Pain Management Community
New to this, need some advise and help
About This Community:

This patient support community is for discussions relating to pain management, chronic pain, arthritis, back pain, cancer, headaches, movement disorders pain, and muscle pain.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

New to this, need some advise and help

Ok.. so I have been suffering from severe pain Since October of 2010. I started going to the ER to treat the joint pain and severe headaches that felt like my hips and back were being crushed.  I was prescribed percocet and muscle relaxers 5mg and 15 at a time.  I always had to take two to make them do anything and when I ran out I went again to the ER... Then I had to go to my primary care because I thought it would have gone away and thought maybe I had pulled something.. but obviously it was not temporary.. so we tried tramadol first which did absolutely nothing and I was in terrible pain and had to go back to him right away.  He finally gave be percocet... I did not have a diagnosis.. but had been seeing him since April that year for severe fatigue and what we thought could be fibromyalgia.  I had mild muscle pain up unto that point but never had asked for pain relief until that october when it got really bad.

Anyways.. so he gave me 5 mg and gave me 90 pills to take 3 times a day.  5 mg did not do anything for me so I took two at a time.. which was strong but I didnt take them 3 times a day.. I just took 4 pills a day. 2 pills 2 times per day. I ran out quicker than the 30 days supply and went to the ER again for severe chest pain and back pain and they offered another percocet prescription so I took it.  So that held me over for the first month.  my next appointment with my pcp I asked for a refill and asked if I could get more than 90 and he said absolutely not.. and asked why i had gotten more from the er.. I had told him that 5 mg doesnt do anything for my pain.. so he understood and increased my dosage to 7.5 mg... so that worked pretty well for about 3 months..

I still did not have a diagnosis, but all we ever did was bloodwork.. all blood work was normal except for thyroid and vit. d deficiency... but he believed I was in pain thank gosh.  but never did order x rays or mri's ect.  until I started getting neurological symtoms (symptoms).. then thought it could be ms... so ordered mri... no ms. but I have chiari malformation.. and herniated disc, degenerative disc disease and arthritis in lower facet joints.....

it lost its effectiveness but I didn't want to increase because I am stubborn and I just suffered more... but then I thought it was time to ask for increase in dose so finally I asked to increase to 10mg.. so he did...

That was good for the next 2 months.. then last month my cousin was over and stole 25 of my pills.  10 mg at this point is barely enough to controll my pain. and the percocets ware off after about 3 hours... so I really need to be taking 15 mg 4 times per day but I am taking 10mg 3 x per day.. but she stole 25 and I didnt ask for a refil because I knew my doc would think I was abusing them... all I did was call up the M/A and tell her and ask if I needed to file a police report.. I mentioned nothing about a refil and she still treated me like I was a druggie! I am so upset and now i am afraid to ask for the increase I desperately need... also I don't know if there is a better alternative... pain patch.. ? I don't know what to do?
Related Discussions
17 Comments Post a Comment
Blank
Avatar_f_tn
Hi Jennifer,

I'm so sorry that you have found yourself in this predicament!!  I'm truly afraid that you might have a problem because of the fact that you have run short so many different times. If you had never had a problem then they might have "offered" you a refill but unfortunately, now they might think that was what had happened the other times that you ran short. It's really difficult to "second guess" a Doctor as to what he will do when something such as this happens.  

Did you sign a PM (Pain Management) Contract? If I understand it correctly, you are getting your Pain Meds from your PCP, is that correct? If you signed a contract, it will cover what happens if you have a theft or loss or shortage of Pain Meds.  It will be right there in "black and white" and you would no whether or not you should ever let them know about it.  

You did the correct thing in alerting your PCP of what happened with your Meds and your Cousin, but that still will send up a "Red Flag" with most Doctors.  Have you heard anything else from your Doctor's Office since you called and reported the loss?  Did you file a Police Report?  If you did, that would help your case a great deal!!  It would have been much better if you had called the police and reported the theft and then called your Doctor and faxed them a copy of the report or hand carried it to them.  What exactly did she say to you when you told her about the theft?

Have you ever asked to be sent to a PM (Pain Management) Doctor?  That might be the route to take and then you will probably be able to get the pain control that you need.  If your Doctor is willing to do that you must understand that the PM Doctors won't put up with you not taking your meds exactly as prescribed.  They, also, will give you periodic UA  (Urine Analysis) Tests to be sure that you are adhering to your Med Plan. Some do it everytime while some, like mine, only do it once every 11 months or so.  

If it were me, I would definitely not mention a word about an increase!!  Not at this time.  Wait until next month and bring it up then, if he won't send you to a PM Doctor.  

I would suggest that you inquire about the possibility of getting a RFA (Radio Frequency Ablation).  That is done when you have Facet Disease, especially in your Lumbar area of your back.  I have the very same problems that you do with your back and I've had the RFA.  My Facet Disease is classified as severe and the RFA has given me almost 100% relief in the Lumbar Region.  Of course with the DDD throughout my entire back I still need help with my pain and I'm prescribed meds for that.  If you are willing to have Epidurals and other procedures done then that helps to prove to them that you really do need the meds and aren't just trying to get meds.  Please understand that I'm not saying that's what you were doing, but I'm just letting you know how Doctor's tend to think sometimes.  :(  You definitely need the Pain Meds when you have the problems that you have. They are some of the most painful things that you can have!! When you add the Chiari Malformation on top of that plus other you've really got your plate full!!!  Bless your heart, I really feel for you!!

The Fentanyl Patch might be an option for you if your Doctor is willing.  Of course, he has your MRI x-rays and knows just how severe your problems are as there are many different levels of DDD and Facet Joint Disease.  That's what would tell him if you need that strong of a pain medication.  I'm betting that your PCP might not be willing to give you the Fentanyl and that's where you might need to be seen by a PM Doctor.  The Patch would definitely help you in using your meds responsibly and not taking more than you are prescribed. Sometimes you need to switch to an entirely different just to be able to get the relief that you need.  Your body will get accustomed to the meds that you are taking and they just won't work as well as before. Of course, chances are that you would have a BT (Break Thru) med and that would be up to you to use it as directed!!  Sometimes you just have to tough it out through the pain!! I've been using the Fentanyl Patch for a year and a half now and I love the results that I get with it.  I use Percocet for my BT (Break Thru) pain.

I hope that you will keep us informed as to what your Doctor says. When is your next appointment?  

Jennifer, I wish you the very best and I will be looking for your update.  I'm hoping that your Doctor will be understanding and will be willing to send you to a PM doctor so that you can get the additional relief that you so desperately need and deserve.  

I'll be looking for your updates..............Sherry  :)
Blank
1448748_tn?1312959808
I have never been short....maybe I wasn't very clear... My very first month I just had an extra script filled from the er because I didn't know I couldn't do that. I've never signed a contact and I recently went to pain management to get an occipital nerve block and sacroiliac joint injections.  And will be brain surgery soon...

I didn't file the police report because the ma told me not to, and i did not mention anything about a refill at all I didn't ask or even mention it I simply left a message saying I've never had this happen and I don't know what to do and wondering if I needed to file a police report... And I had just gotten a refill, and it was only 25 , so I had some so I wasn't even thinking about a refill.

When I had an apt with my doc to get my refill last fri, he was unavailable so I had to see the pa and I told her how the ma had treated me and how I thought it was very rude an unacceptable and she said the office manager would call me...but she hasn't.
Blank
82861_tn?1333457511
You've discovered the dark side of opiate therapy.  We all become tolerant and physically dependent over time.  Most of us figure that means we need an increase in dose.  Eventually we reach a ceiling where nothing puts a dent in the pain and increased dose is not medically possible. There are a couple techniques to combat tolerance but most people don't like them.  One is to change medications every few months.  A slightly different opiate compound can sometimes fool the brain into thinking its had an increase - for a little while.  Another technique is to take a short opiate vacation or taper to a very low dose.  Not an easy thing to do.

You should make that police report.  It's a federal felony.
Blank
Avatar_f_tn
Thank you for filling in the details. :)

Since you've already had your appointment since you talked with them, it looks as if you have nothing to worry about at all.  I'm assuming that the PA gave you your Pain Meds with no problems last Friday.  If you were going to have any type of a problem it would have been then.  They definitely believed you and I feel that the MA was totally out of line.

You need to speak with your Doctor next appointment and tell him everything, especially how you were treated.  We've learned on MH that it really pays to not get really angry when talking to the Doctor about the employees that work for them as sometimes they tend to get their "feathers ruffled" if you are extremely angry the Doctor will sometimes wind up defending the employees.  But if you tell him in a nice way (which I know you have done with the PA and will with the Doctor) he will more than likely listen to you with an open mind and be much more receptive.  That's just a suggestion. :)  The incident I'm referring to here, the employee turned out to be a "Family" member and the Doctor was very angry at the patient.  That's the only reason that I brought that up to you.  We never know who is working for the Doctor's. :(

I'm very surprised that the MA didn't tell you to file the police report.  Usually, they want that report to put in your records.  That tells you a lot right there!  The MA did believe you or else the MA would have told you to file it. :)  Maybe the way the MA talked to you is her normal way of talking.  There's, also, the possibility that she'd had a "bad" day or had a fight with someone, you just never know what's happened to them before you called.  Even though it's their job to be polite, "no matter what" , they are just human.  :(  Unfortunately, you were the one that she was very rude too and your Doctor does need to know this!!!  The MA is the one person that his patients talk to and the MA "represents" his office!!  

The reason I said you ran short is because you ran out early since you were taking 2 pill twice a day instead of 1 pill 3 times a day.  Therefore, you ran out "early".  That's why I mentioned that you were running short.  :)  I understand that the next time you got the prescription increased to 7.5 mg which was exactly what you needed to do.  The 5 mg's just not strong enough for everything that you have going on.  I can't believe that you have been able to exist on just the Percocet without a Long_acting medication!!  You would definitely have much better pain control with a Long-Acting Med to help you!!

I hope that the Doctor will listen to you on your next appointment!!  You need some help so that you can live a more pain free life.  

When is your surgery scheduled for?  I hope that you will keep us posted and remain an active member here on the PM Forum!!  You have so much to offer with your experiences.

I'll be watching for your updates and I wish you the Very Best...........Sherry  :)





Blank
1448748_tn?1312959808
Thanks sherry... I will continue to share...My doc wanted to put me on opana, unfortunately my insurance doesn't cover it. I do want to tell my doc, about the ma s behavior, but I started crying when I told the pa cause it was so excruciating for me the whole month.   From what jaybay said, am I currently at a dose where it's impossible to increase the strength at 10 mg 3 x day? I don't know because before 8 months ago I had never taken so much as ibuprofen and that was rare for me...
Blank
1448748_tn?1312959808
what other long acting pain meds are there... and what are the maximums that jaybay is talking about... this is really a topic I know nothing about... if I know more, maybe I can ask my doctor about it.
Blank
Avatar_f_tn
Jennifer, there are many Long-acting pain meds that are available.  The question that you want to ask your Doctor is "Can we try a Long-acting" medication and see if that would help me along with a "short-acting" medication for my BT (Breakthrough) Pain?  Let him lead the way with the suggestions of what he is comfortable with recommending to you.  There are many Doctor's that aren't comfortable with giving you a choice of all the different one's that are available on the market.  It's better to let them lead the way with the suggestions.  They like to feel that they are in charge. :)

I doubt that your Doctor will be willing to increase the Percocet's to a higher dose.  That's why you should consider asking about a "Long-acting" Pain medication to go along with the Percocet.  This, hopefully, will give you the needed help for fighting your pain and give you the relief that you deserve.  

Please continue to keep us updated as to what your Doctor says.........Sherry  :)
Blank
1448748_tn?1312959808
The only problem is that he did prescribe me opana er.. the long acting pain oxycontin... and then my insurance wouldnt cover it... so then he just didnt address it.. So I just don't really know how to go about even talking about it....
Blank
Avatar_f_tn
Do you have a formulary listing of medications covered by your insurance?  Most insurance companies provide these.  If you don't currently have one, you may be able to request one be sent to you.

Then take that formulary with you to your next appointment, discuss the possibility of going ot a long acting pain med with your doctor (like Namnam suggested, with letting HIM take the lead as to what med to try) - and then you can look in the formulary while you are there in his office to see if it is on the list of covered meds.  That way you won't have to take your chances at the pharmacy when you take your script to be filled.  Your doctor may also be able to look in that same formulary for comparable meds to what he's thinking of prescribing to see if there is anything else he could substitute.

Another option is to call your insurance company and ask them if they ever grant exemptions on medications (tell them your doc has wanted you to try a med, but it's not covered by them) and ask what you need to do to get an exemption.  Some will require something called a prior authorization form where your doctor fills out a simple form, stating what other meds have been tried and why he thinks the one he's wanting you to try would be the best option.  Other times they may require the doctor actually call them and speak to them.  And, alas, sometimes, they either don't have this option or they still deny the coverage.  However, it's definitely worth a try.

Also, many med companies have a patient assistance program that you may be able to apply for and get.  Of course, you would need to know the manufacturer's name of the medication, the strength, the number of times dose per day, etc.,  These programs are usually based on income, but some will also take into consideration your other medical expenses.

I hope you're able to work with your doctor to find the best possible medication soon. I completely agree that you would probably benefit greatly from a long acting med with a short acting one for breakthrough pain.

Best of luck!
Blank
1448748_tn?1312959808
I don't have a list.  I have medicaid.  we tried the prior authorization thing and they denied.. they did the same thing with celebrex.  

I am very poor so I would qualify for any type of those other programs.. I just dont know about them...

I am going to have brain surgery on Aug. 9th... it may help with my pain.. but how do I also address with my current and new doctor how to address the surgery pain? I am not like a regular surgery patient that normally doesnt take pain meds... I am worried they won't adequately give me enough pain relief because i will have additional surgery pain on top of the pain i already have... I am scared I will be in lots of pain and wont have enough pain medicine and don't know how to address this without sounding desperate and like I am trying to get extra drugs... you know?
Blank
Avatar_f_tn
The patient assistance programs are actually really easy to apply for (the ones I've had experience with anyway) - you simply need to either call the manufacturer (the name will be on your prescription bottle or you could ask your pharmacist) - or go to the manufacturer's website and look for a section marked patient assistance or financial assistance.  There is typically a form that you will need to have your doctor fill out and then either mail or fax back to them (if you can fax it or have your doctor fax it, I suggest doing that because it makes the process faster).  The manufacturer will then notify you and your doctor whether you have been accepted and how much they will cover per month.  Some of the programs provide the medications at completely no cost and others reduce the cost considerably.  

The only drawback is that some of these patient assistance programs are not available to those of us with any type of government funded prescription coverage (medicaid or medicare).  However, you can sometimes get around this if you can show them that you've attempted to have Medicaid cover the meds and they have denied the request (provide them a copy of your denial notification when you did the prior authorization).

As for pain management after your surgery - be sure and talk to your surgeon prior to yoru surgery date and let them know exactly what meds you are on and that you are concerned that your pain will not be adequately controlled following the surgery.  I'm sure they'll keep you as comfortable as possible, however, them knowing that you are already opiate tolerant (and wht meds you're taking) is very important - not only for your safety, but also so they are aware that you may require a bit more pain meds than someone else might, simply because you are already tolerant of the opiates.
Blank
Avatar_f_tn
Hi jenniferk,

When I had my THR (Total Hip Replacement) last September, my PM (Pain Management) Doctor was in touch with my Orthopedic Surgeon to let him know what meds I was on and together they went over what Pain Med increase I should have after Surgery and everything was in place before I went in.  It worked out great and I didn't suffer at all.  

I'm suggesting that you contact your PCP and have him get in touch with your Surgeon and be sure that he knows what you are on and let them work out what you can be allotted for pain afterwards.  Believe me, your surgeon does not want you to be in pain after surgery!!  That is the very last thing that he wants his patients to do.  He doesn't want your pain to affect you healing and recovery and severe pain would most certainly do that.  They won't think that you are seeking drugs if you ask about their plan for keeping you comfortable after your surgery.  Your Surgeon should understand your fear of this.  I'm sure that you aren't his first Surgery Patient to be a Pain Medication Patient also.  :) Just go ahead and discuss it with them so that you can be put at ease.  

Please be sure and let us know how everything goes and we are all pulling for you and know that this will help you feel better.  We'll all be here waiting to hear from you as soon as you are able to be on the computer again!

We're hear for you whenever you need us!! Looking for your updates........Sherry  :)

Blank
1448748_tn?1312959808
Thanks for the suggestion.  I made an appointment to discuss with him.  I hope he doesnt think after last months situation I am trying to get more out of him.... with the surgery, should I think about longer acting pain med or just short term pain med increase and or change to like morphine instead of percocets?
Blank
Avatar_f_tn
He shouldn't have any problem with you talking with him about this.  This is something entirely different than what you have talked with him about before. :)   You definitely need to be sure that everyone is on board on the Pain Med issue for your surgery.  Your Doctor's should be the ones to determine what medications you should be on after your surgery.  You shouldn't be suggesting anything specific to them, after all that is their job. :)  

I would imagine that it will be Short-acting meds that they will be giving you after the surgery. After all, once the surgical pain is gone the meds will be reduced back to your normal meds.  Your surgical pain will not last you very long.  As I stated in an earlier post, the last thing that your Surgeon wants is for his Patients to be in pain after your Surgery.  This is the worse thing that can happen to his patients as they can't recover as quickly if they are in pain.  :)

You need, at some point, to discuss with your Doctor about finding a Long-Acting Med for you that Medicaid will cover.  Medicaid should have sent you out a book that lists the meds that they cover.  if you don't have it then you need to call them and find out what they will cover when it comes to Long-Acting Medications.   Their number should be on the back of your Medicaid Card.  Mine was, when I was on it, before my SSDI kicked in.  I was thinking that I had a book from Medicaid that listed everything that was covered from Medicaid.  I know that Medicare sends one out every year as it tends to change yearly.

When you talk to your regular Doctor, you might mention to him, once again, that you do want to try a Long-Acting Pain Medication that is covered by Medicaid after all of this is over.  Since he thinks that this surgery might be able to help you with your pain, he might wish to wait until after the surgery to be able to evaluate just how well the surgery has worked.  Hopefully, this will take care of a lot of your pain issues.  That would be wonderful for you if tis does work!!  :)  ;)

Jennifer, just know that I'm thinking of you and wishing you the Very Best!!!.........Sherry  :)
Blank
1448748_tn?1312959808
Yeah, I am hoping that the surgery really does help with the pain... I am also wondering too about withdrawals though... if I increase meds for the surgery pain... will I experience withdrawals when I decrease my dose or will my normal dose be less effective since it is already pretty much getting to be non effective?  I have been trying my hardest to trick my body into not becoming opiate tolerant... so I will deal with the pain 2-3 times a week at night and struggle and take really hot baths for hours at a time so that I can either take a half of my dose or miss one because I know that my body is getting used to the percocet and that I can feel that other than my real physical pain... after night time in the morning... the aching my body wants a percocet pain... and I was wondering how I could use the surgery situation to my advantage... like if they give me morphine instead... then that would take away the pain of the percocet withdrawals and control my pain for the surgery also and then when my surgery pain goes away in a week or so if... lets say a majority of my pain is gone.. or the unmanageable pain is gone, I don't have to take pecocet (percocet) any more(hypothetically) so... I will be also done with the percocet withdrawal symptoms also since I don't take that much percocet per day right? and my withdrawal symptoms are really not that bad? and then I could stop taking narcotics all together? would this be a possibility?

I mean this is all very hypothetical since I have a lot of other issues... but it is a possibility.. maybe? or is it not  just asking.. and then I am concerned if they are giving me an increase in pain meds if I am still in pain or the same pain after surgery.... wont my tolerance be affected and it will make me worse?
Blank
1743821_tn?1311332855
I identify with you.My story is no different we all stumble to the point where we feel we have absoloutly no choice,however we do have a choice.Medication abuse is very common and nothing to be ashamed of.There is a difference between building up a tolerance for a drug and beomming addicted to it.
The question I beg to differ is How can one tell the difference between addiction and tolerance.
I began seeking for ways and means to get mor percocets and found myself focusing on the drug rather than the problem which was how to effectivley manage my pain from a herniated lower lumber disk.Soon enough I realized I could not stop,I needed painkillers in order to function normally.It was not until I lost my family I realized maybe I had a problem with these pills I was in such denial of the fact that my life became unmanagable I placed the use of this drug ahead of the welfare of my familyand myself.Sure pain is uncomfortable and we use the pills as an easy way out.I found sober support groups gave me the medication to find a new way to live without the use of any drug...very simply I knew if I would continue to use these pills I would continue to lose everything especially my sanity.When one is addicted to anything there primary purpose in life is to find ways and means to continue in a cycle of self destruction not knowing that in the end it is only ourselves we are hurting and knowing that pain can become magnified through our thought process only validated that it was something more than the physical pain i was dealing with in my life.9o meetings in 90 days if 90 sound like alot make an N.A metting a day and the 90 will take care of itself.
narcotics anonymous works only if you work it.
Blank
1448748_tn?1312959808
Thank u for sharing ur story, but what I was asking is if I could in fact use my surgery as a way to stop my pain meds all together I do not want to take them I do not like the way they make me feel. But I do know and realize I cannot go through brian surgery without some type of anesthesia afterwards or I simply will not heal well.

I go some days now when my pain is not that bad sometimes 24 hours (rare) but I've done it and do recognize that I get percocet aches but they are manageable and bearable if I didn't have other pain...but again that has been 2 times in the last month and zero times in the last nine months before that, and I think it's because of the pain blocks I had and would much rather continue to do over narcotics. If it wasn't extremely painful(sacro Illiac Joint injections and didn't have terrible side effects(steriods gave me bad side effects) and took 10 days to work and lasted a mere 4 days at only 30% relief. But 30% releif is about what I get from my percocet right now.  

I have never abused the percocet.  I have only taken them as needed and as directed and prescribed.  I have never sold or given them away.  My mother, father, sister and most of my family had a drug, alcohol or some other addiction problem and I am my whole family suffered and I have made it a point to make sure I will never do the same. This is why I come here, I am pro active and not re-active and asking for help after it is too late.

I'm hoping my surgery gets rid of a lot of my pain, at least the pain that's unbearable and I could possibly treat the rest with pain blocks and anti-in flammatories.

So with that being clarified, What I'm asking, and Maybe I should just start a new thread, if I change to morphine for my immediate surgery pain, will I still experience percocet withdrawal pain while on the morphine?

Also since I will only be on the morphine for 6-10 days the morphine would not cause withdrawals when I stopped if I were to go this route would it?  Normally I know I'm strong enough to handle it, but after surgery I don't even want to try. But if it's a good way to transition and then stop altogether once the surgery is over and have no narcotics at all, that would be my goal.

And that is my case and point.  I am seeking and trying to find a way to relieve my pain through other methods I do not want to take pills, I have only increased once in 10 months since the onset of my pain, not because I haven't needed too, because I don't want to become addicted, and I am afraid of addiction as I have seen it in action.  I want to be free of it if I can and if there is an alternative therapy.




Sent from Yahoo! Mail on Android
Blank
Post a Comment
To
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
Pain Management Community Resources
RSS Expert Activity
469720_tn?1388149949
Blank
Abdominal Aortic Aneurysm-treatable... Blank
Oct 04 by Lee Kirksey, MDBlank
242532_tn?1269553979
Blank
The 3 Essentials to Ending Emotiona...
Sep 18 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank
Top Pain Answerers
7721494_tn?1415940873
Blank
philnoir
Four Corners, CO
535089_tn?1400677119
Blank
Mollyrae
WI
1855076_tn?1337118903
Blank
marycarmel
MA
Avatar_m_tn
Blank
trixy71
Avatar_f_tn
Blank
remar
st. louis, MO
1530171_tn?1418143903
Blank
TheLightSeeker
London, ON