Hey everyone, I need a little advice. - Pain Management Message Board

jodom1979 · 04-11-2008, 12:13 PM

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 "***** 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

Executor · 04-11-2008, 12:27 PM

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

jodom1979 · 04-11-2008, 01:06 PM

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

brianpain33 · 04-11-2008, 04:05 PM

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

jodom1979 · 04-11-2008, 05:42 PM

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