I called my PM doctors office, to let them know my meds are not managing my pain, and I was told I would have to come in. But because I have an apt next week I was told to wait until then. She said I couldn't get anything without seeing the doctor in person. I called before and the doctor called something in for me to the pharmacy.
I was told more than once I just needed to call if the meds quit working for me. Is this common to be told I have to wait? It doesn't seem typical of the way I have been treated there before. It was the office person I spoke to, not the doctor. What am I supposed to do? Suffer until next week? This is crazy! I have been trying to cope on the meds I'm taking for a while, hoping they would work out. They did for a short time. I was told by the doctor not to be surprised if they stopped working, so I wasn't worried until today. Oh, and the lady on the phone informed me to bring my meds with me to my apt. I have never been told that before. What is that about? Could this be just coming from the person I spoke to having a tude?
If things weren't bad enough. I have now had to take some of my old meds loratab. (I don't have many left) And someone mentioned that wasn't a good idea to me. But why is it wrong, if it's my medication. Can I get in trouble now? I didn't have a choice as far as I'm concerned not to take something. The pain is unbearable even with everything I am taking. I hope to hear from someone, because I feel alone and miserable. I thought things were going good for me until now.
Last edited by FairyMagick; 03-31-2006 at 12:20 AM.
Reason: spelling error
I think if you are in pain management this is standard procedure.Or at least that is how it works at my Dr"s office. I go in every month for a DEA check is what I call it. I pay $36.00 just to pick up an Rx. Then every four months I see the Dr $106.00. I know in my case, he will not change anything over the phone or call me in anything. I have to make an appointment. And it is very hard to even get an appointment. Try not to worry about what the office help said. Did this Dr give you the other medicine you had to take? Or was it an old RX from someone else?? My appointments are set up 4 months in advance. They give you a sheet with the next 4 months appointments on it.
I truly feel for you. Read my post "i've seen a 10 on the pain scale". Please try not to worry about the appointment. I know that is easier said than done. Good luck to ya
The reason it's bad is the Dr. didn't prescribe this medicine for you... from what I remember. And even if he did, he didn't give it to you for breakthrough, you're on other medications, and he doesn't think you're still taking it.
You're self-medicating, which is a VERY bad thing in pain management. Grounds for dismissal if you went in and told him you had been taking your old Lortabs.
Bringing in your medication could be for a random pill count, or it could be because he wants to destroy the old medicine (at the pharmacy--if it's a PM clinic in a hospital). That happened with me. I brought in my old patches so they could destroy them, so he had documentation that I didn't have the old patches still with the new medicine he prescribed.
The random pill count could be bad if you've also been taking more than prescribed of that, as well. If you're short, he might dismiss you for that.
Bottom line-do not take anything that hasn't been prescribed by this doctor (especially pain medicine) without his approval or knowledge.
I have lots and lots of old Xanax and Ambien just sitting around. My PM doctor doesn't know that I have it. It's mine. I could be taking that all the time if I wanted... He doesn't know I have it, but in the contract it states not to take tranquilizers like Xanax and Valium without his approval. So, if I did take it, I'd be breaking the contract. But, the medicines mine, why can't I take it? Simply to follow the rules of the contract and not do anything the Dr. wouldn't want me to do.
It's very normal to be asked to bring in your meds or even to take a **** test. If your taking something you shouldn't, your risking be dismissed. Even if it was a med he prescribed 6 months ago, if your not supposed to be taking it now what is he supposed to do? Say it's OK to self medicate because he couldn't see you sooner than next week. That's not an outragous amount of time .
Titrating a new med is tough, but you have to stick with the plan and do what you did, call and be seen asap. Today is friday, when is he supposed to see you. For a PM doc that treats patients with all kinds of problems that last for years, saying hang on a few days untill your apt is very reasonable if you don't have an emergency like an allergic reaction, side effects from meds or procedures and I would bet he's probably booked weeks in adavance.
I'm sorry your in pain, but so is every patient he seeing today, My docs calls no meds in over the phone. A couple patients called their own meds in so they stopped the practice entirely years ago. They don't make med changes without seeing the whites of you eyes. Docs are just protecting themselves against folks that mistake compassion for stupidity.
You should be glad you doc protects himself from folks that call on Friday and need something extra for the weekend and just can't wait to see the doc. Maybe they just get lots of emergency calls every friday and it gets old. It looks even stranger when you an apt next week. Yes, we pay for the abuse of others and even our actions may appear questionbable at times. You have to be aware of how things may look to the nurse. It really doesn't seem that unreasonable to be asked to wait and bring your present meds. To complain about such a short wait may apear unreasonable to the nurse and doc.
I agree with the others, it isn't abnormal for the doctor to ask for you to bring in medication for a pill count, if you signed a contract it is probably already on there as well as that you are not to take any medications he is not aware of.
The reason he won't call anything in other than what others above said is that there are many medications that can not be called in that are used in pain managment. In some states the highest narcotic you can legally callin is Vicodin while in another it could be Percocet. Add to that he's protecting himself from individuals who abuse medications that have a tendancy to call on Fridays as mentioned before.
Unfortunately yes you have to wait it out a week but there's been times I've waited longer when medications have stopped working but the doctor can't see me due to a very busy schedule. We have to tough it out the best we can and know that hope and help is just around the corner. So try to keep positive thoughts, as hard as it may be, and you'll get through it one minute at a time.
Hi, thanks for replying everyone. I don't have a contract. Was everyone given a copy of there contract? I do realize there are other patients needing help. It just seems unfair if I was told to call if my meds stopped working. And I did what I was told, only to be told I have to wait. What was the point in telling me to call then?
When I first started with PM I called and was given a 3rd medication that was called in to my pharmacy. I did not see the doctor. I have been trying to make these pills for for weeks and I just couldn't take it. I have been taking my meds the doctor at PM rxed for me as prescribed, so I'm not worried about them seeing my pills. I was just taken back by the comment. And as for the loratabs they were rxed by a different doctor. I wasn't told by PM not to take them. As I mentioned I don't have a contract. A friend mentioned to me I shouldn't take them incase I was randomly tested. I wasn't ever told anything about random testing either. I just needed talk to people who understand what I'm going through. And wouldn't they be testing for street drugs? Not something I have from my doctor.
Dave just wanted to know why you think pm would think its wrong for me to call right before an apt? I had called a few weeks ago trying to get in sooner, but they didn't have any sooner apts. And like I said I have been trying to manage with what I have. Just wanted some insight on what you meant? And if you don't mind me asking do, you know anything about hydroxy pam? I was given hydroxy pam by pm and it didn't help so I wasn't taking it, but because I'm in such pain I have been giving it a try again. It makes me feel drugged.
I have never taken anything that makes me feel this weird. Not even in the hosptial. Is this a really strong medication?
Last edited by FairyMagick; 03-31-2006 at 08:15 PM.
Hey Fairy, Hydroxy Pam is Visteril, It's used to treat itching and nausea and in higher doses anxiety but it's actually an anti hystamine. It's used in conjunction with demerol injections for nausea and to boost the the meds a little. On it's own it has no pain relieving properties.
As far as calling the week before, If someone had self medicated and ran out of meds,requesting a med change solves that problem, but docs know it is a way to solve that problem. If he gave you a month worth of Vicodin and you ran out early, saying it doesn't work and needing to be seen early would hopefully get the patient a new script for a different med . A new script for percocet over rides the old script and insurance and your pharmacist will run it trough. If they are going to change your meds to protect themself haveing you bring meds in to be destroyed isn't unreasonable. If they don't work or your allergic or can't tolerate side effects, then presumably you would have some left and wouldn't care if they flush useless meds. Some docs have you turn the old meds in when they make a med change. They just need a witness to sign off on destroyingthem, usually a nurse.
As far as calling your doc, of course he should be available, But I wouldn't expect him to try to manage my pain without seeing me. If you had been calling all month, you might have avoided getting your feelings hurt had you just askded if they still had you on the cancelation list and had anyone canceled.
I think It was the way you post came across, like he has done something really wrong by not being able to squeeze you in early? If he's making changes everytime he sees you, he is working on your pain, what's shocking about having to wait a couple days?
The way you described the meds no longer working, it sounds like you expected to wake up one day and they just stop working and you would somehow be in agony. That isn't how tolerance deleveops. The meds that were working usually start working a shorter period of time and the relief is a little less each day. It's not a wham, this dose is no longer effective.
You may have a flair that makes things seem like you took a tic tac instead of medecine, but the nature of pain and pain managment means it will get out of control, how you repond to it is up to you and what your doc has instructed you to do.
If your in the process of titrating a new med, it's OK to call and say this dose isn't working and the doc said to call if we need to make an adjustment, but I didn't get the impression that was the case. Going through all your old meds looking for something to take is dangerous. Those meds were not prescribed with your present meds. They may overlap with a new med your on now or my interact with something. SO stop loking for something other than OTC meds like IBU, apap, aleve, hot baths, whatever helps your pain.
Maybe you have very high expectations of what pain management is about and how they are suposed to respond, but when you live like this for years, or have been on the same meds for a while, they don't usually completely stop working in between monthly apts? You could be having a flair up or simply growing tolerant, but toleance isn't an emergency that needs imediate attn IMO, but that's just my opinion.
If you call your doc every time you have a flair, being a high maint patient doesn' t build the best relationship either. Some folks are just never satisfied and they aren't good candidates for certain types of PM. I would just try to avoid pushing the envelope and see how many weeks in a row you can call before your labeled high maint or never satisfied.
As far as fridays, that's just from my wifes experience in the pharmacy bizz, There is a huge influx of calls to the pharmacy to see if meds wewere called in before the weekend. Folks that abuse or sell meds usually want more for the weekends.
I guess I just didn' t get why someone would ask "can they do this?" and act like your doc patient relationship has been altered because he can't see you before whatever day next week. Of course they don't have to let you come in today to be seen or call in stronger pain meds. What exactly are you asking if it's OK for your doc to do that seems unreasonable?
As far as contracts, they don't gaurentee the patient much at all, They are consent forms that explain the rules and policies and consequences. It's actually a good thing to know up front that they don't replace lost meds. Sure it happens, but it's the oldest story in the book.
I did have meds stolen, I did get police reprorts but I didn't request replacement meds because I knew they wouldn't be given. So why even put myself in the position of them wondering if I'm just trying to get over, or this one time it really did happen. Anyone can claim their meds were stolen and have a report taken by the police.
Living without PM isn't an option so risking it for anything, particularly when the subject has been covered by the contract wasn't an option or risk I would take. I personally wouldn't call the friday before an apt on Wed and ask to be seen because my meds stopped working or be shocked by the response you got. A few bad days or one bad month isn't worth the risk of being labeled anything that's not true. Just keep apearences in mind.
Thanks for the info on hyrdoxy pam.
I think you misunderstand my post. I wasn't asking to be seen right then. I was hoping they would like in the past call something in for me until my next apt. I did call and try to change my apt and yes I am on a cancellation list. I'm not totally without a brain. And also I didn't wake up and the pills stopped working. I have been having problems with my current meds for weeks actually sense February. Not that I owe an explanation, but it took me days of not being able to get out of bed due to pain, before I called and asked for help. It was my Mother and family that said it was crazy not to call. Especially sense I was told to do so. My problem is that I was told to call and then I was disregard. I really don't see how that would be ok with anyone. I am fairly new to pm. So being upset about being in pain doesn't make me high maintenance. Unfortunately my post came across a certain way to you, or maybe I didn't explain my problem good enough. But like I said I'm in a lot of pain. But honestly I think my post was easy to understand my reason for being upset. I also just needed some support. Hopefully things will get better like Barbie and the others said. I valued your opinion and sadly you have misunderstand my question and problem.
Thanks anyway though.
Last edited by FairyMagick; 04-01-2006 at 12:08 AM.
Hey Fairy, Comunication s a funny things. When my wife and I were first married, the floor boards under the furnace cought fire in a locked closet at the apt we lived in. I sprayed Halon under the door crack and the fire seemed to be out. I had told my wife to call the fire dept or 911. After I was done putting out the fire, although we couldn't know for sure, my wife was telling the fire dept that it wasn't really an emergency because it apeared the fire was out. I was in the background yelling yes it is an emergency,they needed to open this door and make sure it was out. So everyone sees things a little different.
Everyone has a differnt definition of an emergency and has different expectations as a patient. I don't think I was the only one that didn't feel this as one of those "I can't believe I was treated this way" situations. There is a thread going on right now filled those types of situations. Having surgery and being sent home with no pain meds or the bare minimum because you are a pain patient. Waitng 3 months to see a PM doc who evaluates you in 3 minutes and says we don't use opiates here and sends you on your way offering no other advice. Those are the unelievable circumstances to me and many other folks that have been involved in PM for years.
Our expectations are much different than the folks new to PM that were prescribed opiates by the first PM doc they ever met. I don't see agressive pain management with opiates as something every persn with pain is entitled too and I see that type of advice given all the time. The meds are available, so everyonbe should have equal access with no other info about a persons condition. To me that's absurd. OPaites are the last thing you try before you trade a free life for that of physical dependence without trying every other method first. But that's just my opinion and the system I came though to be where I am today.
We have folks that cover the entire spectrum. Everything from those that feel entitled to the most potent meds once reserved for cancer simply because their pain meets the criteria of chronic in that it has lasted more than 4 months, I see people suggesting trying meth to folks that are no longer getting relief from Vicodin "which is totally absurd". Some of us know that your not going to die from pain if you have to wait a week for an apt.
Your skin does get tougher the longer you have been at this and you will get to know your docs policies and the way they operate without feeling abondoned because they won't blindly call meds in like some docs may have in the past.
There is no such thing as an instant cure, entitled to pain meds or a docs duty to prescribe if we request. Most likely your call goes through a triage nurse that seperates the need to be seen urgently and those that can wait untill their apt. The calls they get daily determine whether you really do end up on the list for cancelled apts. You learn as you go, your skin gets tougher and you realize everyone has an opinion, but that's all it is.
It's 5 am so if there is some mis spelling Im sorry, too tired to edit right now.
hey fairy,sorry for what your goin thru,been there done that too.my concern is that you are at a PM and have nothing that seems to spell out what the expectations are between you and the clinic.i was aware of the contract thing and was rather suprised at my first and the next like five? visits that no one had mentioned anything about it.until one appt where they finally gave me the thing which I read,and it did really spell out(finally) just what was expected and not.this was also the first time they did the UA that I was told was supposed to have been done at the very first visit?yikes?
I really would bring this up at your next visit and ask them about it so you kinda actually have a clue as to what is going on .i know mine is very specific about the expectations of me and what their responsibilities are to me as well,just being their patient.I think this would at least let you know for sure whats up.Just an FYI on the calling in of rxs at a pain clinic.if they actually did do this for you at one time,in all honesty,it was luck at least from what my pain clinic does.at no time do they ever actually do that.this is also stated in my contract. i know it seems stupid to tell you to actually call if a med isn't working and not do anything.but with the exception of only one time,in my clinic any med adjustments will only be made with an appt.i think that is actuallywhat they had planned when they told you to do that.Just letting them know so they could set up an appt for an adjustment.
Unfortunetly this is the world of pain management.these clinics have been just sooo screwed over that they really do need to be very strict with how they do things.It does suck,but going to a pain clinic is no way the same as when I was getting my Rxes thru my primary,no way at all.They have to do this just to be able to actually Rx the strong meds they do,i do know what you are feeling though as believe me,I just went thru this nightmare last month.i just called to get a sympathetic block set up to try and relieve the hidious pain that had been progressing to where it was terrorizing me at over a ten for about a week,yes it was well over a ten honestly.and when I called after going thru a month of hell trying toget someone to actually read my MRI that stated I actually did tear my meniscus on top of having an already horrid pain process going on that I was in a holding pattern for surgery,i was actually told over the phone that only BECAUSE my pain had progressed since the last vivit which was just two weeks prior where they did absolutley nothing at that time to try and help me with this nightmare,that I would have to actually wait til i could be seen by my NP for a re eval before I could even get the damn block done.I was sooo bummed as I knew that getting an appt with her was not going to be real soon.what really bothered me the most here was that the triage nurse that I spoke to actually made it sound as though if my pain had not progressed since the last visit that I would have been able to actually get in much sooner.now how freakin bizarre is that?once i managed to get thru the heelish week wait,I was just shocked when she came in and was like bending over backwards to try and help me.she actually wanted me to INCREASE my oxycontin to 100mgs in the afternoon(that dose had been already at 80mgs)!i tiold her that it sounded like just a bit too much so we added it to my night time dose which just brought that one up to 60mgs.but this is the incredible wierdness of a pain clinic.honestly,depending on just who you talk to that particular day and how they do things will determine what gets done.it is just the way they work sometimes.
I do hope you can get things all situated and your pain levels stabilized soon.I know this all sucks,but for the privledge of just being able to have the meds I need.I am willing to take the crap.it may seem and actually be unfair at times but this is the way it is.I know how much it all sucks,believe me.hope all goes well for you.just make sure to bring up the fact that you have not seen any sort of contract yet and that you kinda need to know the rules and regs.they may have just forgotten like they did with me.Marcia
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.
I'm new to PM also. I've only been going for about 4 weeks now. And, like you I waited a long time before commiting to the pain meds stronger than vicodin, which by law is allowed to be called in. In Ohio, once the meds get stronger than that, it can't be called in or mailed to the patient and a patient has to pick up the script.
I don't remember you saying how long you have seen this doctor, but apparently, the doc expects to have "work" with you on reaching the proper dose and type of drug to use. Otherwise, he wouldn't have said to call.
I don't know what you were prescribed, but if you are going to see him in a week, why don't you call and ask his nurse if it would be alright to take your current med more frequently until you see him the following week. At least that is something he could approve over the phone.
I'm surprised you didnt have to sign a contract. That has been one of the most shocking aspects of going to a PM doctor. lol Actually, I feel like a criminal with all the pill counting and things they can do. There are a LOT of stringent rules when using narcotics and this whole thing is a huge learning process for me and I'm sure it will be for you.
I don't think we can expect PM docs to react the same way as docs who can just prescribe vicodin over the phone for us. The drugs prescribed by these doctors are high addictive and easily abused. They really need to cover their arses in these matters AND so do we !!
I write down every pain pill I take and at what time and I took that list and my bottle to my doctor. Actually, I think it made a good impression on her. I can thank this forum for educating me on how NOT to **** off your PM doc. My doctor actually hugged me the last time I saw her because I was so thankful to have some pain free days although the med about knocked me out (like you) when I first started taking it.
If you can do so Monday, maybe you can call and speak directly with your doctor's nurse to see if you can increase your dose a little before your next visit. I hope he will comply...
Fairy, I am in the same boat as you. I have been seeing a pain management doctor for 3 years and was never asked to sign (or even look at) a contract. Nor was I ever told, or asked to take a urine or blood test to check my tox screen. I was obviously told not to drink alcohol with these meds. My PM is amazing. I never want to move because she works with me in a way I have never had a doctor work with me. She actually cares. I am 20 years old, so I am sure that would throw off a lot of docs, but she really cares. I have her cell number! She gave it to me so if I am having a bad day over the weekend and can't get a hold of her, or am trying a new med and something happends, I can call her directly and get instructions. To change the dosage, to stop immediately. But I have the same probs as you about appt's. Next time you call, tell the receptionist you have an emergency. The pain medication isn't working and the docor said to call and make an appt to see him/her if that happened. When the receptionist says there are no appts (which he/she undoubtetly will) tell him/her its an Emergency and the appt wont take long. You just need a new Rx, because this one isnt working and it would be a very quick appt. Tell him/her to go tell your doctor your dilemma, and tell the receptionist to ask your doctor if you can be squeezed in. I have to do it all the time, and every now and then I get a receptionist with an attitude, or on a power trip. Be firm, but not mean. You don't want to have receptionists as enemies, believe me. I hope this helps. I personally have never been asked about drug testing, pill counting, or anything. I bet when that receptionist told you to bring your pills she probably just said that. It wasn't an actual order from your doctor, ya know? Hope this has been helpful. Stay strong, and be firm. This is your body, and you are the one in pain. Screw the receptionist who has to work a little harder because she might have to double book a patient. (As long as the doctor okays the double booking or "squeezing you in" then it shouldn't matter to the receptionist) Have a great weekend.
Last edited by Administrator; 04-05-2006 at 04:18 PM.
Reason: inappropriate comments
<<Living without PM isn't an option so risking it for anything, particularly when the subject has been covered by the contract wasn't an option or risk I would take. I personally wouldn't call the friday before an apt on Wed and ask to be seen because my meds stopped working or be shocked by the response you got. A few bad days or one bad month isn't worth the risk of being labeled anything that's not true. Just keep apearences in mind.>>
Dave, you always give the best advise.. I have listened to you for a few years now and have learned valuable information from your posts. The way I look at it is I am sooo blessed to even have a PM doctor who understands and is willing to treat my pain - period. Sadly, so many are not as fortunate and suffer without the advantage of seeing a PM doctor.
I understand you are in pain and we all know what it is like to suffer, however, you must look at the bigger picture here..First of all, how fortunate you are to have a dr. who is willing to treat your pain. Secondly, it is NOT unusual at all for a dr. to refuse any kind of refill for any reason prior to seeing you first. There are so many who abuse the doctors/system and unfortunately, sometimes, legitiment patients pay the price.
I recall Dave mentioning way back about "flying under the radar" or something similiar to this and I have always remembered this advise and it has served me well. I have been told I am a 'good' patient at my clinic..One must remember how lucky you are to be receiving pain management and follow any/all rules in return. It is worth waiting the few days until your next appointment rather than calling and making 'noise' in regard to getting enough meds until then. Also, we are not our doctors ONLY patients..
I, like you, was not required to sign a contract for 3 years. Well, I went in for my 3 month check and there was a contract waiting there for me to sign. I was shocked as I had never had any problems with my doctor. Then, at my next 3 month appointment, I was asked for a urine test!!! I about fell over. My doctor asured me it was only a procedure everyone has to do. Unfortunately, the dea is making many dr's perform these checks due to many who abuse their medications.
From what I read here and what I have experienced personally, doctors are getting stricter and stricter. So, when you look at the bigger picture, waiting a few days until you see your doctor is not unreasonable at all.
Again, I understand what if feels like to suffer in pain, but in the end, at least you know you have a caring doctor who will take care of you. Many do not:*(
I'm a newbie to this stuff also... ANY doctor can prescribe narcotics. Most of us have doctors who wish us to be under the care of a Pain Management "Specialist". Most states have very stringent guidelines in the dispensing of narcotics - thus the contracts. There are people who will abuse doctor's who freely prescribe narcotics. In just the 3 appointments I've had with my doctor I have heard horrible stories from patients in the waiting room, so I'm beginning very much to understand the purpose of this contract.
If a doctor suspects someone of abuse of these drugs they need the RIGHT to check your pills, check your urine and check your blood. The only way they can do so is by having the patient sign a contract.
As for the misuse of pills, even honestly, like in the case of "I just had so much pain" can be viewed as misuse by doctors IF it isnt discussed with the doctor first. It sounded extreme to me also but after hearing some stories I can understand the need for them.
I would be interested in knowing if your doctor is part of a Pain Management facility or rather a primary, internist, or surgeon. That may explain why you didn't have to sign a contract.