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Old 03-24-2007, 04:58 PM   #1
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Ok so here's where I'm at today....

So, my doc swtiched me to mscontin 30mgs, 3xday after trying the 25mcg patch(w/oxycodone5mg 10x/day for breakthrough)...because my 100-110mgs of oxycodone/day was too much(for him). I went to him because my primary wanted him to switch all of my oxycodone into oxycontin and he refused.
So he puts me on the mscontin with no breakthrough. I told him this wasn't giving me enough pain control to get off the couch. I left messages andthey weren't returned. Finally on Friday I talked to the receptionist because I knew my doc was going on vacation. He still said no. I tried explaining that I was going on vacation for spring break and would like to have my pain under control and he still said no! I ended up crying on the phone to the nurse...he made me feel horrible.

So I panicked and called my primary and told her the story. She wrote me a prescription for morphine sulfate 10 mgs for breakthrough. I don't know if I'm going to be in big trouble or what but I'm mad! How dare he go off on vacation and expect me to suffer through mine!

He made me feel like a drug addict begging for drugs! He said methadone was the next med to try so maybe (if he'll listen to me) we can try that one.
He never said why he wouldn't give me breakthrough. It doesn't seem like the morphine works as well as the oxycodone. He did say something about me thinking about taking pills all the time(the patch was supposed to solve that)...maybe that was the plan...I don't think I'm making sense any more.

I don't know what to do....I can't wait until he gets back from his vacation!!!
~Mush
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Old 03-24-2007, 05:35 PM   #2
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Re: Ok so here's where I'm at today....

I had a thought...(that's a first...LOL)...I think I will try to get in to see my primary before I go back to my pm. If I sit down and explain everything that happened she will probably write a letter for me that explains what's going on.
She's known me for 10 years and has always been great and I think she would do this for me. Maybe she could also tell me what she thinks of the whole thing.

My only problem is that she always agrees 100% with my pm so....if he decides not to take care of me like he has been I'm up a creek.

Thanks for listening to me...it helps to vent and if anyone has an opinion....let me have it!~Mush
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undiagnosed lung and back pain after pneumonia in '03, tmj, migraines,(two failed surgeries for) Kienbock's disease

 
Old 03-24-2007, 06:07 PM   #3
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Re: Ok so here's where I'm at today....

Your PM sounds like mine, he doesn't believe in BT medications, many don't.
The reason they do not prescribe them is because many individuals do not take them "as needed" but take them on a regular basis. When this is done it totally defeats the purpose of a BT medication and becomes a part of the daily regimine instead.

If someone is prescribed or alloted 4 BT meds a day most people will take all 4. I've seen a few posts where folks will indicate they take xxx med with 4 bt meds a day. When you do that you aren't doing any service to yourself. In those cases the doctor should actually titrate the base medication up. BT meds are not meant for daily regular use.

I asked my doctor and he was honest in his explanation. I can totally understand where he is coming from and must repect that. I don't think it's fair as I may not be like the rest of his patients but he isn't willing to take that chance. In cases where my pain is out of proportion on a daily basis generally my PM has increased my medication or we've tried medrol dose packs. He just doesn't budge on BT's. I had my hip replaced again this last fall he really didn't want to give me anything extra!

You stated you took your old BT 10 times a day? Did I read that right? Did your PM or Primary give you that much? (trying to understand) It's obvious your medications were not strong enough to begin with which again illustrates my point why some doctors will not give BT medications. If your medications are prescribed appropriately you should only need a BT medication maybe once a day and sometimes less than that. perhaps a 50mcg patch would have been more appropriate.

Sometimes we have to use alternative therapies instead of BT medications. It's all to easy to rely on BT's. Have you tried or learned any alternative therapies like biofeedback, massage therapy, TENs unit etc?

I'll be honest with you, I hope your PM doesn't get upset that your primary prescribed you more medication and turn you loose. Most PM's make you sign a contract that clearly states you can not get pain medication from any other doctor. I do understand that he was not fair in going on vacation leaving you hanging either. It is a very sensitive and touchy subject. I hope you understand I'm not trying to be disrespectful just honest. I also can't believe that your Primary would prescribe anything knowing you are seeing a PM. Granted it could very well be due to the amount of pain you were in.

It does seem the MSC isn't at the appropriate conversion dosage but I'll let one of the folks more versed in that discuss that with you.
I do find MSC far more effective for me with less side effects than the patch or the oxycodone or oxycontin, all 3 of which make me very sick and delusional LOL!

One other ditty, my PM doesn't prescribe oxycontin either. In fact you'd be lucky to find one that does where I live because of all of the bad rap and pharmacist murders and robberies that occurred when Oxy first came out as well as the high that is associated with it. There was another one last week here. That's my guess as to why he refused to switch you and put you on MSC instead.

When does your PM return? Try to hang in there! I do hope you get thing straightened out so you are more comfortable!
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Old 03-24-2007, 10:34 PM   #4
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Re: Ok so here's where I'm at today....

Quote:
Originally Posted by trowftd3 View Post

So he puts me on the mscontin with no breakthrough.

So I panicked and called my primary and told her the story. She wrote me a prescription for morphine sulfate 10 mgs for breakthrough.


Is your primary doctor willing to take over your pain management, and fill all of your pain medicine prescriptions every month, or until you find a new pain doctor? If not, then you are asking for trouble. The pain doctor will be furious that you went to another doctor, and I doubt he will agree with any letter she writes.

Please don't fill that prescription! I believe that your pain doctor will fire you if you do! Did you sign a contract with him? If not, he will probably still hold it against you anyway.

One of my doctors gave me a prescription for a non-narcotic medicine, and I didn't fill it. I was afraid my pain doctor would think I was getting other drugs from other doctors.

Hold on, and try to survive until he gets back from vacation. There must be some way you can get through the next week, or even the next month. Either that, or get another pain doctor right now.

You cannot break the rules and expect him to not retaliate against you.

 
Old 03-24-2007, 10:38 PM   #5
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Re: Ok so here's where I'm at today....

Hi Mush,

Kissa raises some really good points. Reading your post and trying to figure out your primary Dr.'s thinking, it sounds like he/she had reached his limit when it came to Rx;ing pain meds. for chronic pain. Most aren't trained for that and get to a certain point and no further.

If he had you on a 25mcg. patch and was Rxing you 100-110mgs. of oxycodone each day I guess you were taking 2 5mg. pills 10 times a day yes? That is a heck of alot of pills he was Rx;ing each month for you.

It's no wonder that 90mgs. of MS Contin a day withno breakthru meds. was not covering the pain. Based on my 'simple' calculation, that is really about 1/2 of the conversion just for the oxycodone you were taking. 110mgs. of oxycodone is about 165mgs. of MSIR. Plus the patch which, even at 25mcgs. is failry strong. How much MSIR a day are you having to take?

I know that PM's when converting start really low, but man, to start you that low and then to take off on vacation doesn't sound very professional. I worry for you when he finds out that you were Rx'd more medication by your primary. Is there another PM that your primary can send you to? I doubt very much that a letter from your primary to this PM is going to do anything to change his mind.

Did you ever try a patch higher than 25mcgs? IF you did and mentionied it elsewhere I apologize. It is such a great method for the people that respond well to the medication.

Like Kissa said, many Dr.s are not Rx;ing Oxycontin anymore for many reasons. Personally, I think it would be last on my list of meds. that I'd want to try anyway. People are doing pretty dumb things to get that medication from legit. chronic pain patients!!

I feel for you Mush!!

Zach016

 
Old 03-26-2007, 11:24 AM   #6
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Re: Ok so here's where I'm at today....

To answer everyone's questions(and thank you for your input)....

I signed a contract with my primary. I go to my pm very rarely(maybe once a year) and he tries some new injection and figures out my pain meds and then I go back to my primary and she does all the prescribing. The reason I frantically called her late Friday was because I wanted her to call and talk to him...I'm not trying to hide anything...she's known me for 10 years I thought she could talk some sense into him.

My pm has always, always allowed bt meds...always. That's why I was so confused and he never gave an explanation as to why no bt and why such a low dose. If he would have told me why maybe I wouldn't have panicked.

After I tried the 25mcg patch he never mentioned going up to 50....he just moved along to the next drug on his list. ????I don't know why. I swear he doesn't ever titrate my medications...it's just here, try this...doesn't work? ok try this...never any discussion of slowly increasing(or decreasing).

That's what scares me...he said if this doesn't work he's going to take me off pain meds completely! "To see if they are the cause of my pain." I'm afraid he'll make me go cold turkey.
And Kissa,yes, that was 10x. After I had surgery I was taking extra bt meds to deal with post surgery pain. I was dropping down from them but couldn't get lower. The whole reason my primary sent me to my pm was to get him to convert the oxycodone I was taking into oxycontin...to change me from the 20mg to the 40mg(or 30?). But, he didn't like that idea.

Thanks again for your input and please keep it coming.~Mush
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undiagnosed lung and back pain after pneumonia in '03, tmj, migraines,(two failed surgeries for) Kienbock's disease

Last edited by trowftd3; 03-26-2007 at 11:25 AM. Reason: spelling

 
Old 03-26-2007, 04:40 PM   #7
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Re: Ok so here's where I'm at today....

Wow I would be finding a new PM dr asap! How can he just say nope that doesnt work if he doesnt try different doses. Yes start out low but then go up and see if it helps, if not then try somthing else. this Dr seems pretty narrow minded. I've had that experience also, and just simply changed Dr's. Give it some thought, and i wish you the best of luck!

 
Old 03-26-2007, 05:40 PM   #8
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Re: Ok so here's where I'm at today....

OK, I dont have a PM contract, or one with anyone...I have only one doc, hes our family doc and my Pain doc. But isnt that backwards to have your primary and you have a contract, and not your Pain Mgmnt doc? I dont know the relationship, but Id agree that you need someone better to take care of your meds. But I could be wrong. Im lucky, but most primary/family docs are few and far between who will take care of a CP patient. Most refer them to a CP doc. If your pain doc left you out in the cold, and went on his vacation and expected you to suffer while he was enjoying himself, id be looking for someone else. AND Id have the doc who helped you out write a letter stating that you were left in a lurch. Just my 2 cents worth. What is this guys problem? why is wanting to take you off of everything? I think thats almost a huge slap in the face...has he talked to your primary doc?
Wait i just re-read your post. is there any reason that your
primary cant be your sole provider for PM? Shes allowing you b/t and what you need and hes wanting to take you off everything? That doesnt make sense. I wish he were out of the picture because she seems to have your best interests at heart. Hope u get it figured out soon, Mush~ Im really tired tonite, from a long day, so I may not be making sense. Let me know if Im wrong~
xoxoxoxoxoxo,
IZZY'SMOM

Last edited by IZZY'SMOM; 03-26-2007 at 06:26 PM.

 
Old 03-28-2007, 11:58 AM   #9
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Re: Ok so here's where I'm at today....

Darn it, I wrote this long post and it disappeared. Oh well.

I think your situation is quite backwards from most. I know some do have their primary's prescribing because their PM's wont so the situation isn't unusual. What IS unusual is the amount of BT's you are taking. It is not normal and honestly, I'm surprised the DEA isn't knocking on someone's door.

I would highly suggest you seek out a new PM who can handle your pain. You shouldn't be taking that many BT's. Your patch should be titrated up to 50mcg and bt's reduced drastically. Additionally your doctor should be teaching you complimemtary therapies. Relying on pills solely is not the best method of Pain management.

I've been a pain patient since age 10 and active in true pain management for many years. I've never seen such a protocol and frankly it scares me.

How are you doing today? Have you gotten anything straightened out? Are you willing to seek out a new PM?

Please let us know how you are doing!
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Old 03-28-2007, 12:45 PM   #10
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Re: Ok so here's where I'm at today....

Hi, I'm new here and your story sounds kind of similar to mine so I would appreciate any suggestions or input.

About four months ago I noticed a lump in the back of my neck. It proceeded to get worse, more swollen, and more painful so I went to see my primary care doctor. She ordered a CT Scan and an MRI which both came back normal. She had perscribed me 30 percocet 5/325mg once a week for about six weeks. Those were helping but I still cannot sleep through the night without waking up in pain. It's hard to even get through the day without constantly thinking of how much pain I'm in. She then decided to switch me to the 25mg fentynol(spelling?)patch which did not work AT ALL! Man, everything I read online I thought I had finally found a way to manage my pain but nope, so I went back on the percocet. She then trasferred me to the Pain Clinic at the local hospital and since then it has been a nightmare. My neck is constantly swollen and I have been in bed for FIVE DAYS because I cannot barely move my neck. I called to get a refill of the percocet and my primary care said I would have to go through the pain clinic for all my pain related meds now. So I call and the nurse asks what I am doing for the pain. So I tell her taking the percocet and she responds with "OH really? Where'd you get those from?" (made me feel she was implying I bought em off the street or something!!). So I told her my dr gave them to me and she said "Well this doctor is not going to give you those so don't even think about it". I called back yesterday and was given a perscription for ultram which is not helping AT ALL!! I don't know what to do...my pain is getting worse and the meds are getting weaker. I think they assume because I am 22 I must be addicted or something but I am in PAIN! I do not feel any "high" whatsoever from the percocets, in fact sometimes they don't even really help. I'm about to give up on this whole thing and just deal with being in severe pain for the rest of my life...

 
Old 04-02-2007, 11:02 AM   #11
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Re: Ok so here's where I'm at today....

Hi...all!
Still suffering with the mscontin...waiting for my next appointment(11th).
I didn't take the bt that I got from my primary...I don't want to get in trouble with my pm. I'm just lying on the couch...doing the minimum to get by.
When I go back I'm going to ask to start over with a new pulmonologist. Maybe if we start from the begining again we can figure out what's wrong with me.
I am soooo tired of this pain that no one understands or believes is real!!!

Thanks for listening.~Mush
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Old 04-02-2007, 07:04 PM   #12
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Re: Ok so here's where I'm at today....

Have you tried a warm compress? That has saved me so many times when NOTHING else even came close to taking my pain's edge off.

Although someone on this forum came at me when I tried to explain this once. BUT, I only saw my Primary MD for 5 years before anyone mentioned a PM Doctor. I never knew they existed. And now that I go to one...everything makes sense. I really thought I was to just suffer every day. And I think that once you get a proper PM doctor, and not have your Primary take care of your pain...you will also see that a good PM MD can really help you live a close to normal life. Good Luck.
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Old 04-03-2007, 03:12 PM   #13
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Re: Ok so here's where I'm at today....

Hey Mush~
I used to live in Kirkland, and I remember the cold, rainly, dreary days that could make my pain really bad. I used to live with a heat pad, and even now I use one all of the time here where i live. Its freezing until May. Nites here in the winter are almost always 14 below at LEAST every nite. So I have had to try a few other things as well as the meds. I dont know if you have tried a hot compress and castor oil. Use a piece of flannel and castor oil...apply the castor oil, then warm the flannel cloth and put it on the area. cover it all with another heavy towel. you can dampen the towel if you want or the cloth. Mess around with it. Maybe someone else will jump in here and add their 2 cents worth. take it easy Mush!~
xoxoxoxoxo,
IZZY'SMOM

PS you can get the flannel cloths at the heath food store...

Last edited by IZZY'SMOM; 04-03-2007 at 03:13 PM.

 
Old 04-03-2007, 03:59 PM   #14
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Re: Ok so here's where I'm at today....

Thanks for the advice, guys. I do use the hot compress when I'm miserable.
It just hurts to get up to keep it warm...you know what I mean?
I take many, many baths every day cause the hot water helps for a few minutes. And if you can take the edge off for a moment then you have more strength to deal with the pain.

I called today for my refill. I guess they will call on Friday to say it's ready...hopefully early enough that I can make the drive. You gotta love Seattle traffic! Almost as fun as LA. Everything you do here hinges on the traffic.

Thanks again.~Mush
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