Discussions that mention vicodin

Pain Management board


Hello...
I have RSD/CRPS in my shoulder, and upper left arm. I've been going to my family doc while searching for someone for a "real" diagnosis. Also to a local Pain Mgmt doc who has a very small (1 day a week) practice when he's not the head guy in the hospital anethesia dept. He's a great guy. He has an interest in RSD. But, he does not believe in "pain" meds for RSD. He would rather me do without, and get a spinal cord stim.

My family doc is willing to write me script for 5/500 vicodin, if I do not use more than one at a time, and not more than 3 a week. She is stuck in the mode that anti-depressents will take my pain away. For my other pain issues, we have tried 8 or 10 types. I have so many side effects from them - I just cannot take them. The only one I can take is Wellbutrin, and we are trying it now for the RSD - so far after 6 weeks it has been no help. To her credit, she did try three duragesic patches (25's) which did not touch my pain (used one at a time!)

For chonic myofacial pain problems that may or may not be fibromyalgia, I have been on Topamax for a few years. Thank God for that. At least it is used to treat RSD.

Last week I was seen by a Pain Mgmt doc at the Cleveland Clinic who knows RSD. She said it is definitly it. I told her about the vicodin and duragesic not working. She said no wonder, you were under medicated. They don't understand that RSD is the most painful non-terminal disease, and that the pain is 24/7. Unfortunately, I was there for a diagnosis, it's to far to go for treatment. She said since mine has shown improvement, don't go for the SCS.

What I want to know is..... What am I doing wrong? I have asked the family doc, and the pain doc for some sort of stronger med to take occasionally so that I can get some of my "life" back.

I have close friends that are a 3 hour and another a 4 hour drive away. Right now, I know I could not stand the car ride to go see them (even if I was not the driver). I used to go 3-4 times a year for a long weekend to each place. I would not take anything and drive. But it would be great to have something to take when I go to the hotel, when my pain would be high. Or, if someone else was driving, to be able to take something so the trip would not be painful. Also, I used to go on long weekends to a couple convention for the hobby I am interested in - which means driving there, then being there for 4 days. But, 1 of those days would be riding a bus to gardens to tour, and 2 of those days sitting in chairs listening to speakers all day. For these weekends, I'd love to have something to take if I needed it for the weekend. I know I could not tolerate those things as I am without some pain control. So I don't go.

Is it that I still work? Is it that I am not crying uncontrollably when I see them? Should I take them the report from my dentist showing he has repaired 4 broken teeth in the last 2 months from what he believes is clenching my jaw from pain? I just don't get it! I'm not asking for a lot of meds here. I am nearly 50.. I'm not the type you would figure for high risk of selling meds. Geez - when I went to the pain mgmt. doc the first time for the RSD back in Oct, I took a bottle of Oxycontin in to them with about 10 left in that he had prescribed 4 years earlier for a broken foot - because I cannot flush meds in my type of aereator septic system, and I didn't want to dispose of them in a way that anyone could get a hold of them. Now, if I can't be trusted to not abuse meds who could??

The family doc may not understand the pain... but at least she has tried (even if it was not enough to help) But, shouldn't the pain mgmt doc be willing to give me some sort of med to use on a long weekend now and then so that I can get out and not become a hermit???

Or - is it really against the prescribing laws to give meds for these purposes to someone with intractable pain? I think that is what I would have, not chronic... I can expect to have this forever... it may get better to an extent, but chances are better it will not.

Maybe I am just whining because it seems so cruel to me. I have had to "get used to it". Well, for the most part, I guess I have. By not doing anything unless I have to. I'm a shadow of my former self.

Jules
Hey Jules,

Sorry to hear about your pain and the problem with the Dr's. Unfortunantely you are dealing with a problem that many people with pain deal with. That is a Dr that is Opiodphobic. Meaning that they are scared to prescribe opioid meds to people in pain. Even though there are hundreds of studies that show that opioids effectively manage pain and that people with true pain have an extremely low incidence of addiction. However with all the restrictions on PM Dr's and people that abuse these meds, some Dr's are just plain afraid.

I am familar with RSD and know that it is a very painful disorder. There are some good nerve meds out now that you may want to check in. Some people have had success with Lyrica for nerve pain.

Its great that your Dr wants to treat you for the RSD and other pain issues, however sometimes the best treatment is a variety of treatments (meds, injections, therapy, etc). Of course everyone is different. But it sounds like its not your first visit to a Dr for these problems.

I would start looking for another PM Dr. This can take time and its like a job interview. But you need to find someone to effectively manage your pain. You should not have to suffer in pain because a particular Dr is opiodphobic.

Its great that your PCP will prescribe Vicodin 5/500, but that is a very low dose and 3 a week... I doubt this will manage the type of pain you describe.

There is some great treatments for RSD, however, like you mentioned, its a very painful and chronic disorder. I think a good multi approach take to your pain problems may be helpful.

I wish you the best. Sorry you've had to suffer this long. Take Care
Ok, lots of replies to answer, lets see if I can do it and make sense.

KathyMac... I do wish I could have every day pain free. But, I can get by most days without. I had terrible pain in November, and worse in December. The occupational therapy I was trying to do was just to much for me. It was in Nov. that my family doc tried the duragesic patch to see if I could use that and tolerate the therapy better, but it made no difference. After I quit therapy, and started doing the exercises at home, to tolerance, and not pushing so hard, the pain leveled off. I am very lucky that I do not have a lot of responsibility right now. My elderly Mom lives with me, and she does most of the inside housework, so if I can get myself up, do my exercises, get to work and back, that's all I need to do. Now that it is spring, I need to do more as I have a very large perennial and daylily garden, and no clue how I am going to care for it with one arm.

I am VERY afraid to be on pain medication all the time. I WANT to take as little as I can to get by. I have had something wrong in my muscles since I was about 20 that is very painful, and I have learned to live with that. Some say it's Fibro, but I have very few symptoms of it other than pain. I have Dr. after Dr. tell me that I have the tightest muscles of anyone they have ever seen, and I have been like that for years and years. Although the RSD pain is much worse, I am a person who can take a lot.

In Occupational Therapy they wanted me to do something they called Stress Loading. Using a scrub brush and "scrubbing" motions bearing down hard with my bad hand, and also carrying weight with my bad arm, swinging it. It was just to painful. Their manual said it should be done with the patient's pain managed, but my pain was not managed with the little amount of vicodin I was offered, or with the 25 duragesic, so that is when I had to quit and do what I could at home.

Even though I have tried to keep the arm moving, my original injury was to the shoulder, and it was hard to do until the shoulder injury healed. This led to a frozen shoulder that I had for a few months along with the RSD. The pain doc did trigger point injections about a month ago according to something I read on one of the main RSD sites about treating frozen shoulder and RSD. I know he did 40 injections that one day - but it worked. Since then, I have really worked hard and have perhaps 75% of the movement back in my bad arm. I try to use it as normally as I can. It has been very slowly getting better.

Since I am unable to take Lyrica, Neurontin or anti-depressants (including Elavil)...... I do take Topamax. I also take Baclofen and Flexeril because of the muscle spasms. I also use 3 lidoderm patches which help my muscle strain feeling. And the Wellbutrin (the only antidepressant I have been able to take) This combination has helped enough that I am not crying all the time. I have occasional twinges during the day that bring tears... but not nearly as bad as I was before we did this combo.

If I had children to care for, or a husband that expected me to care for him, or a job that required me to be up on my feet, or use my arm... or drive more than 20 minutes to work (and mine is almost all country driving - it's a breeze) ... Or, had to do laundry, or housecleaning, or go grocery shopping, or the other things you normally have to do - then I would want to be on meds all the time. I don't think I could stand it otherwise. And, if I was doing those things I think my arm/shoulder would be worse, so my pain would be worse.

That is why I can get by without the pain meds on a daily basis. It's when I want to break out of that pattern that I run into problems.

As far as researching treatments, I have read everything I can on it. The pain doc I am going to said he thought that was what I had. The ortho said he thought so - but not sure. I don't have sensitivity to people touching my bad area, so there was a question if it was or was not RSD. It took me a while, but I found this doc at the Clev. Clinic that would know for SURE.. that's why I saw her. Now there is no doubt. I am trying to get my insurance to cover botox injections to help with the pain. I am supposed to go back to the Clev. Clinic's occupational therapy in a couple weeks to get a long range therapy plan I can do at home from people who have actually seen RSD (the guy who treated me locally had only seen RSD once before and I'm not sure he was treating me the best way).

Because I have been researching, I KNOW that the pain doc I am going to is actually following one of the latest ways to treat RSD by not giving pain meds for it. He knew about using Botox for it, and you don't see that mentioned often, but when I brought it up, he knew someone to send me to and had been to as seminar about it. So it's hard to decide to change docs.

The hobby I have is that I am really into daylilies. I am a daylily judge. This is the year I have to get my certifications updated to be qualified for 8 more years. That involves going on a bus for 2 days at a convention all day going to gardens, using a clip board, judging plants. If I don't get "re-upped" this year, I have to go through all the 3 years of certifying all over. The convention fills up fast, and I have to send in my money in the next couple weeks if I expect to go. So I have to decide soon if I think I can take doing this or not.

When I go to my friends that are 4 hours away, I usually take about 300 photos (in about 2 hours of morning light) in their greenhouse of daylilies. That means having my arm up a lot.

Those are the things that I want to be able to do. I don't do things like that everyday. I think I could do them if I had the right pain medication. It seems like such a simple thing to me.

Discussing this hear with you all is really helping me think this out. You are helping me see sides of this that I did not see. Such as, it does not make sense to ask for pain meds part of the time. If I am that bad, I should be looking for them all of the time shouldn't I??

I guess I am just to darn scared of the meds to do it !!! That and not knowing who to see so I don't look like a drug seeker. I have told my family doc that I am not seeking drugs, I am seeking help. I took the vicodin prescription back to her the last time I went in. I said that I refuse to take more than prescribed, and at that dose it did no good, so why get it filled. I have suggested some of the other things that I have read that might help, like calcium channel blockers, klonapin, soma, the one antidepressant we have not tried - trazadone.... but neither doc seems to want to try them.

LOL.... I guess you can tell that I have no trouble typing.....

thanks so much !!
Jules

Barbie..... One of my best friends lives in Mayfield Heights. I actually saw the Clev. Clinic doc at Hillcrest Hospital, not downtown. If your mother in law says her friend is a nice person, I'd be glad if you would get his name, and I can see if he is on my insurance. thanks so much. J.
Well, went to the appt. with the pain doc. I asked him to explain his view on no pain meds. He explained that since he only does the pain doc thing one day a week, he cannot properly monitor patients on opiates. He explained the cycle of needing more medication as time goes by with RSD, and said if I felt I needed pain meds, it is better to be on them all the time rather than treat the pain now and then. He said if I wanted that, he would refer me to someone who could properly treat me that way. Then, he said that he felt since I had come so far since he first started to see me, that it was worth trying to hang in a bit longer, and try some other things. He did offer to write a script for vicodin when I ran of what I have, at a higher rate than the family doc.... asked me what I thought I needed. I said when I am in a really bad way, and am not driving, I would like to be able to take two 5/500 at a time, twice a day, possibly for two or three days straight. My ebb and flow is usually that it will settle down in that amount of time. I told him that in the past 25 years, I have used it for back pain, a few a month, and have not had any problems, and so I trust that medication. I am to keep a calendar of what my pain is when I take it, and had to sign a very simple contract saying I would not get any other pain meds from other docs. No coming in for pill counts or random drug screens. I guess that is what he ment about not having time to properly manage people on opiates.

Then, he agreed to try some of the things I had written down from the Cleve. Clinic doc's suggestions. A compounded cream, clonidine patch etc... we will try one thing at a time, every 2 weeks till we get things under control (hopefully) without resorting to full time pain meds. Once we understood each other, we were "cool". He now knows I don't really want to be on meds 24/7, and that I am not giving up on other treatment options... such as I am going back to Clev. Clinic to their Occupational Therapy for one time to get a long term therapy plan I can do at home . My Occ. Therapy near my house has no experience with my condition. He was happy that I am trying to work in my garden, and use my arm in a normal way.

Whew! Now I don't feel like such a criminal going in there and asking him about the meds. Last time he told me "this is the second time you have asked for pain meds since you got RSD - and I told you the first time I do not do narcotics for RSD" and I took it as a scolding. After really talking to him, I found out that he really prefers you try all other methods first - and then that he is not set up to do that kind of prescribing --- not that he was upset with me. This visit, he actually said that if he was sitting where I was, he would be asking about those meds too. I told him that I was asking HIM because he was a PAIN doc, and I wanted to know about the safest way to use those kind of meds - and that he should be able to answer that the best.

SammieJoe - I am still waiting on the Clev.Clinic doc to send the letter of treatment recommendations. She said she would send a copy to my house to (what a great idea!) so that I would have it to take to pain doc, massage therapy, etc. But, pain doc was willing to go ahead and try some of the things without it being in writing.

Jules