Best option for very limited meds, possibly long-term?

[pikalover]

I had a severe non-union tibia fracture 2 1/2 years ago requiring 4 surgeries, 2 of which were bone grafts, the latter of which seems to have finally taken. I now have a rod in my leg, and the bone graft is filling in some of the gap between the two leftover ends of my tibia bone. My orthopedic surgeon prescribed me pain meds during my convalescence  and recovery, including hydrocodone, oxycodone and tramadol. But I had my last appointment with her a couple months ago, and she said any further pain meds I might need I'll need to get from my primary care doctor.

I really don't have terrible pain very often anymore---maybe once every couple of weeks or even less. But when I do, I take 5-10 mg of hydrocodone. This isn't very much at all, and I still have enough medication from my surgeon to last awhile in any case. But I'm worried that when I step up my activity level, my pain will increase.

And the thing is, I just found out that my PCP is a physician's assistant who can't prescribe hydrocodone, even if it's just a very small amount once or twice a year. I'm reluctant to find a new PCP *just* for the small amount of meds I might need once in a while. But I'm even more reluctant to go to a PM doctor and succumb to all the rigamarole (and often, from what I read here, the bad doctor-patient relationships, contracts, frequent appointments and most of all, huge financial and time commitment!) that I'd have to deal with in seeing a specialist just for my limited needs.

But if I do get a new PCP, would he or she even prescribe *any* pain meds, considering we'd have no history together? Do any PCPs even do that now, with all the surveillance they're under (and I guess should be)?

The *last* thing I want is to come off like a drug seeker---I'm definitely *not* addicted to any of the pain meds I've taken. And yes, I'd eventually like to not take any opioids at all. I just don't know if my pain will ever go away completely if I want to live a normal life and hike and walk places and things like that.

Are there any good (not careless) PCPs who will still prescribe low-level opioids in small amounts, but potentially long-term, to a patient they don't have a history with? Or is that too much to bet on?

Another option I though of would be to just use Tramadol, but I'm not sure if that will be enough for the few bad days I still experience. I'm certainly capable of dealing with pain once in awhile. That would suck, though.

I should note: My PCP suggested I call my leg surgeon and just ask to see her if I eventually need more meds, and  I guess keep doing this as long as I need to. But I don't think this is standard practice, she likely won't want to do it, and it might just seem weird. Has anyone with an injury done anything like that before?

Any advice or thoughts on any of this is much appreciated.

[geminigirl1963]

Unfortunately, none of us would be able to say for sure if the physician would be willing to prescribe for you - some doctors seem more willing to prescribe meds for "new" patients than others (even meds that are not narcotics).

Since your PA does not have a physician phsyically located in the practice with her, I would suggest that you make an appt with your PA and discuss this with her and ask her if she would be willing to give you a referral to her supervisiing physician.  That definitely may help, as the physician would be able to see that you have already talked to your PA about it all.

If you do make an appt with the physician, if there is a good bit of a wait for the appt, I also suggest you ask their office if they keep a "cancellation list" - a list of people that they call whenever they have a cancellation.  This may help you to be able to get in to see the doctor sooner.  Some doctor's offices do this and others don't, so you'll have to ask about it.  At any rate, if you decide to make an appt with the physician, definitely do it long before you would be running out of your meds, if at all possible, so to avoid the possiblity of running out of meds before the appt date.  Even if you still have several days or more of meds at the time of your appt, KEEP that appt - that way, also, if the doctor is not comfortable with prescribing narcotics on your first visit, you will be covered.  This way, also, you can take your meds with you (always a good idea anyway) and the doctor can see first hand when the prescription/s were filled and exactly how much meds you have left.

Best of luck and keep me posted onwhat you find out.

[pikalover]

Thanks so much! I should have mentioned that my PA actually has her own practice with another PA. She did bring up her supervising physician at one point when I was talking about the prescription, but it was in reference to me actually making an appointment with that physician, which the PA said was pretty hard to do because the physician is very busy. But perhaps I could book something way in advance. In that case, still, would the physician likely be OK with prescribing for me, considering she doesn't know me directly? Maybe since her assistant does, it would be OK?

[Kabe827]

Mayb you should try going to a pain clinic..u may learn ways to avoid this once in a while pain...or maybe the Tramadol or other non narcotic pain med would help. Good Luck

[geminigirl1963]

Since your PCP is a physician assistant, I'm presuming that there is also a physician in the same office/practice.  More than likely (and I'm only going on feeling and what I've experienced in the past) is that when you do need to see your PCP and if you require narcotics and your PCP agrees, she/he will actually get the physician to write the actual prescription.  When I previously lived in a different state than where I live now, I did have an actual physician, however, she often got booked with appointments and there were times that I had to see her PA (physician assistant).  Any time I required narcotics, the PA would have the actual doctor write the prescription for her/me.  So that's why I'm presuming it would be the same in your case.

As far as seeing your surgeon when/if the need for more pain meds arose - I doubt that your surgeon would do that.  From what you said, your surgeon has already told you that if you require pain meds in the future, you are to get them from your PCP and a surgeon's care typically ends when enough healing has occurred, it's doubtful that she would even be permitted to prescribe more meds for you, unless, of course, it was for a new injury that also required surgery.

I would suggest putting a call into your PCP's office and explain the situation - tell them that you have completed your care from your surgeon and she has told you that if you require pain meds in the future, that you are to see your PCP.  Be sure to tell them that you feel like you have enough meds on hand at this point, but just want them to be aware of the situation and ask them, since you normally see the PA if you would still be able to see him/her if you needed to for pain or if you would need to make an appointment with the actual physician.

Best of luck.