posted 09-11-2003 02:13 PM            

I would like to know how you convinced your doctor to prescribe schedule 2 narcotics (such as Duragesic, MS Contin, Kadian, methadone, Oxycontin, etc.) for you.

Did you have to prove you were a legitimate pain patient with a legitimate chronic pain condition?

posted 09-11-2003 02:41 PM            

I never requested a specific medication. Usually I ask my doctor what will work best for long term, consistent pain releif and he will bring up the different possible meds.

I have been through just about every type of procedure (blocks, epidurals, tens, pt) and have been on every form of medical thearapy (antidepressant, anticonvulsant,muscle relaxers, neurontin, ect)and am at a sort of plateu as far as the effectiveness of these treatments.

I think he is of the opinion that narcotic medication therapy is the last option available that will provide me relief and allow me to live a more normal life.

If he does bring up two or three different meds, and I have some knowledge about the meds, I will give him my opinion of what I think I might want to try.

For example. On my very first visit with my current pm doc, he prescribed methadone. I did not do well on methadone due to severe side effects, so I was switched. I did not ask for another specific med. I told the doc what good and bad effects the methadone provided and that the bad outweighed the good, so it has to go. He told me we could either try Morphine or Duragesic. I told him that I do not do well with patches of any sort and would prefer and oral medication, so he started me out on ms contin and ms ir for bt.

My point is, if you are honsest and do not come across as seeking any specific med, have tried many of the treatments recomended and have a decent pm doc, more than likely he will realize the value of the long acting, more powerful meds. You should not have to "convince" your doctor of anything, and if you do have a doctor that you feel you need to "convince" to get any type of pain relief, then maybe you should seek a different doctor.

I hope this answers your question.

peace

Terry

posted 09-11-2003 07:39 PM            

My BP had been combined over 350 like the 210/160 range for several years while treating pain with prozac and BS methods and failed surgery after surgery. I was only 30 and no family history of heart problems and no cholesterol problem to worry about. So I would say I had to prove it. The clinic he ran didn't use opiates on everyone. Just the ones that that were not going to get better regardless of what they did.

Things have gotten better in the last 10 years but if the doc doesn't have documentation to explain the use of opiates I would think he's taking a chance and they would be harder to come by. If you have tried other methods document them and take them to your PM doctor apt so he can add them to your file to justify the use should anyone ever ask.

It does seem like a more humane option than invasive surgery but opiates aren't completely benign. There is a price we pay. It's not the same as addiction but dependence has it's own downfalls. I guess it comes down to, do they improve the quality of your life and ability to function more than they impair you with side effects and the consequences of masking a problem that may become irreversible if not treated more aggressively? Every doc has a different opinion on the use of these meds.

posted 09-11-2003 09:54 PM            

Well I have been on narcotics since I broke my back in 1985. Except for the the last year I was mainly on hydrocodone preps. Needless to say my tolerance to that med was very high. I had to detox myself every 2-3months just to get some relief which was hell in and of it self. Then a miracle happened we got a wonderful PM doc in this neck of the woods and I was finally given my first long acting med. At that time it was OxyContin then later switched to methadone and OxyIR and Dilaudid for BT. I did have 19yrs of failed methods and surgerys to back up my pain. I'm with shorline any Doc who doesn't document the need for strong opiates is just asking to go out of business. They do need to prove that all other avenues have failed and that Schedule 2 narcs are the only option. It weeds out the addicts and even then a few slip by. I am curious as to why you ask SFangel. Its an odd question.

posted 09-11-2003 10:33 PM            

OK, I am really getting concerned about you. Between this quesion, the crushing vicoden, the "secondary gain" issue, the stongest painkiller in the US...

And, you asked about you using Duragestic while having a xray so you are already on that, which from my understaning, is a VERY strong med.

I really think you need to evaluate why you are using these meds, talk to your doctor and get help if needed!

Oh, and I forgot about the "self abuse" post as well. I think that was you. I think you mentioned in the "secondary gain" email that you had seen a psychologist. Are you still going? Have you discussed all these things with him/her?

Am I over-reacting or is anyone else concerned?

I am just worried about you.
Luv

posted 09-12-2003 01:47 AM            

Please read and let me know if anyone else agrees with me here. I really am concerned and we are here for support and to try to help each other!!

posted 09-12-2003 02:01 AM            

------------------
Hmm where should I begin?? Crohn's disease, sacroiilitis-crohn's related, scoliosis, spina bifida occulta, chronic myofascial pain, tmjd and migraines. Still waiting for bone scan and bone density test to tell me what else is wrong with me!! Too many surgeries to list!!

[This message has been edited by twisten (edited 09-12-2003).]

posted 09-12-2003 04:29 AM            

Please please please try to see our side here and don't think we're all judging you, we're just worried about you.

posted 09-13-2003 09:18 PM            

Please excuse me if this post is long because I want to answer your questions and I want you all to know why I am so very interested about narcotic painkillers.

Before my doctor put me on Oxycontin (I was later switched to Duragesic), I was in severe to excruciating pain because I have RSD in my left knee/leg. I used to cry for hours every day and I used to frequently beat on my knee because of the pain. I also wanted to kill myself or apply for assisted suicide.

Then I was introduced to the world of pain relief by strong narcotic painkillers such as oxycodone sustained release, morphine, hydromorphone, fentanyl, etc. I am not ashamed to say these drugs are my friends because they saved my life. If it were not for these drugs, I might very well be dead today.

After all this, it is only natural that I want to find out more about narcotic painkillers, the drugs and friends that saved my life.

My pain management doctor said that I am “remarkably well informed about pain management.” My primary care physician said several times that she wished I was working in her office so I can advocate for and help other patients in pain. I really want to do that, so I am trying to find out more about narcotic painkillers and other forms of pain management. I also post in many other forums.

Like I told you before, I have trouble expressing my thoughts with appropriate words because English is not my native language, so it is not surprising you think I am a drug addict rather than a legitimate pain patient.

Four different doctors diagnosed me with RSD: an emergency room doctor, a primary care physician, an orthopedist, and a neurologist. You may or may not know that RSD is considered to be the MOST PAINFUL chronic pain condition that exists.

I have tried numerous medications to control my severe chronic pain. The ones that were not effective are: Tylenol, Vioxx, Robaxin, Flexeril, Soma, Lioresal, Valium, Elavil, Dilantin, Neurontin, paracetamol with dextropropoxyphene, paracetamol with codeine, Tylenol with codeine #3, Tylenol with codeine #4, and Vicodin. The ones that were somewhat effective are: Percodan and Dilaudid. The ones that were very effective are: Oxycontin and Duragesic.

Terry, I am glad your pain management doctor did not treat you like a drug addict but gave you the pain relief you deserve because he knows you are a legitimate pain patient.

The primary care doctor who prescribed Oxycontin for me did so after he saw me crying and after I suggested he prescribe Oxycontin for me. He knew I had RSD and would use Oxycontin for pain relief, not to get high. Later I had to change doctors. My present primary care doctor switched me from Oxycontin to Duragesic because (I guess) Oxycontin is a “street drug” that is easier to abuse than Duragesic. I kept on using Duragesic because this drug is effective for me. My psychiatrist also preferred that I use Duragesic instead of Oxycontin.

I have had 2 arthroscopic knee surgeries, which did not help with the pain, instability, giving out, and falls. I also tried aggressive physical therapy for a long time; this also did not help.

Karla, I am glad methadone works for you because you deserve pain relief as much as anyone else.

Avogadro, I am glad you also got the pain relief you deserve the very first time you saw your pain management doctor. He was smart enough to understand that Vicodin is not appropriate for severe chronic pain.

No, I am not seeing my pain management doctor anymore because he feels there is nothing he can do to help me that my primary care doctor cannot do. My pain management doctor only prescribes medications, which my primary care doctor can do.

Shoreline, I understand the pain clinic you are using wanted to make sure you were a legitimate pain patient with a legitimate chronic pain condition. I am glad they helped you.

Thanks for the suggestion about the documentation of the different pain management techniques and methods I have tried. I will do this and give it to my doctor the next time I see her. I sure do not want the DEA and State Medical Boards to give her any trouble for prescribing me Duragesic continuously.

I am afraid of the withdrawal caused by Duragesic if I unknowingly take a drug that negatively interacts with Duragesic.

Yes, Oxycontin and Duragesic improve the quality of my life and ability to function without impairing me with side effects. It is true that besides controlling my severe RSD pain, Oxycontin and Duragesic mask many other symptoms of my RSD. However, this is not a problem because RSD cannot be cured.

Matt, I am glad you got the pain relief you deserve. I explained why I had all these questions about narcotic painkillers. I post a lot on this and other forums because I can only get support from the people using healthboards.com. I spend several long hours on the Internet every day.

Luv2sew, I explained in this post in this thread and in previous posts in previous threads why I asked certain questions about narcotic painkillers. Feel free to let me know if you have more questions or need more information.

I cannot see the psychiatrist and psychiatric nurse I used to see because they only take care of people who are in a crisis. I guess my case is not considered a crisis. The psychiatric nurse told me I would know better than any doctor if I had secondary gain issues because I know better than any doctor what I get out of being in pain. The answer is: nothing (or should I say NOTHING GOOD) so I definitely do not have secondary gain issues.

The neurologist who said I had those issues said this just because he did not like my using strong narcotic painkillers. He also did not believe I have RSD and severe chronic pain because both are masked by Duragesic.

Twisten, you said: “She did have explanations for the other questions she was asking although they didn't seem like very straight forward ones.” Feel free to ask more questions if you need more information. Like I said before, I have trouble expressing myself in a clear, understandable way.

I was on NOTHING good BEFORE my doctor put me on Oxycontin, then later Duragesic. That is what I meant to say in the post you read. Is it not what I said or did I express myself poorly AGAIN?

Dawn, please do not accuse me of being a drug seeker. You do not know me like my doctors and I do. I am just a legitimate pain patient who has trouble expressing herself. I explained in this post in this thread and in other posts in other threads why I wanted to find out more about narcotic painkillers. Feel free to ask more questions if you need more information before accusing me of being a drug seeker. Even if I do not get any information here from other posters, I can VERY EASILY find the information somewhere else. I hope you never have to be in my shoes for even a day because then you would know how bad my pain really is. You would also understand I am a legitimate pain patient.

Crystal, I am sorry to have to say this: if my doctor ever took away my Duragesic, I would order schedule 2 narcotics from the Internet or from drug dealers because I have the right to pain relief as much as anyone else.

Mo, the moderators deleted one of my posts in which I was asking how come I never got euphoric after taking narcotic painkillers. This post was deleted because I included my e-mail address. No matter which narcotic painkiller I take and no matter how much of it I took, I never got high for even a single question.

I often hear that legitimate pain patients who are getting pain relief from narcotic painkillers and who, because of this, want to find out more about these drugs, are accused of being drug seekers. Do you think this is fair? Is it not natural for these people to want to find out more about the drugs that help them so much?

Surgicaldisaster, all the drugs I am taking are either prescription drugs prescribed by doctors or over-the-counter drugs.

You asked: “Why would you wonder how to "convince" a Dr. to get the other meds you mentioned?” I am not trying to get my doctor to prescribe any more narcotic painkillers for me. I even refused that she prescribes more Vicodin for me because I have some left at home.

Unzzz2003 and Karine, please feel free to ask more questions if you need more information before saying I am NOT a legitimate pain patient.

posted 09-13-2003 09:33 PM            

My only question was why you were asking how we get doctors to prescribe schedule 2 narcotics when you are already on Duragesic.

Was that just for research so you would have more information if you begin to counsel others on pain management?

I am glad that the meds have helped you so much. I hate that you still have such horrible pain, which causes the self-abuse. It seems that you probably get as much help as possible from the medications. I'm sure with pain at as high a level as caused by RSD, the meds can only do so much. I was thinking maybe you could just talk to a counselor or someone as far as helping you to deal with living with the pain that can not be relieved by the medications.

But, I am glad to hear that it has at least gotten to a reasonable level of control where you no longer have the BAD thoughts....

Take Care and you are in my prayers,
Luv

posted 09-13-2003 10:25 PM            

Hey Iknow that we all came acroos very strong and I'm sure that there are cultural differences. I was and properly so concerned for your well being only. SF angel. I only want to be an advocate for you and other legitimate pain patients like us. I very much do not want to enable the ones that make it very difficult for us who are in CP to get the pain relief that we so deserve. I hope that I haven't offended you. I am only concerned for you and the others here on this board. Please take good care. I have been dealing with CP for a very long time. 19 yrs to be exact. I have a little experience in recongnizing a person who has legitamate pain issues and ones that are truelly out to make our lives hell. The DRUG SEEKERS. I will not ENABLE those people. I hope that you understand. Plaese take good care......

Matt

posted 09-14-2003 02:41 AM            

Luv2sew and Twisten, I wanted to know how people on this board convinced their doctors to prescribe schedule 2 narcotic painkillers for 2 reasons:

1) I wanted to compare my experience to theirs

2) I wanted to gain more information about narcotic painkillers so I can help other people at my doctor’s office who are trying to get their doctors to prescribe schedule 2 narcotic painkillers for them. Of course, it is up to the doctors, not to me, to determine if these people are legitimate pain patients before sending them to me.

The severe pain in my knee does not cause most of my knee self-abuse; this self-abuse is mostly caused by my anger and frustration because I fall so often. (I have severe instability and frequent giving out and falls because I have a partially torn ligament in my RSD knee)

It is true that with pain at as high a level as that caused by RSD, the meds can only do so much. I have to take the best pain relief I can get, even if it is not perfect.

I am looking for a mental health counselor to help me deal with the anger and frustration caused by my falls and knee problems.

Matt, I think that drug abusers carry a lot of responsibility for the difficulties legitimate pain patients have to convince their doctors to prescribe narcotic painkillers for them. I think that we, legitimate pain patients, have the right to be mad at drug abusers because they make our life harder to live by making doctors think we are all drug addicts.

posted 09-14-2003 06:50 PM            

Surgicaldisaster, I am sooo grateful for the pain relief the Duragesic patches have been giving me. These patches really have saved my life. If it were not for them, the severe to excruciating chronic pain would have driven me to commit suicide or to apply for assisted suicide. I thank my doctor for prescribing these wonderful fentanyl patches for me.

I consider Duragesic like a good friend who has been helping me have a better life by controlling my pain. Tonight, it will be exactly a year since I started using Duragesic. Happy birthday, Duragesic!

I know you all care. As long as I understood this, I did not get offended.

posted 09-14-2003 07:04 PM            

Thank you for being so understanding. I know a lot of people that would have immediatly freaked out at some of the responses to your posts. I really appreciate that instead of getting defensive and starting an argument, that you took the time to further explain yourself! You truly showed a very mature response!

posted 09-14-2003 09:27 PM            

Thanks for accepting that I am really a legitimate pain patient, not a drug abuser or addict.

It is true that we all learn something every day. After all, learning is lifelong.

People have to have our problems to really understand what it is like to live with a "trick knee". I think I will end up with a knee replacement by the time I turn 40.

I am so sick of falling just because of a partially torn ligament that orthopedists absolutely refuse to reconstruct. I use a knee immobilizer and crutches to be able to walk. A cane unfortunately does not provide me with enough support to walk.

posted 09-16-2003 02:35 PM            

First, many doctors are suspicious of anyone in pain, and nurses may contribute to that suspicion. They may have been "burned" before when they have prescribed controlled substances, and are therefore reluctant to do so again. Many doctors I have worked with require pain patients to sign a contract stating that they will only get prescriptions of this nature from that doc, that they will not exceed dosages, etc. If they do, that doc gives them 30 days notice to find a new doc.

Second, an additional oral med is often prescribed to Duragesic patients to control breakthrough pain, especially on days that the patch needs to be changed.

Third, healthcare professionals are now being taught that pain is as bad as the patient perceives it. That is why we have pain scales. Some people are better able to handle pain than others--there really isn't a good way to tell for certain if someone is in pain or not. The physical manifestations of pain mimic those of other conditions--anxiety, for example.

And lastly, just because a person is well-informed DOES NOT MEAN that they are a seeker!!! It means that they have taken positive steps to understand their condition and its treatment. Doctors should be more willing to listen to their patients when they suggest a drug they would like to try, since the patient knows best how they react to medications. Be open-minded, don't be cruel, and don't accuse someone on here of being a seeker! There are subtle, tactful ways to inquire and suggest help. That way you won't be hurting an innocent person's feelings--we are all only human.

posted 09-17-2003 02:09 AM            

I could not agree more with what you are saying in your post.

I can understand why some doctors are suspicious of people in pain. There are certainly many drug addicts who claim they are in pain just to get narcotic painkillers. These drug abusers are the reason why many legitimate pain patients have trouble getting doctors to prescribe narcotic painkillers for them.

"They may have been "burned" before when they have prescribed controlled substances." What do you mean by "burned"?

I have signed a pain contract so that my primary care doctor will prescribe Duragesic for me. This contract says that I will only get narcotic painkillers prescribed for me by this doctor and that I will not use these narcotics to commit suicide.

I use Duragesic for severe chronic pain and Vicodin for breakthrough pain. I noticed Vicodin seems to be more effective when I crush it between my teeth. I have gastro-intestinal problems, so crushing Vicodin might make its absorption easier, right?

"Healthcare professionals are now being taught that pain is as bad as the patient perceives it." I believe this is very important. It might make doctors more willing to prescribe narcotic painkillers if they "get rid of" their wrong idea that legitimate pain patients taking narcotics for pain control will often get addicted.

"Just because a person is well-informed DOES NOT MEAN that they are a seeker!!!" This is ABSOLUTELY true! I could not have said it better! I am sick of being treated like a drug addict, abuser, or seeker just because I know so much about narcotics and just because I want to find out more about them. It is normal I am interested in narcotics; after all, they have saved my life by controlling my severe chronic RSD pain.

"Doctors should be more willing to listen to their patients when they suggest a drug they would like to try, since the patient knows best how they react to medications." I agree.

posted 09-17-2003 05:34 AM            

I honestly believe you're a pain sufferer, and have every right to a great pain management regimen. Honestly, I hope you weren't offended by my previous post because I was just sounding my concern for you.

I know how hard it is to be in pain. It's hard for me to know I will be dependent on meds for the rest of my life, and will possibly not receive the meds I need, due to my young age. I keep hearing that basically I will run out of options and will be S.O.L. if you know what I mean...

I'm glad your doc is caring enough to give you relief.

I wish you the best, and hope you are having a good day.

Please, again, don't be offended by my posts. I honestly care about you and everyone else here. I just want everyone to be okay.

posted 09-17-2003 01:51 PM            

I do not think I misunderstood you or anyone else who posted a reply to my original post in this thread.

I know you were all concerned about me being a drug abuser using this board to get information on narcotic painkillers so as to satisfy my supposed addiction to narcotics.

I was just worried that you would not see I am a legitimate pain patient because I did not know how to write my questions about narcotic painkillers very well.

I realize that many doctors would be less understanding than the people on this board but I also realize that many legitimate pain patients are accused of being drug seekers as soon as they start asking too many questions about narcotic painkillers.

EVEN IF I had been a drug addict, it does not mean that I do not deserve pain relief because drug addicts can also have legitimate pain. Is it better to be a drug addict with pain relief or is it better to suffer severe pain without drug addiction? Better yet, is it preferable to be dead or to have pain relief despite the fact that some people think I am a drug addict?

I did not get offended by your posts and by the posts of other people. I was just hurt that you might have thought I was a drug addict.

"I honestly believe you're a pain sufferer, and have every right to a great pain management regimen." Thank you for saying this.

posted 09-18-2003 10:24 AM            

I hope you can find the help you need to improve your quality of life. Good luck & God Bless. Good luck.

Karen

posted 09-18-2003 03:12 PM            

While I appreciate and understand your valid concerns, I have to ask you to take members at face value. We can't know their personal circumstances.

If you feel negative about a question, please just pass it by and do not repsond to it.

Lets not corner folks about their situations. Just ignore questions that you consider suspect, and notify me, please.

Thanks much!