It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 10-31-2008, 02:16 PM   #1
Junior Member
(male)
 
Join Date: Apr 2008
Location: Redmond, WA, USA
Posts: 43
gregar HB User
New PM specialist issue. (kind of long, sorry)

Hello everyone,

I haven't been around in a while since I've been doing fairly well up until recently. My regular doctor has been handling my pain meds for 10-11 months. I take **REMOVED*** mg Oxycontin 4 times daily and I have hydrocodone **REMOVED** that I can take 1-2 times a day as needed for BT pain. In the last month I've noticed that the oxycontin isn't working as well as it has been. Instead of my pain level being 1-2 (with spikes of 4-5) it is going up to 3-4 (with spikes of 6-7). I went to my doctor and told him about what was going on and he explained to me that the dose of pain meds I'm on now is the maximum he feels comfortable giving me so he wants me to see a PM specialist. I told him I understand and ask if he has one in mind that he likes to use. He does and sends my info over to this doctor and tells me to wait a couple days.

I call this doctor and as I'm giving the person on the phone my info they ask about insurance. I tell them who my insurance is and she tells me that the doctor no longer takes that insurance. I tell her I understand (I had this problem when looking for a PT). I call my doctor back and let him know what happened and he said it might be best if I look up PM specialist on the insurance's website for doctors in my area that take my plan. I found 7 doctors and faxed the list over to my doctor asking him if he knew any of them and if he would recommend one. He got back to me saying there was one on the list that other doctors in his office have used so I said go ahead and send him my info and I'll call to see about making an appointment.

Right from the start things didn't seem right. The person I talked to on the phone was not very helpful. She couldn't even tell me a basic number for what the doctor charges for a visit. I wanted to have some idea since my insurance only covers 75%. Anyway, everything is sorted out and I finally have an appointment.

Two days ago I went to see this doctor and I can tell you I've never been made to feel like such a low life. He made me feel like I was on trial and that I was a junky. He asked me questions about specific dates on when procedures were done (MRI's x-rays and so on) and I couldn't give him that info off the top of my head. To be honest I thought everything he'd need would have been in the info faxed over by my regular doctor. And I've had lots of different stuff done in the last 3 years. He asked exactly what my problem was now and I told him the pain meds are not working as well as they use to and he said there's no way after only being on the same dose for 7-8 months that it could get less effective so quickly.

Now to the examination. I'm diabetic and when he was examining my back (the area I'm having the pain issues in) he had me take my shirt off. That same day I had blood taken for my quarterly diabetes tests. He asked what the marks were and I told him and he got a smug look on his face and said "Yeah, sure" and went on with examining me.

He asked what other meds I had tried other than the oxycontin and I told him I was on the patch about 2 months before the oxy's. I explained to him the patch actually worked better then the oxy's but that there were other issues that made me have to stop using the patch. Issues like rash, problems with the patch not working anywhere but my upper chest and I told him about an issue I had with one of the generic brands.

He said there's was no way the other brand could have made me sick and not worked at which point I started to explain to him that it had a different delivery system and was different then the other two brands. I told him that from what I know there are three brands, one brand makes the name brand and a generic which are both gels, another company that is the newest makes a gel and then there's the company that makes the other kind that make me sick. After explaining to him all this he makes another smart remark about how it's odd that know so much about narcotics. It just went downhill from there. He kept saying I needed to get off the narcotics at which I would say I'd gladly get off them if he could find another way to make the pain go away. He ended up saying he couldn't make any decisions on the info he had and was going to see about getting all the rest of my records.

He had me make an appointment for 3 weeks away.

Now I am not a junky, I'm not getting pain meds for a cheap high which believe me have been in no way shape or form cheap after factoring all the MRI's CAT's specialists that my insurance has pain a maximum of 75% of leaving the rest to me. My regular doctor knows this, I've been with him for 9years. But this has gotten me so ticked off I'm stopping taking my oxycontin starting tomorrow. My prescription runs out today and even though my regular doctor has given me refills to last until January I will not fill them until I get through to this new doctor that all I want is to be pain free and I don't care how it's done. Up to this point the only thing that has worked are the narcotics, everything else has been a waste of my time and money.

I'll take the BT meds twice a day to get me through the bad times but he better have something for me when I see him the 19th and I'm going to let him know that I stopped the oxy's until he does something. You know through all this the one thing that both doctors overlooked was maybe the pain meds are not getting less effective. Maybe my pain is getting worse.

OK, I'm done. Sorry everyone. I had to vent a little and I know the people here at least understand what I'm going through and will read with an open mind.

Thanks,
Greg

Last edited by Mod08; 10-31-2008 at 06:37 PM. Reason: Dosages are necessary for discussion purposes so they have been removed.

 
Sponsors Lightbulb
   
Old 11-01-2008, 03:05 AM   #2
Inactive
(male)
 
Join Date: Jan 2008
Posts: 4,017
Executor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB User
Re: New PM specialist issue. (kind of long, sorry)

I'm sorry you had this experience. It's all too common. Based on just what you've presented, I think I would try to find another Doc. Things just don't seem right with this Doc and sounds as if it's gonna be a battle. Personally, I'd cut ties sooner than later....What I mean by that is there is nothing wrong with going to one appointment and then not going back because you don't like the Doc. After all, you are the customer / patient.

What you're experiencing with your GP is fairly common. GPs aren't trained for major pain, and once you get above a certain threshold, these type of Docs in most cases, just don't understand tolerance and etc. I'm sure you've probably read enough threads here to verify that point.

Now, there really wouldn't be anything "wrong" per se with stopping later, but I think the sooner you quit, the better....Just my .02. I think it would look better to leave after 1-2 appts rather than many, and then maybe have someone think something is amiss. Judging by many testimonials, it's not unusual for patients to search a while before finding a good PM Doc. Maybe others will chime in on this subject.

Then, I would circle back with your Doc and tell him what happened and be honest. There have to be other Docs to try. The whole needle mark comment is really out of line, imo.

If you happen to go back to this Doc again, and this stuff about the patch comes up again, I'd tell him you know about it because you had a problem, and your Doc and/or your pharmacist told you about the differences and why. Or, you could tell him, you did some research on line after having problems. I wouldn't say a whole lot about message boards, personally, but that's just me. While message boards are a great source for support, I don't think Docs (in any field, not just PM) like to hear you get your info from them. Message boards are all testimonials, and what works for one patient may or may not work for another, especially so in pain mgt.

Now, if there are some positive aspects to this Doc that you like, then by all means, stay. However, from your post, it sounds as if it's almost all negative. Please correct me if I'm wrong.

Lastly, a word about pain and pain scales. Part of your issue moving forward with Docs and etc., may be your expectation with pain. To say that your pain is a 1-2 on some days and bad days 4-5, some Docs won't even treat you. I would do some research on pain scales and make sure that you are communicating your pain correctly. I think you may just be saying one thing, but meaning another. And, this could a crucial mistake when talking with a pain Doc.

For example, many pain patients have a good day when their pain is down to a 4-5 whereas a bad day would be up around 7 or so. The best way for me to try to explain it is start at one end and work my way down. So, using that model, 10 is the worst pain you can imagine....Most have never felt this, or have only had it after surgery or a couple of times overall. 9 would be pain that causes one to throw up and etc.....Very, very miserable. 7-8 would be bed ridden and in lots of pain, but tolerable. You get the idea from there.

So, back to you....To tell someone your pain is a 1-2, that may be part of your problem with the pain Doc. Maybe you just don't understand the scale as no one has really explained it to you. Just a hunch. Also, many PM Docs have the theory / idea that we're supposed to deal with or tolerate a certain amt of pain, so again, the 1-2 may not be realistic in some eyes.

Take care, and best of luck to you in finding the right Doc. Lastly....Please keep your GP well informed and in good graces as he seems to be a compassionate Doc. You don't want to lose him in case something ever happens to your pain Doc.

Regards,

Ex

Last edited by Executor; 11-01-2008 at 03:10 AM.

 
Old 11-01-2008, 01:07 PM   #3
Junior Member
(male)
 
Join Date: Apr 2008
Location: Redmond, WA, USA
Posts: 43
gregar HB User
Re: New PM specialist issue. (kind of long, sorry)

Thanks for the reply. One thing I wanted to clear up is when I say my pain is 1-2 on some days and flares up to 4-5 that is while taking the pain meds, not without up until this last month the pain meds were working very well 1-2 on good days but 4-5 on bad. Right now I can say this being my first day without the oxycontin that my pain level is 7-8 and I'm finding I have pain is spots I didn't know were hurting. I don't know if I'll be able to go until the 19th like this but I'm going to try, it's all I can do.


Greg

Last edited by gregar; 11-01-2008 at 06:27 PM.

 
Old 11-01-2008, 08:30 PM   #4
Member
(male)
 
Join Date: Sep 2007
Location: Moyock, NC,USA
Posts: 68
stymie82 HB User
Re: New PM specialist issue. (kind of long, sorry)

Hi Greg, I know you're trying to make a point with not using your pain meds, but I would like to chime in with one caution. This may not be true for you, however my BP skyrockets when in intense pain. My blood pressure is quite good for a 53 year-old man, yet goes very high when my pain is not covered. I was going about like this for a long time until my doc and I found the correct cocktail of meds to keep me at a good level. I bought a cheap electronic home BP cuff and keep an eye on it. Would hate to see you do damage to yourself. All the best, Ernie.

 
Old 11-03-2008, 05:26 PM   #5
Junior Member
(male)
 
Join Date: Apr 2008
Location: Redmond, WA, USA
Posts: 43
gregar HB User
Re: New PM specialist issue. (kind of long, sorry)

Thanks for the warning, Ernie. After a couple days of what I think where wd's I'm feeling ok. My blood sugar levels have jumped way up though and I can't seem to get them back down without having to use twice as much insulin as usual. I remember my doctor telling me that this can happen when pain flares for diabetics. Since my regular doctor trusts me he gives me 3 months of perscriptions so this next weekend if my blood sugar levels are still too high I'll go ahead and fill my pain meds.

 
Old 11-04-2008, 02:46 AM   #6
Senior Veteran
(male)
 
Join Date: Jun 2003
Posts: 3,438
Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
Re: New PM specialist issue. (kind of long, sorry)

Hi Gregar, Not to beat a dead horse and I uderstand the difference between your pain levels with and without meds, But you said you would do whatever it takes to be pain free. Pain free is rarely a goal of pain management. Even the most advanced delivery systems, "implanted IT pumps that deliever opiates directly to your spinal canal only shoot for 50% reduction in pain, meaning if my pain drops from the 8-9 level to the 4-5 level the pump is doing everything it was designed to do.

If your goal is to be pain free you will run into the same tolerance inssues with every drug regardless of the dose. You would continue to need doses doubled and changed to continue to be pan free untill you reach a point where the side effects will prevent any further increasing. It's not a realistic goal and as long as you continue to shoot for an unrealistuc goal your going to be treated the way you were.

We would all love to be pain free but if this was a reasonable goal, pain management docs would be called pain obliterators and life would be great for everyone. The key words is management, and most people when given a choice between living at 8 or 9 or a 4- 5 would take the 5 in a heart beat and forget about 1 and 2's or our life in our 20's when pain wasn't a factor in our daily life and we felt invincible. A 1 or 2 means pain isn't a major factor in day to day life, regardless of how you achieve this. A 1 means virtually no pain and no doc is going to continue to increase your dose every 6 or 8 months to sustain an unrealistic goal.

It sounds more like you had a nice honeymoon from going from untreated to being treated agressively but this is why your presently looking for a new doc and this will be the problem that prevents you from finding a replacement that will once again get you in the 1-2 range. I'm sorry but the probelem really isn't that your doc is being uncompassionate or the other docs is being overly cautious, It's that your goals aren't reasonable or sustainable which makes you a poor candidate for long term opiate use if your don' t have realistc expectations from the medications used.

This isn't your fault if goals of pain management have never been discussed or you have never been to a formal PM program that educates you and teaches coping skills on how to deal with pain that can't be entirely eliminated. It is true that most pure opiates have no true ceiling as far as dose, however what happens when you hit a ceiling as far as side effects? When the urinary retention becomes so bad are you wiling to wear a cath permanately, are you willing to deal with changing clothes 4 or 5 times a day due to profuse sweating. How many hours of sleep can you get by on due to hystamine side efects. Eventually you wil reach a point where the side efects are no longer tolerable and there isn't a way to eliminate all the side effects from high dose usage. Even with a pump their are side efects that limit the dose I can take.

If it was OK to be sedated and asleep when my daughter and wife get home from school and work, If I didn't mind using a cathater daily or didn't mind haveing impacted bowels physically dug out every 3 or 4 weeks in the ER, or didn't mind being impedent I could simply increase indefinitely. However it would be mighty hard to justify the benefit of opiate use while dealing with these side effects. Although you haven't reached that point yet, it is ineveatable if you continue to shoot for 1's and 2's.

I know it's not what you want to hear, but untill you except that pain management and opiate use has limits. Your expectations are likely making you, your own worst enemy in finding a new doc untill you reset your expectations. Trust me, live another 6 months at an 8 or 9 and a 5 becomes a god send, not cause to look for a new doc.
Good luck and god bless, Dave

Last edited by Shoreline; 11-04-2008 at 02:52 AM.

 
Old 11-04-2008, 06:33 AM   #7
Senior Member
(male)
 
Join Date: Nov 2006
Location: Wake Forest NC
Posts: 260
lifeaftr40 HB Userlifeaftr40 HB User
Re: New PM specialist issue. (kind of long, sorry)

I would LOVE to be at a 4 and I can't remember when I was a 1-2 with or without my meds

 
Old 11-04-2008, 08:06 AM   #8
Senior Veteran
(female)
 
momzworkin's Avatar
 
Join Date: Jun 2006
Location: Kansas City, Kansas
Posts: 526
momzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB Usermomzworkin HB User
Re: New PM specialist issue. (kind of long, sorry)

I have to agree with Dave on this! I take an extended relief pain reliever every night and a shorter acting narcotic during the day as a back up. I work full time, have two active teens, garden, shop, clean, etc....everyday of the week. If I can keep this at a 4-5 everyday I feel BLESSED. I had to commit to taking my meds correctly at the right intervals to keep my blood levels the same so I wouldn't start to withdraw and have my BP shoot up and turn into a raving witch with my family. I can't remember what a 1-2 even feels like! An 8-9 is after a long day and I missed an afternoon dose. I am in bed, ice packs or tens unit-pain relievers (note:I no longer say painkiller-there is NO such thing!) and trying to be distracted from the pain till it dials back to a 4-5.
My PM goal is to live my life as normaly as possible. To enjoy my family and friends, accomplish something at work, and toodle around my garden when I need some peace from all the other stuff. So far we are there! I pray you find a PM doctor who treats you with the respect you deserve and helps you set and manitain a PM goal for yourself.
Blessings,
Momz

 
Old 11-04-2008, 04:39 PM   #9
Junior Member
(male)
 
Join Date: Apr 2008
Location: Redmond, WA, USA
Posts: 43
gregar HB User
Re: New PM specialist issue. (kind of long, sorry)

Shoreline,

I'm not sure where you read that I expected 1-2 on the pain scale all the time, I'm sorry if I came off like that. I was stating where I was , what happened as far as change and the reasons my doctor was sending me to a PM specialist. No, I have never had expectations set. I guess though that since going on the stronger pain meds and having them work so well that all that I thought was needed to stay at the same level of pain management was to increase the dose. You are telling me that is wrong, but how can I or you know until that happens, which as of now isn't going to happen.

As far as the new PM's attitude, it was uncalled for. All I had done was exactly what my doctor told me to up to that point. I hadn't gone in to see him with any expectations and all I got from him was attitude. I'm not giving up though.

And to the person that said they wish they could be at 4-5 with or without meds. I'm so sorry that you have never gotten that kind of relief for your pain management. I don't know what your problem is as far as what is causing your pain but I hope that some day you get some good relief. I don't know how long I could stay sane living like that.

Last edited by Mod08; 11-04-2008 at 06:16 PM. Reason: Instead of using the quote, simply address the response to the individual.

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
Unknown Issue when01 Rare Disorders 10 01-01-2009 02:59 PM
does anyone know of addisons specialist in michigan?? pipurrcat Addison's Disease 5 11-09-2007 09:53 PM
I CANNOT BELIEVE he's given me a PORN ISSUE to deal with!!! Laylah Relationship Health 105 09-21-2007 09:54 AM
Trusting a Diagnosis - Finding a Specialist Jean Marie TMJ Disorder -TemporoMandibular Joint 8 04-14-2007 04:51 PM
Ongoing issue.. (Maybe it's not just acne..) KingofLodis Acne 3 03-09-2007 09:14 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added








TOP THANKED CONTRIBUTORS



gmak (155), tortoisegirl (154), Shoreline (148), BB07 (91), backhurtz (84), katlin09 (69), Ilovemycutedog (53), galalena (50), jonnstar (35), Isotope (34)

Site Wide Totals

teteri66 (1164), MSJayhawk (997), Apollo123 (898), Titchou (832), janewhite1 (823), Gabriel (758), ladybud (745), sammy64 (666), midwest1 (665), BlueSkies14 (610)



All times are GMT -7. The time now is 04:42 PM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!