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Pain management newbie

Hello, a little background since Feb 2020 I've had two microdiscetomies on my L5-S1 that were considered failed back surgeries, it re-hernaited and in April was my second surgery. It was determined I have permanent nerve damage with my sciatic nerve. Constantly in pain down my whole left side, leg weakness, numbness, you name it.  My surgeon has been prescribing my hydrocodone for the last 3 months while waiting to get into pain management. He referred me to a pain management DR to do a SCS trial. Seen that Dr to go ahead with trial. That pain management DR filled my prescriptions and said when I am due for refill we will sign contract, drug test, etc. I just finished my SCS trial today, my appt to do all at that is in two days. 2 weeks ago my calf pain flared up extremely bad. I am prescribed 3 hydrocodones a day(every 6 hrs) I was given a steroid pack and it didn't help. For 1 1/2ish weeks I took a 4th pill basically at bedtime around 10-11pm Normally my last dose is 5-6pm depends on if I wake up at 5 or 6am that day. I couldn't sleep with that bad pain. So going to this appointment in my mind I think it is best to be honest and tell them during that time a 4th pill was needed in the time before the SCS trial. They knew I was experiencing bad pain  because they gave me the steroid pack and that didn't help. Honesty goes a long way, at least I think it does. This will be my first drug test there obviously, that will probably not have the hydrocodone in it because I am short 4 days. I know that I should not have added a 4th pill on those days, but I am now worried about this appointment and if telling them right away at the appointment what went on. I'm not even seeing the DR, it's going to be his PA or whatever. Just wanting some advice on if I should tell them right away before drug test and signing contract. Thanks.
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Avatar universal
How did your SCS work? I’m doing trial soon. Thank you.
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20803600 tn?1546262537
That girl,
Welcome to the forum. I have a couple of questions- when was your last refill from the surgeon? How many tablets were you given in your last refill? You still are technically under his care until he releases you. The surgeon should have been the ONLY doctor prescribing opiates until you are formally released to another doctors care. Have you obtained any more prescriptions from the surgeon since seeing the PM consult/trial?
The CONSULT/visit with the Pain Management dr was specifically about getting a scs implant, correct? When did you see him in relation to your last fill from your surgeon? When did he provide the hydrocodone, and how many?
These appts were specifically for the implant, not necessarily for ongoing pain management.
I can see you might have a couple of issues here, with both doctors. The surgeon because you accepted a prescription from the PM CONSULT. If by any chance, you also obtained any new scripts from the surgeon during this and you did not alert the surgeons office of the prescription for hydrocodone BEFORE you filled it, you could find yourself dismissed from the surgeons care.
No matter what ‘reasons’ someone has, you should NEVER take more medication per day/per dose, then you are prescribed UNLESS you get approval from your doctor FIRST. Doing so is automatic grounds for dismissal.
As far as the PM consult goes, as I said, you should not have accepted or filled that prescription without your surgeons approval before filling it.
You will obviously fail the urine compliance testing. They don’t care why- just that you do not have the medication prescribed in the amounts prescribed- no more, no less. Why did you not ask the dr what you should do if the pain continued , since you spoke to them to obtain the steroid pack?

  I wouldn’t be surprised if they dismiss you as well.

I know this sounds harsh, I don’t mean it to, but you have got yourself in a big mess now- and it is likely that both drs will dismiss you. The PM may offer to continue with the scs implant, but refuse to provide opiates from here on out.

If there was overlap in the prescriptions by both doctors- meaning you should have had meds from the surgeon when you got the meds from the PM, that will be a bigger issue.

You are going to have to be honest with both doctors, and face the consequences. Obtaining opiates from two prescribers is considered dr shopping. Taking more than prescribed is non-compliance/self medicating. All are considered huge NO NO ‘s in the world of chronic pain.

  If you are dismissed, it will be extremely difficult finding another to prescribe scheduled medications for a very long time. Things like this become part of your medical record and follow you.

We patients have to scrupulous when it comes to these meds, only taking them EXACTLY as prescribed , and if they are not working, call the doctor and ask them what you should do. Nerve pain is not well managed with opiates- typically other meds are used to manage that type of pain, far more effectively.

I wish you the best, and hope you get this straightened out. You DEFINATELY need to tell BOTH doctors you will not have the opiates in your system, BEFORE the visit ends  and why. Both to the nurse/tech AND the Dr/PA. You need to be 100% honest. Whatever you do, do not ACCEPT another prescription hoping they won’t find out until they get the urine results back. THAT could cause you legal problems.
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Forgive me if I don't answer all your questions, I'll try my best. I went into my appointment today completely ready to be dismissed. It went the complete opposite of how I thought it would. Talked to the DR and told her I was out of pain meds because I take my first pill at 5am when I wake up and my last one I take for the day doesn't last. I either can't fall asleep from pain, or wake up an hour after I'm asleep in pain. She said no problem, you should of called and we would have adjusted it after the steroids didn't work. I told her I was honestly scared they would think I was this 32 year old looking for pain meds. She assured me to never feel that way and to just call. She was very nice and compassionate. After she left, I stopped by the lab, gave a urine sample and went on my way. They filled all my scripts and I just had my husband pick them up on his way home from work. The thing with my surgeon and pain management is they almost work together. My surgeon put in the referral to the pain clinic to do the stimulator trial. While waiting for the trial my meds were due for refill and my pain management DR said I could refill from my surgeon or start refilling with them. So I chose them since I was seeing them now. They now referred me back to my surgeon because he is the one doing the permanent SCS. My pain management will still be handled thru pain management and just my surgery threw my neurosurgeon. My original script was for 3 norcos a day so that's what I the pain management DR filled. I wasn't getting two scripts, one from each, my surgeon reffered me to PM and like I said he told me I could keep getting them from my surgeon or PM. On bad nights I took one and that's how I ended up short after the steroids didn't work. Lesson learned today though, that was definitely a horrible call on my part, which I knew. I really thought they were going to boot me. Today I still didn't even sign a contract with PM, they never asked me to and my next appt isn't for 3 months with them. They told me if the 4 a day doesn't work to call back and we can try perkosets(not sure on spelling of that) my urine still had the hydros in it and I don't do drugs or take any other meds I'm not suppose to, so it was all clean.
Oh and I know narcotics don't typically cover nerve pain, this is also why I have been on a 3 pill regimen that tools months of figuring out what works. I take 3(600mg) of gabapentin a day, one flexiril (10mg) a day, on bad days I take two of flexiril, one in the morning and one before bed, and then the 3 Norco(7.5mg) a day which is now upped to 4 a day(1 every 6 hours). She also said they like to do rotation of meds to keep from building a tolerance, so most likely when I go back in October, they will switch me to the perkosets and do that route for 6 months. Or if need be switch to them sooner if the hydrocodone isn't working well anymore. They did update my urine results and I had all of what was suppose to be in there, even with taking my last pill two days before my appointment. I was actually only 2 days short on meds, not that it matters, as I obviously shouldn't have been short at all, but I most of still had enough of them in my system because it showed on my urine. Counting my lucky stars today as I know this could of went very bad for me since I was self medicating with a 4th dose. Thank you for all the input! And I also know you weren't trying to be harsh, just stating facts and the truth, which I greatly appreciate. I only want the truth and facts when posting something like this.
That girl,
I AM glad it all worked out today! I have seen far too many be dismissed for being even one tablet short.  Most PM doctors are not forgiving when it comes to opiates, pill counts or running out early, no matter the reasons.
If and when you are handed the PM contract, make sure you read it thoroughly before signing, and ask for any clarifications you dont understand, so you and the dr are clear on the ‘rules’/policies of the practice.
Most contracts have clauses for ‘random’ pill counts, urine testing/compliance requirements. Make sure you understand the policies clearly, and what happens in the event of a failed test or pill count.
That’s for your safety and continuity of care.
Since the PM/Surgeon work together, you were very lucky with how this all turned out.
Typically, until the surgeon dismisses you to pain management, they are solely the ones to write any opiates. So, the PM writing for you, and you not advising the surgeon could have really been a disaster. Now, that this PM is providing your meds, I would let the surgeon know, just to protect yourself.
Did they give the results of the urine test in office, right then during the appt? If so, then it was likely a screening , not the actual compliance testing. That type of testing is sent out to a lab and measures the actual amount of the substance in your urine,  not just a positive/negative result. Even screenings done in the office are usually sent out for actual levels, to ensure patients are taking meds in the doses prescribed, and not more or less.
They usually take a week or so to get the results back.
Anyway, I am glad you got things squared away, and hopefully, the additional tablet will help with the pain.
Avatar universal
I don't know how to edit, but also is asking to up my dose to 4 a day reasonable? I am not currently waiting for my neurosurgeon to be able to place a permanent SCS and that may take awhile. It will be at least two weeks because the Dr told me my body needs or heal from the trial.
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