Hi and thanks for the input. Congrats to you on a beautiful family as like you say its a blessing to have one. I know you are very proud of those three young men!
I always have the addiction thing in the back of my mind as my dad and older bro. were alcoholics. I guess . No scratch that! I know I am very fortunate not to have an addictive personality. When my pain level goes down, not often but sometimes, i always reduce my dose, not becase i want to, its just me I have to do it. Maybe just to prove to myself I am not addicted. I know that I am physically dependant as reducing only one pill causes WD symptoms. I am lucky there too as one pill doesnt bother me to awful much. I saw my dentist last week and he said I've been gritting my teeth so much it wont be long before I will be needing caps on some. Since you have been dealing with pain 30 yrs. You know way more than me about the other problems chronic pain causes other than the discomfort. I tell ya you still being here with us and able to even function well enough to write an intelligent post tells me you are certainly a trooper! A lesser man would have burnt out long long ago so my heartfelt congratulations on that!
I have been on the same dose several years and its time for a bump upward if I can find it!
I will check out the other post as well as pseudo addiction.
Thank you for posting! You see that we have a variety of personalities on here, and we all understand one thing-pain!!
On the other hand, we have learned to work around it, enjoy our families and friends in spite of our issues. Life is meant to be enjoyed, and a good laugh or two surely helps.
Your doc is a keeper. Its good to come on here to vent and share. We all wish the very best for you and your search for a good PM doc. mandi
You're lucky to have a beautiful family. I understand your concern over being a good father.
I helped raise three sons, all terrific young men today, with the help of a beautiful woman I've known for 38 years. I am indeed blessed. I spent the last 30 of those 38 years prescribed opioid analgesics for the chronic pain of spine disease.
While any chronic illness puts a strain on the family, do not mistake the illness for the treatment, even if treatment is potentially addictive.
You will know if you are at risk for addiction, or are exhibiting addictive behaviors (see my comment on your other post).
Remember that with chronic pain comes a series of behaviors known as pseudo addiction. For instance, opioid analgesics cause opiate tolerance, meaning the same dose of medication dose not produce the same amount of analgesia with time.
Therefore a dose adjustment is required to restore adequate analgesia. Reporting consistently higher pain levels and asking for a dose increase is not addictive but pseudo addictive, as it appears to be a drug craving, but is actually a desire for pain relief.
Please search for pseudo addiction for a complete discussion.
Finally, physicians use various abbreviations for prescribing. One set of those abbreviations involve dosing, once a day (QD), twice a day (BID), thrice a day (TID), and four times a day (QID). Any more than that is written out as in: take 1 tablet every 4 hours. Divide 24 hours by 4 to get 6. Or: take one tablet QID and 1 tablet at bedtime. There's a dose of 5 times a day.
Hope that helped, Mr. Raskolnikov. Do you know the writings of Dostoyevsky? One of the most famous quotes from Crime and Punishment is
“Pain and suffering are always inevitable for a large intelligence and a deep heart.”
A deep heart makes for a rich life. Enjoy and take good care of that family.
I remember what I wanted to say. I asked my rheumy if I went to PM for pain and it didnt it didnt work out if he would resume my pain meds and he said yes.He really is awesome.But I tell ya I am thinkin of asking him to put it in writing!! Just kiddin but it is a thought!
I would like to stay anom but I am sure the "ya'lls" point toward the southeast US of A! I am in Mississippi and I love Mississipi, its where I found an absolutely wonderful true southern belle who I must add is also the best mother our daughter could ask for! They are more like sisters their relationship is extroidinary. Now dont get me wrong she aint perfect like me she breaks out and acts like the female species on a regular basis!!!!! Only kiddin gals ya'll don't start throwin internet darts at me!! But one thing i said is very true, female is a species all its own and ya'll have to admit it!! Hahaha Ya'll dun figured out those microbes invaded my brain befote the antibiotics killed em off! Later!! PLEASE ALWAYS REMEMBER With my humor I mean no harm in any way, i know that anyone that joined this site needs a laff er two! ESPECIALLY ME My wife says our girl is a female carbon copy of me and had she been a boy she wouldn't have been "able to bear the strain". (Thats a Doc Holliday quote from the movie Val Kilmer played him Tombstone. ) Here is my parting shot! (Can ya still say shot!)
My cabon copy is Super Intelligent and really Good Lookin!! Haha
Oops I got cutoff! Probably my fault as I am technologically impaired haha. Guess what put me in remission! Tetracyline antibiotics. My extroidanary and wonderful wife has spent oh so many hours searching over the internet trying to help me. Dang sayin that misted my eyes THAT DANG ESTROGEN AGAIN!! I guarantee you mine is higher than yours haha. I told my wife if I wake up some morning and "they" feel the least bit sore I M heading to the ER!!! Dear lord thats all I need winding up with a bigger pair than her haha!! The sad thing is it could actually start happening! I had a hot flash Saturday a week ago tthat made me so weak I bout hit the floor and sweat literally poured off me like it was raining!! I tell you this all the menopausal ladiies have my utmost and deepest sympathy!! Its one of those "other issues we RA victims have as RA likes to redesign your whole body with the assistance of the devil prednisone most of us just cant live without. I am rambling once again, one of the bennies of sleep deprivation I guess!! Back to important stuff. MOST cases of RA are from a microbial infection. MANY times it starts from a tick bite. If you dont already know and want to learn more I suggest two books you need to read, The New Arthritis Breakthrough by Dr. Brown and Why Cant I Get Better by Dr. Horowitz. Dear Lord we need a million doctors exactly like Dr. Horowitz. If you read his book you will say the same thing! You can usually get the books used on Amazon at a reasonable price. I.am not offering medical advise here just saying what worked for me so proceed with caution!
Oh ya I dont know what BID means! I see in the post above QID! Didnt know that one either, my latin is non existant! Well I wanted to say more but dun forgot what it was! Oh ya one thing, i am now going to another place for HRT and they gave me an ambidex for the high E level. Heck Im too scared to get my progesterone checked! I would probably lose the deepness of my voice and start battin my eyes at guys!! HAHAHA That will never ever happen haha. Thak ya'll for the input I very much appreciate it!
I make typo's all the time. O;) No problem.
You're right - there are some very strict - and non-compassionate PMP out there. Ppl that have that one great PMP have no clue what it's like to have to look for one - or get "stuck" with a not so good one.
I was blessed and had no clue either. For nine years I had thee best, kind and understanding PCP/PMP in the world. She cried and held me when my dad passed and laughed with me at pictures of my family. She got an offer she couldn't refuse and left private practice. My health - and PM have never been the same. I've not found a PMP that has treated me like a human since. I cannot believe what PM has become. It's a business!
Please don't get me wrong I hear about good PMP, they do exist - I just haven't found one.
But you deserve better PM - plz search for a good one.
I made a typo, it's either 4 hydrocoxonee OR 3 oxycodone. But out of compassion he went above his self imposed limit of 3 oxy and gave me 4. Either one is is prescribed 4 times a day as needed. So I dont have to go by hours. He has never counted or drug tested me but I am going to get him to when I see him in a couple of weeks since I've read some horror stories by folks who swear they were taking as prescribed and got negative result and were dismissed. He knows by looking at this worn out carcass that its in pain! Its pretty obvious.
I am very very lucky as my rheumy is really great. If I did go to PM I would stl be seeing him every 3 months.
Mandi66 I see you also have RA, I know what you are going through and my beaft breaks for you as it is wicked.
Since our poster has only his rheumy and has not ever been to a PM dr. he should be fine. He is not changing his PM doc, he is trying to find one.
I feel very blessed to have both. I know a lot of folks on this forum who do not have a good PM doc, but I do. Usually the rheumy does not prescribe opiates, just anti-inflammatories and/or biologics. Our poster will have to settle for limited amounts that do not really control his pain or search for a good PM.
I wish the best for you, there are some good PM docs out there. No one should have to live with uncontrolled pain. mandi
Mandi66, Thank you for correcting me. Here's the confusing sentence, ";My rheumy's compassion only goes so far and his self imposed limit is 4 hydrocodone and 3 of the oxy," - But than I'm having some major pain issues myself and may have misunderstood,
RASCOLIVICTIM, You if you are only taking 10mg of hydrocodone QID (4 times a day) than you are on an average dose of a SA pain med. As I suggested it would be ideal if you could see both, your good rheumatologist and a great PMP. Many of us haven't had such great luck with PMP given the new climate. Some ppl find wonderful PMPs that monitor and control their pain. The problems is you can't change PMPs more than once or twice or you're a "Doctor Shopping" and that's against federal law and you can go to federal prison. Yikes!! So do a lot of research before you make that appt.
Again, Best of Luck,
~Tuck
I wanted to say more but I keep getting cut off! haha
I certainly can see why your wife does not want you to loose your great rheumy. They are reaaly hard to replace. But I really feel for our new poster because he is living with undertreated pain. Each one of us do not want to take super amounts of opiates for our pain, but there is a fine balance between too much and too little. Pain is frustrating and downright miserable at times. Maybe it is time for a dose increase. The 10 mg just is not cutting it and it is a small dose.
I hope sincerely that you do what you need to do to control your pain. You deserve it. Please keep posting. We try to support each other because we know what it is to live with pain issues. Good luck! And keep that great sense of humor! mandi
Excuse me if I am wrong, but I understood the poster saying that his rheumy is only prescribing 10 mg of oxycodone, not long acting oxycontin. Before then he was prescribing 10mg of hydrocodone. He doesn't have a short acting and long acting. It is either oxycodone or hydrocodone.
The rheumy does not really want to prescribe these meds at all. If our poster has been on these meds for a while, his tolerance is much higher than when he began.
I have RA and other issues and I see a rheumy and also a PM dr. I don't see why he could not keep his trusted doc and consult a PM doc for more options to help his pain. Seems like he is being undertreated for his pain and that is very hard to live with! mandi
Hello and Welcome to our Pain Management Community. I've so very glad you became a contributor and not just a reader - though don't get me wrong, readers are always welcome too.
I'm so sorry to her about your painful condition(s). Makes me say "Ouch" just reading about them. My heart goes out to you.
Don't hit me (Ha Ha) but I tend to agree with your wife and Remar. If I understand your post correctly you are being ordered 10mg of OxyContin, is that BID (twice a day)? Are you also being ordered four, 10mg tablets of Hydrocodone daily? Is that right or did I miss something? A small increase of OxyContin may be helpful. But that's not your question. Often the more or higher dose of LA med the less number of SA meds they'll prescribe - but not always - it depends on the provider.
I know we may have other members post and suggest you consult a good PMP. There are things like Radiofrequency ablation (RFA) that has provided great relief for some chronic pain patients - or at least enough relief that t. hey were more comfortable and could reduce their opiates. Has your rheumatologist considered an RFA?
I don't know the laws of your state. I do know that in most states you can consult a PMP for procedures and keep your prescribing physician. You may want to consider that. I say your doc is a keeper.
Some PMP are extremely strict, indeed most are. You cannot take opiates from another provider or you can be dismissed - my contract reads even in an emergency without contacting the PMP - which in my case he has not returned a call in well over a week. So consider that. Many do pill counts and reserve the right to call you in at any time to "count" your meds. If you're short a couple because you had a flare you can be dismissed. If your fail a drug screen - simply because there was an error or your PMP doesn't know how to interpret - you also will likely be dismissed. Once dismissed you'll be hard pressed to locate another PMP that will treat you - no matter what your diagnosis or how extreme your pain. Sound bleak? It can be. Sadly it's the facts in many states or instances.
Granted there are wonderful, caring and very educated PMPs. It's my opinion they are difficult to find. I wouldn't give up your kind and caring rheumatologist, I may have a discussion with him and ask lots of questions Uncontrolled Chronic Pain can be heck!!
Peace,
~Tuck
Hi Remar and thank you very much for you suggestion, and taking time to help I am going to give that some thought. My problem that I didnt mention is he wont give me anything stronger and I have been at that dose so long when I take a 10mg oxycodone its probably like a normal person taking 2 500mg tylenols. So no matter how its dosed I dont think it will help. I even considered getting him to switch me back to hydrocodone and see if rotating like that would help BUT when I want to switch back to oxy he may only give me three. If i only had two more a day I would be good for a couple more years. He is scared of the DEA so bad. He says everytime I see him he can easily lose his license because of them. He dont say it but I know they are breathing down their neck. If it werent for my job I would get me a sign and march in front of the DEA state office. In fact I may put on a halloween mask and do it anyway!! In fact every chronic pain sufferer that is able should get together some day SOON and and all us us get signs and march in front of the state DEA offices and tell them we are $/^&^//$ sick of being treated like we are and tell them to lay off the harrasment of doctors and pharmacists. Did you know if a pharmacists makes a mistake on their pain med report they get fined $25,000 per mistake. I would say more but I better stop there!
My battery is fixin to croak! Thanks again
Maybe you should talk to your Dr about a long acting and a short acting medication. This is not uncommon. The long acting meds are usually taken 2 to 3 times a day and then you have 3 or 4 short acting pain pill per day for breakthrough pain.
I'm hearing about more specialists that are either under prescribing or not prescribing at all.
There some good pain Drs and clinics out there but then there are others who will require a urine test and pill count at any time. You also have to sign a contract. It can be hard on pain patients to go through all of that.
I take it your RA prescribes without the contract, urine tests and pill counts? If so, I would try my best to stay with him. If he will only prescribe 4 pills per day then it might work out that you're getting 2 different medications that will each be 4 or under per day.
This is a great forum with a lot of wonderful and very knowledgeable members. I'm sure you will get even more advice from them.
We're always here to listen and help any way we can.