Hi all. I haven't been here in a while so I thought I'd drop in and ask a quick question that has been eating at me.
I finally found a decent PM clinic with a great (very conservative, but great in the eyes of GPs and ERs) reputation. I'm sure most of you know what I mean, so I won't explain. heh
Anyway, 12 weeks after my spinal laminectomy I was still having pain so the surgeon sent me off to this place. The doctor there prescribed me some PT and 6 Hydrocodone a day, 2 every 8 hrs.
It's been about 8 months now since the surgery. The pain from the compressed nerve and ruptured disc that was causing it has ceased (ever since the surgery, which worked 100%) but I am still having the same old chronic pain that I have had since my original injury and the first surgery I had.
I was happy that they were treating the chronic pain with the Hydrocodone every 8 hours, even though it was barely adequate.... still better than nothing, right?
So about 2 weeks ago the nurse calls and reschedules my appt and said that the doctor is concerned about the 'massive amount' of medication that I am still taking and wants to cut it in half, down to 1 pill every 8 hours. She said she'd call in the refill with enough to get me by until the next appt at 3 pills per day.
Yeah, they cut my medication in half, over the phone, without an actual sit down appointment to discuss it and at least see how things were going.
I went in today and asked the doc about it and told him I wasn't really happy with the way it was handled and he just completely blew me off. Didn't even look up from his scribbling. I said it again and he just smiled.
I'd drop this practice like a bad habit if I could but they're as close as I can get at an hour and a half away and I sure as heck don't want to start the whole process over again with a new doctor that is even further away.
Suggestions? Any magic words that will get this guy to listen to me?
I also asked him about a LA med, even once a day at a lower dose (as to avoid that 'massive' dose he had me on) and he said it was only for people at the end of the line who are in extreme, debilitating pain...
I have to agree you are on a lot of hydrocodone, and I would be concerned about the amount of Apap you are getting a day and not the narcotic. I would at least get a second opinion, I know it would be a drive for you, but at least see what another doctor would recommend.
I've been on it (or other similar medications) for about 9 years or so now. Honestly, the 15mg only works about 70% of the time. I know some folks can stay on the same dosage for 20 years and not experience any tolerance, but many others (like myself) could stand to have it bumped up a few mg after a while.
The Acetahminophen is under the 2g per day safety recommendations so I am not entirely worried about it. Plus I have my liver and kidney functions tested regularly to make sure all is well.
I suppose it depends on the doctor as far as what is considered a massive amount to be taking. I saw one about 6 years ago that would scoff at the dose this doctor is freaking out about.
It also depends on the patient/person, too, imo. Everyone's tolerance is different. Mine has always been rather stout. I'm not a small guy either. Heh.
Unfortunately the laws/regulations are changing with regards to long term usage of short acting medication. So, many Drs. are having to either move their patients over to an ER/LA medicine...or start weaning down..
And if you truly said to your Dr. that you "aren't happy about how they handled things"....It may have come across the wrong way that you were scolding him or his office...
I would have just focused on how you two can work as a team to keep your pain level down to a manageable level..
Keep in mind that an opiate is just one small way to help lower our pain levels...We must use every single available modality to help deal with the pain..
Are you on a muscle relaxer as well to take when needed? This is very helpful to supplement to an opiate..
As well as exercise, PT, aqua therapy, massage, acupuncture, injections, TENS unit, cognitive behavioral therapy, counseling, steroids, eating healthy, maintaining a healthy weight.
And I'm not quite sure I understood...but is this Dr. an actual Pain Management Dr.? What is his background?
Again...I would speak with him at your next appt. about trying to find the best comprehensive plan to handle your pain...And even then...it's about using everything I mentioned to get to a level 5 or so on the pain scale...That is really the goal with chronic pain.
I'm just afraid that from what you wrote...that you may have come across to them that your only concern is the narcotic medication and that is the "only" thing you take/do for your pain....
As I mentioned....the Drs. are getting a lot of heat from the new regulations to not keep their patients on short acting medication for long periods of time.
I would think he would be open to a long acting medicine if you approach it as just "one" piece of the puzzle and that you want to make sure you are using every modality...
Just my thoughts/suggestions....Your only choices are really trying to work hard with this Dr. or try to see someone else...
I do wish you luck and keep us posted..
*Just wanted to say I really do empathize as it took me a year to find the PM Dr. and Neurosurgeon that I have now...It is not easy
Last edited by Ilovemycutedog; 07-17-2012 at 07:58 AM.
I'm sorry this doctor isn't listening. I hope you can find someone for a second opinion. Maybe your GP would even be able to help you out. I can understand a doctor wanting to cut down or not increase meds, but they need to have some sort of solution for you to try. There are plenty of alternative treatments, injections, adjunct meds, etc, which could be helpful. Even if tried in the past, maybe something has changed, or a different combo could be tried. Hope you get relief soon. My only suggestion for magic words is to explain your pain levels, what they are from (this pain pre existed the injury that required surgery), what they prevent you from doing, etc. Have you searched your insurance website for PM docs that you may be unaware of in your area?
I disagree that LA meds are only for patients at the end of their life, but they also aren't appropriate until many other treatments have been tried. If you have already gone through a multitude of treatments, bringing in those records to document how you did on them could be helpful. But overall I think its ridiculous for a doctor to drop meds when the patient isn't doing better and not have any better ideas.
I've sure had that happen to me...I spent about a year interviewing PM docs and all but one said they would take me off my pain meds (or drop the dose a lot), yet they didn't have any ideas for treatments I hadn't tried. When I asked how I was supposed to function if I was barely handing in there on the meds I was on, they had no answer. They were more concerned if I was on this many meds at 25/26, where would I be in a couple decades. I have hope for medical advances.
Finally found the doctor I'm with now who thought it was prudent to switch around my meds with a slight increase, plus try more therapies I haven't tried yet. I'm lucky to be in a major metro area with at least six PM docs within reasonable driving distance though. There may be a helpful doctor who isn't a PM specialist though. You just need someone who is willing to try to treat your pain, whether that treatment includes pain meds or not. I'd give this doctor one more shot. You may need to stick with them to at least get something while you interview new doctors though.
As long as you don't get meds or sign a contract at a new doctor (all the ones I saw agreed to consult with me without a contract, even though they all asked me to sign one as part of new patient paperwork, even before meds were offered), you should be good. Best wishes.
When I read that the doctor wanted to reduce your intake due to the massive amount you're taking, I almost feel out of my chair! Since when is 6 vicodens a day considered a massive amount? That doctor would have probably croaked if he saw what I used to take (320mg Oxycontin daily). I don't think what you were taking would even qualify as BT meds for me back then.
Listen, the truth of the matter is that some doctors clearly aren't comfortable prescribing narcotics for whatever reason. If what you feel you need for your pain is to take narcotics, then you "need" to find another doc, regardless of what you need to do. I realize that narcotics are part of the plan and other things can help you but at the end of the day, they are the backbone to most pain management regiments. It seems to me that continuing with this doctor or trying to talk sense with him is a waste of both of your time. Move on and consider it a learning experience. I'm sorry you're having so many problems but there are doctors out there unafraid to prescribe what is needed. Good Luck!
It is amazing how so many doctors are treating patients. I know you said you don't want to travel any further than where you are going now. But trust me when I say, most of us that is seeing a decent pmp did not find them around the corner from our homes. You have a better shot at winning the lottery. What I am trying to say is that sometimes to get what you need or get the care you want. You have to bend a little. I know a hour and a half is a long distant. But I have known people to go even farther to find pain management. The only reason I tell you this is because it sounds to me like your doctor is not going to do much more for you. I do agree that you have to be very careful with the amount of acetaminophen you take daily. But I don't agree with what he said about long acting meds. LA meds are for people with CP around the clock. So that you are not taking so many short acting meds. And you wouldn't have to worry about your acetaminophen intake daily. I have been a pain management patient for years due to multiple illnesses. But I will say that after so long on short acting meds and so many a day the docs want you to get something LA. It's better for the patient and the doctor. Hopefully you can find some one that can help. I really hope you can. Also look for some alternative ways to treat your pain. I know that it will help along with the pain meds. Good luck to you and I hope you can find a doctor to help. I can't predict the future but I am pretty sure that you are either going to find another pmp. or deal with the pain and be unhappy with this one. Hopefully you can get this taking care of before your pain become to unbearable and it's going to take a lot to get it back under control. Best wishes! Muah!
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