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pain mgmt

Does anyone know the in's and out's of the pain mgmt rules? I am going back mon for my third visit and still hurting! I have taken all my meds. Will they kick me off the program? I mean its obvious that loritab 10 isn't working for me! Will I get a third chance? I also had surgery a week ago! Do you think that he might take that into consideration?
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Avatar_f_tn
Hi...for your first question, if they're any kind of professional pain management group, they shouldn't kick you out for being in pain!! That said, I'm sorry to say there are a lot of what I call unprofessional pain management groups around. I wish I wasn't in a position to say I'm WAY too familiar with the ins & outs of pain mgmt rules, and i'm sorry for your sake that you have to learn them. The first rule is probably, 'there really aren't any rules.' Different groups handle things differently. The best thing to do is try to approach your doc calmly (as possible), and explain that your pain is not being adequately controlled. Keep a record; the more data you can provide, the more seriously they're likely to take you. Keep a pain diary, & write down everything (& I do mean EVERYTHING); how you sleep, what times you go to sleep, get up, eat, take meds, etc etc. Record your pain levels at LEAST 3 times/day, preferably more, on the good ole 1-10 scale (1= none, 10 = intolerable pain). Record your pain level at the time you take your meds, then an hour later, 2 hours, etc. Heck, write down what you eat at every meal; you may discover unsuspected triggers. Record your mood, jot down random stressors. I know it's a momunental pain in the neck, but I guarantee it'll help, if not this doc, then the next.
Talk to your doc about non-drug management, be open to trying new things. Drugs alone can't do everything; pace yourself by not working to exhaustion, try relaxation techniques, gentle regular exercise, calming herbal teas...the list is endless. I could write endlessly; I have WAY too many years at this.
Anything help? look particularly interesting? I'd love to help you but don't want to bore you to death. Let me know if you'd like to hear more about something. But my #1 advice is the first; calmly provide data. I know it's not easy when you're desperate for help (& probably terrified as well) but unless the doc is the total "pain meds are never good for pain" type of jerk, it will help. If the doc is that type, you need a new one, anyway.
best of luck,
maxlet
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Avatar_f_tn
If the meds are not lasting you and you are still in pain you need to notify the doctor of this. I wouldn't wait till your due to go in for a refill I would tell him when the meds are not helping at the dose and frequency he has prescribed them for you. More the likely you have signed a contract with him stating that this is your part of the deal. If your consistently not getting pain relief your meds might be changed to help you or different treatments may be added to try and alleviate your pain. I hope things work out for you. Communication is very important in getting you to feel better.
Best of luck you you!
Ginger
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Avatar_f_tn
Ginger is correct. You should definitely get aggressive pain treatment after surgery. I have gotten way too used to thinking of this er, stuff in the long-term with teeth gritted. That's a very bad thing right after surgery, as it sets you up to be more likely to suffer chronic pain. I'm very sorry I missed that.
Still, it absolutely will not hurt if you have records of what you took, when, & how well it worked when you go in Monday, especially if you're still not getting adequate pain relief.
When you talk about 'the program,' it sounds like a pain management program, which usually is a more long-term thing. How well it works for you depends on a lot of things, including what state you live in.
Hope you're feeling better, & good luck.
maxlet
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Avatar_f_tn
The usual rules with pain management Drs. is to follow things to a T....So, if sounds like you have run out early of your medication and now don't have any left.

One of the "rules" is usually singing a pain management contract stating that you will not get any controlled substances from any other DR. while you are getting them from him. That is your responsibility to not lose your pills or get them stolen as they will not replace them.

That you may be asked to come in for a random drug test or pill count.

As well as be open to any and all treatments....If someone walks in saying, "I want Percocet....this is the only thing that works for me...I've tried everything else"...This will most likely have the Dr. running the other direction.

It's about being open to possible muscle relaxers, nerve pain med, daily exercise is very important, physical therapy, relaxation, stretching, acupuncture, ice, heat, injections, steroid treatments, cognitive behavior therapy, TENS unit...things like this. You'll never know how it will work until you try..The goal is not to get to pain free.....Most PMs are happy when their patients get to a 5 or so...anything less than that would be amazing!

These meds are extremely well regulated and monitored by the states and the DEA and all PM Dr.s are under pressure to cross all their T's and dot all their i's....

As mentiong....if your treatment isn't working (after giving it a decent period of time like a month to start working well and have the side effects subside), then a DR. is more apt to see that you really gave it a try...

Drs. see that there are rare times with true allergic reactions that could kill someone...Then they say to stop medication ASAP!

Or, if they are just some annoying side effects with some nausea, fatigue, that will dissapate over time...this is where the month comes in to work it out and see if the pain levels steady as well.
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Avatar_f_tn
Wow...thank you all for the advice. Its all very helpful. I live in tn and I know they are under a lot of pressure! I just don't want to be punished for something that cannot help! The dr is very understanding and does listen! But, on my last visit he did say "What is it going to take for you to take your med like your suposed to? He knew I was going to have surgery and I tell you I was in the worst pain that I have ever been in all my life! I did call them and tell them that I had the surgery and my Orthopedic did prescribe some tylox 5-500. Well I will keep you all informed......gotta run get my bandages changed on my shoulder!!
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Avatar_f_tn
It depends on the rules you agreed to and how strict the doctor is.

Running out of your pain med early for whatever reason with out letting the doctor know may cause you to get kicked out PM.

It just depends on the doctor, or if you have to take any urine tests.
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