Please help with pain mgt. medication questions.

Hello all! I have not posted in awhile, but I am finally getting my TMJ surgery in Feb. I had the arthrocentisis (joint flushing) and it made me so much worse. So they scheduled me for joint repair surgery and joint repositioning. I was referred to a pain mgt. doctor because of my continued pain. I was taking hydrocodone 10mg and then they put me on percocet 10mg every 4-6 hours. I was taking those meds (not at the same time) for months. So I got my appt. with the PM doc, and he said that I am an "opiate tolerant patient" because of all the meds I have been taking for so long. He prescribed me the newer drug Opana IR (oxymorphone) as well as Lyrica for nerve pain. Well, I told the doc that I have had a bad reaction to morphine and dilaudid (extreme nausea, dizziness, heart racing, sweating, zombie feeling) and he said that even though this medication has that in it, it would be fine. He also said I could call him if I don't like the meds and he would change me back to percocet.

Well I tried taking the meds, and got extremely sick. (The lyrica is fine, but not the opana). It was waaaayyy to strong and made me very sick. I called the doc the next day and the nurse said to stop the meds, and she would have him write me a new rx for percocet.But first, I would have to return the meds to them so they could destroy them. I don't drive so we had to wait till the next day for my husband to return them.  I had no other meds, so I had to try to continue the meds at night only because of the horrible pain. I thought everything would be fine, but after sending my husband up to the office and bringing the old meds up there, they said they just decided to keep me on the meds.

So my husband called me to let me talk to them. The nurse is now saying that they want me to stay on the opana for at least a week, and then let them know if it still makes me sick. I told her I cannot do that. I don't want to take it and have no other pain meds b/c they have me in a pain contract, so I can't even go to my doc and get them. I told her I would rather just take my usual percocet. She said no. She said this is the best drug and they participate in drug trials with it and they like it alot. The doc decided to keep me on it by calling the drug rep for opana. She said he will not rx me any percocet even if I don't want to continue taking this drug. This is his fav. drug, so this is what I am to stay on.

I have a 2 year old, and I need to not be a zombie for him. I also get a horrible headache from this med and get sick. So I am supposed to stay sick and continue taking it for a week?? I think I want out of this place. I am in a contract and I thought they would help me. The first visit went great and he was very nice. I told him about the morphine reaction and he said we would just try this first to see. So after taking it for 3 days and feeling like total ****, why would he make me stay on it?? Anyone who has experienced this please advise. I need to know what to say when I call back. I cannot take this med! I don't have a way to get my usual meds b/c of my pain contract. The nurse said it was fine at first, and then they all changed it around on me. I am very upset and in horrible pain. I would rather be on my reg. meds that don't work as well for pain than be on this med and get sick and have horrible headaches. What should I do? My husband does not want me to keep calling them and be a "problem patient" but I don't want to take the meds. I just want my old meds back, and they are refusing. They say this is the strongest med and they really like it. I don't want something this strong. I hate it. I don't want to feel so doped up. I cannot tolerate it. Why are they pushing this med on me? What should I do? I was thinking of calling my primary care doc and telling him to see what he says. Do you think that would be good to do? I hate to be a nag, but I am so sick. I have to make it another month till my surgery, and I can't take this for a month. The doc seems to have a conflict of interest by participating in the drug trials with this med. If a patient is allergic or has a bad reaction to a med, why would you take the word of a drug rep and not use your medical degree?? When I go to the ER and tell them I can't have morphine, they certainly would not give it to me anyway.

I hope someone can help me figure out what to say and how to say it to the doc. I feel like they are pushing this med on me and I don't like it. Please advise. Thanks so much for any help! Take care.

[Tuckamore]

Hi Again Tmjpain,

I am sorry you are having an issue with the Opana IR.  It is a stronger medication than Percocet and should work better on your pain. However we are all respond differently to medications. What works well for one person does not necessarily work for another.

I do know our body takes time to adjust to Opana IR or any other major opiate. I think you PMP is requesting that you give that medication time to work properly. "Big Dog" narcotics give me a headache also. I have had to take IB with them to control my headache. Usually with time this side effect will go away. If you are not having a true allergic reaction I understand the PMP insistence that you give your system enough time to adjust to the medication. He may beleive that Percocet is not able to provide significant pain relief based on your condition. And though Percocet is a good medication for moderate pain it is not usually considered strong enough for severe pain.

I think your husband is correct that if you continue to call you may be labeled as a "problem patient." However you have to do what you think is best for you. Just be prepared to deal with the consequences. Maybe instead of refusing to take the Opana you can request medications to control the side effects or ask how you can deal with them. That would put you in a better light with the PMP may change his mind in time. I am sorry but I do think you should give it more time.

Don't be discouraged. Physicians do not always prescribe the pain medications that we feel are best for us for one reason or another. Sometimes you just need to follow their advice for awhile. And often, after time they will change medications that are not effective but again not always to what we feel is best for us.

Others will post with their opinions and/or possibly better suggestions than I have offered you.  Good luck and hang in there. Take care and please keep us posted. Tuck

[scaredmom330]

I take morphine and it did take time for me to get use to it. my questions is if you think they are too strong have you tried taking half dose? maybe cut the pill in two and try that see if it helps with the side effects and your pain...

I agree with your husband, don't call the doctor again. and you are in a spot with the pain contract but try the half dose...keep in touch and let me know how it works..


take care my friend

[tmjpain25]

Thanks for your input. I had to call them again yesterday because I started itching and had welts all over me. I felt like I could not breathe and started vomiting. The headache was horrible. They called me back this morning, and said to come in, but I can't b/c my husband is working out of town and won't be back till afternoon. I asked if I can come in the afternoon, and she said they will be in surgery. So she told me to take a cab. I asked why I need to come in, and she said to make sure I am not lying about my symptoms! I was shocked. I told her I am no longer itching b/c I stopped taking the meds. She said I still need to come up for a drug test. I asked why and she said that he would not rx me any more meds and that they are closed this afternoon and tomorrow and won't be back till Monday. So I asked her if I am to stay on the meds, and she said no. So I asked if he could give me anything to help me till Monday and she said no. So I told her I guess I would be going to the ER. I don't get it. I asked her if she could give me vicoden or anything else that does not have morphine in it, which I am allergic to. She said he will not give me anything else till the old med leaves my system. So I am stuck all weekend with no meds. I am very upset. I called my husband and he is calling their office right now. He said that he is not happy about them leaving me with no meds till Monday. He said now we have to go to the ER again and he is not happy about that either. So now I will probably be kicked out of their program because my husband is probably not going to be so nice. I hate this. I would have NEVER signed up for this if I had known I had to choice to my treatments. He is doing clinical trials for this drug and I don't think it is a fair thing to push this med on someone who said they are allergic to morphine! Now they think I am lying?? Whatever. I am so out of there. I would rather suffer on my own than have people accuse me of lying about a med that I am allergic to. I did try to half the dose and I did try to take it with benadryl. I even tried phenergan. I am still sick and still itchy. I am never taking it again. They can shove it. I am calling my PCP today to tell him I am never going back there. I don't care if I have pain I don't like being treated like this at all. I will let you know when my husband calls me back about the nurse. I don't think it will be pretty. I will probably not be welcome back after he gets done with them. Thanks. Take care.

[tmjpain25]

Ok, so I talked to the nurse and my husband did so as well. I was shocked at the way she treated us both. She told my husband that I am an addict. She told me that my husband threatened her, which I don't believe he would ever do. She called my primary care doc and told them that I was a difficult patient and a drug seeker. I have never been treated like this in my whole life. I got a call from her at about 2pm. She said that they could see me if I got there by 4. I called my husband, and he could not take off work b/c they had already told us they would not see me today, so he made work appointments. They then told me I was trying to avoid the drug test and that I would not be getting any meds to help me. I am very upset. I told them I would just go to the ER and they told me that was fine. Then another nurse called back to tell me if I went to the Er, then it would violate my contract with them. I am very confused. I have gotten totally different stories from both nurses. I have been yelled at and called a liar. They said I only wanted percocet and that they thought I was an addict. I am appalled. I never asked for percocet. I just simply told them that I am used to taking percocet, and have been on it for about a year now. I would love to get off the percocet and take something else. They originally said that was fine, but now refuse to help me and accuse me of things.

I don't know what to do. I did find some of my usual meds in my medicine cabinet from an old surgery. I did not know I had them or I would have been taking them instead of the meds that they gave me that made me so sick. I let them know that I had some meds to get thru the weekend and they did not like that at all. They said that if they did not rx them to me, then I would violate their contract. But, I discontinued the meds they gave me a couple days ago, and have been feeling horrible since then. What am I supposed to do, just sit here and deal with the pain that my usual docs think is bad enough for me to take percocet for a year? I don't get it. I was told I was lying about my reaction to the med. It is a very strong med and I don't like the feeling it gave me. Then the itching started. So why would I stay on it? I thought I was going to die the last time I took it. I called begging for help and they said no. THen they changed their story and blamed it on me. I am not sure what to do.

I called a couple more times to beg them to see me Monday. No call back. I will have my mother in town to take me on Monday if they can see me. I am so scared now, because if they do see me and do the UA, they will see that I discontinued the meds they gave me and took some of my usual meds over the weekend. They will probably kick me out for that right? What do you do in this situation? I don't want to go back there ever again. I have been labled already. I have been yelled at by all the nurses and they obviously think I am a bad person. I was very upset and let them know that. I know that my husband let them know too. So I guess I went about this all wrong. I guess it is not like a regular doc. You cannot be worked in to their schedule and you cannot call them with problems. I think that calling them so much about my reaction to the med made them upset. I was already a problem patient. They hate me already. I am too scared to go back and face them again. I am too scared to get kicked out. I would rather fire the doc and not let him fire me first. What should I do? How could this go on Monday? I have been honest the whole time, but they don't seem to like what i told them.

Should I go back in and let them kick me out, or should I just find a new doc? Will they kick me out? Will they give me another chance, or have I already ruined this for me. Any advice would be greatly appreciated. I don't know what their policies are. I did not get a copy of the pain contract. I wanted to go in and talk to them and clear this up. I just don't know what they are going to say to me and what they are going to do. I am so scared. I don't want to be treated this way. If I swell up and cannot take a med, then why are they making me come in to get a new med? Are they just trying to get me to come in so they can kick me out? What do you guys think?

I know that being on the percocet for a year has made me dependant on it. I do have severe pain, but do not want the side effects of a strong pain med that will knock me out. I want a reg. med that helps pain but does not make me drugged. Let me know what I should do. Thanks for any advice. Take care.

[MyTau]

Dr's get kick backs for prescribing certain meds; do some investigating to try and find out what the makers of the drug give Dr's. I found out my Dr got free golf games by prescribing me Oxycontin, her partner/ Med assistant let it slip out how much I keep them in golf games. The more they prescribe something the more they get; it's money for the Dr's and money for the drug makers.

[frustrated431]

im not to sure about what to do about some of the things you said. I know i can relate to what the nurses said to you i get it all the time from my reg. doc. but i do know that the welts and itching you suffered are probly due to an allergy to the med and you shouldnt take it anymore and as medical proffesionals they shouldnt make you take it. sorry i cant be of more help to you good luck.

[MyTau]

You have made things very hard on yourself, not only do they think you are lying, but are trying to get more meds. Now while I believe you you have to know that so many people are drug seeking patients, and by refusing to come in for a UA(they are within their rights to make you come in within an hour) they will red flag you, and with computer systems any Dr can find out about potential drug seekers. I know it ***** to be treated like that, but you are lucky, most people can't find Dr's to treat their pain, and when we do we have to sign contracts, give random UA's, but this is how Drs will treat your pain and it keeps the DEA off their backs by being vigilant Doctors. I fear you are in a world of hurt, not only did you refuse the requests you went against your pain contract, and most likely they will fire you from their program. If you have some of your meds left you should take it go to the clinic and show them the symptoms; then try talk to them about just how hard it was on you, and that you didn't mean to make it hard on them. It might help, but don't start looking for a new Dr again because you are probably red flagged, your only option is going to the pain clinic and clearing things up. How long has your PCP been your Dr? It might have helped if you couldn't get in to the pain clinic when you needed to go and see your regular Dr, then your symptoms would have been documented.

[jimgreg]

i was on percocet for 14 montes at 6 -10,aday..it did help my knees good and lower back..when i went to the pain m,i told her i needed a stronger relief..so she put me on methadone low dose to start with..after 6 monthes or more they had me on 120mgs aday in 3 -  40mgs  waffers witch they don't prescribe anymore to pain patients..so the pain was controlled..i stayed on that for 2 yrs..then wanted off of it..so i weaned myself down 5mgs aweek to 10 days..then when i got to 20mgs i stopped cold turkey...i found out that was the wrong thing to do..but i went threw it all...it was pure HELL 14 DAYS WORTH....COULDNT SLEEP THAT GOOD AT ALL..YOU MIGHT HAVE TO WEEN OFF OF IT..OR LIKE A POST SAID TO BREAK IT IN 1/2..BUT YOU WILL STILL WITHDRALW A BIT..MABEY NOT LIKE METHADONE..I BEEN THREW ALMOST THIS WITH THEM BUT NOT AS YOU ARE..I WENT BACK TO THEM AFTER I WEENED OFF ..THEY  THEY PUT ME BACK ON A MUCH LOWER DOSE OF 15MGS ADAY AND IT DOES WORK TOO..METHADONE WILL HELP UR PAIN LEVEL!! BUT ITS A STRONG OPIAT!! I NEVER HAD TMJ OR KNOW ANYONE THAT HAST HAD IT..IM ON OTHER MEDS FOR BIPOLAR SO YOU HAVE TO KNOW WHAT UR DOING AND WHAT UR TAKING ALSO!!THE DOCKTERS OUT THERE ARE NOT LIKE THEY USE TO BE..THEY ARE MEAN TO PATIENTS..THERE ARE ALOT OF PEOPLE THAT DO DOCKTER SHOP LOOKING FOR MEDS TO GET THERE SICKNESS AWAY..AND THE PAIN M KNOWS ALL THIS THREW THERE TRAINING..AND EVEN A GOOD PAITENT MUGHT SHOW SIGNS OF NODDING IN THE WAITING ROOM AND THERE NOT DOING ANYTHING WRONG..THIS IS WHAT THEY THINK OF YOU DOING..IM SURE OF IT....THE MORE YOU CALL A PAIN DOCKTER THE WORSE IT IS FOR YOU..IM SORRY THIS HAS TON HAPPEN TO YOU AND UR FAMILY..THESE DRUGS SUCK I HATE THEM THEY RUN UR LIFE..DONT DO ANYTHING FOR 2 DAYS AND YOU WILL KNOW WHAT I MEAN!!....THE E.R. WONT DO ANYTHING EITHER THATS WHY SHE TOLD YOU GO AHEAD AND GO THERE.....WELL GOOD LUCK TOO YOU!!