Aa
Pain management referral
I really hope I haven't screwed myself over. Recently due to all of the new laws regarding pain medication, I had to sign a waiver saying I would submit to random testing due to receive further refills for loritab from my primary care. I have no problem with that since I have nothing to hide. Due to the nerve damage I am dealing with some nights I have to take my meds in the middle of the night which usually causes me to run out early. When I went in for my last test I told them I had taken it the previous day because I was worried they wouldn't refill them thinking I was abusing them since I ran out early. Needless to say my drug test came back negative. Now to my question, I am in the process of being referred to a pain management doctor. Is they going to cause them to turn me down and not see me as a patient?
Just 1 more thing to keep in mind, too, and that is, if you don't take your Gabapentin as directed you won't know how well they do or don't work for you, especially since it's a new med for you. :)
Just letting you know we're thinking of you! .
........ Sherry :)
Just letting you know we're thinking of you! .
........ Sherry :)
Howdy folks. Just a word about these medications.
Neurontin (gabapentin) and Lyrica (pregabalin) are the latest in a long line of treatments for epilepsy (what doctors call seizure disorders).
Many pharmaceuticals manipulate, within the brain, levels the important neurotransmitter GABA. These medications include barbituates, benzodiazepines, some anti-seizure medications, and ethyl alcohol.
Both gabapentin and pregabalin mimic GABA in their structure. Originally designed to manipulate GABA we now know that they don't work directly on the neuroreceptor, but have a wide variety of effects within the brain an on nerve tissue.
Any pharmaceutical that involves GABA, including gabapentin and pregabalin, has a potential to develop dependence, tolerance, and yes, addiction. Discontinuing many of these medications, including gabapentin and pregabalin, can cause highly uncomfortable withdrawal symptoms.
I understand that the withdrawal symptoms of gabapentin/pregabalin are similar in some ways to opioid withdrawal symptoms, and in other ways mimic benzodiazepine withdrawal.
Anyone beginning a course of gabapentin or pregabalin, (or Tegretol (carbamazepine), baclofen, clonazepam, diazepam, and a few others), please be informed about the risks of using these medications.
These medications can have great benefit, but always understand both the risks and the benefits of any medication or treatment you consent to try.
Remember, all medical treatment is accepted under the principle of informed consent. Our doctors prescribe -- but we choose to take a medication or not. We can only make smart decisions if we are informed about the risks involved in our medical care.
I know in this time of medical intransigence over certain classes of pharmaceuticals it appears that doctors have complete control over what we put in our bodies.
This is an illusion that meets the needs of the medical business, and your own medical needs.
It's your body. Please make informed choices.
Neurontin (gabapentin) and Lyrica (pregabalin) are the latest in a long line of treatments for epilepsy (what doctors call seizure disorders).
Many pharmaceuticals manipulate, within the brain, levels the important neurotransmitter GABA. These medications include barbituates, benzodiazepines, some anti-seizure medications, and ethyl alcohol.
Both gabapentin and pregabalin mimic GABA in their structure. Originally designed to manipulate GABA we now know that they don't work directly on the neuroreceptor, but have a wide variety of effects within the brain an on nerve tissue.
Any pharmaceutical that involves GABA, including gabapentin and pregabalin, has a potential to develop dependence, tolerance, and yes, addiction. Discontinuing many of these medications, including gabapentin and pregabalin, can cause highly uncomfortable withdrawal symptoms.
I understand that the withdrawal symptoms of gabapentin/pregabalin are similar in some ways to opioid withdrawal symptoms, and in other ways mimic benzodiazepine withdrawal.
Anyone beginning a course of gabapentin or pregabalin, (or Tegretol (carbamazepine), baclofen, clonazepam, diazepam, and a few others), please be informed about the risks of using these medications.
These medications can have great benefit, but always understand both the risks and the benefits of any medication or treatment you consent to try.
Remember, all medical treatment is accepted under the principle of informed consent. Our doctors prescribe -- but we choose to take a medication or not. We can only make smart decisions if we are informed about the risks involved in our medical care.
I know in this time of medical intransigence over certain classes of pharmaceuticals it appears that doctors have complete control over what we put in our bodies.
This is an illusion that meets the needs of the medical business, and your own medical needs.
It's your body. Please make informed choices.
We're all happy we could help bring you at least, some peace of mind. :)
We'll be keeping an eye out for all of your updates. You've made a lot of friends on here and we'll be here any time you have something positive to tell us OR want to vent just to let it out. Believe me, over the years we all have had to vent, I'm sure you've noticed that on here before. LOL!
Just know we'll always be here for you and hope you'll chime in any time you'd.like to add something on any of the posts you see on MH.
Looking forward to your next update.
......... Sherry :)
We'll be keeping an eye out for all of your updates. You've made a lot of friends on here and we'll be here any time you have something positive to tell us OR want to vent just to let it out. Believe me, over the years we all have had to vent, I'm sure you've noticed that on here before. LOL!
Just know we'll always be here for you and hope you'll chime in any time you'd.like to add something on any of the posts you see on MH.
Looking forward to your next update.
......... Sherry :)
Thank you all so very much for your input. I feel so much more at ease. I was really stressing this after I messed up and wet through my meds too quickly. I will keep you all posted on how things go!
Supposed to be "hear your updates" not "bear". :)
Don't you just love "spell check"!! LOL!
Have a nice weekend! .......... Sherry :)
Don't you just love "spell check"!! LOL!
Have a nice weekend! .......... Sherry :)
I loved what Tuck said & it jarred my memory about the tatoos.
I'm fortunate to have 1 of the outstanding PM Dr.'s anywhere & 1 of his top assistants has tatoos & dyes her hair different colors everytime I'm there. Pink, purple, green, u name it! It's fun to see what color it will be each time. She's there only part time now because she's going to nursing school to become an RN. She'll be a great 1, also, because the young people as well as the older ones, such as myself will really relate to her. Wanted you to know this because, as always, Tuck was right on the money.
Hope it helps you feel a little better. :)
Anxious to bear your updates..... Sherry :)
I'm fortunate to have 1 of the outstanding PM Dr.'s anywhere & 1 of his top assistants has tatoos & dyes her hair different colors everytime I'm there. Pink, purple, green, u name it! It's fun to see what color it will be each time. She's there only part time now because she's going to nursing school to become an RN. She'll be a great 1, also, because the young people as well as the older ones, such as myself will really relate to her. Wanted you to know this because, as always, Tuck was right on the money.
Hope it helps you feel a little better. :)
Anxious to bear your updates..... Sherry :)
Sorry I am so late with my response. I've been in another pain flare. I agree with what has been said here - Sherry has offered some excellent suggestions and support - as has our Phil.
I just want to reiterate the importance of being honest from the get go with your PMP - or any physician for that matter. I'm sure you know that.
It's important to build a good relationship with your PMP. I've seen multiple patients in PM Clinics that have tattoos. They are so common place now - professional men and woman have them. Additionally you'd be surprised what medical professionals see - a few tattoos are not going to sway their judgement. Hah - if it did it may include some PMP and their staff. They are human also and I'll bet there are some with tattoos.
Gabepentin is very effective for some ppl in treating nerve pain (neuropathy). As Phil said it takes time to build therapeutic levels in your blood to be the most effective. Often the dose requires adjustment. Unfortunately Gabepentin was not effective in reducing my pain. There's a newer drug, more stream-lined in it's action, less side effects and of course more costly. It's called Lyrica. It's what I take and has been much more effective in managing my neuropathy.
Gabepentin has been around longer and as I said is less costly. Often it's the first drug that is prescribed in treating neuropathic pain. If it isn't effective you may want to consider discussing Lyrica with your PMP.
You said you'd make the Gabepentin "last". Be sure to take them as ordered. It is not a scheduled drug and any physician should feel comfortable prescribing it for you.
Please let us know how you are doing. I'm happy you continue to post your questions, comments and concerns. You're always Welcome here.
My Best,
~Tuck
I just want to reiterate the importance of being honest from the get go with your PMP - or any physician for that matter. I'm sure you know that.
It's important to build a good relationship with your PMP. I've seen multiple patients in PM Clinics that have tattoos. They are so common place now - professional men and woman have them. Additionally you'd be surprised what medical professionals see - a few tattoos are not going to sway their judgement. Hah - if it did it may include some PMP and their staff. They are human also and I'll bet there are some with tattoos.
Gabepentin is very effective for some ppl in treating nerve pain (neuropathy). As Phil said it takes time to build therapeutic levels in your blood to be the most effective. Often the dose requires adjustment. Unfortunately Gabepentin was not effective in reducing my pain. There's a newer drug, more stream-lined in it's action, less side effects and of course more costly. It's called Lyrica. It's what I take and has been much more effective in managing my neuropathy.
Gabepentin has been around longer and as I said is less costly. Often it's the first drug that is prescribed in treating neuropathic pain. If it isn't effective you may want to consider discussing Lyrica with your PMP.
You said you'd make the Gabepentin "last". Be sure to take them as ordered. It is not a scheduled drug and any physician should feel comfortable prescribing it for you.
Please let us know how you are doing. I'm happy you continue to post your questions, comments and concerns. You're always Welcome here.
My Best,
~Tuck
Just like Phil said, I don't think you should have any problems because you have tatoos. I've seen several young and old men and women come into my PM Doctor's office. It hasn't made any difference in his eyes. His one goal is to try to treat the hundreds of patients he has and to help their pain stop. I would hate to think that it would enter into a Doctor's eyes that you should be treated differently than the Grandma's (NamNam's) of this world.
Everything that Phil's said is absolutely on the money. He's VERY knowledgeable and always has a lot to offer. I'm glad he's on so you got to benefit from his experience.
Hope you've been able to have some of your fears alleviated so you can relax at least a little this weekend. :)
Thinking good thoughts ............ Sherry :)
Everything that Phil's said is absolutely on the money. He's VERY knowledgeable and always has a lot to offer. I'm glad he's on so you got to benefit from his experience.
Hope you've been able to have some of your fears alleviated so you can relax at least a little this weekend. :)
Thinking good thoughts ............ Sherry :)
Hello Rooster.
Gabapentin needs to reach a therapeutic dose in order to be effective, and your doctor probably did not write such a dose.
Skilled pain physicians are better at helping patients find the proper therapeutic dose, a process known as titration.
Usually an intake urine drug test (UDT) is looking for any non-prescribed medications in the urine, and not for compliance with a medication regimen prescribed by another doctor.
Still, you got off to a bad start. Don't lie to your pain doctor.
Claim confusion. "I did not understand the question, Senator." It is clear to me that you did not.
If asked about the lack of opioid in your urine, simply state that you did NOT take a pill for the past couple of days. Tell the truth. Say that the pain medication your doctor prescribed ran out early because one pill every 6 hours (or whatever) did not cover the pain. You had to take it more often, or you had to take an extra dose. Whatever it was.
I'm sure that you did not abuse the meds, and you'll convince your new doctor that this is the case, also.
But an experienced pain doc probably even won't ask the question.
Dramatics are not necessary --- don't offer to "pee in the cup every hour" to show your fidelity.
Your new pain doc will lay down the rules, which include compliance with the agreed upon treatment plan. That means taking medications as directed. Note the term "agreed upon." All medical treatment is by informed consent. Get used to discuss all treatments, including medical treatments with your new pain doctor. This also includes outcomes of treatment, good and bad: side effects, efficacy of medication, and your feelings on the process.
Once you read a little about UDTs, you'll come to understand that they are often inaccurate and subject to misinterpretation. While some docs hang on to UDT results like a drowning man clings to a convenient rock, a skilled pain doctor understands that people who live with intractable pain experience waves of fluctuating pain levels, and on some days require more medication than on others. This is due to "break-through" pain or BT pain.
They also understand that people metabolize medications differently depending on their genetic makeup.
So no, unless you've got illegal substance metabolites in your urine, I doubt that you'll fail your drug test.
Here's to a good and productive relationship with your new pain practitioner that includes transparency, fact, and eventually, earned mutual trust and respect.
Remember, trust and respect is not earned by the wearing of a white coat, and by the same principle, nor is it denied because of a few tattoos.
Best wishes.
Gabapentin needs to reach a therapeutic dose in order to be effective, and your doctor probably did not write such a dose.
Skilled pain physicians are better at helping patients find the proper therapeutic dose, a process known as titration.
Usually an intake urine drug test (UDT) is looking for any non-prescribed medications in the urine, and not for compliance with a medication regimen prescribed by another doctor.
Still, you got off to a bad start. Don't lie to your pain doctor.
Claim confusion. "I did not understand the question, Senator." It is clear to me that you did not.
If asked about the lack of opioid in your urine, simply state that you did NOT take a pill for the past couple of days. Tell the truth. Say that the pain medication your doctor prescribed ran out early because one pill every 6 hours (or whatever) did not cover the pain. You had to take it more often, or you had to take an extra dose. Whatever it was.
I'm sure that you did not abuse the meds, and you'll convince your new doctor that this is the case, also.
But an experienced pain doc probably even won't ask the question.
Dramatics are not necessary --- don't offer to "pee in the cup every hour" to show your fidelity.
Your new pain doc will lay down the rules, which include compliance with the agreed upon treatment plan. That means taking medications as directed. Note the term "agreed upon." All medical treatment is by informed consent. Get used to discuss all treatments, including medical treatments with your new pain doctor. This also includes outcomes of treatment, good and bad: side effects, efficacy of medication, and your feelings on the process.
Once you read a little about UDTs, you'll come to understand that they are often inaccurate and subject to misinterpretation. While some docs hang on to UDT results like a drowning man clings to a convenient rock, a skilled pain doctor understands that people who live with intractable pain experience waves of fluctuating pain levels, and on some days require more medication than on others. This is due to "break-through" pain or BT pain.
They also understand that people metabolize medications differently depending on their genetic makeup.
So no, unless you've got illegal substance metabolites in your urine, I doubt that you'll fail your drug test.
Here's to a good and productive relationship with your new pain practitioner that includes transparency, fact, and eventually, earned mutual trust and respect.
Remember, trust and respect is not earned by the wearing of a white coat, and by the same principle, nor is it denied because of a few tattoos.
Best wishes.
I will let you know about the gabapentin. Haven't tried it yet. Internet says its for nerve pain so it may be right up my alley. Doc wrote out a very short ration of it so I'm gonna try to make it last.
Oops! Hit post too soon. LOL!
I was going to say that NORMALLY being that young you can run into problems getting the proper pain medication that you need and deserve, BUT in your case, I don't think you will be faced with the problems that other young people face because you have all the documentation that you need to show how long you have been suffering.
PLEASE remember that none of us on this Forum are Doctor's, we're all just CPP's (Chronic Pain Patient's) just like you. We can only offer the knowledge that we have gained over the years and share it with each other and try to give each other the help and encouragement that we all need.
Hang in there and keep a positive outlook and PLEASE stay in touch and let us know when you get you're 1st appointment. Then let.us know how that appointment goes and how you like your new PM Doctor.
Can't wait to hear how everything goes and please know I'm in your corner and rooting for you every step of the way. We ALL are here on the Pain Management Forum!! :) I REALLY hope you will remain an active member here and if you haven't joined the Forum, I hope you will, because you have a lot to give to this Forum especially from the young persons viewpoint and the battles you're up against fighting to get the proper medication that you need and deserve.
By the way there's 1 more thing that I'd be interested in knowing, if you don't mind, and that is, how is the Gabapentin working for you? By the way, since you were kind enough to share your age, I'm 1 of the Grandmother's on here. I'm 69 yrs old & I worry a lot about you young people and what you ate up against.
Thinking g of you and wishing you only the very best!! .........Sherry :)
I was going to say that NORMALLY being that young you can run into problems getting the proper pain medication that you need and deserve, BUT in your case, I don't think you will be faced with the problems that other young people face because you have all the documentation that you need to show how long you have been suffering.
PLEASE remember that none of us on this Forum are Doctor's, we're all just CPP's (Chronic Pain Patient's) just like you. We can only offer the knowledge that we have gained over the years and share it with each other and try to give each other the help and encouragement that we all need.
Hang in there and keep a positive outlook and PLEASE stay in touch and let us know when you get you're 1st appointment. Then let.us know how that appointment goes and how you like your new PM Doctor.
Can't wait to hear how everything goes and please know I'm in your corner and rooting for you every step of the way. We ALL are here on the Pain Management Forum!! :) I REALLY hope you will remain an active member here and if you haven't joined the Forum, I hope you will, because you have a lot to give to this Forum especially from the young persons viewpoint and the battles you're up against fighting to get the proper medication that you need and deserve.
By the way there's 1 more thing that I'd be interested in knowing, if you don't mind, and that is, how is the Gabapentin working for you? By the way, since you were kind enough to share your age, I'm 1 of the Grandmother's on here. I'm 69 yrs old & I worry a lot about you young people and what you ate up against.
Thinking g of you and wishing you only the very best!! .........Sherry :)
Thanks again for the encouragement.
I hear you on the age thing. Docs usually look at my beard and tattoos and tune me out when I talk about my pain.
I will tell the PM that I will come pee in a cup every morning if that is what it takes to prove the meds are going to me and not someone else.
I will give an update on how it all goes down.
I hear you on the age thing. Docs usually look at my beard and tattoos and tune me out when I talk about my pain.
I will tell the PM that I will come pee in a cup every morning if that is what it takes to prove the meds are going to me and not someone else.
I will give an update on how it all goes down.
I'm hoping you'll be ok. I REALLY think you will. Once your new Doctor sees everything you're having to go thru with your chest for almost 20 years I don't think you'll have any problems.
Thanks so much for sharing your age. NORMALLY, when someone is as young as you are they can run into problems being able to get the meds that they deserventonhave.for th
Thanks so much for sharing your age. NORMALLY, when someone is as young as you are they can run into problems being able to get the meds that they deserventonhave.for th
Thank you very much again for all your input. I am 33 and have been dealing with collapsed lungs and chest tubes since 14 or 15. And you are totally right, honesty is definitely the rule! I just wish I hadn't panicked and answered untruthfully the first time.
I am just so glad that someone has finally cared enough to refer me to get the help I need with this constant Che's pain and hope I haven't messed it up before I get started.
I am just so glad that someone has finally cared enough to refer me to get the help I need with this constant Che's pain and hope I haven't messed it up before I get started.
Sorry, I took so long to get back to you! I didn't realize you had answered back. :(
Ok, when you get your appointment, let your PM Doctor lead the questioning. THEN when the appropriate time comes for you to say how your pain has been controlled that's when you tell him/her that you have been in terrible pain and tried so very hard to take your pills "as prescribed" but wound up running short the last time because you had to take a few extra when your pain was off the charts and you couldn't handle it.
The one thing to remember from now on is to BE HONEST with you PM Doctor (and any Doctor in the future) that gives you your pain medication. You're going to have to let your new Doctor know that you will take your pain meds according to his/her instructions and if your meds aren't working you will let him/her know so he/she can adjust them accordingly to help you so you can have the pain control that YOU DESERVE! PM is where you belong. Thank goodness for your Lung Specialist realizing this for you.
Rooster, would you mind sharing your age with me? This would help me in knowing what you will be up against when it comes to the amount of help you will.be able to get.
Ok, when you get your appointment, let your PM Doctor lead the questioning. THEN when the appropriate time comes for you to say how your pain has been controlled that's when you tell him/her that you have been in terrible pain and tried so very hard to take your pills "as prescribed" but wound up running short the last time because you had to take a few extra when your pain was off the charts and you couldn't handle it.
The one thing to remember from now on is to BE HONEST with you PM Doctor (and any Doctor in the future) that gives you your pain medication. You're going to have to let your new Doctor know that you will take your pain meds according to his/her instructions and if your meds aren't working you will let him/her know so he/she can adjust them accordingly to help you so you can have the pain control that YOU DESERVE! PM is where you belong. Thank goodness for your Lung Specialist realizing this for you.
Rooster, would you mind sharing your age with me? This would help me in knowing what you will be up against when it comes to the amount of help you will.be able to get.
Actually my wife just reminded me that I did the drug test before the referral paperwork was sent.
That's good. So if your PCP has already sent the paperwork to the PM Doctor you shouldn't have any problem.
Let me ask you 1 more question, if you don't mind. :) Did your PCP give you your refill on
your Lortab so that you have yor meds for this month?
Let me ask you 1 more question, if you don't mind. :) Did your PCP give you your refill on
your Lortab so that you have yor meds for this month?
I am in the process of being referred. They have my paperwork and I am waiting to hear back from them.
Don't worry, we've ALL posted twice at 1 time or another. LOL!
Let me ask you something, have you already been referred by your PCP?
Let me ask you something, have you already been referred by your PCP?
Thanks for your response, Sherry!
Actually my lung specialist recommended I be referred to a pain management clinic. I have been dealing with sever chest pain for months now. At first I thought it was pleurisy due to several collapsed lungs and lung surgeries. The pulmonologist though so as well until he did a full panel of lung function tests and other tests. After all that he realized that my pain was coming from nerve damage to my intercostal nerves. He said that there is really no treatment for that and his bed recommendation would be that I see a pain management doctor for chronic pain. However, the referral had to go thru my my PCP. My fear is that the pain management doctor will see the negative result on the drug test and think that I am either a junkie or selling pills. This couldn't be any further from the truth. I am just in a lot of pain and ran out of medicine early and was afraid to tell the doctor for fear of them not refilling my prescription.
Thanks again for any further advice!
Actually my lung specialist recommended I be referred to a pain management clinic. I have been dealing with sever chest pain for months now. At first I thought it was pleurisy due to several collapsed lungs and lung surgeries. The pulmonologist though so as well until he did a full panel of lung function tests and other tests. After all that he realized that my pain was coming from nerve damage to my intercostal nerves. He said that there is really no treatment for that and his bed recommendation would be that I see a pain management doctor for chronic pain. However, the referral had to go thru my my PCP. My fear is that the pain management doctor will see the negative result on the drug test and think that I am either a junkie or selling pills. This couldn't be any further from the truth. I am just in a lot of pain and ran out of medicine early and was afraid to tell the doctor for fear of them not refilling my prescription.
Thanks again for any further advice!
Hi Rooster! :)
First let me tell you how glad we are that you have found our Forum.
If I may ask, is it your PCP (Primary Care Physician) that is referring you to the PM (Pain Management ) Doctor? Assuming that it is, I would imagine that it's because you are running out of Lortab early. That is letting him/her know that your pain has become more severe than he/she can prescribe for. Normally, a PCP can only prescribe so much medicine. There hands are NORMALLY tied as to what they can do for us. Therefore, knowing how much you're suffering he/she knows you need more help than he/she can do for you. Sounds like you have a very good PCP that really cares you.
I hope that this has been of some help to you and I hope you will stay in touch and let us know how you like your new PM Doctor. I hope that your PM Doctor will be able to give you the relief that all of us CPP (Chronic Pain Patients ) so richly deserve!
BEST OF LUCK TO YOU!!! We'll be looking for your updates!! .........Sherry :)
First let me tell you how glad we are that you have found our Forum.
If I may ask, is it your PCP (Primary Care Physician) that is referring you to the PM (Pain Management ) Doctor? Assuming that it is, I would imagine that it's because you are running out of Lortab early. That is letting him/her know that your pain has become more severe than he/she can prescribe for. Normally, a PCP can only prescribe so much medicine. There hands are NORMALLY tied as to what they can do for us. Therefore, knowing how much you're suffering he/she knows you need more help than he/she can do for you. Sounds like you have a very good PCP that really cares you.
I hope that this has been of some help to you and I hope you will stay in touch and let us know how you like your new PM Doctor. I hope that your PM Doctor will be able to give you the relief that all of us CPP (Chronic Pain Patients ) so richly deserve!
BEST OF LUCK TO YOU!!! We'll be looking for your updates!! .........Sherry :)
Have an Answer?
You are reading content posted in the Pain Management Community
Find out how beta-blocker eye drops show promising results for acute migraine relief.
Could it be something you ate? Lack of sleep? Here are 11 migraine triggers to look out for.
Find out if PRP therapy right for you.
Tips for preventing one of the most common types of knee injury.
Here are 10 ways to stop headaches before they start.
Tips and moves to ease backaches
