Pain Contract

[designgyrl0112]

It officially happened yesterday.  I went and saw my PM doctor yesterday (I haven't seen him in awhile) and let him know that I was on the fentanyl patch and oxycodone.  He asked me how it was working and I told him great.  So we decided to keep me on both of them and that I now am under a pain contract.  I have NO issues being on a pain contract with him, it's just scary because I've seen so many people fail with fentanyl patches on, and my PM even admitted he knows the patches falling off are an issue and that the medication does not get evenly distributed in your body.  So,  I'm worried about testing negative for medication.  I did not have a ua yesterday, he told me to call him at the end of the month and that I could pick up the fentanyl prescription and then he would also put me on a 30 day of oxycodone and then I have another appointment on November 15th. I'm figuring I'll probably get tested on the 30th since I'm picking up my 1st fentanyl script from him.  Or maybe he'll wait until 11-15, Im not sure. But I know I've not taken my medications as written but I've had those previous surgery stuff that I'm sure would come up on a ua.  So, I hope he's as  understanding as he seems.  

Anyone have any suggestions, ideas, and just general information since I'm new to the pain contract thing?

Thanks,

Karen

[mellie4]

The first brand of Fentanyl patch I got I had a bad time with it.  I can't remember the brand.  It would fall off early and no matter how flat I got it or where I put it, it would end up buckling and curling up on the ends.  It was also the gel kind and I had a terrible time getting the glue off my skin.  Then I noticed the glue was coming off on my clothes and I could not get it off the shirts no matter what I did.

Someone mentioned the Duragesic patch and that they had better luck with it.  I asked my NP and she was fine with changing it.  Initially worker's comp didn't want to approve it (a month of the generic was around $522 and a month of the Duragesic was about $1100.)  But when everything was explained, they did approve it.

Since the change to the Duragesic, I have no issues at all.  No need to tape it down, no buckling and no residual glue on my skin or clothes. In addition, I'm getting better pain relief from it.  I think when the other one would buckle and not lay flat I wasn't getting optimum pain relief.

[designgyrl0112]

Yes you are right.  I just spoke to my nurse at the PM and she stated they can get my records from the hospital and that they know that I've been in the hospital.  She also said the only med that jumped out at them was the versad, so there is a good chance that they won't test me on the 29th because they know some of that med can still be in my body.  I told them to do what was legal.  I also asked her if it was ok that I have the fentanyl patch covered and she told me it was fine.  So, there should absolutely not be any problems, thanks everyone for answering!!!

[JadedSweetheart]

I don't think meds still show up a month and a half after taking them, but I could be wrong.  I would look up the meds individually and see if they have a certain amount of time they stay in the system.  
Even if they do show up on a test, you can explain to the doctor that you had them in the hospital and if he has your records from the hospital he can look at it or he can order your records to look at.  
It seems to me that a lot of PM patients have to go to the hospital for one of our many other conditions from time to time and I'm sure the PMP knows and understands.

[designgyrl0112]

I did talk to my PMP doctor about the patches falling off.  He mentioned that he knew that they did, and mentioned that he's had issues with the one that are not name brand so when I come in on the 29th I'll get a fentanyl prescription that is the brand name.  I've got a great PMP doctor and it's not like he doesn't know everything that's gone on, I've always taken my meds as directed, never mis-used or ran out early, I'm  just concerned because I've been on so many meds over the last two months because of the surgeries, etc... and who knows what will show up in a ua test.  I'm concerned that stuff I haven't taken in a month and a half from the hospital will still show up.  That's my only concern.  Everything I've taken I've had a prescription for and I'm VERY happy he's kept me on the same recommendation from the other doctor.  Please don't think I'm unhappy or have done something incorrect because I haven't.  I do have the patch taped on right now with some tegaderm tape.  I'm more worried about versad from the hospital showing up when I had surgery, or all the other meds they gave me....

[Tuckamore]

Hello Karen,

First you should try the patches on your upper back, shoulder blade area. I think Sherry also suggested that. Additionally there are clear adhesive patches that you can obtain that go directly over the patch to keep it in place. They are called Tegaderm. Most manufactures will even provide you with these sheets of adhesive. With a bit of trial and error your patches should adhere without a problem. This is a good subject to discuss with your pharmacist....and your PMP at your next appointment.

In the years that I have been on this forum I have not noted one opiate testing inaccurately over another. We do have "spirits" of reports that seem to lean to one opiate or another but overall they test about equal. So I would not be overly concerned about inaccuracies just because you are on the patch. Just take everything as prescribed and you should be fine.

Best of luck to you.
~Tuck

[mellie4]

I never had a pain contract until I went on the Fentanyl.  The day they prescribed it I had my first UA.  That was back in the summer.  I was a little nervous, even though I've always taken my medication as required.  Since then I've had several more appointments and I've never had to do another UA. I'm not sure when I'll get another one.

The Fentanyl patch, along with the oxycodone 30 mg. every four hours has worked the best for me.  It's a lot of medicine but it helps the most out of everything I've tried.

[designgyrl0112]

I just re-read my post and I meant to say that I've taken my prescriptions as written, but I've also had a lot of other "surgical" stuff done as going to the dentist, having the last surgery last month and a lot of other medical procedures.  I don't do ANY type of drugs at all and the only medication stuff I take is what my doctor provides for me, I never run out early, except some of these pain patches fall off  and he knows about it.  I'm just a little scared because of all the reports that I've read that people say that no fentanyl show up.  It's funny that I finally got medication that works very well for me and now I'm worried about them taking it away.  Bree, I also always bring my medicine bottles with me to the pain doctor so they know what I'm taking but the medicaiton they use to do the root canal, lidocaine will show up.  I just don't want him thinking I've done anything wrong, becuase I haven't.  

[JadedSweetheart]

I have a pain contract with my current doctor and had one with the last.  I had a UA the first time seeing this doc and the month after but not the third time.
I don't think there's anything we can really do to "be prepared" for a UA.  I always bring my medicine bottles to the appts with me so that I can show them how many are left or anything if they ask.  I figure if I ever had a UA issue I would show them the bottle and demand a retest along with a blood test right away.
It doesn't sound to me like he is planning on doing a UA when you pick up the scripts but I have no idea what your office is like.
I would just read over all the info that Sandee has and be prepared to put it into practice.  I think she's got info for the chain of custody of the samples and the specific screens, etc.
Hopefully it will never be an issue!

[crickett7813164]

Hello Karen, I have been on the Fentanyl patch now for about a month along with 30mg Morphine for brake through pain. During this month I became severly depressed and was put on Effexor and Seroquel. It has made me so lazy. I just don't feel like doing anything... I don't sleep I just don't want to do anything.
The contract is designed to cover the Dr.. As we know their are a few that will abuse the goodness of the Pain Dr. If the Fentanyl patch is working and your not in need of the oxycodone then just tell the Dr. Tell the Dr. you don't need it daily and that you are happy to have the oxycodone when needed. Sometimes just knowing it is there truely helps.The Dr. will be pleased and will feel he has done his job.
It sounds like your over thinking the Contract. Pain Dr.s want to help just be honest

Sincerely
Crickett