question here, you can make time to call your doc before exceeding the safe dosage of codeine.

As important as any commitment or activitiy may be, part of PM is learning how to balance your life so that your not so stressed to the point of increasing your own level of pain and then reaching for the pain meds when you hurt more. Self-medicating every time you feel more pain will only destroy your relationship with your doc and turn your pharmacy into the early refill police.

Stress and lack of sleep increase pain, and there are many relaxation techniques that work as well as taking a pill if you take the time to learn them.

I can't imagine any doc prescribing 4 T-4's at a time, Codeine is one of the few meds that actually has a ceiling and your busting the ceiling with 2 doses of 240 mgs of codeine. 400 mgs a day is the max safe dose unless you want to have a seizure in the middle of finals and spend the next six months on various seizure meds rather than admit you were self-medicating with a dangerous drug. As mild as codeine is compared to other opiates, if you take twice as much or 4 times as much as prescribed of any med, it becomes dangerous too.

I'm really not worried about you becoming an addict. Not that I think anything I could say would stop an addict from the self justification and rationalization that makes abuse Ok as long it's for a good cause like finals, or Job deadlines, or just wanting to pick up your child or be intimate without pain. Anyone in pain can come up with an excuse and rationalize taking more than prescribed. The problem with that is there are consequences and your setting yourself up to be labeled a drug addict or seeker even if this was the very first script for pain meds you had in your life. Docs don't need much to through the label out there to justify not taking any chance that your going to drink on top of the meds he prescribes or take so much you land yourself in the ER.

When a patient OD's, and a seizure would count as an OD, the name of the prescribing doc is turned over to the authorities. Why should a doc risk his lifeís work because any of us had a good excuse to self medicate particularly when the consequences of self-medicating with codeine are so severe.

More than likely your doc will simply cut you off or pass the buck to someone else to deal with you. If you wonít be compliant with his instructions, you won't have a doc long enough for addiction to even become an issue.

If your just starting down the road of chronic pain or this an an acute injury, you won't make any honor points by running out of a 2 week supply of meds in one week and not bothering to call the doc and let him know your having problems.

Any excuse you can think of for running out early, they fell n the sink, the dog ate them and died, a room mate stole them, an alien beamed you up and they were in your pocket but the alien seemed to enjoy them while probing you have already been used by every addict that thinks theyare more cleaver than their docs and family and friends that have to sit by and watch someone they care about slid e down the tubes. All the excuses have been used up by every drug seeking addict out there. So that even when a patient that has been 100% compliant for 5 years and some crack head breaks into their home, or they actually do fall down the sink or in the toilet, the meds still won't be replaced even with a police report. Because their are addicts that will stage a burglary and call the police just to get a police report that states you claim the meds were stolen.

Every doc has met a patient that can't or won't comply with instructions. Their philosophy is why bother to treat them and put themselves in a situation of liability. There is a consequence for every action.

Before you double your prescribed dose again or increase it any further which can land you in the ER and they will find the codeine metabolite in a UA. Call your doc and see if he can do anything or refer you to someone to help you get through a rough spot. This is when you go and get the massage or do the extra PT, not simply reach for another pill or pretty soon no doc will prescribe a thing regardless of your condition and regardless of your obligations.

I think most of us that have been involved with PM for several years have met docs that didn't adequately treat our pain or that didn't offer any other tools to manage your pain. If you self medicate and simply take what you think you need you will loose all trust with this doc, and there will be a warning attached to every referral to any specialist that may prescribe a drug you have already shown you would abuse if you can rationalize it.

It sounds like your young to have some doc label you an addict because you wouldn't follow directions on one or two scripts. However that note can follow you for years, prevent you from obtaining security clearances, and effect the rest of your life in ways you would never imagine. Being labeled an addict whether it's true or not or having red flags placed in your pharmacy files so that every script you fill is questioned is a consequence of taking more than prescribed. If the pharmacy labels you and red flags you, they will call the doc and report early refills, they red flag their system so that if you come in after hours when the doc isn't available, they simply won't fill your scripts until each and every one can be verified.

It's easy to justify needing more meds during periods where we have more obligations, stress and demands put on us but it's not acceptable to self medicate during this time and then beg for forgiveness.

If the meds aren't working at least give the doc a chance to make an adjustment before you decide you know more than the doc and set your own dose That happens to be above the safe level of daily codeine intake.

Just think about it logically, if you won't be complaint with what a doc considers milder meds with less abuse potential, why would he give you something stronger with a greater abuse potential?

You also may have to make adjustments in your life, realize that cramming all night leaves in you worse shape than getting a decent nights sleep. If your problem is going to continue, you may have to make some major changes, cut back credit hours, pay for typing services or pay for voice response typing. Whatever it takes to avoid pain triggers and get through what you want to accomplish.

Good luck and welcome, I hope this is something from an injury you will recover from and not something you will have to live with, the rest of your life.
Take care and be safe, Talk to your doc if your meds aren't working.
Dave

Last edited by Shoreline; 12-05-2005 at 07:37 AM.

 
Old 12-05-2005, 08:54 AM   #6
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Re: Pain med inneffective what should I do?

Dave, Just had to thank you for the image of the pill-popping, probing aliens, You made me choke on my coffee but it made my day LOL. CPF, I have nothing to add except Daves advice is sound as a dollar, and I will pray for you, Please let us know what you did and how it is working out for you. Hugs, Fabby

Last edited by Fabrashamx; 12-05-2005 at 08:56 AM.

 
Old 12-05-2005, 02:59 PM   #7
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Re: Pain med inneffective what should I do?

Dave has very sound advice. Do not take more than prescribed meds. Talk to your doc.

 
Old 12-05-2005, 05:56 PM   #8
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Re: Pain med inneffective what should I do?

hey dave i got a question then. I always have filled me scripts at least 2 or 3 days before my 2 week script is up, but not bcuz i am out. Is that bad? i just do it the day i get a new script from my doc. They have never said anything to me.
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Old 12-05-2005, 07:01 PM   #9
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Re: Pain med inneffective what should I do?

Chaddy-they won't say anything for getting your scripts refilled 2 or 3 days early-just like they wouldn't if it was blood pressure meds or diabetes meds...

 
Old 12-05-2005, 09:02 PM   #10
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Re: Pain med inneffective what should I do?

what would they say something? like a weeks? 5 days? im just curious wat it would take
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Old 12-06-2005, 12:05 AM   #11
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Re: Pain med inneffective what should I do?

Hey Chaddy, Best to ask your doc about their policy. I have monthly apts called DEA schedule 11 apts. I go two months in a row, fill out a patient eval, have my meds counted and fill dates checked, have BP and temp and pulse checked and pick up my scripts for net month. Some times a week early, sometimes a few days before they are do..They hand me a treatment plan with the fill date they expect, exactly 30 days from the previous. Deviating even 1 day early is grounds for discharge or a mecialy controlled taper withut the use of opiates acording to the contract they ammend evrey year. IF I explain "Sams," the pharmacy I use and have listed in my contract is clsoed on sundays. If my refill day falls on a sunday, and I calculate ahead of time and simply tell the nurse or doc they will adjust the date on my treatment plan and that's part of my permanent record, The meds prescribed, the day I am to fill it and the number of pills I had left when I came in.

The third month is the follow up visit and regular apt to see how you are, do the need to make changes, try something new or adress another problem.Plus the regular DEA stuff. I can always call and be seen but if I'm stable This is the rouutine since last January. Because I have a pump, I also have pump apts but they never handle orals during a procedrure whether it's a pump refill or your want to talk about a med change during a nerve block.

If you need a med change you make an apt for a folllwow up.

My docs are very clear and I'f I'm unsure I'm expected to ask, and with so much riding on my continued care, It's not worth taking the chance. Whether your insurance wil pay for it on day 25 or day 28, It's still up to your doc and sometimes pharmacist will interveen even when your insurance will cover it.

I know there have been dozens of times to drop it off and pick it ip laterwould have been more conveinant, but they date it the e day they fill it which would probably be the day I drop it off iff I'm close. I beter have the receipt that proves what day I picked it up. It's really not hard to be compliant, being in pain isn't conveinant, nor is fnding a doc willing to risk his licence to treat you. So I have never filled a script even a day early in the last 5 years because it was conveinant or for any other reason than the stoor being closed.

It's not up to me to say your doing wrong by filling a couple days early. If your doc is OK with making life more conveinant that's his choice. I go to a clinic with 5 docs a 2 pscychs and they aren't going to risk their licence for a patients conveinance. They can show they demand absolute compliance and can show the action they took when someone wasn't.

It's not that they are jerks, I've read story after story about docs being persecuted/;prosocuted by the DEA and shut down. The DEA can shut a clinic or practice down simply by doing an audit to see if they are taking measures to ensure complainace among their patients. Once they pull the record out of the office to "audit a doc or clinic" it effectively shuts them down because they can't see a patient without a file or their history of med use. So it's a tactic the DEA uses to enforce policy that isn't backed by law.

It's a pain in the butt, but I would rather know my doc is being vigilant and doing every thing he could to deter and seek out patients there to makea couple G's by having insurance pay for their meds and apt. These PM docs are targets of addicts , there is no way around it. Now you have every GP just passing the buck off to PM to deal with or you have GP's practicing in a field of medicine they have no special training in.

Sure they can do it, but if your a docs only patient on LA meds that's pretty much all he will ever be able to offer. A GP isn't under the scrutiny that say a PM clinic is or a group of docs are that have 500 to 1500 patients they see each month and write class 2 meds for 3/4 of them.

When doc Hurowits was shut down the first time in the early 90's because the DEA felt he was over prescribing to patients who's docs and clincis and hopitals had sent them home to live with pain your would put your dog to sleep over. He was the pioneer on modern treatment of pain, but his doses were greater and more frequent than an active surgeon. At the time it wasn't acceptable and he was unsuccesfully prosecuted but put out of buisness for 3 years while defending himself. He managed hundreds of intractable pain patients that nobody would or could help because of myths about opiates. He saved these folks lives and was driven out of biz by the over zealous DEA that has no medical training, just some old school codgers saying percocet manages all my post op patients pain. ( of his patients killed themself that first month when they were forced back into a life bedridden stricken by withdrawal because the DEA felt he was over prescribing.

He won his case, came back to practice for about 2 years and the same DEA abuse started again and he retired. Fortunately by then there were other docs that had followed his beliefs and more schollary docs started writing on the benefits of appropriate use of long acting opiates. In an industry that has more lobbyist per elected official than any other indusrty in our country. The pharmacy biz and pain management is a booming market for the aging baby boomers that have suffered for years. Those injured but not dying that had suffere for years, folks that feel it's a right because they make the meds and thay have pain, and everyone in between is being referred to pain management..

As far as it being right to fill a couple days early, I'm not so unbending I'm going to say it's wrong, but I wouldn't take the chance with my docs. Do you know your docs policy if the pharmacist calls and says DaveC is filling his morphine on he 28 th day for the 3rd month in a row? It's just to easy to do the right thing and fill on day 30. There is pharmacy on every corner and sams is 5 minutes away. My doc doesn't know how close I live to sams, but he expects compliance and charts it to protect himself so he can continue to help those That will be absolutely compliant.

When I say I can't live with the level of pain I have been left in, It's not for effect.I can't and couldn't and won't take a chance. I think many people use the same phrase and yet why would they take a chance at loosing the one thing they say allows them to live or be prodcutive, simply because it's conveinant,

Docs in a buisy practice draw more attn by the volume of class 11 scripts some write and the DEA visits them and tells them what they expect, like seeing each patient monthly, do UA's and pill counts and date checks.

I woudldn't suggest filing a couple days early or taking an extra pill automatically makes someone an addict or the abuse finger pointed but if you know the consequnces up front to each action,you can save a great deal of heartache and pain when It's really not hard to be the model patient.

I'm sorry, Morphine and class 2 meds are treated very differently than BP meds and insulin. The DEA has never investigated or shut down a cardiologist for over prescribing BP meds or Plavix. You can't say the same about morphine, fentanyl, dilaudid,oxycodone and amphetamines. These are the most tightly controlled drugs there are. To think they aren't controlled and shouldn't be treated any different doesn't make sense to me.

At any given time, any pharmacy should be able to tell you exactly how many tablets it has of any class 2 med on hand without counting and then confim it with a count. They keep a running log, send copies to the DEA and board of pharmacy every month of their on hand supply and quantity they ordered of each class 11. They send reports as to who filled , prescribed, quantity and dates each month to both agencies.They are treated very differently. Just a little info I picked up when my wife was a retail manager of 3 of the big retail pharmacy giants and 13 years of pain management, we learned the rules as part of the education portion of clinics I went too.

I'm sorry If I came across as pointing the finger at anyone in particluar, I'm pointing to the potential consequences which can be devestating if you can't function without these meds. Which is the reason they are prescribed, right?

Take care, Dave

 
Old 12-06-2005, 07:10 AM   #12
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Re: Pain med inneffective what should I do?

I was under the impression that after that last wonderful DEA change,that you could not any longer even pick up your Rx except the day before it was actually needed??Am i wrong/I know,because of my circumstances and the amount of the 20mgs(nine) i take per day,i have to get my Rxs every two weeks,it is always on a wednesday,always,as I always will be out at the end of wed night and need them asap for my first dose in the morning on thursday.
i used to be able to pick up or get the rxs written even like the week before,but could not fill them til the fill date on the Rx itself.but since this new change,i HAVE to wait til wed to even pick the darn things up even if i happened to have an appt on the tuesday before they are actually due.do you know what I mean?i know if you are not in PM things are a bit different,but from what you just explained,dave,i got the impression that you have a bit of flexability there??or did i just read it wrong/thats always a possibility,lol.can you clarify for me/Like always,just a bit confused thats all.thanks,Marcia
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Old 12-06-2005, 08:03 AM   #13
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Re: Pain med inneffective what should I do?

Hi, I'm not sure if I could pick mine up early, Because it says must last 30 days and they do last 30 days, I am lucky enough to have a 24 hour pharmacy, but even then I dont fill until the morning of the day I run out. My doctor allows a once a year early fill for vacations, up to a week early, and she faxes permission to the pharmacy. If I need more med sooner because my base meds aren't covering my pain, I have to be seen, But she will usually get me in that day and then will prescribe up to 150 lortab 10's and I have to see her again before they run out, if my pain is then more managable, she tapers me back down. I looked so long and hard to find someone compassionate and willing to help me, I would never risk getting her ( or me! ) in trouble by trying to fill early. I have been at the pharmacy and seen people arguing with them over fill dates on narcotics, so I know my pharmacy won't do it. If they were closed the day you needed them, I can't imagine how it could be a problem to pick them up the day before, with pain meds, if you run out, it takes more to get your pain back under control, not fun for us. Good Luck! Dave, still giggling about those pill head aliens! heehee! ~Fabby

 
Old 12-06-2005, 08:07 AM   #14
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Re: Pain med inneffective what should I do?

picking up your refill 2 days early is not bad. picking up your refill a week early won't happen.

It depends usually on your INSURANCE company. How early they will pay for it to be paid for...see what I mean?

It's like a refill on diabetes meds or on high blood pressure meds.

Call your pharmacy and ask. Tell them you're on a pain mgmt message board and someone posted a question. I've done that before and they seemed more than happy to answer a question.

 
Old 12-06-2005, 08:12 AM   #15
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Re: Pain med inneffective what should I do?

curious, that is a great idea, can't hurt to ask, and then you know exactly where you stand. I love your posts and I have learned a lot from you. Have as pain free a day as possible and be kind to yourself! ~Fabby

 
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