Hello everyone. I have a questions pertaining to pill counts for those of you who go to a pain management center.
I have been perscribed pain meds through my PM Doc starting roughly a week ago. I take Avinza 60mg q24H and Norco for BT <2 per day. I go back in a week from today for an assessment from the PA.
I wasn't told that I would have a pill count or to bring my meds, but I understand it is common practice and I recall there being a policy in my pain contract reguarding a count.
I'm assuming they want me to come in to assess how well the meds work or don't work. I do like the Avinza, however it seems to wear off around hour 14-16 and I end up taking my BT meds to cover the remaining 8 hrs till my next dose.
Reguardless, I'm curious about the pill count. I plan on bringing in my meds with all their bottles. I recieved the Avinza from the pharmacy on two seperate ocasions because they didn't have enough meds to give me all 30 at the same time, so they gave me what they had then I came back in 4 days later and got the rest of them. Who does the pill count generally? Do you think the PA will do it in the room with me while he is seeing me? Or will he give the pills to a nurse to count? Or will he make me count them so he doesn't have to touch them? Is that how they generally count the meds, manually or do they have a weighing machine and just weigh them?
HI Derek, I have to take all my meds to every apt, IF they do a count they do it in front of me. If they didn't this would put the PA or NP in a precarious position of their word against yours. As far as partial fills on class 111 meds like norco or muscle relaxers, a partial really doesn't throw the count off. As long as you are not owed any pills at the time you go in for the count.
It's not unusual to find that Avina or Kadian doesn't last the entire 24 hours or that OxyC or MSC doesn't last 12,. This period in which they are adjusting your meds is the toughest. It takes the most self control not to self medicate when the dose isn't efffective, but try to look at the process knowing there is light at the end of the tunnel. It may take 3 or 4 or 12 adjustments to get your dosage correct, but as long as you know your moving in the right direction, risking loosing the first doc to treat your pain agressively isn't a risk most chronic pan patients will take.
Docs have allready heard every excuse you can imagine as to lost pills, stolen, short fills etc. So asking a doc to believe that you're the exception rather than the rule they have seen with patients that will never be satisfied or never be compliant really isn't a wise move.
They use the same tray and plastic knife they use in a pharmacy at my office to dump the meds out and count by hand just like the would at a pharmacy. They check the date the script was filled to be sure it wasn't filled early and it's an easy calculation to figure out how many pills you should have left at any given point in the month. I always count before I go just to be sure we come up with the same number and if the nurse makes a mistake, it's really not a big deal to have to recount to see if you have 16 pills left or 14.
Definitely take a closer look at the contract you signed just so you're aware of all scenarios. My contract says not to except a partial fill on class 11 meds, meaning if they only have 25 avinza and you need 30, they aren't going to write you a second script for the other 5 if you choose to accept a partial fill. I'm supposed to find a pharmacy that has the entire amount and notify the clinic within 72 hours if I have used a different pharmacy.
It's really not that hard to be compliant when having your pain treated is the difference between being bed wridden or being able to walk. I'm also not willing to put myself through withdrawal in order to make a count look acurate and I know my doc is not obliged to contue to prescribe should I screw up.
Docs can and will cut you off cold turkey regardlessof what med, what dose and how long you have been taking it. People don't die from opiate withdrawal and we do have the option of seeking help for addiction. So it's not like they are obliged to give us a comfy taper as they discharge us from a practice.
Counts are really no big deal unless compliance is a problem. If it is, use tools to make it easy, like pill organizers, have your spouse hold your meds, whatever it takes to stay on track, whether it's from forgetting if you took a pill or thinking an extra pill every now and then is no big deal. 2 pills short is a big deal. IN the case of avinza, it means severe withdrawal for 48 hours or possible discharge from a practice and a letter being sent to the doc that referred you to PM explaining why you were discharged.
The fact your being seen every 2 weeks at the beginning of a new drug is a good sign that the doc expects he may have to make adjustments. Taking avinza twice a day isn't unheard of and there just isn't any way a doc can look at you or your DX and know how much medicine it will take to manage your pain.
If you looked at ten 40 year olds, all with degenerative disc disease. Some don't need anything stronger than apap, some may need 60 mgs of avinza and some may need 300 mgs. There is no general rule as far as what dose is required to manage any specfic problem.
A person with a failed 1 level fusion may requre more than a person with a failed 6 level fusion. As long as the doc is working towards a reasonable goal, hang in there and hopefully the doc will find the right med, the right dose and right schedule to take your meds on.
It may take a couple of adjustments or a dozen or you may run into side effects that require a change in medication and starting over. Whatever the case, no doc is obliged to prescribe opiates and their goal isn't to relieve all your pain, it's to improve function and they generally shoot for 50% relief if that's even obtainable. I wouldn't burn any bridges when you know you have pill counts. A few bad days when the meds feel like duds is nothing compared to the years ahead or behind when nothing was prescribed.
I was just curious how they perfrom the pill count, I would indeed be suspecious if they took my meds out of my line of sight while I was there. I wouldn't dare take more meds than recommended. I've gone thru way too much to get to this point at the PM center. I've ben seeking pain management for over 2 years and finally I feel on the right track. Usually, the doc's I've experienced are reluctant to treat me. I've had one doc tell me he didn't feel comfortable assisting me with pain managment because I'm in an age group (mid-twenties) with a high abuse potential. I wanted to rebute his point and tell him = pain doesn't care what age I am, but I figured if he feels that way then he must have been burned and respected his feelings on the issue.
I didn't want to take my BT meds just to have full 24 hour coverage. I would like to have them around incase I actually needed them for BT pain. I'm going to experiment taking the Avinza at different times of the day to see if that makes any difference. I've been taking it first thing in the morning betwween 5-6am then before I go to bed at night my pain realy surfaces and I resort to the BT meds. I'll try taking it in the afternoon for a few days and see if that works better.
Just wanted to let you know that my PM doc counts the meds right in front of me. If you are new to Pm or the contract it sounds like the doc is intrested in assessing the amount of meds you may need but it is not an uncommon practice to have your meds counted. My advice is that if you see that you are taking more and the meds are not working call your doc immediately and let them know. Dont be affraid of being very honest with your doc. They appreciate honesty and it will work out for you great in the long run if they know your being honest. I think you should let your doc know that you are having to use you BT meds very frequently that way you can have an adjustment made.
Is it not normal for My PM Dr. to never count med's or do urine tests . I mean he did a urine test the first visit but he doesnt do them after that. He seem's very laid back about it all. Maybe he is just a trustworthy Dr.? Reading these board's about the PM doctors has made me paranoid about doing anything wrong. It also has made me afraid to discuss adjustments with him. Like I realy dont like the oxycodone at all, and would rather take the meth more times in the day instead of adding the oxy. The oxy has side effects that are starting to bother me. Anyway is it common for my PM Dr. not to count meds and have you bring them in?