It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board

  • Hydromorphone Pain Management Issues

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 03-12-2016, 03:44 PM   #1
    Sadistik
    Newbie
    (male)
     
    Sadistik's Avatar
     
    Join Date: Mar 2016
    Posts: 4
    Sadistik HB User
    Hydromorphone Pain Management Issues

    First I would like to give you a little background of my condition. In May of 2011 I had a motorcycle accident in Las Vegas while going 90mph. Luckily I survived the crash and didn't mess myself too badly.

    My left Tibia shot out the back of my knee severing my Popliteal Artery and the major nerve that runs down alongside it. I completely tore my ACL and extremely stretched out my PCL. They weren't able to get blood flow to my foot for almost 3 days and literally had to fillet my left leg at the Tibia on both sides to reduce the swelling and get blood flow to my foot. Due to this and the nerve being severed I now also have foot-drop and have very little motion (about an inch) in my foot and a loss of feeling in most of the foot & leg. I broke my jaw (which they were able to fix with wiring my mouth shut) and cracked most of my teeth. Also my pinky finger on my left hand was completely bent sideways 90 from the first joint. Luckily the only bone that was broken was my jaw. I don't remember the accident at all. Just remember waking up in the hospital after being there for 3 days.

    I was given 9 bags of blood to replace all that i had lost. I am currently 33 years old.

    While in the hospital (30 days) I was on a regiment of Hydromorphone, Morphine, Roxicet, and Percocet. I was in a great deal of pain and even being treated with all of those, I still had severe pain in my leg and foot. Prior to my accident I was literally healthy as an ox, and had no medical issues at all.

    The pinky was fixed no issues today. They were going to repair the ACL & PCL but once they opened it up in surgery and saw how badly my Popliteal artery was damaged they decided to just clean out the area and leave as is. They felt if they clamped off the artery, they might have to amputate my left leg. So to this day, I wear a full leg brace on my left leg with a special foot piece with a spring to deal with the foot-drop.

    After being released from the hospital with an X-fix in my left leg prior to the ligament repairs, I was still on all the pain meds i was given in the hospital. Obviously most of the pain was controlled but still any major movements caused severe pain. After being able to recover to the point of being able to walk with a brace and taking my medication down to 4mg Hydromorphone 4 times a day, I started to notice that I damaged my lower back. I was unable to tell prior due to all the pain meds I was on. Well, I found out I have a protruding disk and also constricted ports where the nerves are supposed to come out in my lower back. I just found out about the ports literally about 3 weeks ago, so not exactly sure about the diagnosis or technical names.

    I started working about a year and a half ago due to being denied SSDI. Most days I can get away with 3 pills of 4mg of Hydromorphone when not working. But if I am working, I need the 4th pill to deal with the added pain that comes along with being back in the work force.

    I am seeing PM doctors now for my medication. My PCP was giving me the 4th pill with no issues at all. But because of the recent crack downs on doctors prescribing narcotic pain meds, I was referred out to PM. Well, PM refuses to give me the 4th pill and will only do 3 per day. My job is physical labor. I am literally about to lose my job due to not being able to physically handle the workload because PM has taken away the 4th pill that allowed me to continue to work. So now, I am coming up short on days I don't work and dealing with 7-8 pain levels. When I was controlled I was dealing with 2-3 which was tolerable and just chalked up to normal pain from the grinds of everyday life.

    I have tried everything that PM has suggested from lidocaine creams, Naproxen, Ibuprofen, Carisoprodol, Gabapentin, Voltaren Gel, Cortisone injections in my lower back, PT, Acupuncture, Inversion, seeing a Chiropractor, and now they're wanting to do a (thing women get while giving birth to help with pain, a shot in the back), and now also a pump that gives morphine directly into my back.

    The pump scares me becuz of the possibility of damaging my back due to my workload. If they would just allow me to have my 4th pill, I would be able to continue to work and be able to provide for my family. Sure there are days when i may need to take a 5th, but itz covered on days I only take 3.

    I have tried switching PM doctors but they still are only willing to do 3/day. I can't go to a PCP because they will refer me out to PM once they see the meds I am on. I have lost 2 jobs already due to not having my medication straightened out. I was initially VA then went to outside providers, all trying to get my medication on a stable regiment and also seeking 2nd & 3rd opinions on my medical issues.

    I'm currently stuck with the likelihood that I am going to lose my current job because I don't have the medication I need to be able to continue to work. I also have to be extremely careful of what I do because I do have a government security clearance and certain things can get it revoked or unable to be renewed. I have tried repeatedly to explain my situation but it's like they don't hear what I am saying. I have never done illicit drugs, or ever failed a drug screen.

    It would be great to be able to get off these strong narcotics but everything I have tried has failed at controlling my pain or controlling it enough that I can continue to work. What do I need to do to plead my case or find a PM doctor that is willing to listen and understand my situation? It seems like everything in my life is being strained due to not being able to get a stable situation with my medication. How am I supposed to provide for my family without being able to continue to work?

    Is there a special hearing I can request from a Pain Board or something that can review my case and help get me the approval needed? It seems like at every turn I hit a brick wall with my needs and it's starting to catch up. I'm getting tired of fighting for the help I feel I need. Luckily I have a very supportive and understanding wife who is my rock and tells me to keep fighting for my livelihood.

    I don't have depression, I'm just exhausted of being told that this is all we can do. I thought doctors were supposed to help their patients instead of worrying about what the DEA is doing. I understand if things look fishy or someone is abusing, but what about us the people who have a valid need for our medication and we can't get it because doctors are afraid of being prosecuted if someone dies or ODs on meds? That recent case where the doctor got 30yrs for a patient she had that died because of her over prescribing meds really did a number on patients being able to get their meds. That scared a lot of doctors and now their answer for everything is Tylenol.

    Someone please give me some advice because I don't know what else to do. Thanks in advance, and sorry it's so long, but it's every emotion I have pouring out into this and still i have curtailed it short.

    Last edited by Administrator; 03-12-2016 at 03:59 PM.

     
    Sponsors Lightbulb
       
    Old 03-12-2016, 05:11 PM   #2
    tortoisegirl
    Senior Veteran
    (female)
     
    Join Date: Mar 2012
    Location: Washington
    Posts: 1,204
    tortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB User
    Re: Hydromorphone Pain Management Issues

    Welcome! Have you been tried on a different pain medication since being out of the hospital? Something may last longer so you can stay within whatever limit your doctor is comfortable with. Hydromorphone is very very short acting, and actually isn't that great of a choice for chronic pain...have they ever tried you on a long acting pain med? Most of us are on a long acting med for baseline pain and a short acting med for breakthrough pain (as needed, not on a schedule). Even a different short acting med may give you more time between doses.

    I would ask your doctor to try you on a different med as you are struggling with only three doses a day. Specifically tell them how long each dose lasts you, what your average pain levels are without any meds, when the meds are working well, and when the meds wear off. Also keep in mind that 50% relief is a common reasonable goal. I'm shocked you were ok with even 4 or 5 doses a day, as Hydromorphone even only as a breakthrough med only lasts me a few hours. The prescribing information says dosing every 4-6 hours is commonly recommended. So, four or more doses a day wouldn't be considered high. As we gain tolerance to a medication (which is normal and occurs for everyone, although for some folks faster than others), besides it being less effective, often it doesn't last as long. Its more likely the total daily dose in that case is over what they are comfortable with.

    I think it would be ridiculous to even consider an implanted pump without trying ALL the pain meds out there and to have escalated the dose high enough to have side effects be a problem. From what you said, you are not a good candidate for a pump yet as your dose is low. Pain pumps are a last ditch treatment after often decades of chronic pain, trying literally everything out there, being on very high dose opioids, and struggling with side effects and/or still not getting significant relief.

    It also sounds like you really need to consider another job...opioids for chronic pain aren't meant to allow us to go about daily activities which significantly increase our pain. Its important to restrict activities that cause us pain to keep our doses as low as we can. A physically active job is usually out for most of us. There is a difference between managing baseline pain levels from caring for ourselves and managing breakthrough pain from being overly active. What does your doctor think about your line of work and its impact on your pain levels?

    There isn't a "pain board" or anything like that to get approval from. It all comes down to what your doctor is comfortable with. They may have outside pressure from the FDA, state, insurance companies, hospital, etc, to keep their patients under a certain dose. Last year I had my dose significantly reduced (by 2/3) as my doctor was no longer comfortable prescribing it, and I already knew they were the best option in the area as far as comfort level with higher doses...they now have a max daily dose they will prescribe, to reduce their risks. There are reasons it can also be in our best interest as patients too, as no one wants to get a letter in the mail saying their pain doctor had their medical license suspended due to suspected over-prescribing and sorry but your next appointment was cancelled and you'll have to find a new doctor before then.

    Have your doctors tried any treatments (besides the pain meds) for the newly discovered back issues? Pain meds are typically only part of an overall treatment plan, despite the type of pain. Other things that can be tried include non-opioid medications, injections, alternative therapies (pt, massage, acupuncture, etc), and lifestyle changes. If your doctor isn't offering to switch your pain med and isn't having you also use other pain management therapies, then it sounds like it may be time for a new doctor anyways. Best wishes.
    __________________
    Kate
    constant headache since 2006

     
    Old 03-12-2016, 05:43 PM   #3
    noevr
    Senior Veteran
    (female)
     
    Join Date: Feb 2007
    Location: Chester, VA
    Posts: 2,200
    noevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB User
    Re: Hydromorphone Pain Management Issues

    Hi I've been on opana ER, which is the long acting hydromorphone. You take 2 x day. I was on 10 MG percocet 4 X day prior and was put on 20 opana er but he also added 5 MG of hydromorphone 3 X day for breakthru. He didn't do the breakthru at first and I said I'm a little scared about the days I do extra things like go to grocery store or clean and overdo and have more pain will I still be covered for pain then he added the breakthru.

    The next visit we went up to 30 on the ER cuz it wasn't quite where I needed to be.

    So I would just say you were so on a pain support board looking for suggestions for other things to try and someone mentioned the ER. also is your major pain your back? You could ask him about a TENS unit and therapy. Let them know you are willing to try other things. When you are at work I'd wear a velcro brace under your clothes too.

    Also, for SSDI did you get an attorney? I'd do that.

    Good luck, cathy

     
    Old 03-12-2016, 06:07 PM   #4
    backhurtz
    Senior Veteran
    (female)
     
    backhurtz's Avatar
     
    Join Date: Oct 2008
    Location: NY, USA
    Posts: 818
    backhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB User
    Re: Hydromorphone Pain Management Issues

    You were on quite a bit of opiates for an extended period of time, and I am not sure how long you have been off the rest of the meds you were on.
    One thing you need to keep in mind, is that no doctor has to continue medications or dosages given to you by another physician,no matter what kind of med it is. Each doctor is going to determine what he thinks is best for the patient. Your primary doctor is not trained in pain management, which is why you were referred to a pm doctor.
    Hydromorphone is dilaudid, which tends to work pretty well when given by iv, but not quite so well by mouth for many people.
    It is never a good idea to take more than you are prescribed, ever, without your doctors prior permission. In the world of pain management, you are required to submit to random urine testing and pill counts, so not having enough of your prescribed meds is just as bad as having too much, and running out early results in automatic dismissals, and makes it very, very difficult to get treated by any physician with scheduled meds.
    Nerve pain typically responds better to medications used to treat that type of pain specifically, Cymbalta, Lyrica, Gabapentin, amiltryptaline are a few that are commonly used for that.
    As far as pain meds go, there are two types, extended release, usually taken every 12 hours, which deliver a constant level of medication to your system. Many people seem to think because they don't feel them kick in, that the dose isn't strong enough, or it isn't working.
    Not so.
    Immediate release or short acting meds are dosed somewhere between 4-8 hours, depending on the med and the physician. The issue with short acting is that there is a lowering of blood plasma levels of the meds, as you get close to the next dose time....this often results in people wanting to take more of the short acting after a period of time.
    I think if I were you, I would discuss extended release med options, along with nerve pain meds and see what suggestions they come up with.
    __________________
    Back surgery x2

     
    The Following User Says Thank You to backhurtz For This Useful Post:
    tortoisegirl (03-13-2016)
    Old 03-12-2016, 08:26 PM   #5
    noevr
    Senior Veteran
    (female)
     
    Join Date: Feb 2007
    Location: Chester, VA
    Posts: 2,200
    noevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB User
    Re: Hydromorphone Pain Management Issues

    Oops my bad hydromorphone is not opana!! Sorry.

     
    Old 03-12-2016, 11:36 PM   #6
    Sadistik
    Newbie
    (male)
     
    Sadistik's Avatar
     
    Join Date: Mar 2016
    Posts: 4
    Sadistik HB User
    Re: Hydromorphone Pain Management Issues

    Tortoisegirl,

    First I would like to thank you for your response. Since being out of the hospital, I have knocked down my narcotic medication to strictly Hydromorphone. At one point when I first started working they added on morphine pills to help with the breakthrough pain, but i didn't like the way the morphine made me feel when not on it, so I discontinued it. No, I have never been prescribed a ER med. I was on the hydromorphone for about 2 years taking only 4mg 4 times per day. Never had a single issue, pain was taken care of and it completely allowed to go about normal daily activities after making it to the point of recovery from the injury that I am currently at. I didn't start having issues with my medication and pain levels until I started back working. Which a lot of the positions I took were physically demanding. Which is what i wanted because I wanted to try to get back to being as normal as possible. My first job just entailed a lot of walking and stairs, minimal moderate lifting. Obviously these were jobs and not careers because I wasn't sure if I would be able to handle workloads and didn't want to screw up a chance with a good company by trying to come back too soon. But as I kept undertaking progressively more physically demanding positions, obviously my pain fluctuated. But I was still able to handle most jobs with 4 pills per day. Then obviously I took a job that really was physically demanding and that's where the add-on of the morphine came in, but I didn't stay at the position too long but I do believe I also did more hurt to my body than recovery. But I'm currently have a career where it isn't too physically demanding but requires the 4th pill. It isn't easy finding a position that I can fulfill that is going to pay decent $$$ without having the extra stress on my body. I can handle my position now no problem, but on 4 not 3. Also, PM wants to do an epidural (couldn't think of name earlier) to see how i respond to that prior to doing a test run of the implanted pump. I honestly have no want at all to try the pump, but PM is making me feel like that is my only choice. They keep saying we're gonna start lowering your medication because I'm on such a high dose. They keep saying they're worried about my long term health. Im 33, as of December, so I'm not super young nor old. But where is my long-term health gonna be if I can't work and be able to provide for myself and my family? Luckily my wife works also, but we have 4 children, 1 just graduated and getting ready to go back for his Masters degree, another is working on his Associates, another is Freshman in High School and then I have another son who lives in Italy with his mom and just turned 11. So, as u can see, money is a big issue because we have a ton to pay for. So to me right now, I'm willing to sacrifice my long-term health to provide a better future for all of my boys. The 3 oldest are my step children but they're my boys, they live with me and I provide for them. I can't do the typical fatherly sport activities due to my injuries but I can provide other things for them. I've switched PCP because my last one told me that I needed to take time off to recover. Which consulting with specialists and other doctors, I am at my max recovery and they're amazed I have recovered this far. And I just started back working for about 2 years now or so, and I can't afford to not work, especially with being denied SSDI and yes I had ALLSUP who was handling my case and trying to get my benefits for me. So I have to have money coming in somewhere to survive and the government ain't giving me a penny to help me. Yes, I have tried literally everything that PM has suggested to deal with my issues. I've been on Gabapentin, Amitriptyline, and more meds that i can remember. Thanks for your suggestions and I will speak again with PM Monday because I have to find a solution that both of us are happy with.

    ALSO I WILL RESPOND TO EVERYONE SO PLEASE BARE WITH ME AS IT WILL TAKE TIME TO RESPOND. AND I WILL TRY TO ANSWER EVERY QUESTION. THANK YOU.

     
    Old 03-13-2016, 12:00 AM   #7
    Sadistik
    Newbie
    (male)
     
    Sadistik's Avatar
     
    Join Date: Mar 2016
    Posts: 4
    Sadistik HB User
    Re: Hydromorphone Pain Management Issues

    Noevr,

    I don't kno what is my major pain because they all come on at different times. I took a dose of 4mg Hydromorphone around 1730 today. About 2200 my pain meds were starting to wear off, but not completely. The first thing I feel is my knee, I can feel that itz feeling abnormal, I can start to feel the movement in the joints and the looseness of the joints. Then I can start to feel a little achiness in my left ankle from walking. Around the same time I can start feeling tightness and a dull pain in my lower back. Itz not painful yet, but it starts requiring me to continually adjust my position. But the pain starts a little while after in my left foot. I can start to feel the nerves start shooting everywhere in my foot. Then comes the leg which starts hurting in different areas. Then the back starts getting progressively worse. Becomes very uncomfortable to sit, stand, lay down for more than 10-15 minutes in a position without changing. Then the ankle starts hurting and you can notice a sizeable limp to my walk, which when medicated u wouldnt be able to tell really that I wore a brace or that anything was wrong with me. Then you start seeing me struggle to drag my left leg. Then my knee starts really bothering me and how I really have to watch how I walk because of the looseness of the ligaments. Then the back starts aching with the shooting pains and I start having pain in my right knee, which typically never has had an issue. I start getting pains in my 2nd toe becuz my big toe kind of bends in toward it and I feel the pain of the nail digging into my other toe, which sometimes it gets so bad I have to put a tissue between them to try to help with the pain. But before it gets this bad, I always take another pill. But un medicated, I can't get out of bed becuz of the pain in my back. I toss and turn constantly becuz of the pain. I can't sleep for more than 30 minutes at a time. Sleep is few and far between when I don't have meds. But I can't bend over, I can't kneel, I can't climb steps, and itz a nightmare without my meds. But the pain goes thru the roof and nothing helps when I don't have my meds. I have tried OTC meds when I am without my meds and it doesn't cut it. Even still while medicated I still have pain in my lower back and left foot and knee. Itz just at a manageable level that I consider it like normal aches and pains from the grinds of life like anyone would have. I do wear a back brace while working and yes I had ALLSUP represent me when I tried to get SSDI. I don't mind having to work for a living, but I need the tools to be able to work.

     
    Old 03-13-2016, 12:48 AM   #8
    Sadistik
    Newbie
    (male)
     
    Sadistik's Avatar
     
    Join Date: Mar 2016
    Posts: 4
    Sadistik HB User
    Re: Hydromorphone Pain Management Issues

    Backhurtz,

    I was given Gabapentin for the pain in my foot, but I didn't get any relief from the pain. I was taking I think 8 Gabapentin pills at one time to try to help with the pain. At the time I was taking those, I hadn't noticed the pain in my lower back due to the Hydromorphone and other medications covering it up. I still have plenty of Gabapentin so I think I will try taking some of those to see if they will help with the lower back issues. But for the rest of my injuries, it did nothing. I have also been on the Amitriptyline but it caused severe memory loss and my doctor took me off of it. I was literally forgetting days where I had no clue about. My wife would tell me things that we did and I had no memory of anything, and I literally thought she was messing with me until I told my PCP and she explained that it was a side-effect of the medication and then I was taken off of it and haven't been put back on it since. I will talk to my PM and see if I can try a ER with maybe having the Hydromorphone as a breakthrough. I am willing to try anything to resolve this matter and continue to be able to work. But not working is not a possibility and I refuse to submit to that. I have bills to pay just like everyone else, with mine being quite more I assure you. And if I can't get help from the government in the form of SSDI then I have no choice but to subject my body to the grinds of working a fulltime job and just having to deal with the consequences. Do you have a suggestion for a ER that would be suitable for my case. I'm literally wanting my PM to do a case study on me just so that they can see what it is I go through each and everyday and that inversely while they think they're helping me, they're actually hurting me. Oh, and yes NOEVR, I have a TENS machine that I put on my lower back which only numbs my back for a short period of time while being cranked to the max practically, and you can see the flinching of my body due to it being turned all the way up. And yes, I have tried it as prescribed and still same no major relief. But I was on the extreme regiment of pain medications for about 6 months or so after being released from the hospital. Then it went down to just the Hydromorphone and Morphine liquid for about 2-3 more months and then just down to the Hydromorphone. Which initially it was 2mg Hydromorphone while on the extreme with other narcotics then when it was only the Hydromorphone it went up to 4mg. So I have tried everything they have requested of me. Even sitting here typing this message, after taking a dose an hour or so ago, my back is aching and starting to bug me, and I have only been sitting here for about 10 minutes or so max. I also believe that my brace is causing some of the pain due to one leg being longer than the other while wearing the brace and causing my back to be unlevel. Which is possibly why when laying down even then I still can't get comfortable for more than 60 minutes medicated or 5-10 minutes unmedicated. So I don't kno what else to do, because nothing is really helping me get better truly, my pain is only being masked. And if that is all that they are willing to do, meaning no further surgery on my knee or lower back, then at least mask my pain to where I can continue working and have some sort of normal life.

     
    Old 03-13-2016, 04:54 AM   #9
    noevr
    Senior Veteran
    (female)
     
    Join Date: Feb 2007
    Location: Chester, VA
    Posts: 2,200
    noevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB User
    Re: Hydromorphone Pain Management Issues

    Hi you know why don't you try to get some feedback on here from others that have the pain pump? I know you don't want it. I have a friend who's back it fused all the way up practically she is on SSDI she has a PUMP. it really helps her. But one thing I would ask would you still get an low dose oral med for breakthru? She had to fight to get that but she did and it really made her life bearable.

    Also there are others nerve pain meds to try lyrica and I like topomax.

    Cathy

     
    Old 03-13-2016, 04:54 AM   #10
    Eva 14
    Member
    (female)
     
    Join Date: Feb 2014
    Posts: 86
    Eva 14 HB UserEva 14 HB User
    Re: Hydromorphone Pain Management Issues

    I just want to say that in my opinion, 12 mg. or 16 mg. of hydromorphone daily is a very low dose for severe chronic pain. I agree that you should try an extended release pain med, such as Exalgo (extended-release hydromophone). Exalgo combined with a short-acting pain med may take care of your pain issues almost completely, and it doesn't sound like you'd need a very high dose of either med.

    I agree that an implantable morphine pump should be a method of last resort. I have excruciatingly severe pain and a complex med regimen, but I've still never had a morphine pump recommended to me. I think the morphine pumps are reserved for CP patients who aren't getting much relief at all from their pain meds (even in high doses). I have no idea what the risks are with the pump, as I've never looked into it.

    I understand your frustration about not getting SSDI and needing to work. I'm in the same situation. Obviously, if there's anything you can possibly do that is less physically taxing, look into it, even if it means taking classes and switching careers. If you're good with computers or anything else where you can sit at a desk all day, that may be a better career choice for you. I know it's not easy switching fields, but we all do what we what must do. Sometimes, learning new skills can be the answer.

    Between your relatively low dose of hydromorphone (which seems to work for you) and some of the nerve pain meds, hopefully you'll be able to find a med regimen that adequately controls your pain. I think that an ER med like Exalgo would be an excellent choice for you.

     
    Old 03-13-2016, 08:17 AM   #11
    backhurtz
    Senior Veteran
    (female)
     
    backhurtz's Avatar
     
    Join Date: Oct 2008
    Location: NY, USA
    Posts: 818
    backhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB Userbackhurtz HB User
    Re: Hydromorphone Pain Management Issues

    Do NOT start taking any old medication, even one previously prescribed without your pm doctors consent.
    Doing that is called self medicating, and will get you thrown out of pm so fast your head will spin and no other pm doctor will touch you as far as being a patient goes.

    There are rules you are going to have to follow if you want this pm or any pm to treat you, and they are dead serious about the patients following them, otherwise they will toss you out of the practice.
    Never take old medications- if they are not part of your current treatment plan-ie. Being prescribed for you right now, then dispose of them properly.
    Never take more than you are prescribed unless and until you clear it with your pm first.
    Plan to be called in for pill counts and random urine tests, because they will happen.
    Read the contract you signed, and understand it.
    In the world of pain management, a reduction of about 50% of your unmedicated pain levels is considered a good outcome. There is no such thing as eliminating all of the pain . PM is about reducing and managing the pain, using combinations of meds, therapies and other treatments.
    As for the gabapentin, do NOT start taking it until your doctor tells you too. If he does, gabapentin, and Lyrics both need to be slowly increased in dosage until an effective dose is reached. Neither medication should just be stopped or started without going slowly and increasing or decreasing the dosage.
    You may have to find different work, and make other lifestyle changes. No doctor is going to give you "enough"meds that you can go out and do physical things your body just can't or shouldn't be doing....doesn't mean you can't work or provide for your family but it does mean that they aren't going to agree to increase the meds you are getting so you can mask the pain and continue to worsen your condition.
    If your legs are uneven and contributing to your back pain, ask for a referral to your orthotist, and they can adjust your kafo or insert a lift to even out your leg discrepancy.
    Have you gotten any MRI or CT scans done to determine what might be causing the back pain? If not, that might be a good idea to discuss.
    __________________
    Back surgery x2

     
    The Following User Says Thank You to backhurtz For This Useful Post:
    ferd144 (03-13-2016)
    Old 03-13-2016, 10:02 AM   #12
    tortoisegirl
    Senior Veteran
    (female)
     
    Join Date: Mar 2012
    Location: Washington
    Posts: 1,204
    tortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB Usertortoisegirl HB User
    Re: Hydromorphone Pain Management Issues

    Agreed--don't start taking an old med or make ANY changes to your meds unless they are cleared with your doctor. One mess up and you could be kicked out and with that in your record, another doctor may not be willing to give you a chance. I'd also recommend not asking for a medication by name or dose either, as that can be considered drug seeking.

    If I was in your situation, I would bring up to the doctor that the Hydromorphone only lasts you X hours, so three doses a day leaves X hours in the day without pain relief. You could ask if there is something longer acting that could be tried so you could get more STEADY relief, or if a different med that might last longer so you could get by with only three doses a day. You could ask if there is anything you haven't tried earlier besides pain meds that may be helpful to pick up the slack since going from 4 to 3 doses a day, such as alternative therapies or non-opioid medications. Ask for referrals to applicable specialists to get a better diagnosis and treatment plan for your other issues, such as the back pain. You can bring up your concerns like you said that the pain meds only mask the pain and you feel the actual issues haven't been thoroughly addressed. Pain management doctors usually only address pain as a whole, but they should address your concerns and refer out as applicable.

    Also state that you are concerned that an implanted pump would be a huge leap, and that you don't feel like all other options have been exhausted. I've never heard of someone going from short acting meds to a pain pump. You could say you did some research and it seems like patients that get pumps are much worse off than you, on high doses, having tried all the possible long and short acting pain meds, getting lots of side effects, not getting good relief, etc, and the risks concern you. Its perfectly acceptable to bring a written or typed list in to your doctor with your concerns, and either use it as a guide to your conversation, or just hand it to them. When you have specific concerns such as one leg being shorter than the other with your brace, bring them up to your doctor. If they don't specifically address them (such as referring you to get a lift in the other shoe), its a bad sign, and you should look for a new doctor.

    Unfortunately with pumps the doctors have a huge incentive to use them even if they might not be medically indicated...profit, both the surgery and the refills. They make a huge profit on them, vs. basically nothing for office visits for meds. Although pumps can be life changing, I think they can leave patients open to a lot of risks. Very few doctors deal with them, so if a patient's doctor retires or whatever, a patient may have a tough time finding someone to take over. There is also the risk that after going through everything, the doctor may still have a dose ceiling in mind, so the patient would still not get good relief (or like someone else mentioned, the doctor may not give anything for breakthrough pain). Insurance may not cover it for someone who hasn't exhausted all other options either.

    Even if you aren't willing to take a less physically active job now, you may want to at least take steps for the future. For example, a certificate or degree program that would help you get a high paying desk job. Best wishes.
    __________________
    Kate
    constant headache since 2006

     
    Old 03-13-2016, 08:57 PM   #13
    Whoopee
    Veteran
    (male)
     
    Join Date: Jun 2011
    Location: USA
    Posts: 451
    Whoopee HB UserWhoopee HB UserWhoopee HB UserWhoopee HB UserWhoopee HB UserWhoopee HB UserWhoopee HB UserWhoopee HB UserWhoopee HB UserWhoopee HB UserWhoopee HB User
    Re: Hydromorphone Pain Management Issues

    You keep mentioning that 4th pill repeatedly but honestly the problem is that you're not taking the right medication for your problem. You should (IMHO) be on a legit extended release (ER) medication that will cover your pain levels for an entire 24 hour period. Personally I'm on 2 Opana ER's 40 mg as my ER med and oxycodones for my BT meds (4 - 15 mg) daily. That works pretty well for me and I think something similar may be just the ticket for you as well. Also something not helping your cause is that I have heard from others on this and other pain forums that hydromorphone (Dilaudid) notoriously comes up short of it's advertised coverage periods. I think it says it should work something like 6-8 hours when in fact, it starts to wear off after 4 hours or so (this is what I've been told). A true long-acting pain med should get you to at least the 7-8 hour mark before you'd need to take a BT dose to ride things out until you can get to the 10-12 hour mark. Then you'd be in good shape to take your second daily ER med.

    Good luck with things and I'm sorry but this is about all I can suggest at this time.

     
    Old 03-13-2016, 09:09 PM   #14
    noevr
    Senior Veteran
    (female)
     
    Join Date: Feb 2007
    Location: Chester, VA
    Posts: 2,200
    noevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB Usernoevr HB User
    Re: Hydromorphone Pain Management Issues

    I totally agree with whoopee you need a long acting med. You won believe the difference in how you feel, not so loopy or whatever. More on an even keel. Cathy

     
    Closed Thread




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 09:01 AM.





    © 2021 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!