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PM dr telling me to cut back

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Old 05-31-2006, 04:38 PM   #1
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PM dr telling me to cut back

I'm very confused. Just started going to a PM a few mos. ago. He's trying me on nerve pain meds (all of which have caused side effects that have made me discontinue but there are more he wants to try). He also kept me on Percocet, which I was already taking. In fact, he increased my dose from 5 to 7.5 (since I said it never really takes the pain away, just takes the edge off) and said I'd be OK even taking 4 a day from my current 2-3 a day. So with the last scrip, I took about 4 a day. I am in constant pain -- it never goes away, but sometimes it gets worse. There is never a day when I don't take it because there is always pain, even if it is mild.

So imagine my surprise when I ask for another scrip (that I could pick up), and I get one but it has a note attached that I am only supposed to use the Percocet "sparingly", only "when needed". And he cut the scrip back from 60 pills to 45. Obviously he must think I'm over-using, but yet he was the one who said I'd be OK with 4 a day.

After reading everything on this board and understanding a lot more about the various forms of pain meds, I was thinking about asking for OxyContin because it is long-acting plus doesn't have Tylenol in it. Now I'm afraid to even bring it up. If he thinks 3-4 a day is over-using Percocet, what will he think of Oxy? Any thoughts or advice? I'm in my 50's with advanced DDD and pain that shoots from buttock down my leg. Thanks, all!

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Old 05-31-2006, 08:19 PM   #2
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Re: PM dr telling me to cut back

I really think the best thing to do is to get in for a sit down appt with your doctor and ask him what is thoughts are on this change. If he told you that you were good on the 4 a day (which is not a massive amount) then I feel he needs to tell you why he has had this sudden change of mind? You are the patient/client. You should be informed of changes in your medical treatment. More so than a NOTE on your script. It warrents a conversation in my mind.

Old 06-01-2006, 11:16 AM   #3
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Re: PM dr telling me to cut back

You have to advocate for yourself. Go in and talk to the doc and set him straight on your pain. I don't know anything about Pain docs, but if this one listens to you, then he should be prescribing the right amount of meds. I think Oxy DOES have Tylenol in it though so check that out first. Have you tried OTC stuff like Naproxen? They have a prescript strength as well. What about other therapies like warm packs, cold packs or accupunture? Before he changed your med qty, he should have spoken to you to explain his reasoning. I would schedule an appointment.

Old 06-01-2006, 11:58 AM   #4
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Re: PM dr telling me to cut back

Percoset is oxycodone + tylenol. Oxycodone is a "stand alone". Oxycontin is the extended release formula. Oxycontin is very difficult to get a Rx for as it has been so extensively abused,(------), the idea is to get a high extended dose into the blood quickly. Too bad for people who really need it.
What "nerve pain med" are you taking? I took Neurontin before my last surgery and it did help me. The worse side effect I had was sexual, makes sense, deadens the nerves.
At one point I was on the 40mg Fentanyl patch, but after I started Neurontin I tapered myself off by asking for smaller and smaller dosages.
I took Hydrocodone for so many years that it stopped working for pain, plenty of side effects though, I now state that I am allergic to it.
Instead of Hydrocodone I asked for Darvocet, (and/or Darvon to decrease the amount of tylenol) both are a "lesser" narcotic than Hydrocodone. It works pretty well for me now though. Insurance won't fill both, I get my doc to alternate Rxs as there is no generic for Darvon. I also take Percoset 5/350 for "breakthrough", 49 since last December. I had a laminectomy in October before, and that has reduced my back pain a good bit.
All that said, I have no idea of your pain level and duration, but I would advise to use the Percoset sparingly. In fact use only the minimum possible of any pain meds. I decided that some pain was better than no life. That is to say that while on the very strong pain meds; like Fentanyl, Oxycodone, or Oxycontin; I was pretty useless, no energy, often slightly intoxicated, forgetful, etc., etc.. Now when I take Percoset or Darvocet/Darvon they help the pain more than the hydrocodone did. That is my motivation, I take as little as possible because I know I am going to need more, because of more pain, as time goes on.
Everyone has a different threshold for pain, I have learned to live with more than I used to. The alternative was not being aware of my surroundings, so to speak.
My experience has been that doctors forget, get patients confused, etc. You do need to go see your doctor and discuss this issue with him/her.

Last edited by HBMod07; 06-01-2006 at 12:28 PM. Reason: Please do not explain how to abuse medication. Thank you!

Old 06-01-2006, 12:33 PM   #5
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Re: PM dr telling me to cut back

I do agree that you should speak with your doctor and ask why there was a change in the dosage. There is a chance he could have confused you with another patient, it does happen! Talking to him openly about it is the best solution. If your doctor still insists on the change and it is not controlling your pain issues there's always the option of seeking out a different doctor.

Additionaly have you tried any of the non medicinal treatments such as TENS Unit, Physical Thereapy, Aquatic Therapy and the like? They can prove to be benificial when used in conjuction with a medication treatment plan.

There are other alternative long acting medications to Oxycontin such as MSContin, Fentanyl and Methadone. Some doctors are not real comfortable in prescribing Oxycontin due to the stigma that is attached. Because you've not been seeing this doctor for very long he may very well try to hold off on these types of medications until other short acting medications have been tried first.


Old 06-01-2006, 01:38 PM   #6
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Re: PM dr telling me to cut back

Thanks, all, for your suggestions. I'll try to answer everyone's questions on the background. I had a diskectomy, which did not help, and I've been told by a top spine surgeon that my spine is in such bad shape that a fusion probably wouldn't help and might make things worse. I've tried chiropractic, PT, TENS, Relafin, back exercises, Alleve, Motrin 3 at a time, nothing has helped. The nerve pain drugs so far have been amitryptiline (I took it for a week and I was so tired, I was a zombie for all but about 2 hours of the day), and Cymbalta (couldn't stand the dry mouth, sore tongue and stomach issues, plus I'm now going through withdrawal symptoms trying to taper off it). The next thing he wants me to try is Pamelor (nortriptyline) which I fear will have the same effects as the amitryptiline. But I'm trying to get my system back to "normal" first before I try anything else. I have to tell you, I am very susceptible to side effects -- almost everything bothers me somehow.

I see folks on here who are methadone proponents but that's the one that I would avoid like the plague -- I KNOW that has a horrible withdrawal.

I do have an appt with my PM next week and will see what I can find out. I actually had a dream about the conversation last night, so I must be very nervous about it! I can understand the recommendation to use the Perc sparingly, but the pain from just normal everyday activities (standing in a line, shopping, sitting in a chair without lumbar support, bending down to clean my shower doors...) is really debilitating. I need something to at least take the edge off so I'm not completely useless. If it takes 4 Perc a day, why not take them?

Old 06-01-2006, 02:59 PM   #7
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Re: PM dr telling me to cut back

hi all,
was it the pm dr that told you to use them sparingly ? I think you should call or wait til you go in but talk to him. I don't understand a dr decrease meds if you are still in pain increase i understand because of tolerence. It sounds like you dr is as bad as my old pm dr.He decrease the dose way down from what my family dr had me on and refused to increase. I knew i had to go somewhere else but no one else took my insr. so i am now paying cash,but i know my pain will get addressed . good luck keep us posted. kelsey1

Old 06-01-2006, 03:33 PM   #8
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Re: PM dr telling me to cut back

There are other nerve pain things like lyrica, neurontin, depakote, tegretol....

And I agree that you should talk to him. I have fou nd that percocet AND naproxen (250 mg) work pretty well and my doc said I can take both.

Old 06-05-2006, 12:46 PM   #9
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Re: PM dr telling me to cut back

Hi all -- had my appt with the PM today. His explanation for the note telling me to use the Percocet sparingly was due to a couple things: the Tylenol content (I have hep-c) could cause liver damage, the fact that it shouldn't be used long-term for chronic pain, and the fact that he didn't want me just popping a few per day on a routine basis. I told him I am in constant pain, so it's not like I'm just taking them for fun. And he agreed 4 per day isn't a lot. So I'm not sure what the real reason for the note was -- I just get the sense he is concerned about writing narcotic scrips continually for a chronic condition. Anyway, I asked him about long-acting medications -- he suggested Kadian (sustained-release morphine). He prescribed a 7-day supply of 30 mg to start. I took one when I got home and still have the pain, so I'm not sure if this is too low of a dose or what. He also said I could use Perc occasionally for break-through pain. I am also on Relafin (anti-inflammatory), but I don't think that does much as I've been on it for years. So the regimen du jour is: Kadian, Perc for b/t, Pamelor which I haven't started yet, and continue Relafin.

Anyone have any thoughts, or feedback on Kadian? Thanks, all!

Old 06-05-2006, 08:51 PM   #10
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Re: PM dr telling me to cut back

I totally agree with KISSA . SHe makes a good point. Honesty with your doctor is the best way to go. Its your pain dont be afraid to tell your doctor that what he is prescribing isnt working. There are many alternatives to just meds. I have been in Pain management for almost 8 yrs and as of this year I was still going to physical therapy. So never cancel out alternatives to go along with your meds.


Old 06-05-2006, 11:28 PM   #11
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wolfmarket HB User
Re: PM dr telling me to cut back

I use Kadian 60 mg bid with 30 mg Roxicodone for bt. I am really not happy with the Kadian so far and in fact, today has been a very bad pain day for me.

Just curious as to your MRI or diagnosis because I'm also told that I'm not surgical with 4 levels of disc herniation and 2 levels of stenosis among other things.

Thanks for sharing!

Old 06-07-2006, 10:01 AM   #12
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Re: PM dr telling me to cut back

Alan, I'm not sure what dx to use since there have been so many different ways of describing it in all the medical reports. But this one seems to sum it up nicely:

"Severe degenerative disk disease with disc narrowing and facet arthropathy along the entire lumbar spine"

I'm on Day 3 of the 7-day Kadian tryout. The pain seemed better yesterday -- not gone, but better. What was nice was that I wasn't "out of it", it didn't slow me down like the Percocet does.

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