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  • Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

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    Old 10-19-2005, 06:47 PM   #1
    TexasWildRose04
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    Unhappy Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

    I went to my pain management doc last Wednesday, and he ask me how I was doing on the Oxycontin, 10mg 3 times a day.... I told him that it really wasnt doing anything for the pain, but I had felt a bit of the depression comming back..., which the pharmacy said would be more due to the Klonopin then the Oxy... but anyway, he said he didnt think so and said to stop both for a couple days, see how I felt and if no change then start 20mg Oxycontin 3 times a day.. but in the process he says.... "So if you are backed against the wall about the Morphine Pump, or the Nerve Root Stimulator, Which would you choose?" I told him IF I had to choose, it would be the Stimulator... but I also told him that at this point I didnt think he had given the Oxy a chance to see if it was going to work, and to adjust it and try to see what dosage was going to work for me.... I mean I just went from 10mg 3 x a day to 20 mg 3x a day.. and only been doing the 20mg a couple days.... but for some reason he is really pushing this stimulator or pump which I don't feel good about.... I mean 20mg.. takes the edge off.... drops me from a 9-10 to a 6-7... which is better then nothing..... why not give this a chance to work first... I really don't desire to have a 35K surgery that I am gonna still be responsible for atleast 7-10K of.... and may or may not work....I honestly do like the Oxycontin, It doesn't make me drowsy, or have any weird Euphoric feeling or anything like that, this is actually the only drug like this so far that I have tried that I haven't had a problem with....I just really don't know how to deal with this....I mean is 20mg 3x a day of Oxy Alot? I really don't know....Any and all input is greatly appreciated....

    Thanks In Advance...

    TRose

    Last edited by TexasWildRose04; 10-19-2005 at 06:52 PM.

     
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    Old 10-20-2005, 06:16 AM   #2
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    Re: Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

    Hey Trose, There is something wrong when a doc backs you against a wall to force an implant because he would rather not deal with prescribning opiates or deal with their side effects. Intrathecal meds have side effects too. What if he sees a 5 as 50% pain relief, if your reporting a 6 or 7 now, is it really worth going through all the hasssle to go from a 6 to a 5 when you know you haven't titrated what's available properly. What other LA pain meds have you tried, any of the morphine products, meth, duragesic. Oxymorphine SR will be hitting the market hopefully sooner than later, it has been aproved by the FDA.

    So it's just a matter of workingout manufacturing and distribution. Often the creator of a drug will sell the rights to market and produce the brand product for millions of dollars. Sometimes they do it from the beginning of marketing and sometimes they simply sell the last 2 or 3 years of a brand for exlusive distribution of the product. Even those last couple years of brand rights are worth millions.

    It's a decsion that requires a succesful trial, you and the doc being on the same page as far as exepectations and as to why your going with one of the most advanced routes of PM.

    I think your right, if you can control the depression and titrate to where your getting better than a 5 on your pain scale, He may not be able to do any better with a pump, these devices are just tools, not cure alls. So what's the advantage if you presently have script coverage and the cost of the meds or side effects aren't preventing you from trying something else or a higher dose. Benzos do cause depression. After the last surgery they had me on Valim for 3 4 weeks and within hours of takng valium I would just be tearful for no reason. Some of us are moere sen****ve to side effects but it doesn't mean you in that corner yet.

    These are last resorts, not first line therapies and it really makes no sense to me to have a doc back you against a wall if you want your pain treated. It creates a lifetime dependnece on this doc to work with you and manage your pain, without the trust and mutual understanding I would be looking for another doc even if you decide you want to do a trial and go with an implant.

    You can change docs once you have a pump, it's just not quite as easy to find someone to take over a pump than someone to continue to try other methods. I know of a few people that did have to change pump docs several times to find one willing to tirate to a an effective dose, use BT meds and really maximize what pain management with a pump can provide.

    When it starts to sound more like extortion than an option when all else fails, something is wrong with the situation.
    Take care, Dave

    Last edited by Shoreline; 10-20-2005 at 06:23 AM.

     
    Old 10-20-2005, 06:18 AM   #3
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    Re: Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

    Now,you DO know just where to tell this doc to go now, don't you????This is just totally ridiculous,really.He has not even given you any real time to see how the oxy works and he is now pushing you into something that you really do not want to have????either straight out tell this doc that under no circumstances do you want to even consider any type of a surgical implant til you have been on the meds for a good length of time.If he still pushes it,see another doc,honestly,i went thru kind of the same thing when right after my surgery which resulted in all of my damage and severe pain,my NS(mind you,this was only dec and i had only had my surgery done in sept)was pushing me really hard at first to try that stimulator,despite the fact that i had not even really started any sort of 'real" PM with anyone.i told him I really did not want to go that route just yet til I tried many other options first.it even states on the medtronic website that their stim is only to be used as a last resort type of thing.i would really tell this doc that before trying ANY sort of implanted device(which causes its own set of real issues to have to deal with)you wish to try and go with meds to see what quality of life they can offer you.i would not let this PM push you into anything that you do not feel is really right for YOU and your particular situation.just say no.good luck and stand your ground with this pm and if he gives you a hard time about this,just tell him you wish to see another doc who will abide by your decisions.after all,it is YOUR body and you will be the one who has to deal with all of the crap that comes along with the implanted devices,not him.Keep me posted.You ARE doing the right thing here,really.Marcia
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    Old 10-20-2005, 10:42 AM   #4
    TexasWildRose04
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    Re: Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

    Quote:
    Originally Posted by Shoreline
    Hey Trose, There is something wrong when a doc backs you against a wall to force an implant because he would rather not deal with prescribning opiates or deal with their side effects. Intrathecal meds have side effects too. What if he sees a 5 as 50% pain relief, if your reporting a 6 or 7 now, is it really worth going through all the hasssle to go from a 6 to a 5 when you know you haven't titrated what's available properly. What other LA pain meds have you tried, any of the morphine products, meth, duragesic. Oxymorphine SR will be hitting the market hopefully sooner than later, it has been aproved by the FDA.

    So it's just a matter of workingout manufacturing and distribution. Often the creator of a drug will sell the rights to market and produce the brand product for millions of dollars. Sometimes they do it from the beginning of marketing and sometimes they simply sell the last 2 or 3 years of a brand for exlusive distribution of the product. Even those last couple years of brand rights are worth millions.

    It's a decsion that requires a succesful trial, you and the doc being on the same page as far as exepectations and as to why your going with one of the most advanced routes of PM.

    I think your right, if you can control the depression and titrate to where your getting better than a 5 on your pain scale, He may not be able to do any better with a pump, these devices are just tools, not cure alls. So what's the advantage if you presently have script coverage and the cost of the meds or side effects aren't preventing you from trying something else or a higher dose. Benzos do cause depression. After the last surgery they had me on Valim for 3 4 weeks and within hours of takng valium I would just be tearful for no reason. Some of us are moere sen****ve to side effects but it doesn't mean you in that corner yet.

    These are last resorts, not first line therapies and it really makes no sense to me to have a doc back you against a wall if you want your pain treated. It creates a lifetime dependnece on this doc to work with you and manage your pain, without the trust and mutual understanding I would be looking for another doc even if you decide you want to do a trial and go with an implant.

    You can change docs once you have a pump, it's just not quite as easy to find someone to take over a pump than someone to continue to try other methods. I know of a few people that did have to change pump docs several times to find one willing to tirate to a an effective dose, use BT meds and really maximize what pain management with a pump can provide.

    When it starts to sound more like extortion than an option when all else fails, something is wrong with the situation.
    Take care, Dave

    Hey Dave thanks again for you helpful input, as far as the other drugs I have tried, I was on Methadone for a year and half.... I have tried Vicodin,
    He mentioned the duragesic patch, but I had been told by another doc that those are only superficial... Is that true? and of course the vast aray of Neurontin, Keppra, etc....He's pretty head strong and sticking to the theory that .."I HAVE JUST ABOUT EXHAUSTED MY OPTIONS OF PAIN MEDS!" he says I have almost been through the entire list, which I highly doubt, I havent tried any of the morphine meds....

    To be quite honest, he has no idea of what the Oxycontin is taking my pain level to on a scale of 1-10 now that I have started takeing 20mg 3 times a day.... on a good day I MIGHT get a 5 which from 1-10 would be 50% relief, but those are very few and far between....and if I do much, I get MAJOR break through pain....and he didnt write me another perscription for more Oxy, he just said, do you still have several? If so up it to 20mg- 3 times a day, take 2 - 10 mg... and didn't give me an appointment until December??....I know I will need more Oxy before then....SO I need to call him and just tell him I have up'd it and that hes gonna have to write another perscription....

    But you are right, and I have been thinking seriously, I am going to start looking for another Pain Management Doctor.

    Thanks Alot again for the helpful info.

    TRose

     
    Old 10-20-2005, 10:51 AM   #5
    TexasWildRose04
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    Re: Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

    Quote:
    Originally Posted by feelbad
    Now,you DO know just where to tell this doc to go now, don't you????This is just totally ridiculous,really.He has not even given you any real time to see how the oxy works and he is now pushing you into something that you really do not want to have????either straight out tell this doc that under no circumstances do you want to even consider any type of a surgical implant til you have been on the meds for a good length of time.If he still pushes it,see another doc,honestly,i went thru kind of the same thing when right after my surgery which resulted in all of my damage and severe pain,my NS(mind you,this was only dec and i had only had my surgery done in sept)was pushing me really hard at first to try that stimulator,despite the fact that i had not even really started any sort of 'real" PM with anyone.i told him I really did not want to go that route just yet til I tried many other options first.it even states on the medtronic website that their stim is only to be used as a last resort type of thing.i would really tell this doc that before trying ANY sort of implanted device(which causes its own set of real issues to have to deal with)you wish to try and go with meds to see what quality of life they can offer you.i would not let this PM push you into anything that you do not feel is really right for YOU and your particular situation.just say no.good luck and stand your ground with this pm and if he gives you a hard time about this,just tell him you wish to see another doc who will abide by your decisions.after all,it is YOUR body and you will be the one who has to deal with all of the crap that comes along with the implanted devices,not him.Keep me posted.You ARE doing the right thing here,really.Marcia

    Thank You Marcia, You are right, I have made up my mind I am going to stand my ground and tell him that I definately DO NOT want to try any kind of implant until I have infact seen what kind of quality of life the meds will give me....I mean this guy has already told me that he doesnt accept Medicaid, and in Sept of 06 I go on medicaid, from being on SSD... so Its time I start looking now anyway, so I am not stuck, when I switch over anyway....but yes, when he said that to me the other day about if I was backed against a wall, What would I choose? I point blank told him... Neither! right now....He didnt seem to happy with that, but frankly I dont care... like you said, its my body, and I am the one that has to deal... Not him! He's already set me up some appointments with the in house psychologist, because he says you have to go through the mental assessment before they can do a implant... which I will see the Psychologist, but they still aren't doing the implant and I will tell this guy too...

    Thank you!!!

    TRose

     
    Old 10-20-2005, 01:00 PM   #6
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    Re: Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

    Hey TRose: You go on Medicaid in '06? Not Medicare? I'm on SSD too, and after being on it for two years, next year (2/06) I go on Medicare. I thought maybe that might be your situation too.

    I think the 20 mg TID of Oxycontin is pretty low to get any kind of significant relief. Not knowing everything about your case, I'm just going on personal results. I didn't feel much until I got to 40 mg TID with BT meds of 15 mg of Oxy IR. The low doses of 10 and 20 mg of Oxy, just don't seem to help many people.

    The Duragesic patch is very potent, that's why it is measured in micrograms rather than milligrams, like most meds. It works quite well for a lot of people. Again, it needs to be dosed every 48 hours rather than the 72 like the manufacture says. I was on it for several months and it worked quite well for me.

    One more thing about the Oxycontin dose and if it's alot. When I was on it, I was up to 160 mg. TID and for a short period QID. Taking it three times a day is 480 mg and four times a day is 640 mg. Everyone is different and my metabolism is fast due to stomach surgery years ago, but that is just an example towards taking 20 mg TID. As you can see, it's pretty low.

    Last edited by Rrector; 10-20-2005 at 01:06 PM.

     
    Old 10-20-2005, 04:00 PM   #7
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    Re: Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

    Quote:
    Originally Posted by Director
    Hey TRose: You go on Medicaid in '06? Not Medicare? I'm on SSD too, and after being on it for two years, next year (2/06) I go on Medicare. I thought maybe that might be your situation too.

    I think the 20 mg TID of Oxycontin is pretty low to get any kind of significant relief. Not knowing everything about your case, I'm just going on personal results. I didn't feel much until I got to 40 mg TID with BT meds of 15 mg of Oxy IR. The low doses of 10 and 20 mg of Oxy, just don't seem to help many people.

    The Duragesic patch is very potent, that's why it is measured in micrograms rather than milligrams, like most meds. It works quite well for a lot of people. Again, it needs to be dosed every 48 hours rather than the 72 like the manufacture says. I was on it for several months and it worked quite well for me.

    One more thing about the Oxycontin dose and if it's alot. When I was on it, I was up to 160 mg. TID and for a short period QID. Taking it three times a day is 480 mg and four times a day is 640 mg. Everyone is different and my metabolism is fast due to stomach surgery years ago, but that is just an example towards taking 20 mg TID. As you can see, it's pretty low.

    No, Im pretty sure they said in Sept of 06,Which would be 2 years.... I would qualify for Medicaid, cause I ask about Medicare, and they said I get/make to much to qualify for Medicare....but I will definately check again to be sure which one it is....yeah, the 20 mg 3 time a day, I think I am getting a bit of relief because after they weaned me off My Methadone, I went for months without any kind of pain meds at all, they just said take Advil... so I guess when I say it helps some what I mean is better then no meds or just advil, because I do still get ALOT of pain... even on the 20mg...So I guarantee he will be upping it when I go back...Thanks for the info...

    TRose

     
    Old 10-20-2005, 04:27 PM   #8
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    Re: Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

    TRose: I definitely would advise you to check again into the Medicaid/Medicare situation. When you said you make too much money to be on Medicare, are you working in addition to receiving Social Security Disability? I'm not and I qualify for Medicare (it's automatic) after being on SSD for 24 months.

     
    Old 10-20-2005, 06:54 PM   #9
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    Re: Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

    Quote:
    Originally Posted by Director
    TRose: I definitely would advise you to check again into the Medicaid/Medicare situation. When you said you make too much money to be on Medicare, are you working in addition to receiving Social Security Disability? I'm not and I qualify for Medicare (it's automatic) after being on SSD for 24 months.
    No, Im not working, I only collect a little over $600 a month on SSD... and they went back to when I originally went on disability which I collected long term disability from the job I had for over a year....before approved for SSD... and said that Sept 06, would be my 2 years... So I will definately check.

     
    Old 10-21-2005, 05:09 AM   #10
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    Re: Pain Management Doc being pushy about Morphine Pump, or Stimulator!!!!

    Sooo, he is sending you to see a shrink?just what part of "i don't want this" does he not understand?definitely start looking for a brand new PM as soon as you can,honestly this guy does not seem to really understand anything about actual pain management.Even his Rxing methods are stupid.He should really know exactly how many meds you actually have and how many you will need,i mean come on,ya know?
    in my case,I did not really 'feel' any real relief til i went up to 60mgs three times a day.You have lots of room for improvement here really,but you most likely will not be able to actually work thru this with this idiot as your PM.Yikes,what a putz!

    RUN,RUN as fast as you can.......marcia
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