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  • PM and Hospital visits for a different Med

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    Old 11-10-2015, 10:08 PM   #1
    anok
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    PM and Hospital visits for a different Med

    Hello all. I am on percocet 10mg 4x per day and recently gabapentin 300 mg 2x per per day from my PM DR. The gabapentin was added to try to "smooth the transition of my compliant to my PM DR that there is always BT pain in between doses and refused to up the frequency or put me on an extended release oxycodone formula. I feel this is not proper for chronic referred pain from a disc herniation in my neck causing constant muscle spasms in between my left shoulder blade. So i went the ER 2x they gave me Baclofen which did nothing than 3 days later i went back and they gave me 10 5mg Valium for the constant muscle spasms. I have not felt this great in 2yrs, the spasms are almost completely gone, i dont worry about how much pain im going to be in when i wake up Question is can i get in trouble from my PM DR for receiving Valium from the ER? I know im on a contract for narcotics, but would Valium apply as well? I want to tell him that i finally found something that is working but dont know if i would get in trouble? Anyone know?

     
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    Old 11-11-2015, 12:51 PM   #2
    backhurtz
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    Re: PM and Hospital visits for a different Med

    Yes, you absolutely can get in trouble/dismissed for doing what you did.
    Part of the contracts usually reads that you will not obtain scheduled meds from another provider, which includes the ER. In the event you need to go to the ER, you are usually supposed to notify the doctor PRIOR to filling any prescription given to you for the condition you are being seen for. When it comes to scheduled meds, you always need prior approval before filling them, no matter what.
    Baclofen takes several days before you see the benefit of it, since it works differently than other muscle relaxers.
    Your pm office will know, whether you tell them or not, since almost all states have a prescription monitoring program in place that requires physicians to check the database prior to writing prescriptions for scheduled meds.
    I would be prepared to be dismissed.

     
    Old 11-11-2015, 03:16 PM   #3
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    Re: PM and Hospital visits for a different Med

    Quote:
    Originally Posted by backhurtz View Post
    Yes, you absolutely can get in trouble/dismissed for doing what you did.
    Part of the contracts usually reads that you will not obtain scheduled meds from another provider, which includes the ER. In the event you need to go to the ER, you are usually supposed to notify the doctor PRIOR to filling any prescription given to you for the condition you are being seen for. When it comes to scheduled meds, you always need prior approval before filling them, no matter what.
    Baclofen takes several days before you see the benefit of it, since it works differently than other muscle relaxers.
    Your pm office will know, whether you tell them or not, since almost all states have a prescription monitoring program in place that requires physicians to check the database prior to writing prescriptions for scheduled meds.
    I would be prepared to be dismissed.
    -i never understood why a Pain Management patient would have to go to the ER for additional PM therapy?

    -beyond a SERIOUS medical emergency ,there is ZERO necessity IMO

    GL

     
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    Old 11-11-2015, 06:36 PM   #4
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    Re: PM and Hospital visits for a different Med

    Read any contract you signed for the answer. They all vary. Mine for example is more liberal and allows any meds (including opioids) on a short term basis (and doesn't even define that), and I am supposed to tell them afterwards. Others are very restrictive and don't allow any short term meds that can be used to treat pain. So, it could be anywhere in between being dismissed without question and your doctor better understanding that your pain is under-treated. Note that it is uncommon to be prescribed both opioids and a benzo like Valium as the combo can be dangerous. My doctor for example only prescribes Valium as "sedation" for procedures.

    If your doctor isn't sufficiently treating your pain (often defined as 50% relief), and isn't trying anything new, then find a new doctor. Make some initial appointments and see if anyone else would be a better fit. Only after choosing a new doctor should you cancel care with your current one. As long as you don't accept any scripts from more than one doctor at a time, there shouldn't be any problem. Keep in mind that if your doctor is continuing to try you on new treatments, it can take significant time to find the best regimen.

    Its often a combination of long & short acting meds, alternative therapies, and lifestyle changes. Your doctor may not feel comfortable changing or upping your opioid at this time, but as long as they are trying something, they are trying to treat your pain. They will start conservatively and work up from there. Pain management is moving away from using opioids in non-cancer chronic pain patients, even those with years of failed treatments who have done well long term on low dose opioids. Best wishes.
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    Old 11-12-2015, 07:28 AM   #5
    backhurtz
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    Re: PM and Hospital visits for a different Med

    Gabapentin is not a medication that works instantly to relieve additional pain. There is a very large dosage range, that must be slowly increased until it starts working, while keeping the side effects at a minimum.
    Just like baclofen, both meds need to be slowly increased in dosage and allowed to build to a steady blood plasma level for them to work well.
    Muscle spasms are not generally a medical emergency, and while they can be painful, usually can be managed with over the counter meds or creams, or even the disposable Tens unit available in pharmacies.
    While there is some variation in some contracts, the key words are usually involving acute injuries/illnesses and being seen by another doctor/facility and receiving prescriptions for the condition you are being treated for by pain management.
    Either way, I would be prepared to be questioned about both ER visits and why you failed to contact your doctor before filling either prescription.

     
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