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Old 04-11-2008, 11:13 AM   #1
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Hey everyone, I need a little advice.

Hey everyone,

I guess I should post a little history about before asking what to do here. Back in '05 I had knee surgery to remove some shrapnel out of my knee and to repair torn ligaments in it. Things healed up with little to no pain... Nothing a little NSAID could'nt handle if it hurt bad enough. One year later I was at work and a ladder wobbled on me and fell dislocating my knee and all that good stuff and soon developed burning nerve pain and also what I call "Structural" pain within the joint. Well I thought this was in my head and I was going crazy so I let it go until it got really bad and went to see my GP she sent me to an ortho fro MRI's, Xrays and he came back and told me theres nothing he can surgically do but he thinks I have RSD due to the color and temp difference and sent me back to my GP. she look at it freaked and sent me to her friend (PM doc) for a DX. I went to the PM and she ran some of the usual tests and they all came back positive for RSD. We tried all the injective modalities to little or no help.

Well to make a long story short my PM (wonderful woman BTW) sent me back to my GP with instructions to start and opioid program and to not hesitate to consult her for advice. Ok, lets fast track to now. Currently im on 25mcg duragesic,hydrocodone 10/500 3Xday,klonopin .5 3Xday, and Topamax as well. This provides great pain relief and I have been stable at the same dose for almost a year now without any tolerance issues. My only complaint was a little brain fog. I asked my GP if I could try and come off the klonopin and see if that would help and it has. Though it has raised my pain level a little bit I think it is due to Anxiety from stopping the Benzo. Honestly no biggie... Gosh.. Im getting side tracked.. Anyways Im going to go back and see her in 3 months and I want to come up with something else besides the lortab for BT pain.. I would like an alternative to Lortab for BT pain as I dont want any Tylenol destroying my liver. I know im not on a high dose of it but still. Me and my GP have that "Trust" thing going on so she trusts me with these types of meds.

Well, today at my appointment we got to talking and I asked about the tylenol in the lortab and that I dont want to be having that in my body day in day out possibly hurting my liver. She told me she thinks oxycodone IR would be perfect for me and should would like to write it but she is scared of the DEA going on what she called a "witch hunt". She was truly being honest and I completely respect that with all the news going on about this stuff. I dont want her getting any heat from "big borther" on the account of me. She changed my lortab to something with 325 instead of the 500 APAP and I cant think of the name right now but its the same as lortab just not as much tylenol and to go home research some ideas and she would do the same and to see her in 3 months. BTW I have tried Ultram and it didnt work. Any advice from you guys (and girls!) would be greatly appreciated thanks. I really sorry about the long post I just wanted to try and cover my basis as best as possible. Again thank you all.

Jon

 
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Old 04-11-2008, 11:27 AM   #2
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Re: Hey everyone, I need a little advice.

Well....This is a tough one. You certainly have to respect your Doc because she knows the behind the scenes issues with the DEA, and how they operate in your area. What you don't know is that she may have some other patients who got in trouble or whatever, and maybe she is either being watched, or doesn't want any more attention. Who knows, and it could be anything. She could also just be really conservative, but after all she's already scripting you the patch, which is a CII. However, there is much less abuse potential with it, so she probably isn't as worried with it (vs OC for example).

If you're ok with what she gave you, then case closed. If not, then maybe at your next appointment, you could push a little harder and say that the hydro isn't working. She probably felt that if your only concern was the Tylenol, then she'll just reduce it and you'll be ok, and she doesn't have to worry about the DEA. However, if pain control starts to become an issue, then she may up the med for you for good reason.

To be honest, it does sound as if some form of Oxy is what you need. The only difference between Oxy IR and Percocet is that the Percs have Tylenol in them. Furthermore, if your condition is truly "chronic" and you'll need meds for the rest of your life, then you really need to move away from the Tylenol.

When is your next appt, or refill date? You can either wait till then, or make another appt and go back.

Hope this helps.

Ex

 
Old 04-11-2008, 12:06 PM   #3
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Re: Hey everyone, I need a little advice.

Hey Ex,

Actually im the only patient in her practice she Rx's these types of meds too on a "Chronic" basis and from what she has told me she chooses her patients wisely. My condition is life long and most likely will continue unless some new magical treatment comes out.(We can hope right?) I really dont think she is or has been in any trouble as she does have checks and balances like contract, random pill counts and UA's to cover her tail (rightfully so). I just dont know which way to go.. I just wish there were some other options available too me and it really seems limited. The only reason oxy IR was thought about was there are no hydrocodone only meds out there right now unless you go to a compounding pharmacy and pay crazy prices for them. I guess it comes down to the age old topic alot of people here talk about is Big brother making doctors nervous to be Rx'ing these types of meds. I just dont want to hurt my body in the presuit of pain management. You can understand that cant you?

Jon

 
Old 04-11-2008, 03:05 PM   #4
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Re: Hey everyone, I need a little advice.

John,
You are a little limited in the fact that there is probably no way she will Rx Oxy IR, considering it's nearly the same as Oxycontin. I do know that there is a big DEA issue in Kentucky and that there are probably almost NO DOCTORS that will prescribed Oxycontin or anything similiar. I do have a couple of suggestions for you. How about increasing the fentanyl patch by 12mcg. This could help out quite a bit and also keep you from even having to take the BT meds. I am sure what you are RX'd now is Norco which is 10mg hydro and 325mg acetaminophen. You may also want to try out some of the nerve pain meds such as Lyrica, Neurontin, Topomax, amitryptilene, nortryptilene, or even Cymbalta. These meds have helped out a lot of people on here(I take Lyrica). You could really benefit from these meds and it could help you from having to increase the narcotics.

brian

Last edited by brianpain33; 04-11-2008 at 03:06 PM.

 
Old 04-11-2008, 04:42 PM   #5
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Re: Hey everyone, I need a little advice.

Hey brian,

Thank you for the response. Im on topamax now which definately helps compared to the Gabapentin I was on. Actually I think what you just said will fix my ordeal up. I will probably just have to go to the 50mcg patch due to insurance issues and then just have a small handful of norco (10 or 15tablets) tucked away for a really bad flareup day... That way im not swallowing tylenol on a daily basis. I just dont want to rot my liver out by the time im 39. Im just hoping as we all head into the summer months things calm down for all of us. I do know winter happens to be a rough season for me atleast in the pain department. You are soo right about KY and the OC scandals that are floating around in the news. It really is a wide spread problem particulary here on the eastern side of the state. The papers here call it "Hillybilly heroin" and it really is in the lime light right now.

BTW, I wish you the best luck comming off the tramadol. I have a friend that was put on it ten years ago when it was touted as non-narcotic non-addictive and he is having a horrible time comming off of them no joke. I feel so badly for him as I have seen him stuggle with this stuff. Im suprised it isnt classified as a scheduled substance under the CSA seeing what he is going through. Anyhoot thank you for the response and please keep posting on how you do comming off of them. Good luck!!

Jon

 
Old 04-11-2008, 04:58 PM   #6
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Re: Hey everyone, I need a little advice.

I really can't speak to the KY / DEA issue...I've heard about it, but have no real knowledge about the situation....It could be what's going on. If so, shame on the DEA and our Gov't. I just don't understand how in one state Docs have been harassed to not script OC, but in others, they give it out like candy. Doesn't make sense in my logical oriented brain. I guess I always assumed the drug laws were more federal oriented than state. Sounds like whoever is in charge of the DEA offices in KY has made it their personal mission to change the rules and control the Docs medical practice.

This is very unsettling given the recent announcement / trend of the DEA where they agreed with many objecting medical associations to allow the post dating of CII scripts for up to 90 days...Which for all intensive purposes is a refill that is disguised. However, in KY, you can't even get the drug, much less for 90 days.

With that being said, I'm not sure anyone can really give you advice. You know your Doc best and if you are truly the only person who she scripts these meds to, then asking for something more may not be realistic. This is a very complex situation and we just don't know all the variables involved.

Thank God I don't live or need to move to KY....I'd be in big trouble.

Good luck, and I hope all works out for you.

Ex

 
Old 04-12-2008, 03:49 AM   #7
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Re: Hey everyone, I need a little advice.

I'm kind of surprised that this is still forefront in the news(and I'm not trying to downplay the problem in any way, shape or form). Jon, correct me if I'm wrong but I'm pretty sure I was reading about Oxycontin issues(Hillbilly Heroin and all) in Kentucky two to three years ago. Is it just that the problem has not gone away and/or has gotten worse or is it 'new' news?
Sorry, just curious.
Good luck in your search for a new med. I agree with Brian that adding a med like Lyrica, Cymbalta or amytriptiline might help.~Mush
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Last edited by trowftd3; 04-12-2008 at 03:51 AM. Reason: clarification

 
Old 04-12-2008, 07:39 AM   #8
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jodom1979 HB User
Re: Hey everyone, I need a little advice.

Hey everyone,

Theres been a couple stories floating around although its not front-page material the papers still remind people about it. Its been about 8 months since the last i guess what you would call official big story. I never really knew about the problems doctors have or how the drug abuse problems would have affected me until I became a CP patient and needed to take these types of medications. It really is a big deal for me to go every month to her office to pick up a script when it comes to my pain issues.. I wish I could send my better half but she works from 9-7 and my doc would be closed by then. She calls everything she humanly can in for me and will even post date for me as well as much as she can as long as I turn them in during normal buisness hours when she is in her office to be there to validate when the pharmacy calls. Its just amazing how I never knew what CP'rs go through until I became one myself.

I read here all the time although I dont have much to say as usually someone else has had my problem and posted and everyone here really bands together to share advice and help (Thank you all!). Its amazing how alot of peoples problems mirror mine. I too have been treated like crap at the pharmacy. I too have been treated poorly because I went to the ER and as soon as the ER doc looked at my meds he spent 10 minutes asking in a condescending voice why I was on medications that "ONLY terminal cancer patients need to be on". Mind you I was NOT there for a pain issue.. I was there because I had segnificant amount blood in my stool and it scared me pretty badly. Those are just two examples of things I/we have had to deal with..

What I do to keep things as smooth as possible is fill on the day im due. keep my meds locked up. I dont tell anyone what im on and if soemone asks I just lie and say I take tylenol for pain. And I never bring all my meds with me to where ever I go. I get a second bottle from the pharmacy for my BT meds so I only carry a small amount with me when im out and about(Thank you too who ever posted that idea BTW). I guess what im getting at is besides learning to deal with chronic pain.. I have had to learn how to navigate the RX side of things as well and there really is ALOT to learn. I wish there was a pamphlet on this! LOL I definately have to say thank you to everyone here as you all have helped me over the past year without you even knowning about it.

Jon

 
Old 04-12-2008, 09:50 AM   #9
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Re: Hey everyone, I need a little advice.

I like the pamphlet idea!
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Old 04-25-2008, 11:01 AM   #10
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Re: Hey everyone, I need a little advice.

Sorry to hear about all the mess...

This is what I am aware of with our current doctor/patient/drug situation...

Any practitioner that works in pain management, surgery, or oncology are able to prescribe Schedule I, II, and III medications, i.e.; oxycontin, methadone, kadian, duragesic, etc...

I used to get very upset when some of my old doctors told me "I cannot keep prescribing you these medications because I have been 'red-flagged' by the DEA"...

A "red-flag" from the DEA sounds REAL SCARY, right? Actually, the DEA red-flags people ALL THE TIME!! As a chronic pain patient who has been using those narcotic and Scheduled meds, YOU ARE RED-FLAGGED!! I know this because I have SEEN my record red-flagged in a DEA communication report to my pain clinics. This is basically how it works...if you take a Scheduled prescription for longer than 3 months and/or if you CHANGE narcotic prescriptions, the DEA AUTOMATICALLY red-flags you in their system. But this is the thing...it happens so often to so many people...should you have to constantly worry about that??

What is worse...a doctor should NEVER give you the "DEA" excuse (that is my lil terminology ...these doctors that have licenses to prescribe Scheduled meds are PROTECTED by the LAW...that means they are under the actual protection of who?? THE DEA.

As a prescribing doc (pain manage)...you are responsible to 2 parties when you prescribe these Scheduled meds; 1)the patient...if a patient is in pain...the doc HAS to treat it...and...2)the DEA and any other law enforcement agencies...the doc MUST NOT OVERPRESCRIBE or prescribe in poor-faith.

If your doctor was prescribing you TOO MUCH Scheduled narcotics or prescribing under the wrong circumstances...that would be a reason for them to worry about the legal logistics...but only then!!

I have been under Scheduled and other pain med treatment for 3 years...vicodin, oxycodone, morphine sulph, kadian, duragesic, dilaudid, methadone...gapabentin (neurontin), tryleptal, wellbutrin, cymbalta, ritalin, lunesta, restoril, lyrica...ETC...

It seems to me that you might be OVERPRESCRIBED...however, I am not saying that in the thought that your doc is doing the wrong thing, on the contrary; I think your "brain-fog" problem could easily be related to the Duragesic 25mcg/hr patch...especially in combo with two of your other meds...the Topomax and the Klonopin...both have extremely poor interaction with the patch...

Another problem...are you aware that the FDA put a FULL RECALL out on ALL Duragesic and Sandoz (fentanyl) 25mcg/hr patches back in FEBRUARY of 2004?? What is worse...they just released a SECOND recall of the EXACT SAME patches two months ago (Feb 08)...

The recall applied ONLY to the 25mcg/hr patches...all patches with exp dates prior to October 2009 (10/2009) are within the recall request. The recall was made because of a HIGH number of extreme side-effects, deaths, comas, and organ damage. The reason for the recall specifically...the patches have poor seals...they leak out of the edges...the gel releases in larger and more dangerous amounts. Have you ever had rashes around the edge of your patch?? Have you ever had to rip the patch off because of an oncoming black-out, nausea, or incoherence?? MOST IMPORTANT...check your exp dates on the box...is your doctor prescribing recalled patches?? If so, you have to ask them WHY, if they even knew about the recall, and find out why the hell the pharmacy is even prescribing those patches...

I am sorry about you having to read all of this!! I just really care about these things and I hate to hear about other people going through all of this mess!!

So, that great term you used..."brain-fog"...that is more than likely a poor interaction between the patch, Klon, and Topo...OR MAYBE??...the patches are from the recall batches???

I am on an amazingly great pain-management regiment right now after many combos of the aforementioned drugs I had to take...

Lyrica (300mg 2/daily), Methadone (10mg up to 8/daily..avg 3-4), Wellbutrin (anti-depressant used for pain...works well 150mg/daily), Ritalin (Yes, for pain!! 5mg 9/daily...also works great to counteract the "brain-fog"!!), and Lunesta for sleep...

The Lyrica is Pfizer's high quality replacement for Neurontin...and trust me when I tell you it is MUCH better and MUCH safer. The Neurontin used to scare me from the extreme side-effects...the Lyrica side-effects are not even noticeable anymore (first 1-2 weeks was minor). The Methadone has been the most successful narcotic painkiller I have ever used...I have an appetite, I can maintain weight (rather than the extreme loss from previous drugs), and I do not pass out randomnly!!

I could go on and on about this stuff, however, I hope that gives you all something to chew on for a bit!!

REMOVED

Also, I have an IPG implant (SCS/PNS implant) that has done wonders for my pain...ask if you would like to know more, ok?

-Dave

Last edited by Mod08; 04-25-2008 at 02:32 PM. Reason: Do not post email addresses.

 
Old 04-25-2008, 01:53 PM   #11
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Re: Hey everyone, I need a little advice.

Quote:
Originally Posted by djbds View Post
Also, I have an IPG implant (SCS/PNS implant) that has done wonders for my pain...ask if you would like to know more, ok?
-Dave
Hey Dave what exactly is this IPG implant? Is that the nerve stimulator?

brian

 
Old 04-25-2008, 02:47 PM   #12
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Re: Hey everyone, I need a little advice.

Honestly, the brain fog is a side-effect of all of those meds. Especially the patch. There isn't much you can do if you do take pain meds, especially narcotic ones (IMO.) You just have to find which one doesn't have that affect on you. It's really trial-and-error.

and if you dont want tylenol in your system, I would suggest Oxy. It seems to be popular in pain management also.
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Old 04-26-2008, 02:38 AM   #13
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Re: Hey everyone, I need a little advice.

Quote:
Originally Posted by djbds View Post
As a prescribing doc (pain manage)...you are responsible to 2 parties when you prescribe these Scheduled meds; 1)the patient...if a patient is in pain...the doc HAS to treat it...

-Dave
Dave: CA has a patient bill of rights, and therefore that would make the above statement true. The state I live in, however, does not, and a PM doc is NOT REQUIRED to prescribe meds, etc, so I could be in the worst pain in the world, and a doc can "get away" with not treating me, just simply because we don't have a BILL OF RIGHTS. I'd be curious to see how many states are as progressive as Cali is and does protect their patients??


Just a thought!! Hmmmmm!!
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Old 04-26-2008, 03:31 AM   #14
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Re: Hey everyone, I need a little advice.

Quote:
Originally Posted by SpinalMalady View Post
Dave: CA has a patient bill of rights, and therefore that would make the above statement true. The state I live in, however, does not, and a PM doc is NOT REQUIRED to prescribe meds, etc, so I could be in the worst pain in the world, and a doc can "get away" with not treating me, just simply because we don't have a BILL OF RIGHTS. I'd be curious to see how many states are as progressive as Cali is and does protect their patients??
Excellent point for all to consider!

Ex

 
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