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Old 04-30-2012, 10:55 AM   #1
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Question New to Formal Pain Mgmt - Pill Counts

While having treated this for years, I am new to formal pain management clinics. No doctors or clinics locally want to prescribe controlled narcotics anymore for longterm cronic pain. So I am driving an hour each way to a Pain Management Clinic. First appointment was straight forward. Doctor looked at my records, x-rays, & MRI's, took his own x-rays. All that's for another posting.

The question for this thread is, I left with an Rx for 120 pills for 30 days. When I have my 2nd appt and show up with say 10 pills left in the bottle, can I expect him to issue the new Rx for 120, or just 110. New 110 pills plus my holdover 10 equalling my 120 pills for the next 30 days.

 
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Old 04-30-2012, 01:59 PM   #2
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Re: New to Formal Pain Mgmt - Pill Counts

It depends on the doctor's practice and on how the instructions are given for taking the medication. If the prescriber's instructions say , for example- Take one tablet every 6 hours, then that is how you should be taking the medication. No more and no less than the way you are directed to take the medication.
At the end of the 30 day period, you should have none left. Most pill counts however are done by call in, which means that the dr's office calls you, say on day 12 of a new prescription- so you should have 18 days plus two or so tablets left, depending on the time of day you are called to bring in the pills for the count..on day 30 , you may have 1 -3 tablets left depending again , on the time of day of the appointment.
My PM doctor has me come in up to a week ahead of time, before my current prescriptions will run out, and I have never had to do a pill count.
If you do have meds left at the end of the month, then your doctor may or may not cut the amount of pills for the coming month.
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Old 04-30-2012, 06:44 PM   #3
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Re: New to Formal Pain Mgmt - Pill Counts

What med are you on and why do you have leftovers at the end of the month? If your doc rx'd you a certain amount and told you to take so many a day each day and you didn't thus having leftover at the end of the month, that can cause him to think that A)your not taking your meds correctly or B)you don't actually need that amount of meds.

Next, why would you take the leftover pills to your next appointment?

Normally a Dr. prescribes meds by the month, not by the amount of pills, he gives you enough pills to last for 30 days and that's exactly what you should have. The variation in this can be Breakthru meds, which are generally PRN, or as needed. But you only mentioned 1 med.

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Old 04-30-2012, 09:59 PM   #4
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Re: New to Formal Pain Mgmt - Pill Counts

Yes, more info would be helpful. I haven't heard of them checking if you have pills left when you are supposed to be out of them. If so, it would be in your favor to leave the 10 extra at home! If you have 10 "extra" if it was me I would leave them at home. I've found for mine they never asked me for bottles, although I do bring them (and I try to only have what I should in there, not extra). Pill counts as I know them would be mid-refill. Whether you are a new patient and they give you 4 weeks of meds but want to see you at 2 weeks or whatever to check in, or they suspect (or don't suspect) a problem and call you in.

I have always taken less breakthrough pain meds than prescribed (even though I needed it) as I like to build up some extra and to build my tolerance as slow as possible. I guess it also makes me feel more in control. Some months I need them all though. I also delayed starting my first long acting med so I'd have a week or so buffer (and did that for subsequent meds) as you never know when you may have a delay. I also used to be on a 30 day schedule so sometimes I'd need to come in early (and a few times late) so I got some extras that way.

Its easier schedule wise now that I'm on a 28 day schedule but harder to accumulate extra. I have a fear of being cut off...you read the scary stories about a bad UA or whatever and not even getting a month to taper off. By the way, if you ever have a question like this I highly suggest being straight forward and asking your doctor. Although this is a more simple question, sometimes online folks can lead you wrong, and I think a major problem for issues between pain doctors and patients is mis-communication. I think too many folks don't read their contracts carefully and ask questions, which can get them into trouble. Never assume. I don't think its out of line to ask a "what if" question if its something plausible that isn't covered on the contract.

Hope this pain clinic works out better for you even with the drive. My switch over from my primary to a pain clinic a few months ago has already really helped me. Hope they also do more for you than pain meds (unless you really have tried it all--often folks haven't had all the treatments/diagnoses available to them though). Best wishes.

 
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Old 05-01-2012, 07:37 AM   #5
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Re: New to Formal Pain Mgmt - Pill Counts

Ive been doing formal PM for 18 years, The first 7 years were without any pain meds, They simply didn't use them in the 90's. My doc does pill counts at every encounter and has never called me in mid month. We have talked extensively about how he weeds out the people that shouldn't be their and he pretty musch believes and says they weed themself out in the first year. When I see him every 3 months he writes 3 seperate scripts for each month but puts fill on or after dates on every script, 30 days after the prior script, All scripts are 30 days supply and I either fill on day 30 or day 31 depending on whether i saw the doc or one of the NP's. The NP tend to calculate to fill on day 31 believing we should be just fine filling on day 31. I have never balked about this plicy as 30 days worth of pills will get you to day 31, You may not have your dose for the morning of the 31st day but your not going to detox waiting to get a script filled on the the morning of the 31st day if you have been taking your meds properly.

A perfect example of how pill counts work is a patient I knew of, from a freind that new he saw my doc is now deceased due to his misuse, People that abuse simply can't control themself, This guy would go through a month worth of bt med the first week,Then he would take all his long acting meds the second week, and then use anything and everything he could find to get through the next 2 weeks, All his benzos or muscle relaxers or whatever he could find on the street. He lasted 4 months with my dc before being discharged with a script for clonodine and neurontin their standard withdrawal cocktail. His feeeling is that the abusers and adddicts simply wont be able to comply and will wash themself out either by pil count or dirty UA's or UA's that have no drugs in them whatso ever. So I go in 87 or so days after my last apt, should have 3 or 4 days left and the process starts all over, I can fill 30 days after my last script was filled if I see my doc, or day 31 if it's his NP. If I go in short a couple pills the doc or NP will note it and I still have the same fill on or after day, If it means I have to make 3 days worth of meds last 4 that's what I have to do. In 10 years, The most I have ever been short was 2 pills so it's never been a big deal.

BTW, the guy that is no longer with us was discharged by my doc after 4 months he went on to doc shop and one morning his wife found him cold and blue on the floor at the age of 28. The constant monthly withdrawal had enlarged his heart and the stress of constant monthly detox after several years of doing this to himself caused a heart attack and he died alone in the night on his own kitchen floor. Thank god he was no longer a patient of my docs.

Pill counts are designed to prevent people from misusing their meds and prevent diversion, "selling" of meds. People with addictions simply can't control themself for something as simple as leave a couple left in the bottle knowing your going to have a pill count. I'm sure he used every excuse in the book, a roomate took some, the dog chewed up the bottle, they fell down the sink, an alien abducted him and took his meds, etc etc. Their isn't an excuse you can think of that someone else hasn't already used. Even with PRN instructions, The scripts are still 30 days supply. PRN just means that you may take 4 one day, and 2 the next but as long as the script last a month, you dont have to worry. They also do randomn UA's and patient observation is another tool. Docs aren't dumb, Patients nodding out in the waiting room or in the exam room, slurring words, or in the midst of withdrawal sweating and shaking with outragous BP when they should have enough meds to make it to each and every apt and a have a few left until it's time to get your next script fillled is what's expected. Anything short of that is ground for immediate termination. We have contracts, all this is very clear, Lost or stolen meds will not be replaced even if someone bothers to make a police report. Because the cop doesn't know if you actually had meds stolen or if it was 3 pills or 30 pills. A report is just a report, what you claimed happened, It's not proof of anything other than you bothered to callthe cops. After the first time my neighbor broke int my houise, I had a security system installed and bought a florr safe you bolt to the floor from the inside of the safe. The bottomline is we are responsable for keeping our meds safe. My neighbor only got half my meds so I simply reduced my dose and sucked it up knowing reporting the theft would only harm me. Compared to going back to the days when nobody prescribed opiates for chrionic pain is a whole lot worse than having to suck it up for a couple weeks.

If yu folow the instructios med counts are just pat of PM. No big deal. If you need to use a monthly planner to keep yourself on track, do so, do whatever it takes to keep on track and if you take an extra pill one day it means you have to take one less on another. Their really is nothing else we need to know in order for you to understand that 30 days is 30 days. You better have the it right all month just in case he does call you in for s spot check, not that my doc has time to bring people in for pill acounts alone, The abusers and those that simply can't folow the most basic instructins will quickly wash themself out a PM program and move on to the next doc that has no biz prescribng meds to someone that has been washed out of program after program.Unfortunately their are so many docs practicing PM that aren't trained in PM, their is always someoneone out their wiling to write scripts for the money. GP's playing PM doc is a real pet peeeve of mine, you wouldn't ask them to treat cancer if you had it, you wouldn't beg them to foperform any needed surgery, why would you ask someone with absolutely no additional training than a GP to prescribe the most potent meds ever available to treat Pain. I remeber when Percs only came in 5 mg tablets and in fact every surgery I have ever had, from my wisdom teeth at 16 to mymy last 6 level fusion revision, 5 mg percs are what I was given for post op pain and that was quickly dropped down to vicodin as soon as the doc felt I no longer needed percs, They didn't make 10 mg pers or 15 mg and 30 mg oxy tablets in the 90's. Oxycontin wasn't aproved untill '97 or 1998, prior to that only MSContin existed and that was reserved for the terminally ill.

Regardless of how your script is written, more than likely your doc intends it to last 30 days, When the med is filled at the pharamcy, they have to put a days supply, meaning the number of days it should last. If that number is divisable by 30 you can bet it's a 30 day supply even if it appears to have leeway with PRN directions.
Good luck, Dave

Last edited by Shoreline; 05-01-2012 at 07:42 AM. Reason: grammer, only got about 2 hours sleep last night. In fact I havn't ben able to sleep more than 3 hours straight since 99

 
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Old 05-01-2012, 08:14 AM   #6
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Re: New to Formal Pain Mgmt - Pill Counts

Thanks Tortiosegirl.

Yes, I've tried it all over the last 15 years. Previous 2 PCP physicians (1 died 1 moved) readily gave me hydrocodone for breakthrough pain. New PCP (2yr), like almost all in my area, now rarely Rx controlled meds. Thanks to always using less than rx'd and the moving PCP's goodbye rx with 4 refills, I had a good accumulation (if really rationed) to use for BT pain for the past 2 years. I used ibuprofen for base pain. Due to Blood Pressure med issues my PCP and Cardiologist moved me totally off NSAIDs. I've done chiropratic for over 20 years, physical theraphy, cervical injections for the last two plus a surgery 1.5 years ago (all stories for another tread). All the local PM/Physical Medicine doctor would do is give 4 cervical injections per year plus neurotin(disaster) or tramadol (8 50's a day). They'd stopped rx'ing controlled substances for chronic pain several years ago.

New PM Clinic also does chiropratic, physican theraphy, and acupunture. Old PM in refering me, suggested continuing tramadol for basic pain and hydrocodone for BT. New PM said that was silly to mix them and to just use Norco (7.5x325). He thought 2 to 3 Norco should exceed the relief from 8 ultram. So he just suggested starting at 4 a day,2 basic + 2PRN (though Rx just says 1 every 6 hours), plus continuing my at home PT and neck traction (have my own device). He also wanted me to be aware that I would be needing increasing amounts and stronger meds in the years ahead. He knows of my previous accumulation and use and seemed to approve. I told him, it's in my records and I've never concealed it from any doctor.

I only asked the question in my original post because of stories I heard or read online. My contract calls for me to bring all meds to each 28-30 day appt. I read it, but somehow left without a copy. I just wondered what people in this group had experienced. I read a lot of online groups. I'm only posting to this one because it seems the most "adult" and to have the least BS.

 
Old 05-01-2012, 08:33 AM   #7
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Re: New to Formal Pain Mgmt - Pill Counts

Thanks for info Shoreline. Your reply posted while I was replying to Tortoisegirl. I know about the sleeping problem. I last 3, maybe 4 hours in bed, then get up, take a flexerile, get my earphones and iphone, move to the recliner chair set up at the foot of our bed, and just catnap till dawn listening to new age/meditation/sleep music.

 
Old 05-01-2012, 06:13 PM   #8
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Re: New to Formal Pain Mgmt - Pill Counts

Like Dave, I've been doing this a long time, 25 years worth, I wanted to add 2 quick things to his excellent explanation.

If your Dr. has you on 8, 50mg Ultram a day (400mg) he has you taking over the max daily amount. Please be careful, Ultram is a dangerous drug, esp. when your taking more than you should.

You signed a Contract, probably a standard Pain Management Contract that most of us have signed. In that contract it forbids accumulating pills, that is grounds for dismissal from the practice. You said your Dr. is fine with you doing this....just be careful. Dr.'s are famous for seeming like their fine with something and then dropping a patient for doing that same thing. Accumulating a stash of pills is pretty much the same as telling your Dr. "I don't think what your doing works, at some point I think I'm going to need more pills and I'm making sure I have them." He should have a problem with that.

Kat

 
Old 05-01-2012, 07:05 PM   #9
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Re: New to Formal Pain Mgmt - Pill Counts

The poster said that Ultram dose what one doctor offered, not that they ever took it or currently take it. Make sure you get a copy of that contract (with your signature on it) in case they ever change their standard contract and then say you signed that one. I agree its a bad idea to be accumulating months or years of pills, but I do think its a good idea to stash away a small amount when you can in case of an emergency. To me, that means I have enough to taper off if I got cut off.

Its not something I would ever tell a doctor but if they asked I would say that I have a bit extra. Honestly I don't think a doctor can really expect you to not have a single extra pill. I got extra by delaying starting my first long acting med and I take a bit less bt each month. Then I'm not stuck having to wait for the rx that day at the pharmacy (I get it the next day). One time I actually had a week delay getting my meds and I was so glad I had the extra. Neither the doctor or pharmacist (who both knew about it) asked if I was in withdrawal! To me I don't accumulate extra pills thinking I'll need them...its hoping I won't.

But to the original poster, I would definitely not be using any extra meds (if you have any left at this point) now that you are with a clinic and on a contract...if for some reason a previously prescribed med or more than prescribed showed up, thats a problem. They also do have an expiration date...not that it'll make you sick, but after awhile they lose effectiveness. My contract actually doesn't say anything about accumulating meds...it says to take them as prescribed and not more...nothing about less or tapering off. Everyone has a slightly different version though, and a lot is open to interpretation. I can see that is where you can get into problems.

I don't get the med counts on your refill day...aren't you supposed to have no or only a couple pills? Does that just mean you bring in the nearly empty bottle? Only way that would work is if your doctor has you come in a few days early and then post dates the script (like it appears Shoreline gets), but I haven't heard of that before...usually you come in on day 28 or 30 (depending on how many days of rx you get) and you are supposed to be out. A med count would usually be something extraneous between refill appointments, whether scheduled or not. Do they somehow mean for you to bring all meds in as a way of seeing what you take from other doctors? Some like you to bring in the bottles rather than a list just so they can verify. Best wishes.

 
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Old 05-01-2012, 07:32 PM   #10
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Re: New to Formal Pain Mgmt - Pill Counts

hmmm....I guess there's concern that my post might be confusing or wrong, so let me be more specific.

IF your Dr. has you or had you on 8, 50mg Ultram a day, (400mg) he has or had you taking over the max daily amount. Please be careful, Ultram is a dangerous drug, esp. when your taking more than you should. I bring this up in case you are storing up some of the Ultram for a rainy day, like your other pain meds, you need to be careful how much you take in a day.

 
Old 05-01-2012, 07:52 PM   #11
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Re: New to Formal Pain Mgmt - Pill Counts

Yes Kat, Ultram is a dangerous drug, more so that Norco Esp. if they also have you taking Flexeril or similar drug. But, still around here docs Rx them all like candy since they are not controlled drugs. 400mg is the max daily dosage of Ultram/Tramadol. As my new PMDr suggested, I gladly stopped taking Ultram. In the garbage, but I guess I still have 4 more refills of 240 available at the drug store.

Tortoisegirl, as to you last paragraph, don't know. Guess I'll find out in 9 days. The old 7.5 have become weaker. I'd say one new one is as effective as 1.5 old one, which are now all gone.

 
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