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    Old 09-23-2006, 06:31 PM   #1
    Sage48
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    Visit to Pain Mgmt. Dr....

    Had a very bad week, developed bad headache,,,,from my neck, lower skull into my right side of face and eye....not pleasant..(had an ACDF 2 1/2 yrs. ago) .at the same time, my lower back and leg were much worse than usual. So I did the logical thing, so I thought, I called my Pain Mgmt. Dr. He is a good guy...but I was thrown by his first question.....why was I there, I had an appt. about a month ago.... Well I told him that I had had a problem with the headache (I do not get headaches....very rarely..like once every year or two..)..., as well as the increase in pain in my lower back..

    End result, he is referring me to Shands in Florida. I had been to the Mayo Clinic last May/June...but when the neuro didn't fine the cause of my symptoms...(he was looking for compression>>>I have herniated discs/bulge/and other stuff...but he said my symptoms were from compression, but he didn't see it...well, he basically dropped me....
    So now my PM Dr. wants me to go to Shands

    PM Dr. is also changing my meds from 10/325 oxycodone..to MSIR 15 mg. 2 tmes a day. I have had problems with meds in the past...I am afraid take this new stuff......has anyone had it prescribed???? Any advice on this new med???

    Guess this doesn't make much sense tonight...I am sorry, but I needed to "speak" with someone.....but I am concerned about this new med....

    Sage

    Last edited by Sage48; 09-23-2006 at 06:31 PM.

     
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    Old 09-25-2006, 02:56 PM   #2
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    Re: Visit to Pain Mgmt. Dr....

    Hi there... I am very sorry to hear about your pain and frustration... Just hang in there and believe that there will be a better day... 6 months ago I was in so much pain, and thought it would never end... but now, thank God, I am doing better.. ever so slowly... but better and keep excercising to strengthen myself.. As far as the oxycodone goes... I too take it as needed.. It is basically Percocet, without the Tylenol... I take it with muscle relaxers (valium) and with aleve or ibuprofen, but only as needed... In the beginning, I took it every day, but now, every once in a while.. It makes you feel loopy at first, but your body will adjust... My only complaint was that it makes your stool very hard, so you may need stool softener... and / or take alot of prunes and lots of liquid... Sorry to sound so gross, but it is the truth.. Occasionally, some people get nausious and vomit, so if this happens, let your doctor know, but dont be scared, as it is somewhat a normal reaction..

    God Bless..

    Maurizio

     
    Old 09-26-2006, 05:21 PM   #3
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    Re: Visit to Pain Mgmt. Dr....

    Thanks for the reply Webdude,

    Yeah, it does get really tiresome having a bum back!! Unfortunately, it has been going on for four years now....took 16 months to get the cervical ACDF, and have spent the remaining time trying to get to the bottom of the lumbar and leg pain (MRI's show stuff, but not what they are looking for...?????)

    The pain mgmt. Doctor changed my meds from the oxycodone to the MSir...which I discovered is morphine...yikes....

    I haven't taken the MSir yet, the back is a little better this week, and the headaches have gotten much better......I am afraid of the MSir....have problems with Ultram..(major rash), and sulfer...the pharmacy called me about these side effects which I had in the past...but they called the Dr. and he didn't seem to be bothered by them.....BUT, that really bothers me, I am allergic to antihistimines....I swell up from those....imagine that...scary, so there would be no use for that med if I did have a side effect.... So, I have postponed taking the MSIR......Guess I'll wait until I have another bad attack from my neck and lower back....I'll have to be really desperate...
    I know this sounds stupid...go to Dr. cause my meds weren't being too effective, and now that he has changed them...I am afraid to take them....

    Haven't heard from my primary Dr., who has to schedule my appt. at Shands...(HMO ins.)...I called this morning, and was told they would call back....no call today.... Just want to get rid of this back......and all of the pain that goes with it...

    Again thanks for your kind thoughts...

    Sage

     
    Old 09-27-2006, 06:45 AM   #4
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    Re: Visit to Pain Mgmt. Dr....

    Well, I read one guy's post where he was afraid of getting addicted to some drugs, and another member said that it was better to get addicted to a drug, than to be addicted to pain... I kinda see his point.. So, you just need to ask your doctor all sorts of questions.. such as how addictive it is, and what can be done to come off it if needed.. Also, ask about the alergic reaction, etc.. As long as he is aware of your complications, and still tells you to take it, then perhaps you need to try it.. If you feel sick from it, then you can stop as you will notice right away.. And just keep on trying... eventually, you will find the right drug and perhaps a fix to the problem... But if you dont keep looking, you wont find it.. I have heard of alot of horror stories, but they always end up good, or at least where the pain is manageable over time.. And dont forget excercise, but see a good physical therapist first!

    God Bless,

    M

     
    Old 09-27-2006, 09:59 AM   #5
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    Re: Visit to Pain Mgmt. Dr....

    Ultram is not the same thing as Morphine at all. You may not react from it but the only way to know is try it. Your doctor increased your meds because you complained of increased pain. He could have increased the Percocet which may of made more sense, instead of having to take it only twice a day he could have given it to you 4-6 times a day. I can understand your worry about taking the Morphine. It may make you sick when you do take it and if you are worried of a reaction be sure to take it when someone is home, just in case.

    Your PM doesn't seem to do much for you. Most individuals who are in pain management are generally on long acting medication which reduces the highs and lows of pain. 2 percocet a day isn't that much medication at all. He must be ultra conservative when it comes to pain management.

    I wouldn't worry about addiction either. Individuals who are in true chronic pain rarely ever become addicted to medication. Studies have showed it's less than 3%. You can become physically dependant but they are not the same thing. Addiction is the desire to get high, abuse medications, take more than needed etc. Physical dependancy occurs when your body is used to a certain level of medication in it's system and when it is stopped you go through withdrawals. Indviduals who take sleeping pills, anti-depressants and even those who are on insulin can all become physically dependant on their medication.

    There's a good pain management board here, I really suggest you drop by there and do some reading. There's a lot of great information there and lots to learn about Pain Management.

    Good luck to you!
    Barb

     
    Old 09-27-2006, 11:14 AM   #6
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    Re: Visit to Pain Mgmt. Dr....

    Barb.. .thats very good info.... I didnt really consider the difference between addiction and physical dependency. So then, if you do become physically dependent, and you start to feel better and want to stop taking the drug, what do you do? Do you slowly come off it? I also take percocet and valium occasionally, but hate taking them because I am afraid of dependency..

    Thanks for the great info..

    Maurizio

     
    Old 09-28-2006, 05:30 AM   #7
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    Re: Visit to Pain Mgmt. Dr....

    I don't see my PM until 10/5 and I'm out of Percocets.. Yikes ! Chewing my nails here....I wonder how you know when your addicted ?

     
    Old 09-28-2006, 05:36 AM   #8
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    Re: Visit to Pain Mgmt. Dr....

    I take MS Contin 30mg I never heard of the other stuff,,just a different name brand or somthing ? I also take perc's 15mg for pain. The Morphine makes me sick when I come down from them.

     
    Old 09-28-2006, 12:34 PM   #9
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    Re: Visit to Pain Mgmt. Dr....

    Many individuals, especially those who are not a part of a pain management protocol do not understand there is a vast difference between addiction and depenancy. There is such a stigma attached to those in pain management. People often think surely you must be addicted if you have to take morphine every 8 or 12 hours. Society, and even many doctors, are ignorant to the actual Pain Management Process and how pain medication actuall works. It's so sad because millions of Americans and people all over the world suffer needlessly due to this lack of education or knowledge.

    You know you have an addiction problem when you are taking your medications for the purpose of feeling or getting high, you are taking your medication in ways it is not intended such as crushing or injecting. The only thing an addict cares about is when and where they will get their next high. They run out of medications early and often suffer through withdrawals until their next fix. They will often seek out multiple doctors and use different pharmacies to fill their prescriptions. Addicts will often, but not always, obtain medications illegally and aren't afriad to steal your medications if you leave them laying around.

    Physical dependance comes when you take the same medication every day for a period of time, generally on a regular schedule. Again, there are many medications people become dependant on. Anti-depressants are one of the bigger ones that individuals don't realize that they can become dependant on. Stopping them suddenly will cause nausea, vomiting, cold sweats etc. These are signs of withdrawals. Your body is expecting the medication and you are depriving yourself of it. Withdrawals can be severe in nature but generally not fatal.

    Another one that's huge is Ultram. Because it is labeled non narcotic people think it is "safe" compared to actual narcotics. This can't be further from the truth. In fact the DEA has put out many warnings regarding physical dependancy and Ultram.

    If you get to a point in your treatment that you are well enough to consider stopping the use of your pain medication it is best to titrate down. Stopping suddenly will throw you into withdrawals. This does not mean you are an addict! As mentioned, withdrawals can be horrendous, especially with some of the stronger medications like Oxycontin, Morphine and Methadone. In fact Methadone is one of the most difficult medications to stop. For many individuals it takes many months to titrate down.

    The goal of titration is to get your body used to having less and less of the medication in your system. Eventually you'll get to the point that you can safely not take the medication and there will be no withdrawal. The length of time it takes to do this can vary but many generally do it within a month or so.

    Shawley if Morphine, MS Contin, is making you sick it may be that you are not opiate tolerant. If you've not taken large amounts of say Vicodin for a period of time then your body will simply not tolerate the Morphine. Additionally you may not be able to take it at all. Some individuals are very sensitive to it. MS Contin is a long acting form of Morphine as compared to the Percocet. When you first take the pill it takes about 45 minutes for half of the medication to be released, so in your case 15 mg. About 4-6 hours later it will release the other half. Generally they are prescribed as every 8 or 12 hours. I take mine every 12 hours but when I was on 90mg I took them every 8hours.

    Another medication that you can talk to your doctor about is either Kadian or Avinza, these have a very slow release mechanism and you may find you will not get as sick on them as you do on the MS Contin.

    I too have problems with the MSC but I take a anti nausea medication with it. I can definately tell when the second round of it is released because I will feel a bit of nausea. Without the anti nausea meds I was vomiting regularly. I can't take Methadone because it makes me too drowsy and Oxy tears up my stomache so Morphine is the only med I can take. I am also allergic to Fentanyl which is another medication that is often used.

    No one really likes being in a Pain Management program but for many of us it makes the difference between being able to get out of bed in the morning and walk rather than suffering in misery unable to move.

    Barbie

     
    Old 09-28-2006, 06:33 PM   #10
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    Re: Visit to Pain Mgmt. Dr....

    Thanks Webdude, Kissa & Shawley for your replies.....It is comforting that others have similar problems...(& I'm sorry about that for your sakes), it makes it easier for you all to understand....

    I have had problems with meds...side effects/reactions etc. so I am very careful about what I have to put in my body...I know I told you before, but meds. really do scare me....BUT, I do take them...have to, cause I can't accept living with my back pain...

    I am not afraid of becoming dependent on medications...that is the least of my problems right now....when I had my ACDF, I was basically off meds. withing 6 to 7 weeks....and I had been on them for well over a year..

    I think my PM Dr. is conservative....from what I read here on the Boards, others take a great deal more medication...my strongest up until last week was 10/325 oxycodone every 6 hrs. and that as we all know does not cover the pain...the 45 min. for it to work. then it wears off about 4 hrs later...there is some lag time there..which is not very comfortable.

    As I mentioned, I had a bad flare 2 weeks ago, and PM Dr. changed my med to the morphine sulfate (MSir)... My pharmacy called me & my Dr. regarding previous reaction to Ultram...but my PM Dr. said to take the med. I also have major problems with sulphur...but PM Dr. said take the med again. I hate to seem like I am not willing to follow directions, but I am afraid of the side effects...yikes...I can't take antihistimines...I swell up from them, so if I get a major rash I would just have to live with it!

    Kissa, you said my PM Dr. seemed conservative....I think I agree on that...he told me that I was at the top of the Oxycodone dose...but from what I am reading, there are higher doses.... I have also asked him a few months ago if maybe we could try a discogram to see if that would indicate the problem....he said that they are very painful (and what I am living with, it is not???) He also said that they only do that if they are planning surgery.... My MRI's show stuff (herniations, lateral herniations, bulges, hypertrophy, arthritis etc..) But my symptoms appeared to be from compression, according to the neuro I saw a few months ago...when he could not find the cause of the symptoms on the MRI, he basically dropped me.... nice huh?

    I am at a place right now, where I don't know what to do...got a call from my Dr. today, and the referral he was trying to get to a new neurosurgeon didn't work out....they didn't give any reason, but refused to make the appt. (the neuro. office). It is so discouraging....when symptoms and MRI don't match up....it doesn't mean there isn't something wrong, it just means they haven't found it....(like the lateral herniation I had which didn't show up until cervical ACDF surgery...and wow, that Dr. then said, geez, you must have been in
    pain....)

    My daughter is so sweet (and smart), she said they probably refused to see me because it's too complicated!) She made me feel better by acknowledging that she knew how I felt...discouraged.

    Sorry you guys have bad backs too, but you all have helped me...I am learning I am probably not getting enough meds...(why change me from my oxycodone, which does work...except for when I have a bad flareup...a breakthrough med. would probably work for a short time. oh well

    Thanks again
    Sage

     
    Old 09-29-2006, 07:21 AM   #11
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    Re: Visit to Pain Mgmt. Dr....

    Hi Sage... sometimes, you have to be a bit more aggressive with your doctor... Not to be mean or obnoxious, but stand firm and ask questions and just dont take an answer that doesnt make sense... For example, just tell him about the other doses of oxycodode that others are taking...

    Also, you mentioned compression.. Perhaps, you can try the DRX-9000 machine, which is basically a high-tech traction machine.... I know people personally that swear by it, and also others that said it did not work... The only problem is that if your insurance doesnt cover it, then it will cost you approx $2500 for the complete regimen.. (20 sessions or so)... Some doctors give you a guarantee and tell you if you dont feel SOME results in 8 sessions, they will refund your money... Or if you dont feel it getting better after 8 or 10, you can stop...

    God Bless..

    Maurizio

     
    Old 09-29-2006, 07:25 AM   #12
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    Re: Visit to Pain Mgmt. Dr....

    DRX quoted at $4000 for 20 sessions. No guarantee, additional treatments, if necessary, cost $250 a session. This has not been a tested proven cure. Expensive, not guaranteed, not proven...so why do it?

     
    Old 09-29-2006, 07:51 AM   #13
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    Re: Visit to Pain Mgmt. Dr....

    Sage,

    I am sorry to hear you hurt so much. I can surely relate. I had an ACDF too a few years ago and then was in a car accident which broke a screw and did permanent nerve and muscle damage. I have other health problems as well including a herniated back, but the damage to my neck seemed to be the straw that broke the camels back. I do find that Lidoderm patches help me alot but they are not for everyone. For some folks it does work and others it does not. It's trial and error.

    I'm sorry but your PM is not telling you the truth. THere is another member on the Pain Management board who's doctor told them that long acting Oxycodone doesn't exist, then they later went on to tell them they only make it in 5 or 10 mg.

    Doctors do this because of they fear getting in trouble with the DEA because state laws do vary and they can be quite strict. If he doesn't want to help control the pain then I would seek out a new doctor. If you have no choice but to see him then it may take being assertive to get the help you need.

    If you can take the percocet without issue then I would think you would be ok with the Morphine but again, you won't know until you try. And the real key to pain management is not to take pills when you need them but to take them before you need them, sustaining a level of medication in your system on a regular basis.

    You might do well on Oxycontin but many doctors do fear prescribing it. I know my PM will not prescribe it at all, he prefers Morphine or Methadone. Each doctor is different.

    I think it is essential to find out exactly what the problem is. Medication only masks the pain, it doesn't cure it. If there's a viable fix it's always better to go that route.

    Have you tried any alternative means such as a Tens unit? Deep heat and massage therapy might also prove to be benificial. There are many tools to controlling pain, not just medication alone. Sadly our society today wants an instant fix or control so they opt for medication rather than trying more natural or non prescription type alternatives. You do not strike me as that type of person since you are very concerned about the medication you do take.

    Alternative methods won't be the cure all either but it might help to get you through some of the tough spots.

    As far as a break through medication during the tough spots, it does make sense but you are currently on short acting medications to begin with. I could see potentially that he would put you on Oxycontin or the Morphine as your base and permanent medication until you are better. Once those are titrated to a level in which you are comfortable then you should consider break through medication and only use it as such.

    Many individuals use their BT medications as part of their daily regimine. It totally defeats the purpose. You should only take BT meds when you need them. If a patient finds they need them every day then their base does is not strong enough. (not directing it at you, just saying in general)

    I do hope things get better. Please do continue to let us know how you are fairing. I know that it is difficult to be in chronic pain. It does control your life.

    You should really stop by the Pain Management board here. The folks there are very welcoming and are great at offering wise advice. You might learn a thing or two over there as well as here.

    all the best
    Barbie

     
    Old 09-29-2006, 01:36 PM   #14
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    Re: Visit to Pain Mgmt. Dr....

    Dear Jlo & Webdude & Kissa....

    Thanks for so much info.....I haven't tried or even considered the DRX treatments...I've been reading about them...BUT I do not believe that my insurance will pay for that...some of the people who have used them have some results immediately, but return to the way they were after a period of time..others have had good results. I would try them, but I am not working, and I really can't afford that amount, unless my insurance paid for it.

    I have been in physical therapy in the past...it helped a bit....the heat therapy was great, as was message...I even paid out of pocket to see a rehab. massage therapist..she was wonderful...they usually only delt with insurance companies...for people who were in auto accidents etc. They really didn't know what to do with my checks...but they were so good to me....and it helped...but again. it doesn't last...but, oh it was sooooooo good. I'd try it again....but, I could not affort almost 200 a week forever...

    I have done aqua therapy also, again...the water was so soothing, nice and warm...again...temporary fix. I have done several epidurals...but with no long term lasting results... I unfortunately developed adrenal insuffiency from all of the steroids...so I haven't had any more epi's in the last year or so....

    Looking back at my Pain Mgmt. Dr., he is a good man, trying to help. He is at the end of his treatment plan with me. From what I am gathering from this board & the Pain Mgmt. Board, he has been very conservative with the meds. I have been on the hydrocodone, oxycodone & now the morphine... I had lidoderm patches before I had my ACDF...they worked pretty good, but I seem to have developed a problem with them, they set my heart off racing, tachy...not good... The PM Dr. sent me to the neuro...who looked for the cause of the compression symptoms...which he didn't find on the MRIs....so no help there, he didn't continue searching for the cause.... Trying to get another appt. with a different neuro...

    I have been on the Pain Mgmt. Board...they are great people also. Some of the same ones who are on the Back Board!! That's where I learned about the long acting meds...which obviously I don't have....and other things.

    Guess I will be changing Pain Mgmt. Drs., not necessarily because I don't like this one, but because he doesn't seem to understand that this back pain is not going away on it's own, and I need the long acting meds...3 or 4 oxycodone a day is a pain...litterally... Also, when I asked him about the discogram...I was told it was painful, and only used if surgery is planned...Now I have learned from you guys & others...it is a diagnostic tool... Just a lot of little things, change can be good...also, he is getting tired of me...me not getting that much better....etc.

    Thanks for all of your thoughts and ideas....I do really appreciate it.

    Sage

     
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