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Old 04-13-2011, 10:42 PM   #1
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Question Latest PM Appt.

Well, I went to see my PM Dr. last week...hoping that we were changing my pain meds....That didn't happen. I had to see the actual "Owner" of the practice...haven't seen him in years, so I was a little nervous. I found out that the PA I was seeing was fired...nothing new. But she was the one that thought I needed a change. Anyway, the Dr. said that because of my insurance..Medicaid, he didn't think I could change to anything but Morphine..which isn't true because I brought the Preferred Drug List with me and I have a lot of options...but then he said that they were treating the Tolerance not the disease...and he said something about me taking a "DRUG HOLIDAY"...... NNNooooooooooooooooooooooooooooo!!!!!

I have heard of this before...they take you off ALL Pain Meds for a month....this is supposed to reset your pain receptors so the meds work better when you start taking them again..... I think not Dr. sir....not this girl... Yes I know I've been on pain meds for a long time...and yes my tolerance is high...but I won't be able to function at all for an entire month!!!

Has anyone here had a "drug holiday" before? and what did it really do for you?

I am scared to death....I don't think it will really happen...but just thinking of it makes me have an anxiety attack.....

Rhonda

 
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Old 04-14-2011, 05:32 AM   #2
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Re: Latest PM Appt.

Hi Rhonda...I don't go to a Pain clinic and nor would I ever, unless they chained me and court ordered me. Sorry...but I have heard too many bad stories and not enough good ones. With that being said, I know for some, that is the only choice, so I respect that.
My friend's daughter goes to a pain clinic here in NH. They spoke of a "medication holiday" CAN someone PLEASE explain to me what people are supposed to do for WITHDRAWALS during that time, let alone the pain? OMG!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I am so sorry you are going through this. Is there a regular MD, say your GP that would prescribe for you? My Lupus doctor takes care of my pain, THANK GOD! I never know what any one day will bring and they are a**es if you cannot make it to an appointment. My God I am on disability because I don't know from one day to another if I can make it from point A to point B.

I think this pain holiday should be against the law! Sorry I get so wound up over this. It is just that I hate, HATE to see people suffer!!!!!!
Please keep us posted. I hope you get the proper treatment and feel better soon!!
Madison

 
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Old 04-14-2011, 06:22 AM   #3
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Re: Latest PM Appt.

My PM did suggest a Med Holiday but it was NOT to take away all my meds. She switched the meds around a bit. She calculated the comparable dosage and I went from Perc to norco for my BT meds for a couple months. We also changed my LA med as I had been on morphine for a few years.
I am lucky in that I have not had to have any increase in dosage for any of my meds as this rotation keeps my tolerance in check. Plus injections and RA have kept my pain level down to about 5 at its worse

 
Old 04-14-2011, 01:14 PM   #4
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Re: Latest PM Appt.

A medication holiday is supposed to be just that, a break from any opiate medications , hopefully to give your body time to reset the receptors. It is one of the more controversial things done in pain management.
I don't know how much medication or what type you are taking but if you are taking a lot of pain medication, either some change to your regimine by swapping around your medications might be a good idea and so might a medication holiday so that once you are tapered off the medications and a bit of time passes, you may very well find that you don't need as much medication to control the pain.
I've done my own version of a holiday a couple of times ( with my doctors approval) and it did help some to guage where my real pain levels were and what dosage of meds I needed.
Done properly, the doctor would give you a tapering plan for you to follow that would reduce the medications over a month or more if necessary. And then once you were off completely, it usually takes a few weeks to see where your pain levels are at then......and then reinstate medications as necessary to meet the pain levels then.
It is normal though during the tapering for your body to feel increasing pain levels, some of it due your actual pain levels, some of it due to your body's response to the decreasing levels of pain medications.
It does work for some people, and it might not be a bad idea to at least give it a try. That way the doctor might look at it that at least you were willing to give it a try when it comes time to go back on medications again.
I know it is not ideal but as I said, it did help for me to try it to see where my actual pain levels were and what medications I still needed and what ones I didn't need or need as much of.
The one thing that I will say though is that one of the big problems with medication holidays is that if the doctor puts you right back on the same pain medications you were on before the holiday, it tends to lead to the patient being right back at the old doses within two months or less. So when you do go back on medications, try to make sure that they are not the same ones that you were on previous to the holiday.
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Old 04-14-2011, 07:41 PM   #5
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Re: Latest PM Appt.

I find this whole concept of a "medication holiday" ludacris! Anyone who has been on meds knows that even if you take a "break", after a week or two, your tolerance is usually right back up there. What I have done is on my own, when I can is, try and cut back a BT or 2 and find this actually helps. This can be done whenever you want and as BT meds are as needed this is not any kind of self medicating.

I think "medication holidays" are cruel!

 
Old 04-14-2011, 08:57 PM   #6
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Re: Latest PM Appt.

Sometimes you need to be cruel to be kind - we are seeing people in their 20's going into pain management now, if tolorance is left unchecked, by the time they are 65 they will be taking 20 or 30 Oxycontins twice a day if they dont have tolorance managed in some way.
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Old 04-15-2011, 05:53 PM   #7
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Re: Latest PM Appt.

So then would a DR give a medication Holiday to a high blood pressure patient to see if they really need the meds? I don't think so. I advised a Dr. to treat me the way she would treat her husband if he had my documented problems. She does show compassion as she should. But, I never give any reason to dought me.

 
Old 04-15-2011, 06:15 PM   #8
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Re: Latest PM Appt.

Hi Rhonda:

With all due respect, (and mind you I am no doctor) in my opinion, I think the idea of a "medication holiday" is something that is very individualized. However, having said that, I do believe that there are some doctors who just are not FLEXIBLE at all, and are not willing to do anything LESS than a quick taper, and then cut off all opiates for a specific period of time, then re-institute the medications again. I've even read where some don't even offer the taper! YIKES!

Personally, I just feel that in todays hectic society where docs are part of HMO's that are needing to see patients at a warp speed rate, I don't think they really take the time to evaluate the patient and their needs to see what has to be done to combat tolerance.

My situation is much like ncmommakat's. I am very lucky to have a PM doc who takes time out and evaluate my needs on a yearly basis for tolerance prevention, and basically rotates out different medications that affect different receptors to prevent huge tolerance increases. He does a dosage conversion equivalence, and just changes from one drug to the next. I have had almost no issues with this, my pain coverage has remained great, and I haven't become dependant on any one medication. Because of the conversion calculations, there haven't been any withdrawl issues.

I understand that I am probably one of the lucky ones. In theory, (at least the way my PM explains it to me) this is what he does with most of his opiod tolerant patients. He has switched out both my LA, and my SA meds with me. I just think it's sad when a doc will say to a patient, you are taking "too much", especially when there really is no real ceiling on LA meds that do not have APAP in them. Some docs are just scared of the DEA, and refuse to Rx more than a specific amount of medication XYZ, or plain refuses to Rx a certian medication regardless of a patients history, or condition. It just baffles my mind.

Good luck to you on your Holiday Rhonda!! I hope it goes better than you expect. We all get nervous when we feel that our comfort level that we've (FINALLY) come to know and are able to live with might be taken away.

Blessings,

Becky
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Old 04-15-2011, 07:00 PM   #9
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Re: Latest PM Appt.

I agree that tolerance needs to be checked. Personally I do that for myself. My doc has asked numerous times if I need to increase anything and I am at a level where my pain is managed, I am clearheaded and can function. Could I use more pain control, yes, but at what cost. I see and hear the stories of people falling asleep, slurring their words, and I would rather have some pain that I can deal with in other ways or at least try to, but managed enough to be able to enjoy life and function. We all need to take responsibility because there are docs out there who will just continue to increase meds ridiculously. We had some friends over from dinner and one couple was someone my husband invited from work as both husband and wife were CPers and he thought it might be nice. Well she couldn't stay awake to save her life and was on a crap load of stuff. It was awful. I do not want to be like that!

But there is no proof that med holidays resets tolerance for a beneficial length of time. I know everyone is different but I personally have not had an increase in over 4 years and before that I was on the same strength about 3 years. I have only increased LA twice and BT's twice as long as I have been in pain management. Now I know it takes time for people to titrate and get the right mix, but at some point we have to acknowledge that we are going to live with pain and even though in theory, there is no ceiling for narcotics until side effects become intolerable, going up into high doses has it's liabilities.

Just my thoughts.

 
Old 04-15-2011, 10:18 PM   #10
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Re: Latest PM Appt.

Thanks for all the replies...and I do understand the "concept" of a Drug Holiday....but without trying another pain med first? I have been on the same pain meds and the same amount for years...and the whole purpose of me seeing him was to change my meds around. and NOW I have no choice about coming off the Methadone... I found out on Thursday that I have Prolonged QT Syndrome...and Methadone is a NO NO...could be very serious. I thought I said that his office isn't a Real PM Clinic, I went there for 4 years before he gave me any pain meds.. he did procedures, got me my last surgery, and they all have done everything they could to help me....but there isn't anything they can really do anymore... I know I'll be on pain meds for the rest of my life...so why even Try the Holiday??? It seems like torture to me. Just going through Withdrawals alone sends me into a panic...

 
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Old 04-15-2011, 10:25 PM   #11
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Re: Latest PM Appt.

Quote:
Originally Posted by Rhonda_m_37 View Post
Well, I went to see my PM Dr. last week...hoping that we were changing my pain meds....That didn't happen. I had to see the actual "Owner" of the practice...haven't seen him in years, so I was a little nervous. I found out that the PA I was seeing was fired...nothing new. But she was the one that thought I needed a change. Anyway, the Dr. said that because of my insurance..Medicaid, he didn't think I could change to anything but Morphine..which isn't true because I brought the Preferred Drug List with me and I have a lot of options...but then he said that they were treating the Tolerance not the disease...and he said something about me taking a "DRUG HOLIDAY"...... NNNooooooooooooooooooooooooooooo!!!!!

I have heard of this before...they take you off ALL Pain Meds for a month....this is supposed to reset your pain receptors so the meds work better when you start taking them again..... I think not Dr. sir....not this girl... Yes I know I've been on pain meds for a long time...and yes my tolerance is high...but I won't be able to function at all for an entire month!!!

as anyone here had a "drug holiday" before? and what did it really do for you?


Rhonda, I usually posts on the addiction recovery board. I was looking at some other posts when I came across yours. Number one, you will have horrible withdrawls if he takes u off of all of your pain meds. that is plain cruel. I take roxicodone for chronic pain and am wanting to wean off or at least down. I feel like the drug is controlling me too much. I have horrible pain though and it has been hard. You might seriously think about seeing another dr. before this one goes bonkers and messes u up.

I am scared to death....I don't think it will really happen...but just thinking of it makes me have an anxiety attack.....

Rhonda

 
Old 04-16-2011, 09:05 PM   #12
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Re: Latest PM Appt.

I totally agree Rhonda!

 
Old 04-17-2011, 05:02 PM   #13
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Re: Latest PM Appt.

Actualy, that is quite commonly done in HBP patients, it should be done with any long term drug therapy

Also, I dont get tolorant to my HBP meds, I'm not going to end up taking 20 enalapril every morning when I am 60, but with my pain meds thats a possability.

Rhonda, a pain med holiday wont be fun, but keep in mind that its only a limited time, and then you get your meds back. Provided he tapers you properly you shoudnt get nay but the mildest withdrawl symptoms.

I guess you have two options if you are determined not to do a drug holiday, 1 is talk to your doctor honestly and openly about why you feel it isnt appropriate for you, or 2 is start to look for a new doctor who is more receptive to your needs.

I think any doctor who is totaly dogmatic about this sort of stuff is a bad doctor, he needs to take the individual into account when making decisions, not say "all my patients get a drug holiday every year and thats that" - that isnt good medicine.
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