need help with pm situation

[RNinCP]

I'm new to this forum but not to CP. It has effected my life for the past 10 years of which know I have an opiate dependence. I work full time as an RN at a samll community hospital and try to function to the best of my ability. In my mid twenties I was in 2 MVA that has led to having chronic pain in my neck and back. In the tens years I've seen around ten different MD's from 3-PCP's ,2-Rheumatologists, 3-Orthopedics, 2-Psychologists, 5-Phys.Therapists, 1-Chiropractor. All of which have tried to manage my pain. I've been/tried on many different meds over the years. I smoked pot 2 times but never any other illegal drugs and don't drink ETOH at all. My dependance started with vicoden that was prescribed for some pleuric pain to my back and I noticed it elleviated the neck pain I had but put up with at the time. As the years went on it went to percocet in increasing strengths then to oxycontin which I had a reaction to ,then to fentanyl  patch's up to 100mcg q48hrs to MS contin and MSIR  which I've been on a maintance dose for over 2 years of 30mg 1-2 Q12hrs and MSIR 15mg  q2hrs for btp.
Now my situation is My PCP 5 years changed in Sept of this year. Same office All new staff. My first office visit II met her she and she reviewed my chart and I told her I was having Sciatic "nerve" pain she appeared overwhelmed to the fact that I was on such a high dose of opiates and said the previous PCP seemed to overmedicate her CP pts and she wouldn't continue prescibing my narcotic meds and I would have to see a pain specialist. I was in shock at how unprofessional and unsympathetic she was towards my situation. Since I work as a nurse only a few people close to me know about my CP and problem. Not one co-worker I work with knows, I keep it to myself in fear of losing my job. As far as I know only the PCP that I had before who I still get to see every now and then  knows, thank god for HIPPA. For know my new PCP is still filling my monthly scripts. Per her request I went back to physical therapy and instead of her making a few calls to hepl me find another prescribing doctor she gave me a referral paper and 2 md nubers who when I called don't due pain narcotic management. So when I made my calls to find the PM specialist I had to ask if they did Narcotic Maintenance, does that sound like drug seeking or what. I finally found a PM MD 45 min away who when I called said they did this narcotic maintenance I gave them my hx and they sent me a packet with papers to fill out and I waited each week for the office to call and make an appt with me after 4 calls and 7 weeks later I get a appt for 2 weeks later. I went last eek to see the Pain Specialist who interrogates me about my PMH, does a brief PE cloths on! basic strength reflexes and tells me he also won't prescribe that high of dose of narcotics and I get the impression he doesn't belief I take that much medication and says the doctor who prescribed it should be reported to the DEA people who take that much PM  usually end up in trouble?. I'm dumbfounded a PM specialist who won't prescribe me maintenance PM that I've been on for over 2 years. Dumbfounded I ask him then what could you do for me he said take me off of the PM, do injections, get professional counseling, WTF. He said to think about it and let him know then he would take me as his pt! and btw merry Christmas to you to. So here I am feeling stuck in limbo on what to do, continue to look for a MD who will take me and prescribe my PM to continue to work and function and pay that monthly mortgage or go down this other path of coming off my MS/MSIR and find out I cant work full time function day to day, maybe even disability if the pain is worsens. Thanks for read to my cry for help and appreciate any and all suggestions.  

[peekawho]

I'm terribly sympathetic to you, as I'm in the same situation, but on less meds right now.  

You need a concrete diagnosis.  Something is wrong if you're in a lot of unresolved back and neck pain and can't get an MRI.    You do not need to have weakness or tingling to get one.  I have an incredibly tightwad HMO, and they approved 2 MRIs this year.  

You need an MRI, then you can make a rational treatment plan.  Using narcotics for non terminal pain will not work forever...you simply develop tolerance to higher and higher dosages until someone gets.their panties in a wad about it and refuses to prescribe.

You cannot treat without a diagnosis.  Its not appropriate.  

I will also say, as a nurse, my PM said that I cannot work if I have to have a fentanyl patch,  there is too much potential liability involved.  My pain is getting worse and worse, but I can't go further with other meds unless I go on disability.   Which I may have to do soon.  

Good luck,

Peek

[namnam46]

Just had ANOTHER thought RIGHT after I posted the above post.  :)  

Can you go outside of your small community to find help.  Maybe, your Doctor will have additional contacts that AREN'T in your area.  It would DEFINITELY be worth a TRY!!!

Hope that you will wind up having a VERY Happy New Year!!!.....Sherry

[namnam46]

Hi Jay,

OK - here's my suggestion.  First - I'm REALLY happy that you are in such close contact with you OLD PCP.  Can you go to her and tell her what is going on with you and what the NEW PCP did to you by sending you to a PM Doctor that DOESN'T do ANY maintenance PM.  ASK her to PLEASE recommend a Doctor that she KNOWS will give you the Maintenance care that you NEED and DESERVE.  Mention to her that you KNOW that she didn't have the intention of leaving you out there with NO resources to control you pain as she had controlled it so WELL for so many years.  Lay it on the line to her JUST how much you LOVE your job and won't be able to continue IF you can't keep your pain controlled.  IF she's as good and caring a Doctor as you've ALWAYS considered her to be then she WILL help you find the Doctor that can help you.

As far as the dependency goes, you AREN'T alone.  ALL of us that have been on pain meds for ANY length of time have the SAME dependency that you do.  I've been on Hydrocodone 75/500 since 2003 and then switched to the Fentanyl patch when we moved to AZ and I got my FIRST PM Doctor. That was last January - 1 year ago - that I've been on the patch and I'm also on Percocet 10/325 for my BT {as I stated above}.  BUT as you know the dependency IS because of your pain!!!  It's NOT an addiction - as you are aware of - BECAUSE of your pain.   The VERY fact that you don't need to take as much on different days - just like I do - IS the proof that you have a dependency.  :)

We are ALL here to help you and I just HOPE and PRAY that your OLD PCP can HELP you in your search of finding a CARING Doctor.

Please let me know if this is a possibility for your OLD PCP to be of ANY assitance to you in your search.

I wish you the VERY BEST of luck and I'm sure there will be others along this week that may have OTHER ideas for you.  JUST keep in mind that this is a VERY slow time of year on here because of the Holidays.  :{

Just remember that I'm here for you in the meantime........Sherry

PS I'm sending you a PM.

[RNinCP]

Hi Sherry,
     My past PCP now works at the same hospital I work but as a hospitalist who is a MD who treats inpatients only. When she left I was seen Q3-6 months for F/U visits. As for how long my new PCP will prescribe I haven't a clue she basically blew me off at the end of our first visit and had me speak with her medical secretary who gave me a phone number to call to find a PM specialist who didn't do maintenance PM. There isn't a specialist close to me plus like I mentioned I'm afraid of people/coworkers finding out I take PM  which makes it tough for me to get good care because its a small community here where everyone knows someone. For instance when I went to have physical tx the therapist turned out to be a friend of my fiance who lives a few houses down from her parents. I am so afraid of losing my job. I was recently denied an MRI of my back because there wasn't any weakness or tingle to my legs. I went to PT instead which help the nerve pain but it still comes and goes depended upon how much I walk. I do other things to rx my pain other than my PM which do help but the fact is I have a dependance  cetain days I don't take as much. Right now I take 3 to 4 30 mg MS contin in 24 hrs and 3 to 4 MSIR in 24 hrs sometimes less. I also take wellbutrin 150 XL, Klonapin 1mg 1-2 per day. tylenol, advil alleve prn.  I try not to take to many different meds. Past meds other than narcotics I've tried Indocin, Effexor, Cymbalta, Elavil, Neurontin, Savalla, Xanax, Ativan, Soma, Skelaxin etc. Like you suggest I will try another PM specialist and will keep an open mind thanks for your input its appreciated.                                                         Jay

[namnam46]

Hi RN,

First I want to welcome you to the Pain Management Forum and let you know that we are glad you found this Forum. I want to let you know that there are NO Doctors on this Forum only CP - Chronic Pain - Patients that help each other with our OWN expertise and experiences that we have developed through our OWN CP Issues.

I want to let you know that my heart is BREAKING for you and the situation that you have been left in!!!!  It's so VERY frightening when we lose our PCP's OR our PM Doctor's that we have put our TRUST in to take care of us!!!  I just lost MY PCP last summer and HE was the one responsible that led me to ALL of my specialists that have been giving me such WONDERFUL treatment INCLUDING My PM Doctor that has me on the Fentanyl patch at 88 mcg's q 48 hrs {I'm tapering from 125mcg's AFTER hip surgery last September} with percocet 10/325 3 OR 4 q 8 hrs.  I was FORTUNATE as his replacement is JUST as wonderful as her was.  I'm SURE that you will find someone too that will be able to help you!!!

How long will your NEW PCP continue this regimen for you?  What state are you living in?  MOST states require you to use a PM Doctor as the PCP's don't/won't/can't prescribe narcotics.  Since you are having such a difficult time finding a Doctor - that's WHY I was wondering which state you are in. :{  The ONLY state that I know of that allows the PCP's to give narcotics in the SAME dosages as a PM Doctor is Wisconsin.  The ONLY reason I know this is that one of our CL's lives in Wisconsin and she get her meds from a PCP.  :)  With this amount of meds you really do NEED a PM Doctor.

If I followed this correctly you are now OFF of the fentanyl, is that correct?  You ARE on MS Contin 30 mg 1-2 q12 hrs and MSIR 15 mg's q 2 hrs for BT.  I'm assuming that you are taking the higher doses of the MS Contin - 60mg  q 12 hrs.   Is this correct?

I need to find out {and I'm sure you have ALREADY tried this} if your OLD PCP is still practicing and IF so can you still go to him/her?  WHY did your OLD PCP leave? WHY did your old PCP's ENTIRE office staff get booted. Normally when they change a Doctor the staff remains the same as the patient's will still be the same and that original staff will be VERY helpful to the new Doctor.  When my PCP changed his staff remained the same. That's why I was asking. :)  

I'm SURE that SOMEWHERE there would be a PM Doctor that could help you.  When we are looking for a new PM Doctor and we are ALREADY on STRONG pain medications then we HAVE to inquire whether or not they give out the SAME medications that we are already on.  I know that can make you FEEL that you are med seeking but we have NO OTHER option but to ask that question.  

Is the sciatic nerve pain the only cause of your pain?  You mentioned your neck pain earlier, what is the diagnosis on your neck pain. Would you be willing to share your exact diagnosis with us.  I have severe DDD with arthritis throughout my entire body, as well as nerve damage, so I KNOW what you are going through. :{  I would be in the SAME position YOU are in if I LOST my PM Doctor.  

I KNOW that you already know this BUT yo didn't mention anything about it so I'm going to ask - you did take along ALL of your x-ray's, MRI's, cat scans OR whatever tests results that have been obtained, that ALLOWED your OLD PCP to be able to give you this amount of meds to begin with.  What tests and records did you take with you to this NEW PM Doctor when you saw him?  You MIGHT need to get some current ones done that will show the damage that you have to warrant these meds.  MOST Doctor's will WANT this {as you ALREADY know being an RN} before they will give you these meds. I'm SURE that you know how much the DEA is cracking down on these Doctor's that are prescribing these pain meds  and pulling their license's AND prosecuting them.  They HAVE to be VERY careful. Did this NEW PM Doctor suggest that he do ANY type of testing to determine your diagnosis BEFORE he blatantly dismissed your meds?

One thing that you need to know about a PM Doctor and that is that IF they suggest other forms of treatment you MUST be open to their suggestions because they NORMALLY won't just hand out the meds without at least TRYING some other types of treatment to see if it will help.  They don't like it if you always tell them no.  So  keep that in mind - to be OPEN to their suggestions.

That said - it DEFINITELY sounds like you need to KEEP looking for ANOTHER PM Doctor.  You MAY have to taper down, especially on the MSIR 15mg q2 hr.  I'm sure that you recognize that is an incredibly high dosage.  You yourself said that you have become dependent on them and you may need to change to something that is entirely different.  You will just have to be open to anything and everything to find an answer to help with your pain that you are suffering.

We are here for you!!  I'm looking forward to your update on your exact diagnosis as that will help to give you more precise information as to what you can expect and what suggestions to give you.  :) .........Sherry