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Old 04-05-2012, 05:50 PM   #1
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Bit Of A Problem Need Advice...

I have chronic back and neck pain, along with fibromyalgia. This has basically resulted in intractable pain for the past 12 years, only recently have I been able to get a pain management specialist.

I have been prescribed Norco 10/325, 4 times daily for pain. It really doesn't cover it sufficiently but it's better than nothing. I hate asking for anything stronger as I just started at this clinic.

I started going to the clinic back in Dec of last year. On my visit last month, I was short on my pill count by (maybe) ten pills. My doctor was very upset, he told me that I would need to make up for the overtaken medication, although I clearly should have listened carefully and read the sheet he gave me. He told me I could fill the script as early as the 11th of March. Since I ran out of my previous script early, that's what I did. I did not hear him say that I should not refill it until the 15th (this is what the sheet said though) However, I discovered today that in the fine print, he expected me to make this script last a full month, through the 15th of April. That's not going to happen unless I ration my pills out carefully. Still, I have an appointment on the 12th and I will (maybe) have 6 pills left if I am careful. If I have followed what was written on the sheet, I should have been covered through the 15th. So when I go in, instead of having 15 or 16 pills, I will only have 6. I don't deny that this is my fault for being careless. Since I got a pretty stern lecture last time, I'm hoping I don't get dumped.

I don't drink, do any street drugs or take excessive amounts of pills. Over this past month, I have taken no more than the prescribed dose but the mistake I made last month is killing me. I won't have enough pills to stretch out through the 15th. Wondering if anyone else has had this experience. I've had doctors write scripts for pain medication before, but they have never been this tough, they would at least allow for a couple extra days.

In short, I don't want to lose this clinic, they are one of the only decent clinics around and they offer more than just meds. Thanks and I appreciate any input or constructive feedback!

 
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Old 04-05-2012, 08:32 PM   #2
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Re: Bit Of A Problem Need Advice...

It sounds like you have a very strict doc and if he was unhappy with you last month for being short I doubt he will OK with you being short again this month. Even if I had to go without a day or two I would make sure that pill count was where it was supposed to be. Especially because he said he wanted you to make up last months shortage. I know it won't be fun or easy, but it is way better than being kicked out.

 
Old 04-05-2012, 09:12 PM   #3
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Re: Bit Of A Problem Need Advice...

Yea, that would definitely mean going without (almost completely) to have enough to cover through mid month. I can understand the doc getting upset for being short last month, but expecting a script to cover 35 days seems a little unreasonable. I expect I'll be a few pills short, although certainly not ten, maybe 4 or 5 and again, that's if I cut my dose to less than half. If I go without completely, which would easily cover I would have none in my system.

I was just wondering if anyone has heard of pain docs being so strict on pill counts. He had mumbled something about hydrocodone being the most abused RX drug and although he didn't yell, he was upset. I'm sure there are people who abuse their meds on a regular basis and probably sell them, which is appauling. This is almost more trouble than it's worth.

 
Old 04-06-2012, 03:56 PM   #4
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Re: Bit Of A Problem Need Advice...

Hmm...hundreds of views and one reply? Help a brother out man, or am I the only one in this entire forum who's ever had to deal with this! lol Not possible.

 
Old 04-06-2012, 04:33 PM   #5
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Re: Bit Of A Problem Need Advice...

Yes I have heard of doctors being this strict, as well as requiring you to come in anytime they call for a pill count (ie. you don't have more than 12-24 hours notice). It sucks, but you need to be very careful what you sign. If you don't think the rules are a good fit, I'd find another clinic (but be sure to be careful in coordinating, such as you can't sign a new contract or receive any meds until cancelling this contract).

Unfortunately they think they need to be so strict to try to limit the amount of meds that get diverted to the street. Same reason they may do UAs and use other methods. If they let you be a few short one month, that in effect shows you its ok to break the rules, and they you may be a few more short the next month, and so on. Its an escalating thing they are trying to prevent. Same with if your meds were lost or stolen...they typically won't replace them, as an abuser would just do that as often as they could get away with to get more meds.

I would do anything I had to do to get to the correct pill count. If you are on a schedule taking these around the clock, you need to start tapering now as quickly as you can without being too miserable. Not a good idea to go cold turkey. If you can't do it, you just can't. Honesty is always the best policy. If it comes down with it, say that you were confused at first but later figured out you were supposed to have made it up, and that you won't let this ever happen again. If you know you are going to be short no matter what you do at this point, you may even consider calling ahead to inform them. That may look a bit more proactive.

The very best thing for you long term however is to get the pill count right, as another clinic may not take you if you get dropped from this one (they often check with your previous doctor...if you say you didn't have one, they could prove you wrong by pharmacy records in some states which now have records, or by looking through your insurance in some cases).

However, I haven't personally ever had pill counts...I just have my appointments monthly and get my new scripts (I never have meds carry over to future appointments). I've basically only ever been on CIIs too...no refills (I think I only filled two prescriptions before that like Tramadol and Vicodin, which didn't help me). I'm supposed to be out of pills at that time, but I always take less so I have extras in case I have issues. You never know when due to a doctor, pharmacy, or personal problem you can't get your meds on time. Once I had a delay of almost a week due to a combo of doctor and pharmacy issues. I was so glad I had enough meds!

I'm so sorry to hear about your uncontrolled pain. Once you get past this issue, I'd just be straight with your doctor and discuss your pain levels, percent relief, etc. A reasonable goal for pain management is to reduce the pain by 50%. Most folks can function much better at this. You don't want to be aiming for 75 or 100% as you will be building quicker tolerance that way, etc.

Depending on how long you have been on that dose, it could be reasonable to switch to a stronger med. It is normal to build tolerance over time. I do think the best way to approach it is to be saying that your pain levels have been increasing, the meds haven't been helping as well (or lasting as long), etc...not can you prescribe something stronger, or prescribe me X med.

It may be time for you to be on a long acting medication (one you take less frequently than 4 times a day which will have a more stable level in your system). With those, often something like Norco is prescribed for "breakthrough" pain. Best wishes.

 
Old 04-06-2012, 05:17 PM   #6
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Re: Bit Of A Problem Need Advice...

Quote:
Originally Posted by tortoisegirl View Post
Yes I have heard of doctors being this strict, as well as requiring you to come in anytime they call for a pill count (ie. you don't have more than 12-24 hours notice). It sucks, but you need to be very careful what you sign. If you don't think the rules are a good fit, I'd find another clinic (but be sure to be careful in coordinating, such as you can't sign a new contract or receive any meds until cancelling this contract).

Unfortunately they think they need to be so strict to try to limit the amount of meds that get diverted to the street. Same reason they may do UAs and use other methods. If they let you be a few short one month, that in effect shows you its ok to break the rules, and they you may be a few more short the next month, and so on. Its an escalating thing they are trying to prevent. Same with if your meds were lost or stolen...they typically won't replace them, as an abuser would just do that as often as they could get away with to get more meds.

I would do anything I had to do to get to the correct pill count. If you are on a schedule taking these around the clock, you need to start tapering now as quickly as you can without being too miserable. Not a good idea to go cold turkey. If you can't do it, you just can't. Honesty is always the best policy. If it comes down with it, say that you were confused at first but later figured out you were supposed to have made it up, and that you won't let this ever happen again. If you know you are going to be short no matter what you do at this point, you may even consider calling ahead to inform them. That may look a bit more proactive.

The very best thing for you long term however is to get the pill count right, as another clinic may not take you if you get dropped from this one (they often check with your previous doctor...if you say you didn't have one, they could prove you wrong by pharmacy records in some states which now have records, or by looking through your insurance in some cases).

However, I haven't personally ever had pill counts...I just have my appointments monthly and get my new scripts (I never have meds carry over to future appointments). I've basically only ever been on CIIs too...no refills (I think I only filled two prescriptions before that like Tramadol and Vicodin, which didn't help me). I'm supposed to be out of pills at that time, but I always take less so I have extras in case I have issues. You never know when due to a doctor, pharmacy, or personal problem you can't get your meds on time. Once I had a delay of almost a week due to a combo of doctor and pharmacy issues. I was so glad I had enough meds!

I'm so sorry to hear about your uncontrolled pain. Once you get past this issue, I'd just be straight with your doctor and discuss your pain levels, percent relief, etc. A reasonable goal for pain management is to reduce the pain by 50%. Most folks can function much better at this. You don't want to be aiming for 75 or 100% as you will be building quicker tolerance that way, etc.

Depending on how long you have been on that dose, it could be reasonable to switch to a stronger med. It is normal to build tolerance over time. I do think the best way to approach it is to be saying that your pain levels have been increasing, the meds haven't been helping as well (or lasting as long), etc...not can you prescribe something stronger, or prescribe me X med.

It may be time for you to be on a long acting medication (one you take less frequently than 4 times a day which will have a more stable level in your system). With those, often something like Norco is prescribed for "breakthrough" pain. Best wishes.
Very nice message, thank you so much!! My initial post might have been a bit confusing because I didn't want to go into tons of detail for obvious reasons.

Your story about my being confused is exactly what happened, just like you said! Problem is, I'm sure they have heard every story in the book, some are true, many are not. If this were a *normal* script, I would be coming in one day short of a refill, but because I was told (on paper) to make up for the meds I took in Feb/March, it was supposed to last through the 15th. I was told (verabally) I could fill it as early as the 11th of March, but on the paper work it says the 15th of March through the 13th of April. I don't recall the doc stating that I had to wait until the 15th, maybe it was stated and I just missed it. So I'm a little confused about all of this, I don't have the contract available. If I am supposed to make a months supply of pills last 35 days, should I be showing up at my appointment with enough meds to cover through the 15th? It's like trying to turn a 10 dollar bill into a 20 in a way. I really didn't read the paper work until it was too late.

Last edited by mszach; 04-06-2012 at 05:26 PM.

 
Old 04-06-2012, 05:46 PM   #7
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Re: Bit Of A Problem Need Advice...

I don't think your Dr. is being overly strict. Many would have dismissed you the first time you were short meds. You had written instructions on when you could fill the script and you didn't follow them. If you go in again with less pills than you are supposed to have you very likely will be dismissed. If you are in a state that has implemented electronic monitoring of prescriptions for controlled substances you may already be in a position where you will be dismissed no matter what you do now.

Even if it means you take no meds for some period of time you need to:
Show up prepared to produce a sample that proves you have taken your meds.
Show up with the exact number of pills you are supposed to have.

Some advice for you, if you are willing to listen. First of all, read your contract, follow it TO THE LETTER. No matter how bad you hurt, never, ever, take more than the amount prescribed. If your script says 1 tablet 4 times a day, the only time you should take more than 4 tablets in one day is if you talk to the Dr. on the phone and get verbal permission to take an extra pill. If your contract says not to call to ask to take more DON'T. Start a pain journal, log your pain levels, activities, etc. That gives the Dr. a better idea of how you are doing. I would not expect to get any kind of increase any time soon. You are going to have to prove yourself to the Dr. and that may take time. These days many PM Dr's don't prescribe opiates to anyone other than terminal cancer patients because of the DEA/FDA. You are fortunate to have found a Dr. that will prescribe opiates at all, it's up to you to follow whatever rules he has. Also, keep in mind it's pain management, not "no pain at all". Most PM's use a pain level of 5 or a 50% reduction in pain levels as the goal. Expect to be asked to use a variety of other methods to reduce pain levels, things like physical therapy, massage therapy, ice, heat, resting appropriately, other medications like muscle relaxers, anti-inflammatory, anti-depressant, anti-convulsant, injections, nerve blocks, etc. in addition to opiates.

Good luck,

Tigg.

 
Old 04-06-2012, 06:23 PM   #8
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Re: Bit Of A Problem Need Advice...

Quote:
Originally Posted by tiggertoo2174 View Post
I don't think your Dr. is being overly strict. Many would have dismissed you the first time you were short meds. You had written instructions on when you could fill the script and you didn't follow them. If you go in again with less pills than you are supposed to have you very likely will be dismissed. If you are in a state that has implemented electronic monitoring of prescriptions for controlled substances you may already be in a position where you will be dismissed no matter what you do now.

Even if it means you take no meds for some period of time you need to:
Show up prepared to produce a sample that proves you have taken your meds.
Show up with the exact number of pills you are supposed to have.

Some advice for you, if you are willing to listen. First of all, read your contract, follow it TO THE LETTER. No matter how bad you hurt, never, ever, take more than the amount prescribed. If your script says 1 tablet 4 times a day, the only time you should take more than 4 tablets in one day is if you talk to the Dr. on the phone and get verbal permission to take an extra pill. If your contract says not to call to ask to take more DON'T. Start a pain journal, log your pain levels, activities, etc. That gives the Dr. a better idea of how you are doing. I would not expect to get any kind of increase any time soon. You are going to have to prove yourself to the Dr. and that may take time. These days many PM Dr's don't prescribe opiates to anyone other than terminal cancer patients because of the DEA/FDA. You are fortunate to have found a Dr. that will prescribe opiates at all, it's up to you to follow whatever rules he has. Also, keep in mind it's pain management, not "no pain at all". Most PM's use a pain level of 5 or a 50% reduction in pain levels as the goal. Expect to be asked to use a variety of other methods to reduce pain levels, things like physical therapy, massage therapy, ice, heat, resting appropriately, other medications like muscle relaxers, anti-inflammatory, anti-depressant, anti-convulsant, injections, nerve blocks, etc. in addition to opiates.

Good luck,

Tigg.
I think I had mentioned in an earlier post that this clinic does have more to offer than just meds, this is why I decided to go there, I do PT and they have ordered an MRI of my neck. I am new to pain management and I was honestly not aware that the medication issue was so tight, yes, a smarter person would have made sure that he/she kept a copy of the contract and read it front to back. Alas, I didn't do that. In the past, I had a PCP who prescribed my meds, some months I had extra, most months I was taking exactly what was prescribed and on occasion, I would run out early and this was never an issue. I do take responsibility for not reading the contract and I realize that claiming ignorance is a lose/lose situation but it's exactly what happened. I simply did not know.

I was confused with the way the script was presented to me last month. I am not familiar with the start and stop dates on the paperwork that is given, instead, I listened to the doctor who said I could fill it as early as the 11th, why he mentioned this I have no clue. Being new to pain management, I am hoping they are willing to work with me on this as I invariably will be a few pills short. The concept of making a script last from the 11th of March through the 15th of April was confusing.

In the end though, I can't really blame anyone but myself, that much I understand. I'm not sure if the contract states a certain amounts of strikes per person, or how it works. I'm sure every contract is different.

Thanks for the contructive feedback Tigger, it sounds like I will need a little luck.

 
Old 04-06-2012, 10:14 PM   #9
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Re: Bit Of A Problem Need Advice...

You should be able to call Monday and ask to pick up a copy of the contract you signed. I always keep a photocopy that shows my signature, the date, and what it said (for anything I sign). Sometimes they give you a copy before you sign it, and they could technically update their standard contract and say that is what you signed...but if you have a copy showing what you actually signed, you have that safety net (hopefully it never comes to that!).

Was the doctor talking about a refill on an open script? They let you fill it a certain number of days "early" (to have extra for emergency, vacation, etc), although it varies depending on local laws and your insurance and such. I think the lesson here is if you don't understand something, ask. I still don't think I get what you are saying...did you get your meds 5 days early last month so they wanted you to make these last 35 days? Yeah being short (requiring early refill) isn't going to fly with any pain doctor I've heard of.

Also, there is nothing wrong with asking for written instructions at a doctor's appointment. Written always trumps oral. I take notes, but often my doctor will write me something on a notepad separate from my prescriptions. I suggest you do what you have to do to try and make this pill count, and also save up some extra for if you do ever have problems in the future. You never know when a natural disaster will prevent you from making your appointment, the pharmacy can't get your meds, the doctor messes up the prescription, etc. I routinely start new meds later and slower than prescribed to start out with some extra. Sorry you are having to deal with this. Best wishes.

 
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Old 04-07-2012, 12:18 AM   #10
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Re: Bit Of A Problem Need Advice...

Quote:
Originally Posted by tortoisegirl View Post
You should be able to call Monday and ask to pick up a copy of the contract you signed. I always keep a photocopy that shows my signature, the date, and what it said (for anything I sign). Sometimes they give you a copy before you sign it, and they could technically update their standard contract and say that is what you signed...but if you have a copy showing what you actually signed, you have that safety net (hopefully it never comes to that!).

Was the doctor talking about a refill on an open script? They let you fill it a certain number of days "early" (to have extra for emergency, vacation, etc), although it varies depending on local laws and your insurance and such. I think the lesson here is if you don't understand something, ask. I still don't think I get what you are saying...did you get your meds 5 days early last month so they wanted you to make these last 35 days? Yeah being short (requiring early refill) isn't going to fly with any pain doctor I've heard of.

Also, there is nothing wrong with asking for written instructions at a doctor's appointment. Written always trumps oral. I take notes, but often my doctor will write me something on a notepad separate from my prescriptions. I suggest you do what you have to do to try and make this pill count, and also save up some extra for if you do ever have problems in the future. You never know when a natural disaster will prevent you from making your appointment, the pharmacy can't get your meds, the doctor messes up the prescription, etc. I routinely start new meds later and slower than prescribed to start out with some extra. Sorry you are having to deal with this. Best wishes.
Man oh man, this is not my weekend. Had it all typed out and my computer crashed! lol Good thing I have a backup PC.

I was being relatively vague for privacy reasons but there is really nothing to hide here, it is what it is. Actually, it should have been 34 not 35 days, my bad!

Bascially I was told, in writting, that in order to make up for the overtaken medication I would need to either make my script last 34 days (filling it on 11 March) or wait until the 15th and fill it. The medication start date on paper is on 15 March to 13 April. It really seems like six in one, half dozen in the other. In hindsight, I could have waited until March 15th (and cut or eliminate my meds) or, I could fill them early (on the 11th) That much I have put together as the doctor did clearly say I could fill it as early as the 11th. He would not have said that if it were not legal. Had I waited in March, which I clearly should have done, I would be in the same physical situation I'm in now. The script was hand written with no refills. I have not received a script in my state for a controlled that wasn't hand written or printed.

My state does have a PMP but refilling meds a few days early is certainly reasonable (on rare occasions) The pain clinic uses this PMP. One thing that they made very clear during my initial visit was that I could not obtain opioid meds from another doc, that's more common sense stuff though, I'm sure once I do get a copy of the contract I'll find a few surprises. I think the PMP has been implimented in order to prevent diversion/doctor shopping more than anything else. Thank God I don't need to worry about that, that's a much worse situation (I would imagine)

Well, like I said, it is what it is. I certainly will not be out of meds when I arrive but I'll be a few short. It's a holiday weekend and I can't afford to be completely out of it, sick and in bed the whole weekend. My father is very ill, and I will be traveling to spend Easter with him.

Thanks for all your support. Worst case scenario, they fire me and I have to go without meds, there are certainly worse situations to be in. I'll be in a lot of pain but I've been there before.

 
Old 04-08-2012, 01:17 AM   #11
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Re: Bit Of A Problem Need Advice...

I'm sorry about what you're going through and I do really believe it's an honest mistake. However, at this point the best you thing you can do is conserve your medication and whatever you can do to make the medication you have left stretch until your appointment, so you have the correct pill count to match your Doctor's office records. I'm afraid since he already gave you a stern talking to and even gave you an information sheet with his expectations that your pain management with that Doctor could be at risk, if you don't have the exact amount of pills he's expecting you to have.

I realize you will likely have to endure some additional pain (which as a fellow pain sufferer, I do understand how horrible it is to be in pain). But, if you can possibly really manage your pills by cutting them in half until your appointment and taking your medication with regular OTC Tylenol. This will at least give you some pain management and remember, as long as you have the correct amount of pills on your appointment on the 12th, you will be able to return to your regular pill quantity.

Also, having the right amount of medication might help opening the dialogue with your Doctor with looking at other options for your pain management. Possibly, adding a LA pain medication the Norco (maybe taking the Norco for break-thru pain) and using a LA pain medication that will remain in your system longer, so you're getting better management. I don't know how willing your doctor is to have that discussion with you. But, I know I found it so beneficial having my LA pain medication it has made all the difference. Prior to LA medication, I could barely roll-out of bed with out every step being in excruciating pain.

I really hope you're able to manage your existing pill count until your next appointment. I do understand how important pain management is and would hate for yours to be in jeopardy.

Keep us posted!

~ Fiona Jo
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Old 04-08-2012, 08:32 AM   #12
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Re: Bit Of A Problem Need Advice...

Quote:
Originally Posted by mszach View Post
Man oh man, this is not my weekend. Had it all typed out and my computer crashed! lol Good thing I have a backup PC.

I was being relatively vague for privacy reasons but there is really nothing to hide here, it is what it is. Actually, it should have been 34 not 35 days, my bad!

Bascially I was told, in writting, that in order to make up for the overtaken medication I would need to either make my script last 34 days (filling it on 11 March) or wait until the 15th and fill it. The medication start date on paper is on 15 March to 13 April. It really seems like six in one, half dozen in the other. In hindsight, I could have waited until March 15th (and cut or eliminate my meds) or, I could fill them early (on the 11th) That much I have put together as the doctor did clearly say I could fill it as early as the 11th. He would not have said that if it were not legal. Had I waited in March, which I clearly should have done, I would be in the same physical situation I'm in now. The script was hand written with no refills. I have not received a script in my state for a controlled that wasn't hand written or printed.

My state does have a PMP but refilling meds a few days early is certainly reasonable (on rare occasions) The pain clinic uses this PMP. One thing that they made very clear during my initial visit was that I could not obtain opioid meds from another doc, that's more common sense stuff though, I'm sure once I do get a copy of the contract I'll find a few surprises. I think the PMP has been implimented in order to prevent diversion/doctor shopping more than anything else. Thank God I don't need to worry about that, that's a much worse situation (I would imagine)

Well, like I said, it is what it is. I certainly will not be out of meds when I arrive but I'll be a few short. It's a holiday weekend and I can't afford to be completely out of it, sick and in bed the whole weekend. My father is very ill, and I will be traveling to spend Easter with him.

Thanks for all your support. Worst case scenario, they fire me and I have to go without meds, there are certainly worse situations to be in. I'll be in a lot of pain but I've been there before.
Unfortunately with the above bold.....you were specifically told at your last appt. that you needed to make up for the overage of pills that you took the previous month...

I know it's hard...but Drs....especially ones prescribing narcotics...expect us to follow their directions to the tee..If you were taking heart medication or blood pressure meds....you wouldn't just decide on your own to take more than your Dr. has ordered....So they expect us to do the same with pain medication.

As Tiger mentioned, we cannot, at any time, play Dr. and take more than prescribed. If we are having a bad day, then we have to rest and use other means in addition to our medication to help manage our pain.

What do you do daily, weekly, monthly to manage your pain besides meds?

It would have been so easy to make up for those meds if when you filled the last prescription, just take one less pill for however many days you were over....Then you wouldn't be where you are now having to take a lot less...

As others have written....I would do everything I could, which is going without...to make sure you have the exact amount that you should when you go see him next time. Most Drs. will give you one pass....which he already did. He could have dropped you last visit without giving you any more medication.

But since he let it go and is still caring for your as a Dr. if you show up again with the wrong amount, I'm afraid he might go ahead and dismiss you from his practice.

What is doubly bad about this is that you can have a permanent RED FLAG on your record so if you go to see another Dr. They will see that you do not follow directions and have taken more than prescribed. That is why it is imperative that you have a few bad days now before your next appt. to get back on track and regain his trust in you that you.

At least that is what I would do.....I am actually friends with my PM over the years I have gone there. They are under extreme pressure with state and federal laws and the DEA and they have to answer for every prescription that is given out.

Same thing with Pharmacies....40 states have the Prescription Monitoring Program that follow a patients prescribing habits. This is so they can work with Drs. and ER's to make sure people are following the rules.

It's obviously your choice and it seems like you are set with going in with less medication.....and I certainly hope it goes well for you..

Keep us posted..

 
Old 04-09-2012, 08:36 AM   #13
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Re: Bit Of A Problem Need Advice...

Again, just to reiterate, it's difficult to ascertain exactly how many pills I am supposed to have since my doctor told me in plain English that I could fill my script on the 10th of March and then in writting, said it had to last until the 14 of April. There is nothing that specifically states I must have three days worth of pills, two days, it simply said that the RX has to last through the 14th of April. It's not always easy for people to put pills away! Well, it may be easier if you're getting 160 mg of oxycodone/morphine and 6 norcos for breakthrough pain, but I don't have that luxury and please, don't take this the wrong way but I am not working with a lot of meds here. So when I finally do go in, I will likely be about 5 (give or take one or two) short. That being said, it's a days worth over a 34 day period, again, the whole thing seems ludicrous to me. I am prescribed klonopin for sleep, a controlled substance the last time I checked, there was a period of time in late 2011 that I needed several early fills, one as early as 5 days. My doctor was willing to work with me on that, understanding that sometimes, we DO need more than we are allotted. Now that we are into April, I am 5 days out from a Klonopin fill but I have three weeks left. Most of the time, it works out that I have more than I need. Perhaps a psychiatrist is more likely to understand that than a pain doc. If any clear thinking expert were to encapsulate RX abuse, it would not include anything that's occured with my pain medication over the past couple months.

I do work and I work very hard, I have been on the same medication (at virtually the same dose) off and on for many years, mainly because doctors are so cautious. I am well aware of why, diversion, doctor shopping, but I am not going to get involved in discussions that don't pertain to me. Everyone knows this happens and it sucks. They tell you to call them if the meds aren't working but God knows, one to many calls and that's ground for discharge as well (I"m sure) at many clinics.

I do see a lot of good advice here, but opinions definitely do not vary as is often the case with longer threads. Either do this, or your doctor will fire you. I'm sure it does vary from state to state, I know states like Ohio and many of the eastern and southern states have gone over the top, almost like a witch hunt when it comes to pain docs and clinics. Now clearly, you have to get rid of the pill mills, we had a bunch of those on the news all the time when I lived in Ky, most are gone now. But it seems like many have gotten much too militant when it comes to treating pain patients as drug addicts. If it all comes down to that with me, they won't need to show me the door, I'll be more than happy to leave.

Thanks for the advice and well-wishes.

 
Old 04-09-2012, 01:07 PM   #14
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Re: Bit Of A Problem Need Advice...

[FONT="Comic Sans MS"]Unfortunately, we do indeed have to play by the rules of pain management if we want to continue opiate medication as part of the treatment protocal. The reasons why are kind of irrelevant at this point, because it is what it is.
If you are dismissed for being short again, then you seem to be okay with that, and if you are, then maybe opiate pain medication is not the right kind of treatment program that you really need. Injections, therapy, swimming, TENS, and even a spinal cord stimulator are just a few of the many other options available to you, without the Norco. And they work well for many people who are in pain management.
I know of no doctor who is going to be okay with any patient, taking more than they are prescribed a day of any medication. From what you have written, you were told that you needed to make this last prescription last for the original 30 days plus the 4 days that you ran out early before, which should have told you then that you needed to somehow take half a pill to one full pill less per day for how ever many doses that would equal the number of doses that you would have taken for those 4 days. Even without explanation from the doctor, being told that would have told the patient that no matter what, they somehow had to find a way to make the new prescription last until they are due for their next appointment.
I understand being in tremendous pain, having lived with it constantly for many of the last 20 years or so of my life and having been in pain management for many of those years, while seeing the tremendous changes in the care and treatment of pain over those years but as someone else pointed out, doctors are not going to continue to treat a patient who is non compliant and doesn't follow their directions, whether that be with narcotics or insulin or high blood pressure medications. You said that maybe a psychiatrist is more willing to be flexible when it comes to treatment/early filling of prescriptions than a pain doctor, but I don't believe that psychiatrists are capable of treating pain as well as a specialist in pain management , just as I don't believe that a pain management doctor is capable of treating psychiatric conditions or anxiety as well as a psychiatrist. Your psychiatrist might have been willing to refill your anxiety meds early for several reasons, one of them being that klonopin has a lower profile for abuse than other anxiety meds and they are not as strictly regulated as opiates are.
Pain management doctors have to protect their livelihoods , as well as try to work with the patient to find the best options available to help the patient, while maintaining strict policies to protect both the patient and their practice. I would be very uncomfortable with a doctor who just let me decide on my own how much of a medication I needed a day and make adjustments to the amount without talking it over with him first......that's what I pay him for, his knowledge and guidance to help me be able to function at my best.
Anyway, good luck. I hope that you find a solution that works for you.
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Old 04-09-2012, 03:21 PM   #15
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Re: Bit Of A Problem Need Advice...

Quote:
Originally Posted by backhurtz View Post
[FONT="Comic Sans MS"]Unfortunately, we do indeed have to play by the rules of pain management if we want to continue opiate medication as part of the treatment protocal. The reasons why are kind of irrelevant at this point, because it is what it is.
If you are dismissed for being short again, then you seem to be okay with that, and if you are, then maybe opiate pain medication is not the right kind of treatment program that you really need. Injections, therapy, swimming, TENS, and even a spinal cord stimulator are just a few of the many other options available to you, without the Norco. And they work well for many people who are in pain management.
I know of no doctor who is going to be okay with any patient, taking more than they are prescribed a day of any medication. From what you have written, you were told that you needed to make this last prescription last for the original 30 days plus the 4 days that you ran out early before, which should have told you then that you needed to somehow take half a pill to one full pill less per day for how ever many doses that would equal the number of doses that you would have taken for those 4 days. Even without explanation from the doctor, being told that would have told the patient that no matter what, they somehow had to find a way to make the new prescription last until they are due for their next appointment.
I understand being in tremendous pain, having lived with it constantly for many of the last 20 years or so of my life and having been in pain management for many of those years, while seeing the tremendous changes in the care and treatment of pain over those years but as someone else pointed out, doctors are not going to continue to treat a patient who is non compliant and doesn't follow their directions, whether that be with narcotics or insulin or high blood pressure medications. You said that maybe a psychiatrist is more willing to be flexible when it comes to treatment/early filling of prescriptions than a pain doctor, but I don't believe that psychiatrists are capable of treating pain as well as a specialist in pain management , just as I don't believe that a pain management doctor is capable of treating psychiatric conditions or anxiety as well as a psychiatrist. Your psychiatrist might have been willing to refill your anxiety meds early for several reasons, one of them being that klonopin has a lower profile for abuse than other anxiety meds and they are not as strictly regulated as opiates are.
Pain management doctors have to protect their livelihoods , as well as try to work with the patient to find the best options available to help the patient, while maintaining strict policies to protect both the patient and their practice. I would be very uncomfortable with a doctor who just let me decide on my own how much of a medication I needed a day and make adjustments to the amount without talking it over with him first......that's what I pay him for, his knowledge and guidance to help me be able to function at my best.
Anyway, good luck. I hope that you find a solution that works for you.
Back FONT]

Nice objective post here, I appreciate you taking the time to give me your thoughts, sounds as though you do have a lot of experience with chronic pain and for that, I am truly sorry. Yea, benzos are probably not abused as much as opiates, but the withdrawal is far worse.

I actually was able to get in to see my doctor today, and everything went fine. I had to change the dates a bit initially because of privacy issues, but the math still works out the same. I was indeed supposed to make the script last 34 days. My doctor was not upset, he mentioned that if it continued to happen, it would become a major issue. In my mind, that simply means don't do it again (period) He was cool about it though, he mentioned that he sees a lot worse, some of the other things I mentioned in a previous post. I think the reason why he went off on me the first time was that I am a new patient, and he wanted to make it very clear that early fills are not acceptable. This is definitely a good doctor, scheduled an epidural for my back and neck and we talked for a good 20 minutes about PT, exercise and other issues.

He mentioned the possiblity of getting on a LA med, as someone else put it. I told him I wasn't really ready for anything stronger or longer acting at this point because I'd like to see how the epidurals and PT go first. Going to try and stay away from the stronger stuff if possible. Being on benzos and opioids really bothers me anyway, and I know some long acting drugs like methadone don't mix well with benzos.

Lesson learned though, I put myself (what felt like) a really nasty position, and was fortunate enough to be blessed with a compassionate doctor. I've had bad luck with male docs in the past, but this guy has changed that stereotype. Got a copy of the pain contract and after all was said and done, an extra day of meds.

Thanks for all the replies, like I said, I think much depends on what state you are in. If it's an area (like Kentucky) that's seen a lot of issues, docs are forced to have a zero tolerance policy. I also apologize if my last post seemed like I was snapping on anyone, I was feeling absolutely awful.

Last edited by mszach; 04-09-2012 at 03:28 PM.

 
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