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Old 03-09-2007, 11:39 AM   #1
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Cool Advice in talking with Pain Management Doctor

Hello! I have 7 herniated disks in my back - from T-12 all the way down. I've recently changed PM Doctors due to my old one leaving to take a new position elsewhere.

I was taking MS-Contin, but this made me very sick. I take Vicoden for breakthrough pain. The new doc seems very nice. At least he hasn't treated me like a "drug seeker". I mean, they do have the MRI's and my history.........but anyways, I told him that the MS-Contin made me sick, and he gave me Dilaudid. I take 8mg every 12 hours. This also makes me sick to my stomach.

Should I get information regarding different pain medications and ask him to try different ones? I don't want to be treated as a "drug seeker", but have friends that have back injuries, and both have said I should try Oxycontin. I've read up on this and see that it has a bad rep. but I need meds so that I can function and relieve my pain.

Should I ask the doc about this med or would this be a strict "don't". I usually just take whatever is presecribed and shut my mouth. However, I can't take the nausea and upset stomach. I do not do good with Morphine at all. I've tried Oxycodone in the past, but asked to have it changed as I didn't like the way it made me feel. It did work good on my pain though, and at this point, I'd try to get used to the feeling to get relief.

I just need some advice on open communication with the doc. I don't want to say anything or suggest anything that would cause damage.

Is it ok for a patient to ask about certain pain meds, and ask to try them since they've heard they work? Or do I just continue to grin and bear it? Any thoughts/advice would be greatly appreciated!

Thanks!

 
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Old 03-09-2007, 12:33 PM   #2
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Re: Advice in talking with Pain Management Doctor

I did let him know that the MS-Contin made me sick, and he did switch me to Dilaudid, which I've only been taking since this last Monday. But now this is making me sick too.

So you think I can ask to try something else? that's ok? I will make sure I take all my other meds with me......I haven't taken the Dilaudid today, and I finally got rid of that sick, nasty feeling. So, I don't want to take any of them.......

 
Old 03-09-2007, 01:02 PM   #3
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Re: Advice in talking with Pain Management Doctor

Sometimes it takes time for you to adjust to taking the meds also. Have you tried taking them with food/without food? Have you tried taking them before bed? Before I went in and told my PM I didn't like the ones I was on, I tried taking them all the different ways I could to see if I could tolerate them any better.

I wanted to be sure that I have given the meds a chance to get in my system and to get use to them. Sometimes it takes a couple weeks to settle in. Just a suggestion.

I would take a list of what you take, have taken, how long and how they affect you. You don't want your dr. to think that you are just shopping for the latest "in" drug to be taking.

good luck...


 
Old 03-09-2007, 01:42 PM   #4
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Re: Advice in talking with Pain Management Doctor

I think ibake&pray just gave you some REALLY GOOD advice. That's actually good advice to talking to ANY kind of Doctor. They like to see that you used your head, and didn't just jump to a thumbs down conclusion. I am sure that many people have that reaction to Dilaudid, and your doctor probably has seen that after patients use the drug for a few weeks, the side efffects tend to subside. So, Try to take the med all different ways, and times of the day. Any Doctor wants to see that the patient gave his suggestions/scripts a good couple of rounds before its time to change.

Believe it or not, there are so many people out there that give up quickly on doctors's suggestions, or do it the wrong way when they get home....then they freak out on the doctor. You sound like you care, so this is not about you. LOL. But wow....I've seen this in action, many people try something one time and find themselves to be an expert on all the negatives about the med, or a PT experience, or a brace thay have to wear. This makes Doctors very upset... and it should. They have a degree in helping people thru educated decisions. Many people just like to undermine that authority and complain how things "don't work" all the time. All they want is to see that you are trying to make it work.

A little trivia: The #1 problem that Docotrs have with their patients is that the patient does not follow his instructions/scripts as insructed by the Doctor. #1 problem of the Patients to the Doctors were the extended time in the waiting room issue...this was a recent survery I read in a health magazine.
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Old 03-09-2007, 01:50 PM   #5
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Re: Advice in talking with Pain Management Doctor

Hi there,

I agree with Bake/Pray that you have to be careful and just ask for just specific medicines sometimes and let the Dr. use his expertise in helping you with your pain. This is NOT to say that you shouldn't tell him about your upset tummy, but from what it sounds like, you are sensitive to most medicines like I am. That's just something I have to unfortunately live with and be very careful about having it with food, carrying crackers with me at all times, TONS of chewable Rolaids that are in my purse, kitchen, car, etc.....Again, not saying that you should always keep an eye on your tummy and keep track, with the Dr. on how much Acetamenophin (sp?) you are taking for your liver.....and make sure you don't develop an ulcer..... But again, ALL medicines have some side effects and it's really trial and error with which one's have good pain mgmt....(getting to a 4-5 for me personally is FANTASTIC!!!) and living and managing the upset tummy, fatigue, etc...that comes with the chronic pain package....

I don't think it's realistic that you will find a medicine that makes you feel all happy, energetic, warm and fuzzy, with no side effects whatsover....it's just the degree of "yuck" effects with taking such strong narcotics.....and then praying and working with your Dr. to get your level down to an acceptable level for pain and then managing and changing your lifestyle, eating habits, sleeping habits, work, life, etc. to really live a good and happy life WITH the pain....

You mention that Oxycodone didn't make you feel good...what exactly did you mean by that?.....Oxycontin is oxycodone without the Tylenol added.....

Also, I agree with others that you really have to give the medicine much more time to get used to it....a month is actually a good amount of time as I'm sure your Dr. will tell you to really work out the major "kinks" and side effects to decide what you can deal with....

You said that you stopped taking the Dilaudid and it hasn't even been 7 days on that....It might start to look bad if you keep only taking the medicine your Dr. is prescribing you for less than a week and keep asking for the next stronger thing....Again,,,,not that you don't NEED something stronger....but as we all know here with Chronic Pain....we have to really watch everything we do because in our world...we are guilty until proven innocent....it's just the lay of the land.....

So, unless you had the most awful experience ever with severe heart issues, throwing up constantly and not getting any food or water down for a day or two.....it's really not a good enough reason to stop taking a med just because it makes you naseaus...there are other meds that your Dr. can prescribe if necessary or OTC medicine that I take to help with your tummy issues and deal with it better...


You said that you take Vicoden for BT...so if that is not making you too sick then I would suggest asking for a long acting medicine with the same property of Hydrocodone....since it would be the exact same medicine minus the tylenol....

It took me awhile to find the right combination (meds plus lifestyle) to get to a 4-5 on the pain scale along with my 3rd major fusion surgery for my neck ( they went in through the front and the back this time)...and keeping healthy with my food choices, yoga, exercise, sleep, PT, stress management, drinking lots of water, etc.....

The medicine I take...after 3 surgeries in 4 years and all of the above non medicine things, is Oxycontin 20mg, one every 8 hours...Percocet 7.5/325 one to two every 4-6 hours but never more than 8 a day to keep my tylenol in check...Robaxin as my muscle relaxer, and Cymbalta for nerve pain and then Ambien to help with sleep when needed....
As Shoreline as others will say too, you also have to show your Dr. what else you are doing to manage your pain that doesn't include medicine and work with him to find a TOTAL BODY/MIND plan that will work for you instead of just asking for medicine after medicine so that you can be a participant in your pain management along with your Dr...

BTW...have you done PT, injections, shots, traction, surgery, or anything yet to maybe help fix some of the herniations? Just curious....

Hope that this can help some and that I don't come across harsh but want to be honest about what it can "look" like as you qouted in your post, sometimes when we just ask for certain meds....

I really wish you luck in finding a great pain mgmt. plan that can help you live the best life possible and I'm sure you will great some wonderful advice from others on this board as they have been so helpful to me...

Blessings,
Ingrid

Last edited by TraveltoSL; 03-09-2007 at 01:50 PM. Reason: sp..

 
Old 03-09-2007, 03:23 PM   #6
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Re: Advice in talking with Pain Management Doctor

If you are getting an upset tummy from your medicines, maybe you could ask your PM doc for an anti-nauseau (sp?) medicine like phenegren until your body adjusts to the meds. I did that with my doc and he was very willing to help me in that area.

I also agree with the others that say it takes time. Don't stop taking your meds. If you could lay down for an hour or so after taking your meds, this also can help.

Hope this helps. Good luck!

 
Old 03-09-2007, 09:08 PM   #7
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Re: Advice in talking with Pain Management Doctor

Hi.You mentioned that you wanted to bring up to your doctor about trying oxycontin.But you also mentioned that you tried oxycodone in the past, and it made you kind of sick.[this could of been mentioned in a reply already] Oxycontin is time-released oxycodone without the A.P.A.P
So you may want to try something else.

 
Old 03-10-2007, 05:30 AM   #8
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Re: Advice in talking with Pain Management Doctor

I recommend that you talk about your quality of life, or rather, lack there of....instead of what meds may, or may not help you. State clear goals you would like to accomplish. State clear examples of how your pain is interfering with your goals. Make a list to show the doctor. For example, pain kept me from being able to work. When I finally went to see a pain specialist, one of my goals was to return to work. I am back doing part-time work for the first time in a year. It is easy to see that pain management has enabled me to obtain this goal, and greatly effect my perception of "quality of life."

Your list can include things such as:

1. My pain keeps me from doing some things I used to do....such as .......

2. I have plans for the future that are conflicting with my current ability to work, sleep, play, ect.....

3. My pain makes me feel......

4. I feel that I could do.......BLANK......if my pain were more manageable. You deserve to have your pain treated, and to have the highest quality if life that you can achieve.

I wish you all the best, and I pray that this doctor will help you.

 
Old 03-10-2007, 08:38 PM   #9
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Re: Advice in talking with Pain Management Doctor

Thank you all for your insights. I have had all the injections, Pt, and the rest with little relief. I want to ask about oxycontin because I was told by others with back problems that this med worked wonders for them, and I'm desperate for relief. I too am in ministry. I'm a youth pastor, and need to be able to minister/keep up with a bunch of teenagers. I'm not looking for a high, I'm looking for pain management. I wouldn't be wasting time and money and hours in the doc's office if all I wanted was a buzz. I'm a minister of the Gospel, and want to be sober not lacking judgment. My morals are extremely high, and the standard set for me is the one set by Christ.

I'm sick of the guilty until proven innocent mindset. I've been treated like a drug-seeker/addict by a couple doctors and have been offended beyond what any person should be. My MRI's, XRAYS, EEG's, etc speak for themselves. My records are almost 7" thick and show that I've done everything asked of me. The dilaudid are not even getting me down to a 6 - I'm at a constant 7 or 8 and on bad days, unable to get out of bed and do simple things like walk.

I asked the question I asked because, like I said, I take what is given to me without saying anything. But I can not continue to do this as I can not do much. Again, I'm frustrated, desperate, and in extreme pain just like many here. I needed advice, and thank you for it. But I must decide for myself what route I will take. And many have told me, including the pharmacist, to ask if certain meds will be right for me. After all, that IS open communication. I want to know what is right for me. The dilaudid has had me vomiting for 2 days straight, not able to keep much down, and the yuck factor is not worth taking these pills - I'd rather be in bed.

I wanted to know if it was alright to mention specific meds. Some say yes some say no. I need relief and I need it NOW. The thought of going to the doc's and talking about this makes me sick. I should not have to defend myself, but should expect to receive the best possible care - after all, that's what I'm paying for.

I will talk to him openly and honestly. I will let you know what happens, but I can not continue down this path - it must change, and if I don't say anything, than it's my fault.

 
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Old 03-10-2007, 08:47 PM   #10
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Re: Advice in talking with Pain Management Doctor

Oh yeah, what I meant by oxycodone not making me feel good - it made me feel dizzy and weird, which I didn't like. But it worked better on my pain with NO upset stomach.........that's why I'd like to ask about this med. I took it, no yucks, but it did make me "fuzzy". I'd deal with that to get my pain under control. I just don't like feeling "buzzed up". Does that make sense?

 
Old 03-10-2007, 10:21 PM   #11
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Re: Advice in talking with Pain Management Doctor

I think you have the right idea when you say "if I dont say anything ... then its my fault" You need to speak up and it is called participating in your own treatment, which is supposed to be a good thing. But asking for advice on how to best conduct that conversation with your doc is very smart of you, because as we all need to know and admit, it is important to be careful of what we say. Now I have heard some act like that cautiousness is suspicious, but that is stupid, being cautious is SMART, especially for pain patients. If I were you I would tell my doc that you have heard, read here, researched on the internet, about oxycontin and you feel it may be a good choice to try next as a long acting med would provide better coverage etc... and since oxycodone ir did take care of the pain with out too much problems, what do you think of me taking oxycontin? That would be a straight forward good open conversation with the doc. BTW of all the side effects I have heard and read that the "fuzzy" feeling does wear off after some time and so I personally think it is a good informed choice for you. I think your doc will be pleased that you are communicating and speaking up about how things work and it gives him some direction to make his decisions. Pain management doesnt work well when you just say I am in pain they presctibe you say I too nausiated, he prescribes another then another problem and ya cant take. The point I am trying to make is you help your doctor make better decisions when you give more input into how things work or suggest what would be a good idea to try. I think you will be ok talking to your doc, and I am glad you have a good idea to share with him let us know how things go.
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Old 03-11-2007, 08:00 AM   #12
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Re: Advice in talking with Pain Management Doctor

Hi there Brettman, and Mzpain,
[removed]

I TOTALLY agree that we shouldn't have to feel "guilty" but I was just stating that I , along with others, have been through the ringer with Dr.s who thought the worst about us just when we are trying to get some relief. The only reason that I personally don't reccommend asking for a specific medcine is if you are not with a caring and understanding Dr. that knows you very well. If you are, then that makes the conversation much more easier. But, if this is someone you don't know, I was saying it COULD look bad just asking for the Oxycontin because of all the bad press and problems by addicts with this specific medicine...

Again, please know that I totally suppurt being open, honest, and very straightforward about your pain level and what works and doesn't work for you as well as what reaction you have to each medicine....I also just suggested that it might be good to give each medicine a little more time...

So, as I have said in another post...without being able to know eachother and see our faces.....sometimes my (or others) posts can come across a different way then intended....I was in no way suggesting that you were not looking for pain mgmt. and only looking for a buzz....not at all....I was just giving my personal opinions based on being with terrible Dr.s.....and then know, being blessed by a wonderful Dr....

I can surely emphthasize with your situation and as you can see, I am on Oxycontin and Percocet and have found that these, instead of the hydrocodone products and morphine, work best for me with the least side effects....I also, cannot do the Duragesic patches as I also wound up in the ER because I put one on and then took a nice long, hot, shower like I always do in the morning and passed out on the floor with too much of the Fentanyl in my system...I knew to not go into a hot tub with these on but didn't think my regular hot shower would an issue...I was throwing up all day and into the night even after I called the Dr. and took the patch off...That's my whole point about the trial and error and finding what works for us since there are so many others that can totally handle and use the Duragesic patch....

Brettman, that's so awesome that you are a youth pastor!!!! That has been most of my mission trips in the US with our youth group....I have been helping with our High School kids for about 8 years...Last year we went to help with Katrina and I am always soooo proud to see those kids give up a few weeks of their summer vacation and give back to others and their lives to Christ....

So, I hope I clear up what my intentions were in my posts and hope that people can see that I truly am a curious person and that when I am asking questions...I truly want to know the answers and not being sarcastic or judgemental with these questions...It helps me know more about you and others to give the best advice I can coming from little ol' me and my certain experiences....

When can you meet with your Dr. next to talk with him? I hope and pray that you can try other medicine to help get your pain levels down soon!

Blessings,
Ingrid

Last edited by HBMod07; 03-19-2007 at 06:32 AM. Reason: inapropriate comment

 
Old 03-11-2007, 08:01 AM   #13
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Re: Advice in talking with Pain Management Doctor

Hi Brettman:
I want to start by thanking you for being a youth minister. I'm so glad that people think about their communities and help guide our young people in the right direction.

As far as asking for oxycontin, keep in mind that OC(oxycontin) has gotten a bad rep, from all the misuse by abusers, and alot of docs won't rx it, period.
I would suggest that you explain that the Dilaudid made you sick to your stomach and that you seem to have similiar reactions to alot of pain meds, but, you took oxycodone before and you didn't have that sick stomach feeling. This way you can get an idea of what his/her feelings are about rxing oxy and if your doc is willing, ask about the oxycontin.

It is sad that you can't come right out and ask for something, but, alot of docs think if you ask for a particular med that is a red flag for a drug seeker.
I think it's better to just explain what has or has not helped in the past and then go from there. I've read on the boards that some pm docs have signs up that say they don't rx oxycontin. Believe me, I don't agree with that kind of policy, but, it does happen.

Keep a pm diary of your pain and what meds you've taken and the reaction you had, and include the other non-med treatments you've done, i.e; hot baths, massage, etc. and the relief you got.

Good luck

 
Old 03-11-2007, 08:01 AM   #14
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Re: Advice in talking with Pain Management Doctor

Whichever path you decide on friend, please come back and tell us what happened within your dialog with the PM MD. I find it interesting how the different conversational appraoches result in either a good outcome, or a weird face an MD might make, or a series of questions, or even a total bow off. If your used to being flat out direct with people, than that is prob your best bet.

Whatever makes you more comfortable, go with it. My only caution to you is what someone once said to me , "you can't help how other's perceive your actions even if you are being honest and doing nothing wrong." That was about a situation that I got in which I didn't do anything wrong at all, and felt that since I had nothing to hide it wasn't a big deal...but the action itself looked suspect. So, people usually (Doc's) just go with how the the action looks, not so much the person him/herself. That made me part of the nervous nelly group on this forum, b/c I never thought of it like that. I'm an honest person, but I guess sometimes its not enough in this PM world. And it does feel just aweful to be doubted when you ARE being very honest. Good luck.
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Old 03-11-2007, 10:49 AM   #15
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Re: Advice in talking with Pain Management Doctor

I'm fairly new with my PM doctor, but I asked him at my second visit if it was ok for me to be honest & frank with him. He immediately told me that he absolutely wanted me to be honest and not hold anything back. He told me he is always open to listening to his patients and if he feels what we suggest is in our best interest, he will give in serious consideration, and if he feels it is not in our best interest, he will explain why. I may just be lucky in finding a doctor who will actually allow me to have some input, because I know there are some doctors who won't take a patient's requests into consideration at all- I've read some of the stories here on the boards.

This made me feel better because it made me feel like I do have some kind of control/input into helping my doctor to help me. At our second visit, we were discussing modalities & medications I'd tried in the past and what worked as well as what didn't. When we got to discussing medications he would treat me with, I specifically told him that for BT pain, Vicodin helped bring my levels down to a 4-5 range which was something I felt I could work with. Because of my IBS, there are certain medications that my body just will not tolerate, and Vicodin has never given me any kind of loppy feeling. He told me that it is a great medication for BT pain and he would rather I take that than oxycodone. He did put me on Norco because it has less of the acetamenophen in it. His main stipulation was that while taking the Norco, he wants me to push my activity levels, which I do. He monitors how well my regimine is by the "payback" I get after pushing my physical activities.

Anyway, I know how frustrating it is to feel that you can't be totally open and "frank" for fear of being perceived as a "seeker", because I still kind of feel a bit aprehensive sometimes in speaking with him. I just plain don't want to sound like I know what is the best way to treat my pain. I do however, know what does and doesn't work in managing my pain levels, and I alone, know what I can and can't live with, so I do let them know what is and isn't working, and also the things that might start helping as we continue trying them. They have never made me feel like a "bad" patient for being honest and for that I am truly greatful.

No, it's not really the best idea to go in the office and say something like, "I want you to prescribe me oxycontin.", but I don't think it would hurt to say something more like, "How do you feel about maybe trying oxycontin, or something comparable?". You can explain why you feel you want to try it, and assure him/her that you aren't trying to take over, but are just trying to find relief that will bring your pain levels to a more manageable level so that you are able to live a somewhat more normal life.

All doctors are different, and they all have their own reasons for the route they take in treating patients. First, they don't want to bring the scrutiny of the DEA down on themselves or their patients, but secondly, most of these doctors are very knowledgable in pain management and they know what they are doing. They aren't just grabbing ideas out of the air. They do want us to live a "normal" life, they want us to follow their directions, and if a patient is just too unwilling to try their way, then it will give the appearance that the patient is noncompliant, and it won't go over very well. I think there really is a fine line between being open, honest & frank with your doctor and actually coming off as a "seeker". It's tough, but there really does need to be an open line of communication.

I hope things go well at your next appointment. It's difficult living with chronic, intractable pain, but feeling as though you have to be scared, or feeling as though you have absolutely no control can make it that much worse.

 
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