I have several Docs, a PCP (Reluctantly prescribes my pain meds), a GI Doc (Who thinks all of his patients are whiners and should only take Aspirin), and a Psychiatrist who is also a Neurology Diplomate (Not sure exactly what a Diplomate is... but he seems the most compassionate of the bunch).
I'd like to have my 'Shrink' take over from my PCP the writing of my pain med scripts. Will he claim he is not qualified to do so, or be otherwise unable?
Not sure about that one isotope sorry, I guess it depends if the psych was managing you for pain in a wholistic sense, or just dishing out 100 Percodan a month...... I think your PCP would be a better bet, but no harm in asking.
Are you going to try SR Tramadol? That isnt a controlled drug, so your PCP would probaby be less nervous about prescribing, also, you only need 30 pills per month for 24/7 pain coverage, so it doesnt feel to the doctor like he's running a pill milld, dolling out hundereds of tablets a month (as he would if you were taking an IR med that needs to be taken every 4 hours)
Regular doses of SR hyoscamine or Donnatal might also help you, as you say that you have isssues with smooth muscle cramps, generaly narcotics are less effective than anticholinergics for this.
Best of luck which ever way you decide to go.
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The desire to take medicines is what seperates man from the lower animals - William Ostler
I will bring up the Tramadol but I must say that out there in the internet-ether Tramadol gets pretty bad reviews by the psuedo experts>
"Tramadol is hands down the worst pain medication there is. It is a poor excuse for a pain med and is often rx'ed as a first step or by doctors too afraid to rx narcotics. Some feel that Tramadol is useful in easing withdrawl symptoms."
Naturally those comments make me a bit hesitant to put my eggs in that basket.
Yes, I have the spectrum of Anticholinergics at hand, and to some degree they do work (When the immune system isn't fully raging in a destructive process).
One point that should have been brought to my attention by my PCP when he handed me the OxyContin CR script was 'acclimation'. Going from a PRN Hydrocodone of relatively low daily dose to a long acting Oxycodone has a few bumps built into it. After a few days on the Oxy I bailed because I was so spaced and dizzy I couldn't go to work.... I should have been told that it takes a week or two for those effects to settle down and for my body/mind to get acclimated to the drug.
So, in that sense, my PCP was no expert. My Psyche Doc has never dealt with me regarding my physical pains, only those of the mind. Though, as we know, it all goes together. I'll let you know how it all shakes out next week after my appointment.
Tramadol can be a very high risk drug, it has very serious side effects that have to be watched out for, and if you're used to taking Narcotics, then the chance of you getting pain relief from it is little to none.
On to the pdoc issue. I am a CP patient and I also have BiPolar, so I have a PCP and Orthopaedic surgeon who handle my pain management, PCP prescribes. I have both a pdoc (psychiatrist) and a tdoc (psychologist). My tdoc is also a CP patient so she's good at handling both problems.
I can almost without a doubt guarantee you that your pdoc is not going to prescribe pain meds for you. I don't know what you see your pdoc for, but if it's in any way related to depression or self harm, then I'll triple that guarantee. Pdocs do not like to prescribe any meds except the ones that have to do with what they are treating you for. There is also a great deal of liability as an issue here, for overdosing and tightly controlling the meds. They generally don't have the kind of setup that allows them to do this like a Dr.'s office would. I've had the same pdoc and tdoc for 5 years and they are great, but we've talked at length about this. There preference would be that I didn't take pain meds because they interact with the psych meds and it makes it hard to find the right combo. But they also know that I can't walk or function without them, so they accept it.
Sorry, don't mean to sound all negative here, but I have alot of experience with all this, so maybe it can be of help.
Good luck, let us know how it goes.
Kat
The Following User Says Thank You to katlin09 For This Useful Post: Isotope (12-02-2010)
The psychiatrist will probably say it would be acting outside of his specialty. Unless he's also got the other specialty (Neurology), maybe he worked with pain patients before he went into psychiatry. I have heard of people who are board-certified in another specialty also doing psychiatry work.
However, some psychiatrists I know also treat people with addiction problems and I have heard of them agreeing to take over prescribing pain meds in order to work with a patient who has addiction problems. I'm not saying you do, just using this as an example of a psychiatrist prescribing narcotics.
The Following User Says Thank You to Toonces1 For This Useful Post: Isotope (12-02-2010)
Generally the way it works here in NC, is the pdoc is a Diplomat in Neurology/Neuroscience, as is mine. Which basically just means its their subspeciallty. Toonces has a good point about he drug addiction help, they do that sometimes, but usually by rx'ing methadone and monitoring it. The area just gets very gray and shady when you start trying to mix specialties and treatments, and not many docs go for it.
Tramadol is NOT a "high risk" drug, and as for not giving releif, 100mg of tramadol is = to acetaminophen 1000mg/codeine 60mg (eg 2 Tylenol with Codeine # 3) or acetaminophen 750mg/hydrocodone 7.5mg (eg Vicoden ES)
For someone who has been taking one Lortab per day, I think LA tramadol is a reasonable step, with a few Lortab on hand to deal with breakthrough pain rather than starting right of on Dilaudid and all of Elvis's favorites.
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The desire to take medicines is what seperates man from the lower animals - William Ostler
Thank you guys/gals for the good info. Regarding my Psychiatrist -Who knew that Pain pills would be out of the sphere of practice for a guy who regularly prescribes Powerful Anti-psychotics, Highly Addictive Benzo's, Mind Altering Serotonin Tweakers, Thorazine and Lithium!
You have to admit the irony of that....
And no, that list above does not represent what he prescribes me!
I'm a pretty mild case for him, we chat about being a man in this crazy world -then he asks me how the Prozac is working for me.... Then I get billed $325
I'll know more next week, I get to see all three , GI Guy, Psy Guy, and PCP Guy. Maybe I need a woman?
J-Star-
Don't take the Tramadol Thrashing too personally. If it works for you -great! We all have our favorites and our personal preferences. But, Wow. I was surprised when I looked into the stuff how universally despised it seems to be. Nucynta didn't fair much better.
Oh, not taking it personaly, just offering some facts.
Pain treatyment should start with the mildest narcotics (codeine, tramadol) and SR tramadol is more convenient, taking one or two pills a day as opposed to 8 or 12 Tylenol with Codeine...... also, doctors seem more comfortable prescribing 60 SR tramadol per month as opposed to 240 - 360 Tylenol with Codeine, even though they give more or less the same amount of narcotic.
If thses mild narcotics arnt adequate, then you move onto the stronger stuff. Many, many people get adequate and satisfying releif from these mild narcotics combined with peripheraly acting analgesics, but a few dont and need high potency stuff.... you wont know which group you fall into untill you try. Having said that, if your pain is controlled by a 10/325 norco, there is a very good chance that tramadol would give you good pain coverage. if you and your doctor prefered, Tylenol # 3 or Norco taken every 4 hours (6-12 pills per day) would probably give about equal pain relief.
And, whatever any of us might say and think here, its gonna come down to what your doctor thinks is appropriate, wether thats Tylenol or morphine.
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The desire to take medicines is what seperates man from the lower animals - William Ostler
On Friday I canceled my Psy appointment and made one with my PCP. I didn't want my PCP to be thinking I was trying to 'go around' him to my psy to get my Pain Meds.. Which I sort of was.....
Best to just be honest with him. After my initial 4 day OxyContin run last month, I stopped cold turkey and called him to tell him that I was fine with prn Norco. But, now, After restarting the Oxy on my own and getting acclimated to it these last couple of weeks, I'm changing my tune. It works, plain and simple, and much better than Norco as far as the ups and downs that short acting meds naturally entail.
So, that's why I was hesitant, and dreading going back to him. But, I realize, I'm still experimenting, I'm trying these things out, and going from Norco to Oxy was a big leap for me, I panicked, but now I've come to a different conclusion since I gave it a proper testing. That's all I need to explain to him. I'm still a bit too dazed and spaced out for my liking, hence the thoughts of Opana as another possibility. he may want me to continue on OxyContin a while longer before switching me... ya think?
Last edited by Isotope; 12-04-2010 at 02:37 PM.
Reason: Typos
If its releiving your pain, I'd give it 4 weeks before changing, and potent narcotic is going to leave you a bit dopey in the initial stages, wether its Opana or Oyxcontin or Dilaudid.
You might need to start on a low dose (say 10mg twice a day) and then increase after a couple of weeks as needed.
A good rule when taking any drug that effects the brain is "start low and go slow"
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The desire to take medicines is what seperates man from the lower animals - William Ostler
Multiple anecdotes do not equal evidence - Me
The Following User Says Thank You to jonnstar For This Useful Post: Isotope (12-04-2010)
Thanks again 
, GI Guy, Psy Guy, and PCP Guy. Maybe I need a woman? 
