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    Old 06-28-2008, 05:01 AM   #1
    sammyo1
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    Advice on approaching PM with med. change

    As most of you know I have started with a PM doctor.
    He kept me on the percocet & allowed me up to four aday, which I was up to 3/12 to four anyway. I appreciate that he listened to me & allowed me that amount. I was honest with him & told him at times I have to take at least 1/3 to 1/2 more in the morings & am very careful to take the least amount that would work for me.
    The instructions are 1 10-325 every 6hrs. Well not matter how hard I try I cant make it 6 hrs most of the time, & 1 is just not enough most days for mornings. I am one who follows the rules but I just cant wait that long in between doses.
    I have stuck to the amount allowed, no more then four aday, In fact still trying my best to stay at 31/2, he did make it clear that 4 is all he would allow me. I have had to go back to work & that makes it alot tougher. I have no choice at this time. Anyone living where I live knows if you have a job you better hang on to it & count your blessings. So I am sure this PM is well aware of that. Like I said I am doing ok with the allowed amount per day, its just the dose & hrs between. I can up the valium abit but I really dont think that will make a difference. The weather has been awful & that is making it even worse for me. In the evenings I when I am home I just try to rest & ice or moist wrap. That thus far is saving me from needing to take that fourth dose, but if I continue to work & the weather is not going to cooperate I can see me needing it in the future.
    So what is the best way to approach the PM with my problem? since I just started I dont want to rock the boat so to speak.
    I will have to let him know I had to go back to work. I am going for the Transforaminal epidurals & praying that I get some relief but I am not getting my hopes up. I would really appreciate any suggestions. Thanks everyone.
    Sammy

     
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    Old 06-28-2008, 06:10 AM   #2
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    Re: Advice on approaching PM with med. change

    Sammy.....Maybe you've said it and I just missed it, but what is your prognosis? Is your pain "chronic" and something that is expected to be around for awhile / forever.......Or, are you expected to eventually recover somewhat? I think the answer to that usually yields the treatment plan.

    If chronic for example, you should be put on some type of LA med with something for BT pain. What you're experiencing is perfectly normal....The Percs just aren't cutting it anymore. Although the initial punch of the med may be enough, the time in between isn't.

    I think I would just be honest and say that the Percs are working, but just like you wrote here, that the pain gets very bad and waiting 6 hrs is tough. Just be sure to characterize it as your pain, and not your body wanting the Oxy....Big difference between the two.

    However, if your prognosis is some type of recovery, then you don't want to go down the LA road and the absolute minimum required is prudent.

    Hope this helps.

    Ex

     
    Old 06-28-2008, 08:48 AM   #3
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    Re: Advice on approaching PM with med. change

    Sammy, I know this doc made it pretty clear that he doesn't intend to give you any more than what you are currently prescribed, but I feel that with CMP and your other shoulder issues, you really need some form of LA med. That is why I would suggest that you try to hold out till the other PM who is in the process of participating with your insurance, comes on board and make an appointment with him. It bothers me that the one you are seeing right now kind of blew off the myofascial diagnosis anyway. Especially when his office staff told you he had other patients with CMP and was familiar with it.

    I know the waiting is painful in more ways than one, but if you can do it, I would just keep calling the other office to check up on the status of his application with your insurer. As soon as they tell you he is on board, I would make the earliest appointment that they can give you and go see him. Or if they allow it, I would ask if they can put you on some sort of waiting list, so that you will know as soon as it happens. If I remember, they seemed to be quite nice when you initially spoke with them, right? They may even have other potential patients who are waiting for him to participate as well.

    I am sorry it has worked out this way for you right now. Especially since you have returned to work and need better, more lasting coverage than just a short acting med right now. Maybe if you explain that your situation has changed with going back to work, your present doc might reconsider an LA med. Have you told him you have had to return to work? I think it is at least worth a try. Even if he could give you a real MR instead of just the valium, that would make a difference, I believe. I know the valium does help, but it's not quite the same as a true MR.

    Sorry I'm rambling. Hubby has some nasty stomach bug and I haven't slept too well the past few nights. I've been sleeping on the couch so as not to get whatever it is he has. Sad, but true. I am taking care of him, of course, but I've washed my hands raw and I've been following him around with disinfecting wipes! I can't even let myself think of getting this bug. It would probably put me in the hospital because I wouldn't be able to keep my meds in me. (I am shuddering just thinking about it)

    Anyway, Hang in there hon. My heart goes out to you. I wish you didn't have to go through this. But please remember I am praying for you and sending positive thoughts your way. Hugs, CMP/MM

     
    Old 06-28-2008, 09:44 AM   #4
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    Re: Advice on approaching PM with med. change

    Sammy, it could be that when the doctor told you he would prescribe no more than the 4 percocets per day because he is testing you to see how bad the pain is. I know when they first put me on pain meds they gave me the lowest dose then moved it upwards as needed.

    I would go at your next appt and tell him how you take the percocets you are at a 7, 2 hours later you are down to 4, then by hour 4 you are at a 6, hour 5 you are at 6, hour 6 you are at a 8. You might even consider showing him documentation to this effect that you take the meds, it works then it slowly starts building back up. Hopefully at this point, he will increase your meds or move you over to long lasting. All you can do is show him what is happening and let him decide what the next step is. If he says he will NOT adjust the meds, then you know you need to seek out another doctor who will help you.

    Good luck.

    Last edited by ms_west; 06-28-2008 at 09:46 AM.

     
    Old 06-28-2008, 09:17 PM   #5
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    Re: Advice on approaching PM with med. change

    I think that you need to be on a LA medication. I know that he said that he would put you on no more than 4 of the Percocet per day but that doesn't mean that he wouldn't put you on something else. You should really tell him just how much pain you are in. Tell him that your average pain level every day is "x out of 10". Tell him that the pain is making it extremely difficult to be able to work. See what he suggests then. Hopefully he will then put you on something long acting. Maybe he would put you on Oxycontin with Percocets as the breakthrough. I know many doctors are staying far away from prescribing Oxycontin but there are other LA meds like: Avinza, Kadian, Fentanyl, Methadone, and Opana.

    brian

     
    Old 06-28-2008, 10:11 PM   #6
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    Re: Advice on approaching PM with med. change

    I strongly agree with the others, It is time to put you on a LA med. Has he said no to that? I think it would be ideal if he put you on a LA med and left you on the same dose of the oxy for breakthrough.

    Good luck and hang in there! I'll be looking for your posts to see how you are doing, and as always, you will be in my thoughts and prayers.

    Hugs, Fabby

     
    Old 06-29-2008, 05:39 AM   #7
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    Re: Advice on approaching PM with med. change

    Quote:
    Originally Posted by Fabrashamx View Post
    I strongly agree with the others, It is time to put you on a LA med. Has he said no to that? I think it would be ideal if he put you on a LA med and left you on the same dose of the oxy for breakthrough.
    I strongly agree with Fabby. I'm not sure the Doc will move this fast with a regimen change, but honestly, it's probably what you need.

    With that being said, however, the bigger issue is staying in good graces with this new Doc. You cannot afford to lose him. Like Cmpgirl said, "you can do it." You've got to hang in there. You've had one appointment. Be careful on how you handle this. Be discreet. I'm not trying to scare you, but you just don't know what's in your file from this wacko surgeon. The LAST thing you need is to have this new Doc thing something is up right off the bat.

    Tread lightly my friend.........

    Ex

     
    Old 06-29-2008, 05:44 AM   #8
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    Re: Advice on approaching PM with med. change

    Ex & company, thus far there is thought to be damage done in the myofascial. This PM thinks that there is cervical issues & is going for it. Although he has said that there very well could be damage in the rib area . So no that is not going to get better. He will in the future be injecting that area & doing the epidurials to test the cervical area. His words were we can see about cutting the pain level down so that we cut back on the use of pain meds. He explained there will always be pain but his job is to try to get the level of pain down. Now that was the first appointment. I am curiious to see what happens with the epidurals. I know somethings going on because I am having more & more problems & pain in my other shoulder/arm & both hands, oddly enough certain fingers are giving me big time problems some morinings. So he may be on to something in the cervical. He is lost when it comes to the ribs, thats why he said thats where the damage may be.
    Mean while I am in alot of pain. I was on oxycodone in the past & to be honest I did not care for it & still had some problems with pain control.
    I gather from watching the board that I am not on to strong of a pain regimen, is that correct?
    This PM does not like to up the meds alot. He believes there is to much potential for abuse. I know he is right & does not know me but I need just abit more control. He said that alot of the time people dont realize that they start taking thier meds for other reasons besides pain control, I cant see myself doing that when I could have upped them more at anytime according to the instructions on the percocet after surgery. It was 1-2 every four to six hrs, I was pretty darn strict with myself & came down from a high dose following surgery & would not allow myself to go back up. Trust me I wanted to at times. I know I have to build a trust with this doctor but the only way to do that is get the right control at the start.

    cmp, I am really curious to see what he ultimantly has to say about that rib area. I am hoping in future visits I can get abit more out of him on his opinions about myofascial. I was surprised the first visit he did not give me something more as far as MRs, he described to me what I was feeling as far as the spasms & he pretty much had it down, these spasms can be bad & hard to explain whats going on in that chest & rib area, but he was pretty darn close so I was hoping to at least try something different.

    I consider this to be new to me, all of the PM stuff, but I do know some days especially mornings are just to much to handle. After my morning dose which I took 1/2 more (had to) I was in agony, sat on ice & cried till it was time for the second dose, yesturday. I think if I can get good pain control in the mornings it would help me throughout the day.
    It is difficult starting with a new doctor. I have the epidurals scheduled for July 9 & the follow up is July 29. So if these epidurals do not give me more pain control I will have to bring up the need on July 29. He is not aware that I have returned back to work. I have to make it clear to him that at least part time I need to be able to work. I think at times because I am married & not the main wage earner some of these doctors think I dont have to work, infact the Rehab. came right out & asked me. At this time I do need to contribute. I dont think it should matter whether I am the main source of income for my family or not. The economy is just to bad for me not contribute. I would sure welcome any extra prayers for these epidurals to work. Thanks everyone. Sammy

     
    Old 06-29-2008, 07:11 AM   #9
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    Re: Advice on approaching PM with med. change

    Hey Sammy,

    Forgive me for not being up on everything that has been going on with you, and thaks so much for helping me get through my ups and downs recently.

    I know it is tough to be with a new doc. And I do understand the fears and concerns of asking for meds.

    It does sound like your new PM is pretty up beat, thats a good thing. Running you through a battery of tests and treatments is I think the standard in PM.
    If you are in so much pain...IMO I think you should bring this to his/her attention. Hopefuly he will consider the fact that you have not had any issues with the medications in the past and offer you some other help then your current meds.

    I know that this is tough and all the waiting is a drag drag drag!!!
    When is your next appointment with this new PM? In the begining my PM had me coming in every week then after a month it was every two weeks and now every month. Of course we have been working together now a whule and totally trusts me with the meds.

    I am in a similar situation. I don't think the Robaxin is helping me anymore and the Valium does, but I hate to ask for an increase in the amount a month or an increase in the mg's. But it is cheaper and helps better. I gotta think on this a while.

    Hopefuly the Trans. ESI will help you. They are a little different then a regular ESI as they get right down into the foramin where the inflammed nerve roots come from the spinal cord. It may take two to see a difference. SOme folks really respond well to these ESI's and i really hope this is your case.

    I feel for you Sammy because I know how hard this is on you and .... how long it has been going on.
    You are always in my thoughts and prayers. I will send out a little extra for ya! For everyone!!~~~~

    Hang in ther my friend!
    Chrissy

     
    Old 06-29-2008, 05:01 PM   #10
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    Re: Advice on approaching PM with med. change

    Sammy if you pain is this bad in the morning, you might consider taking some type of med in the night toward morning. Even if you have to set your alarm, take a pill, drink some water, and go back to sleep. It could be that by morning your meds are completely out of you so you are in sooooooo much pain that it is requiring a heavier dose in the morning to get it back under control.

     
    Old 06-30-2008, 04:24 AM   #11
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    Re: Advice on approaching PM with med. change

    Thanks pepper & chrissy, I have thought about that pepper & am going to have to try something like that. I have to be careful or will go over the amount allowed per day. I am up & moving pretty early so its easy to take that four aday. Laying in bed does not help or I would stay in bed abit longer. I am going to have to go over better pain control with this doctor, I am going to up the valium dose abit today, since I have only been taking like 1/3 of a tablet in hopes of not being so tired or sluggish. The valium dose reads every 8hrs. so thats not to much either.
    I will have to do something the mornings are just to bad. I normally have low blood pressure, I am talking like 90s over 60's but I am having some problems so I checked my BP last night & was amazed to see it running high. Now I will have to try to figure out why its up to those numbers. I know pain can do it but the pain was at a decent level for me. All of this is really getting to me lately. Tired of pain & tired of not feeling well. I know I have alot of company here. You ever just get to that point where you just get fed up with it all?
    Stupid question, I know. Sammy

     
    Old 06-30-2008, 07:59 AM   #12
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    Re: Advice on approaching PM with med. change

    (((((((((Sammy))))))))))))))))

    Sometime I get to that point several times in one day. Hang in there!
    Hugs, Fabby

     
    Old 06-30-2008, 08:45 AM   #13
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    Re: Advice on approaching PM with med. change

    Quote:
    Originally Posted by sammyo1 View Post
    You ever just get to that point where you just get fed up with it all?
    Stupid question, I know. Sammy

    NOT a stupid question at all darlin'. I feel this way more than I would care to, but I guess I've gotten used to it and I've just taught myself how to deal with it. Some days, I just let myself wallow in it. Some days, I have things going on that I have to be "present" for and I just pick myself up and carry on. It all depends. Just know you are not alone and try not to beat yourself up over it.

    Pepper is right on with the suggestion of taking something late at night or setting the alarm about an hour before you get up. I used to do that before I was on LA meds. Hopefully the upcoming injections will help. Try to hang in there my friend. I'm here and I'm praying every day for you. Take care of yourself. Let your hubby and kids help where they can. Especially now that you are back to work. God Bless and I'm sending positive thoughts your way. CMP/MM

     
    Old 06-30-2008, 06:46 PM   #14
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    Re: Advice on approaching PM with med. change

    Thats one good thing we all feel the same way.
    I am really abit concerned about my BP jumping up, that is a pretty big jump for me, from low BP to 140/80s. Anyone know why that may be happening. I am feeling so dang off, tired & just off, out of it. I dont like messing with B/ps. I have had every cardiac test under the sun, the thing is I already have chest pain so heck I would not know if something was up or not. I thought all the pounding sounds in my ears(like water kind of was allergies) every night when I lay down it drives me crazy. I was shocked to see my BP up that drastically. Although its not skyhigh it is really high for me. I cant help but wonder if that has something to do with why I am feeling so tired & off. What do you all think? To strange. Sammy

     
    Old 06-30-2008, 07:09 PM   #15
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    Re: Advice on approaching PM with med. change

    I really believe it is due to your pain not being controlled. My normal blood pressure is 95/60. However, when we track it and rate my pain rate with it my pain has brought my numbers up to 160/108. It is amazing what pain can do. I would try recording you numbers and put your pain level next to it and you will have your answer within 72 hours.

    I am to the point that I can feel my blood pressure going up.

    Last edited by ms_west; 06-30-2008 at 07:09 PM.

     
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