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Question about one of my doctor's cutting me off from pain medicat...
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Question about one of my doctor's cutting me off from pain medication

I'm new to this group and was reading several posts and hope maybe folks can help me out.  I just learned last week Wednesday that the doctor I have been seeing for surgery on my arm is no longer prescribing pain medication to me because he found out I was getting the same medication from another doctor.  The other doctor sees me for lower back pain.  Both doctors are seeing me for legitimate health issues.  The pain was just so bad and my tolerance is up on the Vicodin that I needed more to get through work.  I work two jobs and have been traveling a lot for work as well.  I realize now that I should have been upfront with both doctors about the prescriptions.  I was afraid one would refuse to see me once they learned (or stop prescribing).  I wasn't trying to scam them, but I can see how it looks like that.  I also am beginning to think I let this whole thing get out of hand.  I was relying on the Vicodin too much for my pain.  I've been staying away from pain medication for the past 4 days and I feel okay so far.  I'm just really scared.  I'm supposed to see the arm doctor (and ortho) next month for a follow-up.  I'm so embarrassed and ashamed I feel that I can't go-plus I'm afraid he'll yell at me.  Tomorrow I'm supposed to go see my back doctor and I am worried the other doctor told him too.  I haven't heard anything though.  The only thing the back doctor has said which is new is that they want me to bring in the original bottles of my pain medication.  They have said this in all of their messages confirming my appointments.  They don't sound menacing or suspicious when they say it, so I'm hoping it's just since I've been on it for 3+ years.  

Sorry to be rambling.  I don't know where to go. I'm afraid to go tomorrow-what do I say if the back doctor knows?  I'll be so ashamed.  I really like both doctors but I was weak and needed to be working at full speed despite my pain.  I felt I had no choice, although the truth is that I lied.  I wasn't doctor shopping because I have referrals for both these doctors from my PCP. I also have a 3rd doctor, a neuro, who sees me for migraines and also prescribes Vicodin.  I fear I'm going to lose them all and will have to start all over.  I swear I will never do this again.  I feel so stupid.  Like others I just want to be normal and live life without pain.  I think I can do it based on the past 4 days.  Can anyone help me or reassure me?  I'm scared.  
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Avatar_f_tn
Hi BridgetLee,

First, I want to welcome you to the PM (Pain Management) Forum and let you know that we are glad you found this Forum. We are all CP (Chronic Pain) Patients that help each other with our own expertise and experiences that we have developed through our own CP Issues.

Oh,Bridget, I'm very concerned about you.  Have you been taking your bottles in each month in the past to your back Doctor? You sound as if this is something that you do every visit with him.  What strength are the Vicodin that you've been taking from all 3 Doctor's?  How often are you taking them?  I'm very concerned about the acetaminophen that you've been consuming daily.  How long have you been taking all of these meds?

I'm really afraid that if you lose them all you won't be able to find anyone to help you with your pain for a very long time.  I'm surprised that you have gotten by with this for this length of time without being caught.  Do you use the same Pharmacy for all of your medications or have you been filing them at different Pharmacies?

What exactly are the sources of your pain that each Doctor is treating you for? I'm sorry that you found yourself in this mess.  Why weren't you up front with these Doctor's to start with and let them know the amount of pain that you were in so they could have talked with each other and adjusted your meds accordingly? As I said, I'm truly concerned about you!

I've always felt that it's best to be honest and above board with my Doctor's so that I don't wind up in a mess such as this.  I'm too afraid of being caught and losing my Doctor's.  Not so much for the meds but because they are all the Top Doctor's in their field of expertise.

You will have to decide what to do at your appointment.  If you had your appointment today, how did it go?   If it's tomorrow, how are you going to handle it?

You definitely need to make your appointments and if it's brought up, be honest with them.  Don't lie about it, explain it as you did on here.  You'll have to face the music, whatever it is.  Just know that you could very easily wind up with no pain meds.  They could also dismiss you.   Are any of these Doctor's a PM (Pain Management) Doctor?  Did you sign any Pain Contract with any of them.  If you did, then you are in for some really serious problems such as dismissal.  :(

Please keep us informed as to what happens.  I'm so sorry that you made these choices as you may really wind up in mess.

I'll keep my fingers crossed for you but if you make it out of this with your medication you must promise to be forthcoming with all of your Doctor's from now on and take only what they tell you to take.

I'll watch for your update..........Sherry
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Avatar_f_tn
I also am very sorry that you've in this situation.  I know how difficult it can be to try and function when you're in constant pain.  However, as you now know, the way you went about trying to get relief was definitely not the right way.

Unfortunately, as Namnam said, you very well could wind up in quite a mess.  Even though each of your doctors is treating you for a legitimate health issue, and they prescribed the vicodin for different reasons, it still could very well be considered doctor shopping because you knew that the meds you were receiving were the same and you had not notified any of the doctors about the other/s already prescribing it for you.  I'm hoping it doesn't happen, but there is a very real possibility that you could be dismissed from all three doctors' care and if that does happen, it could be extremely difficult for you to find another doctor willing or able to prescribe narcotics of any kind for you in the future.

My guess (and it is only a guess) is that since you say your back doctor requesting you to bring in your original pain med bottle is a new request - something they haven't asked you to do in the past - that they more than likely are aware of you getting the same med from at least one of yoru other docs.  it's very common to have  PM doc (or any doc prescribing narcotics) to request to see your original pill bottle, ask for a UA (urinalysis), do a pill count, etc., but it seems a little strange and concerning to me (for your sake) that this request was just made recently after you having received notification from yoru surgeon that he is not prescribing your meds any longer.

As Namnam also stated, you NEED to keep any appointments you have with your docs AND be completely honest and upfront with them about who you are getting meds from, what the meds are, the strengths, the doses, etc. - do not keep anything from them.  Their job is not only to help you with your pain and get well, but it is also to keep you SAFE - and also like Namnam, if you are getting and taking vicodin from three different doctors, I'm very concerned about the amount of acetaminophen you've been ingesting.  While large amounts of narcotics are dangerous and can do damage, tylenol (acetaminophen) poisoning/overdose is a very real and many times, a much larger concern - mainly because since it is an over the counter medication, many people think tht it's completely safe and ok to take as much as needed.  Even short term over use of tylenol has been shown to cause liver damage.

I know it won't be easy for you to "face the music" wiht your doctors, but you've got to do it if you have any hope of not only having them agree to keep treating you, but also for your own safety.

Please do keep us posted on how your appointment/s go.
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Avatar_m_tn
Hi Sherry and G-first, thank you both for your replies and sincere concern.  Your messages are so appreciated-I really felt alone.  Thank you.

I had my appointment with my back doctor and it all came down in a big way.  No surprise.  He knew about all the doctors-and I think they all know now.  He had a print out of all my prescriptions and doctors-even doctors that never gave me any pain medicine-even my primary care.  They said it came from my insurance.  I guess to answer your questions: I was using different pharmacies, sometimes not suing insurance.  Yes, I was bouncing around.  But I always felt like it was justified because I am really in pain and working two jobs.  I just wish the pain would go away and I could be normal like I used to be.  

Bottom line-my doctor is going to continue to treat me on the condition that he notify all my doctors and I only see him.  I realize I am extremely lucky.  He was about to dismiss me-he gave a few choices.  That's the one I took-I know that's a blessing and shows he cares about me. It almost breaks my heart.  

The more I researched my situation, the more I saw I really created a mess-just like you said.  I cried for an entire hour-but I told the truth all the way through.  I was prepared for the worst and to face the music.  Man, I never ever meant for all this to happen.  It was so embarrassing and I felt (still feel) so bad.  He wants me to take a test to make sure I my liver is okay, but now I'm worried I messed that up.  We changed my medication, although I still have Vicodin, but at a lower dosage-and the thing is that now I feel worse.  I am having a hard time getting used to the new dosage and other medicine.  Do I tell him that?  I guess I do right?  I just feel like he'll say I have to deal with it-but that's how the mess got started.  

I'm afraid of liver damage now-does it feel like anything?  

Well-thank you again for caring and replying.  BL-  

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Avatar_f_tn
I'm so glad to hear that you had your appointment and that your doctor has agreed to continue with your care.  I'm sure your honesty with him today went a long way in helping him make that agreement with you to continue treating you.

Now the hard part really begins for you.  You MUST stick to taking your meds EXACTLY  as prescribed no matter how much pain you are in.  I know it'll be very difficult at times, but in order for you to be able to continue receiving the care you are, it's imperative that you do it.  You're bound to feel worse right now because of the decrease in dose - and you may have a very rough several days as your body adjusts to the change.  Do what you can NON-MEDICINALLY to make yourself as comfortable as possible - warm baths/showers, heating pads, ice, soothing music, meditation, massage - whatever it takes, but DO NOT take more medication than what has been prescribed.

If, after you get over this initial hump of your body adjusting to the lower dose of Vicodin, you still feel that it's not helping, then talk to your doc about other options.  However, I feel you really need to give it the "old college try" at this new dose.  Because of your past history of over self-medicating (even though it was prescribed for you, you were taking more than what was prescribed either by increasing each dose or getting the meds from multiple sources), he's probably going to be very hesitant about any increases in dose, at least for a good bit of time to come.

What other medicine has he put you on?  Is it something completely new from what you've had in the past or have you ever taken it before?  

I'm glad he's testing your liver function.  As I stated in my previous comment, tylenol overuse is an all too common cause of liver damage.  One of the early warning signs of liver damage is jaundice - yellowing of the skin and/or whites of the eyes.  Other symptoms include abdominal pain, nausea, vomiting - although early stages of liver damage quite often have few or no symptoms - that's why it can be so dangerous - by the time you start experiencing symptoms, the damage can be pretty bad.  Keep in mind that acetaminophen is also present in many other medications - both over the counter and prescription - ones, so definitely be sure to read ALL labels.  Don't take ANYTHING other than your prescribed meds without first clearing it with your doctor, but even then, be sure and read all labels to check for acetaminophen (tylenol).

I hope your adjustment to the new dose and new meds isn't too rough.  You can do it!  And if you ever need anyone to just vent to, please feel free to message me.  Living with chronic pain is tough and we all have times when we need to vent, yell, scream, cry - and sometimes having someone available to do that with is a help.  Just knowing there are people out there that DO understand how you're feeling I know has helped me immensely.

Best of luck and please keep me posted on how you're doing.

Robyn
P.S. I just noticed that you live in Alexandria, VA - I'm in King George (used to live in Herndon)!  So an extra hello and best wishes from a fellow Virginian!
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You are a very fortunate Lady!!!  I'm glad that it worked out for you as it did.  Your Doctor knows that you have a lot of pain and that's why he is willing to keep treating you.  I've seen many cases where, even though the patient was in real pain, they were still "kicked to the curb"!!  I'm glad that you realize how fortunate you are to still have your Doctor.  I'm also happy that you were upfront and honest with him.  If you had tried to "lie your way out of it" he wouldn't have kept you as a patient.

You did everything right and, as I said, I'm very happy for you!!!  :)

I doubt that he will up your doses for quite awhile, at least not until you have had your liver test done.

Exactly how many Vicodin and what dosage were you on when you were getting them from all of your Doctor's?  What does he have you on now?

Again I'm so happy for you!!!  I was very worried about you.

I'll be looking for your update............Sherry  :)
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Avatar_f_tn
Like the others, I am very happy that this doctor will still treat you.  You will have to earn his trust back.  While you're adjusting to the lower dose, you can try some OTC remedies.  Some people like ice; I prefer ThermaCare heating patches.  Also ask your doctor about Lidoderm patches.  I find them a lifesaver.  He may also suggest ibuprofen to work with the Vicodin and he can tell you the correct dosage.  You may want to ask him about other options that are non-narcotic ... any kind of injections, some topical gels???  I have two prescription gels that I use and they take the edge off.  In the long run, you'll have much better care treating with one doctor.  I see a pain management team and my primary care gets notes.  All my pain meds go through the pain clinic.  Even when I've had my worst pain, I never took an extra pill or took something early without calling or messaging the pain clinic and getting a response.  They have always been good about responding to me.  It will take some time to build up trust but it can be done.  You are extremely lucky they didn't drop you.  Many find that happening to them.  I'm sure you've learned your lesson and know that being honest is the only way to deal with this.  I hope you'll keep us updated on how it's going.
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Avatar_m_tn
Thank you Sherry, Robyn and Mellie--I appreciate your support and ideas for how to deal with the pain.  Thank you Robyn for your offere-where is King County near?  I realized I jumped off the computer before I answered a lot of your questions.  Basically I was taking Vicodin 5/500. I didn't have any other medication I was taking.  I thought my daily amounts were around 10-12, but my doctor told me that in one month the records showed me taking as much as 20 a day.  I was surprised at that really but I know the records don't lie.  My new prescription is for a Vicodin with a lower level of acetaminophen (no more than 6/day) and ms contin 30 mgs 2/day.  The second one is new for me.  The adjustment hasn't been too bad I suppose, but it is a change.  I still feel the pain- a lot more now, and I can easily see how I got into the cycle of taking more than I was supposed too.  It makes it hard to get things done at work and at home when I feel so crummy.   Mellie-thanks for the idea about the Lidoderm patches and topical gel, I will ask about that.  I tried to ones you can buy OT but they didn't work.  

I'm committed to giving this the old college try and I will give my doctor the honest update every time I see him.  I won't jump into asking for increases.  I think the point is to get me taking less but still address the pain.  And I totally agree, I have to earn his trust again.  I am committed to doing whatever it takes to honor the second chance he is giving me and respect him in that way.  

I haven't been able to take the liver test yet, but I am carrying the order around with me so as soon as I can get away from work I can get it done.  I expect to do it this week or early next week.  I don't have any of the symptoms Robyn described, but as you say, it could be symptom-less.

One thing I did was make a list of all the reasons why doing what I was doing was bad-all the pros versus the cons.  I came up with over 25 reasons so far why it's bad, and the pain relief was the only reason why it was "good"-so I can also see that more clearly now too.  I just want to be normal and live like I used to and like everyone else around me does.  I want to work out more in the gym, and do a lot of the things I used to do.  This is the right start to going there--because let's face it, even at the highest point of how much pain meds I took-I still was in pain.  When I think of it that way, compared to how I feel now, I think, "I can do this another way-a way that's legitimite and by what's the right thing to do.

One remaining issue for me is what to do about the other 2 doctors.  They are both doctors  I really like and they are also very good doctors.  I haven't had any contact with either of them-no letters of dismissal and only that one call with the ortho telling me they would prescribe any medication to me anymore.  Do I still see them?  I'm really afraid they'll yell at me-that may sound dumb to say that.  I had thought to write them letters apoligizing and telling them I accept the consequences of my actions.  I made my bed and I'll lie in it so to say.  But I really want and need to keep seeing my neurologist. Same with my ortho-I suppose I could pass on seeing the ortho since my injury is almost healed, but what if something happens again in the future-I don't want to have find a new doctor.  I THANK GOD I didn't lose all 3 doctors, but maybe I lost 2 out of 3.  My biggest fear is getting yelled at or humiliated. I'm sure their staff all know and will look at me and think bad things- I still feel so embarrassed and stupid.  So many people would have hugely disappointed and upset with me if they knew.    

Well, I have to go, thanks again for your support, advice and guidance.  Bridget
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Avatar_f_tn
I hope you soon find that the MS Contin and vicodin combination become helpful for you.

I'm glad your doctor has given you a hydrocodone/acetaminophen combination that is a lower acetaminophen dose than what you were taking. Even with the 10-12 vicodins you thought you were taking a day, you were still ingesting 5,000-6,000 mg of acetaminophen a day and the MAXIMUM dose is 4,000 mg daily.  Based on the prescription report information from your doctor, you very well could have been ingesting upwards of 10,000 mg daily!  Think about that - more than twice the maximum recommended dose!  It's even more important now for you to follow through on that blood test for liver function just as soon as possible to rule out any problems.  I'm defnitely not saying that you HAVE got damage - only that with that level of tylenol ingestion, it's much better to be safe than sorry and get the blood test soon.

As far as your other two doctors, chances are that your back doctor has already notified them that he has made this "pain contract" with you where you have agreed that he will be the only doctor to be prescribing your meds.  However, I don't believe it would hurt a thing (and may very well help) if you write them both a letter - and basically tell them just that - that you have entered into a pain contract with your back doctor and you can and will only receive pain meds from him - however, you hope that should the need arise, that you could continue to seek their medical help for other issues other than pain control.  And, of course, if you do need to see either one of them, and they want to give you prescriptions of ANY kind, you MUST clear them all with your back doctor before getting them filled.  In fact, you could even ask whichever other doctor it is that you're seeing in that instance, if they could/would call your back doctor and clear any prescriptions with him while you're there in the office.  That way you're not even accepting any prescriptions that he may not want you to have.

King George is about 20 miles east of Fredericksburg and about an hour north of Richmond.

I have a neighbor who uses the lidoderm patches and she does find them helpful - particularly if you have one specific area that is more painful than others.  I've not tried them yet myself, however, I do intend on asking my doctor about them at my next appointment.

Best of luck and please keep me posted on how you're doing.  And like I said, any time you need/want to vent, feel free to send me a message.

Robyn
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Wow!  You are one lucky lady!  I'm so glad to hear that your doctor was willing to start over with you on the right foot.  Sounds like you have a good one.  :-)

Try not to worry about the liver damage business.  Your enzymes may be a bit high from all the tylenol but they should come down now that you aren't taking so much.  Your doctor may want to recheck them in a few months.

There's one thing I want to caution you about, and it's what got you into trouble in the first place.  Most of us think of pain management and pain meds as something that will cure our pain.  If one pill doesn't cut it, we take more and more until we reach a level of comfort.  We soon become tolerant to the higher dose and increase it over and over again.  As you already know, in that way lies disaster.

The goal of pain management is exactly that: management.  It's rare for a patient's chronic pain to be fully cured.  The goal is to reduce pain to low enough levels so that the patient can have some kind of quality of life.  At some point, we all have to learn to live with a certain amount of pain and make lifestyle adjustments to accommodate it.  It's just the nature of the chronic pain beast.  If you can learn to accept that, you won't become quite so anxious while you're in pain and be driven to either take more than prescribed or stop living altogether.  Anxiety causes a documented physiological response that increases our pain, so anything you can do to deal with anxiety will help.  It's not an easy task to rebuild our lives around our pain, but it's not impossible either.

You might want to ask your doctor for a referral to a pain psychologist.  A good one will help you to learn some mental tricks to better manage your pain.  That includes concious relaxation techniques, meditation, and finding activities to distract you from pain so that your first thought isn't to reach for the bottle of pills.  It takes work and practice but it's so well worth it.  My pain shrink has been so helpful to me over the years.  Without therapy I would have stopped living years ago and spent those years in bed just waiting to die.  She has also been very helpful in other areas of my life.  You know that chronic pain turns our lives and relationships upside down.  A good shrink can help you find ways to deal with those changes with a minimum of uproar.

Cheers to you for handling this crisis very well!  You're off on the right foot with a clean slate.  :-)
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