Tapering off Norco with Tylenol #3?

[Lizzy57]

First off, WOW, what a change has come over the medical community in the past few years!! I was prescribed Lortab 5 years ago by my PCP for a worsening back condition. She routinely gave me 90 a month with refills and never said a word.
NOW, after 2 major back surgeries in 2 years and a major foot surgery (dropped a full pain can on my toe--just smashed it to a pulp)...just 2 months ago, my new(ish) PCP is giving me HUGE pushback on letting me have ANYTHING for pain. I'm going to have arthritis in my back and my foot is now bone-on-bone in my big toe. Basically, I am going to hurt forever.
At my last visit I asked her to step me down to Tylenol #3. She was not happy that I even KNEW what to ask for. (I'm almost 60 years old and not stupid--I know Tylenol #3 is a step down from Norco 7.5). She was VERY hesistant and asked me why I couldn't just quit taking the Norco. (DUH? Withdrawal, for one thing) She did a step down list--and wrote the scrip and sent me on my way. A week or so after I filled it, I realized she'd shorted me 21 pills, from the step down she'd written out, to what she "prescribed". Basic math, couldn't do it, I guess. I just came back from the pharmacy, and the pharmacist said he couldn't do anything w/o her say so. He also said that Tylenol#3 is NOT in the same class as hydrocodone and she can call in scrips for it. I asked him if this was an OK way to step down pain meds and he said it was MUCH safer than doing it CT. I trust my pharmacist so much more than this dr. I do NOT want to be a problem patient. I honestly feel like a junkie, the way this woman has treated me. If I was ONE day early on a refill, I got this "look". I've had a horrible year, back surgery after not even recovering from the first one, major foot surgery before I was 100% from the back---constant pain and anxiety. I'm on Cymbalta which has begun to help, and Klonipin for the anxiety. Honestly? The thing that makes me most anxious is the worry that one day )and it's coming) this dr will dump me as a patient. I have not had a really decent PCP for years.  My question--is taking Tylenol #3,  2-3 times a day (along with ibuprofen piggybacked on with that) a serious drug problem? I feel so dirty. Going to the dr makes me want to cry. Are there drs out there who treat chronic pain and don't treat you like a street criminal?

[Tuckamore]

You're so right - what a change in the opiate climate!

How most of us are prescribed is not what the written guidelines tell these doctors! You can look on the AMA, Pain Management, DEA or similar sites and their guidelines are more liberal that the actions the doctors are taking. I think they are just frightened by the stories that they read and the stories they hear about fellow physicians. A few are losing their licenses, being sanctioned or what ever the case may be. Our physicians are frightening to death that the years and money they put into their career may be lost. Who can blame them? However I do think they have over reactivated - and the DEA is over reaching. But who am I? :0)

You know most PMPs are Anesthesiologist. Yes, that initially surprised me - until you think about it, than it does make sense.

No scope from your son the Gastroenterologist? I get it. I wouldn't either. There are some things that are just forever private with we moms.

It's not unusual that our children, especially sons just don't get our pain. Mom has always been strong, warm and giving - so why should she ever be anything else?

Good luck at your next appointment. I'll be anxious to hear how that turns out.

[Lizzy57]

Of course the Drs in the family are out of state. And they know of my dependency and they don't particularly care. Their specialties are Anesthesiology and Gastroenterology, so my "problems" bother them not one whit.
They also say that 3 Tylenol #3's a day is not a problem, esp after I have tapered off of Oxycodone (post back surgery) and Norco to this. I function (in their eyes) just fine and that is all they care about. If I can fly in and babysit for them for a week or so, life is peachy. Everyone thinks it's awesome to have drs in the family, and it's not. Unless I need to be anesthetized or have a colonoscopy (and my son is NOT doing that for me) they only see what's in their field of vision.
I am going to see my PCP doc next week and if she is still giving me serious pushback on this, I will find another dr. I know PCP's, well, ANY dr is under such scrutiny these days!! My back surgeon gave me one week's worth of Oxycodone to take for MAJOR lower back repair, and then said "We're done with you, see your Primary Care doc." One week. I was still practically bedridden. This same doc did my first back surgery 2 years ago and had me on Norco for 4 months. What a change!  

[Tuckamore]

You might want to talk to two of those "Big Babies" - the Drs - and ask their assistance in directing you to a good physician. :0)

I bet their out of state?

~Tuck

[Lizzy57]

THANK YOU! for your comments. I have been struggling with this issue for a long time.
I have already tried to find a chronic pain dr who will even take me as a patient.. When I tell them my age and what I am looking to do, they have told me "Your PCP can handle this!" But she is so resistant!!
I have never even had a drink of alcohol. I gave birth to 5 HUGE babies via C-section and came home from the hospital with extra strength Tylenol. I have had migraines for 52 years, off and on. Take IMitrex for those. It was when my darn back started to go (thanks, huge babies) that I began to have chronic pain. Changed  my life, and not in a good way. I will have pain the rest of my life. My PCP does not accept that. (She's maybe 45--at 45 I felt great, too). I just want to ride out the "golden years" being able to play with grandkids and walk without pain. I'm sure not looking for a "high". The absolute joke is this: there is a known "drug house" in my neighborhood (I think everyone has one, right?) and I could walk over there and get anything I wanted. I don't. Trying to take care of chronic pain and the judgment that falls on my head!! Phil--I want to take you to my next drs appointment. I'd never heard of that 'Patient's Rights" document. I swear that drs are becoming the enemy. Sad, 'cause 2 of my kids are drs!!

[Tuckamore]

Hi Lizzie,

My heart goes out to you! So many of us feel this way you do. Chronic Pain patients are often made to feel like criminals. The first time I watched as they counted my opiates one by one I felt like a criminal! It was obvious from the bottle's fill date and just looking at the amount of tablets in the bottle that it had to be on or so close it didn't matter - honest what's one tablet over or under at any given moment? But no, they counted every appointment. I was felt ashamed, like a child that had done something wrong. By the way my count was always right one!

Phil has offered some great suggestions and I agree with him wholeheartedly.

We all feel your pain. A few of us are blessed to have one of those great PMP or PCP that treat us like what most of us are, responsible adults that have the misfortune of having chronic pain - and that have been compliant for years.  

Your question, "My question--is taking Tylenol #3,  2-3 times a day (along with ibuprofen piggybacked on with that) a serious drug problem?" The answer is a solid No. This is not a high dose of an opiate by any stretch of the imagination.

You're not 20 years old looking at 60 years of having to manage chronic pain. You have joined the ranks of seniors and with no history of drug or alcohol abuse. I  that should be a concern at this point.

You may be better off searching for a PMP. Look on the internet for PMP that say they treat with opiates - not just interventional pain management. Look at the ratings other patients have given them. Remember there is always going to be someone that hugely dislikes the PMP for whatever reason and someone that loves them too. I look at all the reviews. Phil has said that often they will have a pain contract on their website if they RX opiates. That is true most of the time  -  mine doesn't have one on his website and he does RX opiates.

I've tried to just ignore the second class citizen most medical providers appear to look upon me as - and know that I am a worthy human with chronic pain. I wonder how well those that look down upon us would handle the pain we do. Hold you head up high my friend in pain. You are doing just fine, it's your physician that is not!

Take Care,
~Tuck

[philnoir]

Lizzy, many people who have to take pain medication feel this way, because we've demonized "drugs" in this country for the past 120 years.

And, for many reasons, chronic illness makes people feel shameful, especially Americans.

Your story is chronic pain, and you have a right to adequate pain treatment. It's that simple.

The International Association of the Study of Pain (IASP) is a professional group of medical and scientific professionals who specialize in the study of pain. At their annual meeting in 2010, these learned gentlemen published a document called the Declaration of Montreal.

They said this:

"... recognizing the intrinsic dignity of all persons and that withholding of pain treatment is profoundly wrong, leading to unnecessary suffering which is harmful; we declare that the following human rights must be recognized throughout the world:

Article 1. The right of all people to have access to pain management without discrimination. ..."

You can read the entire Declaration here:

http://www.iasp-pain.org/DeclarationofMontreal?navItemNumber=582

Learn to stand up for your rights, Lizzy. You have nothing to be ashamed about.