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    Old 12-27-2015, 10:57 PM   #1
    12Victor34
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    What to do ...

    Hi all,

    I have been in pain management for about 10 years now and have done very well with it. I truly attribute it to giving me a life with much less misery than I otherwise would have to be going through and was going through in the years prior to starting up with my pain management provider. I am quite sure many of you in pain management tell a similar story about the positive impacts treatment has given your life, in particular through the use of opiate therapy.

    Very long story as short as I can, I have been with and still am currently seeing the same pain management clinic for the last 10 years. I initially was seeing a most excellent doctor and he was of the sort that prescribed as required within reason of course (some may think , others not) to achieve what could be said is as comfortable a life as possible. I valued this doctor very much and was blessed to have him for as long as I did.

    Needless to say ten years is a long time and my worst fears have come true, my doctor who has been taking care of me the majority of the time at the current clinic has moved on, and the current doctor who is seeing me, appears dead set on drastically reducing my dosages from where they are currently at.

    In fact i have already my dosage reduce by approx 40% from where I was at, and I am afraid I am nearing the thresh hold of having my meds reduced any lower would start to impact my quality of life.. Fortunately the doctor I am seeing is quite decent and reasonable in that he is lowering me at what would be considered a fairly moderate taper, and it hasn't been drastic.

    But the moral of the story is that he is dead set (at least I think he is at reducing my dosages to numbers that would be about a 1/6th of where I was previously at.

    I have told him how positively opiate therapy has inpacted my life, and how I tried many other methods and undoubtedly opiate therapy is the way to go for me. Regardless of my input he just sites what industry standards on maximum dosages per day are and various studies that say opiate therapy is not quite the benefit that people think.

    I am to be honest very scared at the moment, as I see this impending doom right around the horizon and I don't know how I will handle living if such a circumstance where to occur.

    I am considering going to Another clinic , of course my big concern would be , is one will the new clinic treat me and 2 will they treat me as I suppose i am hoping to get treated (as stated above) and of course that means maintaining my current levels..

    The other concerns I have would be , while in the process of attempting to find another clinic , will I risk Anythhng with the current clinic I am at. But I don't want to wait till the last minute a few months down the line, when I will no longer be able to handle things, at the levels I am afraid this current clinic will reduce me too.

    In all honesty I hate the thought of leaving the place I am at, the office and the facility as a whole has been a God send for me and I just dunno, I am sort of rambling here.

    To be honest I am not quite even sure to EXACTKY where this new doctor intends to take me, maybe he will stop cutting my scripts in an appointment or two and I can find a way to live life at the new levels he has reduced me to, I guess my biggest fear right now is the unknown.

    I am sure many of you have been able to relate or can literally relate as I type this.

    Any advice or idea or anything would be much appreciated. Again I am not sure what I am even looking for by typing this post, maybe a similar story with a good outcome or not, or just anything someone who has been in this situation before that has done, that might help my current predicament.

    Thanks again!

    Last edited by Administrator; 12-28-2015 at 06:55 AM.

     
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    Old 12-27-2015, 11:32 PM   #2
    backhurtz
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    Re: What to do......

    I was in a very similar situation, having a phenomenal doctor, who was very receptive to adjusting my meds as I felt were necessary for 10 years as well.
    He left, his replacements were similar in their philosophy and willingness to let me guide increases or decreases, until the owners of the practice decided to close the local office.
    I decided on my own several months prior that I wanted to see how low I could go in my overall dosages and did that in conjunction with my doctor.
    I was on a relatively high dose of fentanyl, with breakthrough meds, so we reduced it by one third at first, then half , finally converting to another oral extended release, again at a further reduction of equivalent of the lowest dose of fentanyl, and it worked out quite well for me.
    I have not had unreasonable increased pain and also managed to reduce my breakthrough meds frequency as well.
    Try to be positive about the reduced amounts, and try pacing your activities a bit, and expect some short term increased pain , but try to keep in mind that it will settle down, given a bit of time.
    You may find yourself pleasantly surprised, as I was, that despite significant reductions in overall dosages. I didn't loose as much in pain control as I thought I might.

     
    Old 12-28-2015, 01:08 PM   #3
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    Re: What to do ...

    I too had a dose reduction (now on 1/3 of my max Methadone dose daily and 1/2 my max Oxycodone dose as needed), although it was following a forced Suboxone trial, and things turned out well. My pain levels now aren't any significantly higher, although I had a miserable couple months.

    I think dose reductions when done right are a good thing to try. Many patients do fine on less. I think however:
    - the end goal needs to be communicated with the patient
    - reductions should be a small percentage so it doesn't get more difficult as you get lower in dose (for example from 15 to 10 mg is more of a drop than 20 to 15 mg is its a larger percent of the total)...often doctors take the easy route for them on prescriptions and calculations which is harder on the patient
    - reductions should be a small percent as to minimize the risk of withdrawal
    - ideally it should be done at a time of year which is more manageable for the patient, such as if they get less pain typically or have time off in summer

    Its always not a bad idea to line up a second opinion, just be sure not to sign a contract or accept any scripts. If you have voiced your concerns and are being ignored, thats not good. I don't think its a risk, but there is always a possibility of trouble of course. I have only heard of trouble when accepting (and edpecially filling) scripts from more than one doctor.

    Is your doctor trying anything new to try to make up for any increases in pain? That is where a new doctor could be helpful; even if they too wouldn't support your dose, hopefully they would have ideas to try. Unfortunately the climate is changing and many doctors aren't willing to keep any pain patient on opioids long term. Best wishes.

     
    Old 01-02-2016, 06:51 AM   #4
    BigBlock21
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    Re: What to do ...

    Too many doctors these days think they are the doctor god and you must do as they say. It is in fact the other way around, the doctor works for the patient. If you do not like the service you are getting, it is very much acceptable to look for another doctor, a second, even third opinion. Some doctors are just plain bad at their job. Every profession has people like that. Please do tell them you aren't just shopping for pills.

    I'm not afraid to stand up and say "no doc, you're not listening to me, and I don't think your advice is correct". I'm in the process of making formal complaints against my primary care doctor right now for this type of behavior.

    The patient is the person who is in charge of their medical care...don't let them boss you around. It's your body, and nobody is more of an expert in it than you are.

    Good luck with your pain.

    Last edited by BigBlock21; 01-02-2016 at 06:57 AM.

     
    Old 01-02-2016, 06:55 AM   #5
    BigBlock21
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    Re: What to do ...

    Another thought, have you considered anxiety drugs, even if only temporary? It seems like you have anxiety about changing your dosage. Anxiety actually makes pain worse in itself. Sometimes an anti-anxiety medication can help with pain for that reason.

     
    Old 01-03-2016, 09:00 PM   #6
    12Victor34
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    Re: What to do ...

    I have but I don't react well to anxiety drugs and while I agree anxiety does and has made my pain worse, I just don't know if I want to go down the path.

    After trying everything under the sun, opiates is the only thing that has worked for me in such a way as to minimize pain so that I can work, sleep, and function in a productive and positive way.

    I also have a very sensitive stomach, many medication cause me all sorts of difficulties and discomfort in this realm, actually opiates has helped me on this level too, I have suffered over the years actually since childhood from severe stomach cramps and irritable bowel syndrome issues and opiates has really helped with this issue as well, as I really badly suffered in that respect as well until starting opiates and that's another anxiety and fear I have of having my current opiate intake lowered to who knows what.

    So good advice and idea with that, but I think might not be for me, as benzo have been a stomach irritant to me over the years as well.

    It's just sucks, I almost was to take a lie detector test and I think we all should do discuss honestly how we suffered prior to opiates and how for some of us they have successfully helped our situation and quality of life...I wonder how much my own doctor (my new one) really believes my pain level or if he thinks my concerns are only as it relates to withdrawal , I just don't know anymore ..

    I hope I am wrong but as I see it now I need to find a new doctor who will truly believe me and is concerned with helping me, and j know that how much he is willing to prescribe may not even have anything to do with that, it could be one of many factors, such as prescribing guidelines, or well whatever we all know the various reasons doctors prescribe as much as they do or don't, etc...

    We will see what happens, I pray it all works out and whatever the result I can still live in comfort and as pain free as possible and I truly pray the same for every one else on this forum...as I can sympathize/empathize with everybody here regardless of the condition of their pm treatment.

     
    Old 01-04-2016, 04:41 AM   #7
    BigBlock21
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    Re: What to do ...

    Quote:
    Originally Posted by 12Victor34 View Post
    but as I see it now I need to find a new doctor who will truly believe me and is concerned with helping me,
    That's exactly right, you gotta keep looking until you find somebody who really cares. Some people become doctors because they want a fancy house, others become doctors because they want to help people. Unfortunately there are probably less of the later.

    It seems like one of the biggest issues for people with pain to manage is managing the doctors and all the stupid little games they play. I feel like I need to start talking to my elected politicians about these issues...

    Just don't be afraid to let your doc know you disagree with the treatment, and it isn't working for you.

     
    Old 01-04-2016, 11:52 PM   #8
    12Victor34
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    Re: What to do ...

    Thank you for the words of encouragement j just hope it all works out!!!9

     
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