Discussions that mention botox

Pain Management board

Hey Izzy, Sorry your not feeling well, But I think you likely already know that this doc has a very defined comfort zone. It may only be with oxyContin because of the repuation, but Do you really want to be a GP's guinea pig if he's presscribing doses or meds he hasn't before and obviously insn't comfortable with. A lot of docs simply use PM docs as a way to shuffle CP patients out of their practice and if you do have a good relationship with your GP, than use that to find a PM doc that's comfortable treating your pain and capable of offering more than a script.

Personally I don't believe in burning bridges and you can either push a good GP to the point where he doesn't even want to be your GP or you say you understand your pain condition may require someone that specializes in that field and can offer more as far as different modalities and the latest research and trends in PM.

I've seen and experienced amazing things from adding adjunct meds and additional treatment options. At one point my wife was using 100 mgs of MSC 3 times a day. She was still miserable and this was at the hight of finding she has chiari 1 after an MVA that whiplash induced seizures in addition to all her other problems. Insteasd of increasing her dose or prescribing it more frequently, her PM doc added Nemanda, then started using Botox and Occipital blocks. Now she takes 30 mgs 3 times a day and does the injections every 3 months and contues the nemada. She's been at the same dose of every med for the last 3 years. She was offered something else and gave it a shot just like we both have with every modality that's ever been offered .

People do improve with the right treatment and people get worse when given the wrong treatment, sometimes more or more frequent opiates aren't the right treatment. Just beause we have access to medical info doesn't mean what we read means anything more to your doc than what a total stranger without a medical education suggests is protocol.

If we need to tell a doc what he needs to do, that should be a giant warning sign you are at the wrong doc. QID dosing would leave even the most respected PM doc in troubkle should something negative happen to his patient. He has nothing to fall back on as far as justifying his actions. Particularly when all a prosocutor has to do is read the prescribing info from the manufacturer that has kept this drug in court for the last decade based on it's claim of 12 hour duration. I'm sure Purdue could turn over thousands of copies of those letters that were sent to pharmies and docs instructing them not to prescribe this drug other than twicea day. You may get by on 3 times a day, but when you are completely disregarding the manufacturer, that is negligence. I doubt the better PM docs wouldn't have a problem testifying to that. There are alternatives to QID dosing if you can't find relief with TID.

It was only 6 years ago when Purdue was writing to every Pharmacy chain telling them to refuse scripts for oxyC if written for anything greater than twice a day. They also wrote every large PM group and told them absolutely do not prescribe oxyC more than twice a day. Purdues' PAP programs won't supply more than twice a day dosing to a terminal cancer patient.

I've never believed a GP is any more qualified to practice PM than he is to practice psychiatry. Aside from the years of extra training there are the years of experience were patients are closely monitored, GPs don't have that kind of time to spend on med checks.

His discomfort and experience level with PM doesn't make him a bad doctor, but if you push and push regarding the opiates your liable to become the bad patient that he simply gets tired of dealing with. I would hate to see trying to change his opinion interfere with finding better PM because someone told you something rediclous is actually protocol. Sure their are a few people taking OxyC 4 times a day and throwing more than a couple doses of BT meds on top, but that's not the norm, protocol and makes no sense whatsoever.

How does a patient benefit from long acting meds if you take them like short. You not only have the psych aspect of needing to take something every 4-6 hours, clock watching, living from dose to dose and planning your day around dosing schedules, but the serum levels would be a roller coaster from the overlap of each dose plus BT meds. Find someone that knows what their doing and take the advice of the people that know what their talking about and have actual experience with what their talking about, recomending or doing.

Good luck, Dave