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Please Advise.

I hope this message finds you well!  I am writing for your professional opinion.  I am a 35-year-old male suffering from chronic intractable back pain.  In 2004, I fell off a ladder resulting herniated discs at L4, L5 and S1 with mass effect on the right S1 nerve root.  In short, over the years, I have done everything asked of me; my treatment has been as follows:  +Bedrest initially in addition to Meds & ESI x 3 before operation  +Rehab which consisted 5 months participating 3x/week of PT, Message, Acupuncture, Trigger point injections.  No Better after 5 months.  PCP managing pain meds.  July of 2006, after no relief +Back Surgery TLIF L4-L5-S1  +PT post-op  +Sleep Study  +PCP Consults Pain Management from Anesthesiologist; Pain Management Specialist [PMS] after nearly three years into my treatment.  I abided, entrusting my life and continuity of care with my treating physicians.  

After nearly a year with Anesthesiologist [PMS] prescribing meds and continued ESI Q3months, also PT at home per swimming almost daily, it was recommended a spinal cord stimulator [SCS] should perhaps be placed.  It was my understanding this Boston Scientific device was implanted in the epidural space which generates electrical signals to the spinal cord to control chronic pain. I found this similar to the TENS Unit prescribed in early treatment except the SCS was internal.  Also, I was told the SCS is used mostly in the treatment of failed back surgery.  Well, again...entrusting by best interest was being looked for, I had the SCS placed with paddle leads placed at T2.  An intrathecal pump was discussed to be implanted simultaneously but was not placed.  Reasons not known.  

Pharmacologically, I have tried everything under the moon.  Lists as follows for the medications prescribed since 2004:  Duloxetine Cymbalta®, Pregabalin Lyrica®, Amitriptyline, Lisinopril HCTZ, OxyContin, Percocet, Oxycodone, Neurontin®, Opana®, Lidoderm® patch, Hydromorphone, Soma, Flexeril...you name it, I have been compliant and done what has been asked of me in every regard.  OxyContin and Oxycodone in combination Zanax XR, Cymbalta®, Soma, Lyrica®, Lisinopril HCTZ, Lidoderm® patch has been the best combination to control my pain.  In late 2011, my pain became much more intense.  At this time, I was prescribed, 240 mg of OxyContin/day and 45 mg Oxycodone/day in combination with all other meds mentioned.  After discussing with my PMS, he said there is a new formulation on OxyContin® now which the absorption rate is not the same as indicated in the old formulary.  As a result, per that appointment, he prescribed 160 mg more of OxyContin [exact prescription added, OxyContin 40 mg PO ii tabs BID] and 15 mg more of Oxycodone was added per day.  Now I want to say, I realize problems may be psychosomatic, at least that is my wife's take.  She has a Masters in Nursing, and against her better judgement, I decided to take the additional doses of narcotics prescribed in late 2011.  Since then, the PMS as prescribed a few different things, saying it was beneficial to do a "Narcotic Rotation" which has been done in the past, so I agreed.  In February, he prescribed, Hydromorphone XR and immediate release Hydromorphone 8mg for breakthrough pain.  I did not tolerate the change well, GI upset, so was converted back to Oxycontin/Oxycodone regime.  So, in June of this year, I went in for my scheduled appt.  Since the beginning of 2012, random urine drug screens along with another urine test to measure if the correct amount of the prescribed narcotic level is within your urine are of routine now, expected, no less.  Ok, I get it, I completely understand the DEA is coming down with guidelines being severely strict on physicians.  So, this day was no different.  He gives me two months supply of prescriptions and on with my day I went.  Well July 25, 2012, I received a letter which was dated June 19 but postmarked by regular mail on July 25, 2012, stating he was terminating our relationship because I failed a drug screen for Xanax and Hydromorphone.  Now, the Xanax has been prescribed from my PCP for the last five years, no break, and the Hydromorphone was prescribed in February.  I was not instructed to discard the Hydromorphone, and I was having a couple bad days in the beginning of June so I did take the 8mg of Hydromorphone for breakthrough pain a couple of times.  Honestly, I thought no harm was being done.  So, my predicament now, I have no PMS, my PCP will refer me to another PMS, but it can take up to 6 weeks to get an appt.  My PCP only felt comfortable writing for OxyContin 20mg PO i tab Q12H and Clonidine.  My last full amount dose was yesterday at 5:30am.  I realize I am just at the very beginning of this process, however, I am scared as to what I am going to experience.  I was advised to go to the ER if necessary; however, I have never been to the ER for such and after reading posts on here, it would not do me any good, anyway.  I could maybe understand if I had multiple Pain Specialists, I've only utilized ONE in the last five years, being compliant!   What are your suggestions?  What do you advise?  Was the proper treatment given when prescribed the additional dose of OxyContin/Oxycodone?  What is the PMS's responsibility in terminating our relationship?  I did read that they are responsible for your care from the postmark date of letter of termination.  It has made it clear, no prescriptions will be written, but I am interested in knowing my rights.  I am just to the point...if one mistake to what I thought was permissible can have this much control over my life, maybe its in my best interest to try and detox from all these medications.  What do you advise?  Please help me, I would be greatly appreciative!!
       
 

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Avatar universal
When you see A Pain Doctor Anywhere, you not supposed to get any meds to treat your condition, you signed A contract and it states only meds for pain or for the treatment of ur condition is to be prescribed by ur pain doc only, oh and FYI pain docs now if ur dismissed as patient for any reason it goes on a list& other pain docs see that it's like that here in Oklahoma plus I've been Nurse for 12yrs and seen it. Goodluck
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Avatar universal
If i were you I go ahead and get your PCP to make the referral with another PM doctor.

The contracts unfortunatley are being taken serious & any hiccup will get you discharged no matter what the excuse was.

My co worker had to go to the ER because she was bit in the buttocks by a pit bull last week. (24 stitches)..She told me they only gave her 10 hydro's and before they would even give her the presciption she had to take a urine test....They are coming down hard on pain pill prescriptions.

Technically yes the dr. had every right to discharge you.
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Avatar universal
I realize my comment is rather lengthly; however, I just wanted all facts known.  I welcome all advice and help and thank you in advance for helping me through this difficult time -:).  
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