In an earlier post I read here, a person was put in the predicament of whether or not to tell the doctor they were out of a medication that should of lasted 30 days.
I have some thoughts about that situation and hope no one minds I post them. If they are not your thoughts I understand and please feel free to post. This is not a direct attack on this person just my personal expierences.
I am fairly new to pain management only about 6 months or so. I was having problems titrating my LA medication and it causing horrendous side effects. So I was blowing thru my SA but dead on count with my LA. I did not feel I was abusing the pills, I called everytime I thought I needed to take more SA medications and made a face to face appointment to make a more permanent change. The PA that I was dealing with under the supervision of my PM doctor, never clicked with me even from the first appointment. So I choose to not lie and say I had all my meds I told the truth and was asked to bring it all the bottles I had.
He came to the conclusion that since I had taken more SA then alloted that I was addicted and was no longer welcome to be there patient. He then took all of the medication I was on and told me good luck with detox and buh bye now. WOW what a huge predicament I was in and I was scared to death. If you look up a past post you can read the whole thing in its entirety.
Long story short I now see an addictionologist and what a GOD send. But he did spell it out to me in terms that made me understand. Though our pain is the front most thing on our minds to our doctors we are a folder among many other folders of cases to decipher. They have gone to school there entire adult lives and make huge sacrifices to beable to do what they do and provide nicely for there families. They are not willing to put all of that in jeopardy to fix something that "WE" screwed up in the first place by self medicating.
I learned a valuable lesson and that is take DIRECTLY AS PRESCRIBED, no I do not believe that 2 weeks of good pain control and 2 weeks of withdrawals in an acceptable way to live. They trust us with medications that would kill most opiote naive people. We as patients need to trust them that they know what they are doing and will work with us in the coming appointments to titrate the right combo thats gonna work.
I also accept I will never be 100% pain free, that just isnt in the cards for most PM patients but finding out if a 3 or 4 out of a 10 is acceptable then that is what we should shoot for.
Just remember, if there is an excuse for why you need more meds to replace stolen or dog ate it or fell in the sink reasons to give more meds they have heard them all. And what makes your story more reliable then someone that is just chasing a high?
I say we should all be greatful there is someone willing to listen to us and treat accordingly and will never jeopardize that privildge again.
Sorry if I ruffle feathers just had to get my point across.
It was me, in the Running Out Early thread I had started.
Self medicating, for me anyway, is something I have always done and have been very cautious in doing. I'll get back to that in a bit...
That said, I also have a naturally high tolerance to just about everything, and if you do some research you'll find that there are indeed people out there like that and it can be handed down through genetics. My father was a horrible alcoholic. When I started drinking I could always drink far more than the other guys at that time and people just thought it was "cool", but it was actually somewhat of a curse. His mother was an alcoholic, as was his grandfather.
People like to assume many things. Assumptions are fine, of course, but more often than not little more than stereotype, bias and/or bigotry. I think pain patients run into all three of those more often than they would like when it comes to people assuming that they are only wanting narcotic pain relievers for the euphoric high they produce.
Myself? Been there. I am actually pretty careful not to slip back into that again though, now. This fits in, though, when I talk about self medicating and the assumption of addiction and the accusation of abuse. (not by you, but from doctors and busy bodies)
My thinking is, and bear with me here, that if your doctor gives you, say, 10mg of OxyContin (OC) to take twice a day and it isn't doing squat for your pain, then why even take it? Does that make sense, to take it just for the sake of taking it?
So, anyway, and let's assume you are taking it exactly as directed, you're following the rules and you are no further ahead than when you started. So you request from your doctor more, because afterall, that is the whole point; to treat the problem, not under treat it.
Then, the doctor denies your request. So there you are, still in pain and taking a dose too low in vain.
Here is where people start self medicating. For me, the option was waste my money and this opprotunity to actually have some relief, or continue to take the medicine for nothing. Well, if you're truly in pain, imo, the choice is easy. At least for me it is. I gradually work up the dose until it works. Dangerous? Sure it is, but that was my choice.
My situation was that I had two options, as far as I was concerned: The first was to wait for the day when I was prescribed the amount that would work and suffer in the meantime, or self medicate and get the relief I needed.
In the end I came to the conclusion that it is far better to have some relief rather than none, and that was that.
Personally, I don't consider it abuse. I consider taking the meds when you aren't in pain abuse. Others will certainly argue otherwise, and that's fine.
Self medicating is abuse no matter how you rationalize it. It's also extremely dangerous. The acetaminophen in many pain killers will destroy your liver eventually. The most common drug that lands people in the ER with an overdose is Tylenol (acetaminophen). There's a reason doctors will only prescribe so many a day and that is because there's a maximum amount that your liver can handle. You might think you have a high tolerance but your liver can only take so much. I've been on pain meds for about three years now and the high I got from them lasted maybe a month before I got used to them. I was not about to chase it and stayed within my plan. When my pain increased I told my doctor and he made adjustments and also tried other things like injections or physical therapy. I long ago gave up any hope of being pain free but have found that level 4-5 pain is tolerable. Yeah, it's tiring and it wears you down but it is what it is. I'm not about to abuse my meds and I can't imagine self medicating the first half of the month and spending the second half going through withdrawals.
I have been on this board for a number of years now, and one thing I have noticed that I think is interesting, is that when people get in trouble with their meds, Its almost exclusively with the short acting meds rather than the long acting ones.
I have seen it so many times that I must assume that doctors also see it and will jump to conclusionsions when a patient wants more SA meds and claims the LA meds arent working.
The idea is that the short acting meds are to be used maybe a few days a week, but most people end up taking the maximim allowed, which of course means they are no longer break through meds, theyre just meds, part of your medical regimin.
The idea is to use the break through meds to get your LA meds tirated up to where you need little or no of the SA.
When I see someone say that the LA meds do nothing for them, and they prefer the SA's, I admit it makes me worry a little.
Theses are just my observations from years of talking to CP patients, I am not claiming to know what every individuals situation is. so please do not take this as any kind of personal attack on anyone, its merely what I have seen.
The problem with self medicating is that pretty soon you dont want to suffer those last 2 weeks before a fill and begin to look elsewhere for relief. No one wakes up one day and says 'Gee, I think I'll become an addict today'.
Its a slippery slope and avoiding self medication is one of the biggest ways to avoid starting that long slide into addiction.
Theres also the fact that one pill count, one UA, and youre out. if its in the part of the month where there are twice as many pills in your system as should be or right before your fill when you have nothing in your system, either are enough to get you booted out of PM. and its not a matter of just finding another doctor, no one will prescribe these kinds of meds without your records in hand and this can follow you for years.
God forbid you have a UA right before a fill and your doctor decides you must be diverting the meds by selling them on the street, you will never be able to convince him otherwise.
There is also the toll it takes on your mental and physical health to constantly be thrown into withdrawals, that kind of yo yoing is really bad for you physically and spiritually.
Right or wrong, I think some doctors ask us to stick with a regimin for a time to see if we can be trusted. If you keep coming back and complaining of more pain, eventually they will trust you and raise it or refer you to someone who will. If they refuse and then see you showing up in ERs, losing meds, calling for early fills, they know. they arent stupid and they see it every day.
I have nothing but compassion for those of us who suffer night and day with pain, and mistakes can and should be forgiven, but we also need to understand this is a serious thing with set rules and expectations of behavior on our part.
I really didn't want to get involved in this conversation but I have to agree with Fabby 100% " I wish I could get long acting med's for pain."
I screwed up thanks to my Dr. leaving town without telling me , leaving me when I was taken 90MGs of MsContin and 30MGs of Oxycodone a day and no one to refill my scripts . I went crazy and called everyone to help me and it must have put up a red flag because now all I get is 10MG Norco that doesn't touch my pain anymore... Please be careful . Oh yeah I'm no addict either if I wanted drugs I could get them off the street.
YEA to FAB they really get pain management! I work in a pain clinic and i can tell you that is how our clinic really does run. Keep in mind at our clinic we will call patients for random pill counts and have them take their meds to the pharmacy for counts. One more thing is that many states have reporting systems and can look up from the pharmacy board exactly how many scripts you have had filled, when, what doctors, what pharmacies, when the script was written, when filled, how you paid for the script etc. This is how patients get themselves into trouble. If you are having pain just make an appointment and speak to your doctor, if your plan isnt working be persistant or get another referral to another clinic. You must be your own pain advocate but when you go to the clinic be honest, if your pain score is a 2 say its a 2 not a 10. If your score is a 10 and you get meds then the next 10 visits and 10 more raises its still a 10 "then meds arent working and you will lose them". We also have pain contracts and once signed our patients are not allowed to deviate. You must be honest and up front and 10 to 1 you will develop a lasting relationship with your doctor. good luck Virginia
Virgina - Sounds like you work for a great Dr.
Last week I went to the PM office to have my spinalcord stimulator reprogrammed by the Med rep , while there I ask the nurse if the good Dr. would up my dosage of Lyrica and Cymbalta because I couldn't stand my pain or sleep at night , she came back from talking to the Dr. and said he's not giving you a higher dose ! I said I'm not asking for any more narcotic's just my cymbalta and Lyrica ? She said you need to make an appointment ! Now I live 30 miles from my Dr. and I do have an appointment on Sept.21 but the wait has been pure hell . I don't deserve to be treated like that .
I just want to get my pain level down to a 5-6 thats all...
I too agree with Fabby. I'm not judging anyone on their choices, so please do not take it that way. I just had to chime in though.
As a chronic pain patient, I have to say that the people who self medicate or abuse their medications and get caught are a big part of the reason why it's so hard to get treatment in the first place.
I know what it's like to live with pain and also know what it's like to live with pain that is being "under treated" because I've been there. Taking more medication than what the scrip said to take just was never an option for me because I was thankful to have even just a small amount of relief from the daily pain. I am now in a place where, after much patience and trial and error, my pain levels are being managed appropriately and I am so thankful for that. It just had to come at the pace my doctor was comfortable with.
I also agree that the thought of being dropped from my doctors practice because of a failed urinalysis or by breaking the rules of my contract scares me because I hate the thought of going back to living life in the pain I was in before. Missing out on things I love and need to do as a mom and wife.
We all have a responsibility to ourselves and our doctors, and honesty is a huge part of the whole picture here. My pain isn't at a "0", and I've accepted that it never will be, but as the others have mentioned, living with a 4 is better than living with an 8-10 any day.
72575- I do hope that your doctor and you can come up with something that will get your pain levels down to a more acceptable level. It stinks being in pain, and it stinks when the meds don't really help. We all understand that.
You were lucky when you saw your doctor in that she didn't ask for a pill count, but please be careful. It sounds like you have taken measures to keep this from happening again and this is a good thing. Many people wouldn't have done that. Some folks would just continue with the cycle of taking more and running out early only to suffer until a refill.
Shawley why dont you ask your pcp to take over your lyrica? Our usual maximum dose we prescribe is 300mg a day and it is titrated up due to people getting tired and dizzy. PCPs usually do not mind that but do keep in mind that it is still a schedule 5 drug and does require a dea number when prescribed. Also keep in mind that one of the side effects of lyrica is that it does increase the effects of oxycodone so this is usually why people seem to get such a dramatic reduction in pain levels. One more thing you might not realize but many pain physicians goals are to have the patients pain score be 5 or below so be clear to your physician what your goals are. PS: a zero is usually not a realistic number for chronic pain patients. It would be wonderful but usually not realistic. good luck
I just wanted to add my two cents by saying I agree with you guys whole hardedly. I told someone on another board who ran out of meds the same way 72575 did that that was the way to kicked out of their PM. I am so grateful my PM is willing to work with me to keep my pain at a 3-5. I would absolutely not want to do anything that would jeopordize his practice, let alone put me back where I was writhing on the floor in pain. We are so blessed that in todays climate these docs continue to advocate for us pain patients. Shame on whoever is trying to put one over on them. As was said, that is what makes it harder for those of us who are following the rules.
I don't judge anybody here, my heart goes out for all of you. I am pretty sure that most of people wouldn't want to deal with Drs, meds, etc if they wouldn't be in pain. And to people who get addicted to meds: I feel horroble for you, I know that this is not what you want for yourselves. Just be strong and smart about it - get help ASAP!!!!
I had my major spinal surgery 18 month ago, it Failed, now I am facing 4 levels done soon. I know what it means to leave in pain. I have very strong pain tolerance all my life but there are is a limit to it. I was on Morphine at first for the first month after the surgery, until I realized that my irritability, hallucinations (sp?), mood swings come from this med plus I hated it what it did to me and to my clear thinking.
I called and asked my Dr if he can suggest something different for me, not as strong. I asked for a lower dosage to start. He was suprised but gave me only 5/325 of Percocet. It did not work, of course, and when I asked for higher dosage - he did not even hesitate saying that he can trust me since he feels I am careful with my meds.
One day after nerve blocking procedure I called them screaming in pain asking if they can give me something stronger - Dr suggestied to take 2 pills at the same time even though before he suggested never overdose and take as prescribed. How come?? He said that in emergency only, not for every day pain.
March '07 I was hospitalized with terrible pain and Dr at the hospital called my PM right in a front of me describing my condition and saying that he put me on Morphine and it's not working - my PM again, without hesitation, asked him to max it and add Deudoral since I am a very responsible and he trusts my judgement regarding pain levels.
I realized how important to have that trust -relationships with your Dr. My brother is a Dr and he says that if a patient with CP ends up over- medicated or addicted to PK - this is personal responsibility of a Doctor. They take it very personaly since they try to trust their patients and some of addicts are very creative and when patient gets in trouble - Dr feels that he failed him.
He added: "We don't hate patients who over med themselves, we feel for them, but we have to be very firm about it - they don't need another trouble and health issues come with it in their lives".