Is there a guideline pain drs go when treating?

[1spartan]

I've been in pain management since 8/06.  Before the 2nd surgery I was given oxycodone, lortab, dilaudid, celebrex, and lyrica.  Between 2nd and 3rd, the same. Pain got worse, not better, he quit all scripts and told "detox" is hell. To shorten this, I've seen 3 pain drs, each one lowering the script, I've since had a fusion (my 4th)....and right now I take one or two percocet every 6 hours. Do they have guidelines or do they a failed back w/ fusions is lying? Maybe they think it just tickles.

[chmski]

I just had just the opposite problem.  I have a suggestion you will probably hate.  I had two spinal surgeries for fatback.  Between the two my PM doc had me on 50 mg morphine x 2 daily and 15 mg ox for break through.  Though I told the doctor about my meds and dosages, and asked for a PM consult in the hospital before the surgery, I had to beg to see one the day after surgery.  He thought I was on enough with the psa mainlined and oral hydromorphine.  I was never a medication seeker, but I needed some relief.  I was released from the hospital with just oxy 5's.
Once home for a few days the pain became worse and I finally called my PM. He said to come right in and he would see me.  He gave me two morphine shots and prescriptions of 6o mg morphine x 2 and 30 mg oxy.

I realized that staying on higher doses of meds after my first surgery made me too adapted to their effects.  Now I needed more.  I knew I was going to be facing knee replacement within two years and I couldn't allow myself to stay at high levels of drugs or the same things could happen.

Long story short my PM kept me oh higher levels and then raised them more.  I decided to wean myself off of every thing.  I started with cutting down the morphine to two one day and one every other day,  Then one a day after two weeks .  Then one every other day after a month. I only took the 5 mg I had from surgery x 2 every 4 hrs pen.  Eventually, I needed only one every 6 hours.  I found I could manage quite well with only one a night when I had a particularly tough day.  I recently had my knee replaced and, except for the hospital phase I needed minimal medication for pain.

I haven't just resolved my back pain.  After a serious fall on my upper back I developed proximal junction kyphosis.  So, I still have pain. But I don't reach for the pills.  There are other straggles I employ and I am more capable of controlling my pain.  Maybe you could talk to someone about reducing your dosages and the tolerance you've built up.  It's well worth it.

[hadenoughpain]

Why is it that the government allows any and everybody to go to a methadone clinic and outrageous amounts of methadone everyday just on the peoples word but yet I have soooo much proof of my pain but because of the government I can't find a pump that will do anything? I do not want to go to a methadone clinic I want to have a PMP. I can't handle living in this much pain. This is not living when the pain has u thinking of killing yourself because I just can't take it anymore. Isn't there a PMP in Florida that is willing to say "screw the government, there is proof on file that my patient needs these meds". The government does not mind who or why someone is taking 190mg(and moving up) but they stop Dr.'s from helping people that TRULY NEED IT. I CAN NOT live with this much pain much longer

[Tuckamore]

Sounds like you were raised as I was, it's black or white. I'm just learning that there is a lot more gray in this world. It also sounds like you have an intelligent and supportive wife. I suspect you know how fortunate you are as some CP patients have no one!  I suspect she also knows how fortunate she is to have you.... you actually listened!  :o)

I cannot tell you how very pleased I am that between your wife, Mellie and I we were able to make a difference. I am so glad that you took the time to post in our community and I hope you won't be a stranger.

Best of Luck... You deserve it.
~Tuck

[1spartan]

Your comments and recommendations fit my wife's perfectly. By nature I'm it's black or white, no grey. I was also raised that pain was for sissies. So I'd go in pain scale well over 10 and say I'm fine. Today 9/12 I told my new pmdr how I really felt. He trashed the prescripts my surgeon gave me and put me on something that really works......my wife lovingly gave me the told you so. But thank you both for talking with me. I would have done the same thing I did because of your advice. Thank you

[mellie4]

I think most pain management doctors prescribe what they think  you will need based on your tolerance and the type of surgery you are having.  I've had 9 hand surgeries in the past 4 years.  After each one, my pain management doctor usually prescribed more than what I normally take for pain for the acute phase after surgery.  Then when the acute pain settled down, they would back the script down to what I normally take, or adjust it based on the pain I was having.  After one surgery, they had prescribed Dilaudid, thinking that I hadn't been on it and that it would work well.  It didn't work at all for me.  It was like eating M&Ms.  I put in a call to the pain doctor and she immediately wrote a different script for me, which covered my pain perfectly.

Have you spoken with your doctors?  Is it your pain doctor or your surgeon who is prescribing your post-surgery medication?  Is the problem just post-surgery, or is it all the time?  Are they doing anything besides medication?  Most pain management clinics/doctors use more than just medication.  They often use PT, OT, injections and other procedures.

If your pain is undertreated, you need to speak with them and make sure they understand that.  If they aren't willing to come up with a plan to help with your pain, then you may want to find another pain team (though I wouldn't quit the one you have until you find another one.)

Best of luck, and I hope you'll keep posting and let us know how things go.