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Pain meds other than hydrocodone
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Terrell65 posted:
I have been actively seeking relief for chronic pain now for over 2 years. I was first diagnosed with FM although I didn't have the typical pain responses to the tender pressure points. The rheumatologist prescribed Lyrica which helped for about 3 months and then stopped working. My PCP prescribed Cymbalta which helped for about 3 weeks. I have also been prescribed the following meds in the past: Wellbutrin, Ultram, Tylenol with Codeine, and Celebrex.

My PCP prescribed Savella and 5/500 mg Hydrocodone in Dec.2010. (I've also been on short-term disability since Dec.2010) He also referred me to a pain clinic which referred me to a neurologist and neuropsychologist. The Hydrocodone seems to be the only thing that helps with my pain but it only lasts 4-6 hours. My PCP increased my dosage from 5/500 to 7.5/650 in Jan.2011, then in Feb., he increased it to 10/325 mg X 4 daily. He did so reluctantly because he wanted the pain specialists to take over my pain treatments yet all they had done so far was refer me to a neurologist after two months of waiting!

Finally, the pain clinic agreed to start prescribing my pain meds but I had to first sign an opiod agreement and do a drug screen test. After I signed the contract, the doctor came in and said he was giving me a prescription for only 3 pills per day instead of the 4 per day that I had been taking. He didn't ask anything about my pain except how long have I been taking this medication? The nurse told me to call if I was still having pain and they would make the necessary adjustments. I called back a week later but the doctor refused to change anything. Now I am worse off than before coming to the pain clinic.

I cannot effectively manage my pain just so I can do most normal quality of life activities. I try to contribute by doing some house work, cooking and cleaning, etc., helping with the kids homework, bath time, etc. I started to build a wall to wall, reach-in closet for our youngest son, but it took 5 pain pills just for me to get through the day and work for only 6 hours!

Why am I being treated for chronic pain with a medication that is intended for break through or episodic pain? I have 24 hour pain not 4-6 hour pain! This is so frustrating and it has definitely increased my anxiety which exacerbates my stress which causes distress which exacerbates the chronic pain and vice versa. I also feel like they have me over a barrel because I am on short-term disability and if I were to go to another doctor then I might have my claim denied. So no matter what I do it seems I'm "screwed"!

Anyway, that's my situation. I know others have much worse circumstances than mine. However, we all have to deal with our own unique set of circumstances. I am open for any suggestions and thank you!
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TDXSP08 responded:
Well 1st off you make a very solid point in that a day is 24 hours and you are only offered partial relief for a part of the day. I would surely have started calling the on call Dr. at odd hours off the morning rousting them from bed for "advice" on how to deal with your pain when you have no meds for it as you have taken you daily limit. and if they give you grief tell them you are presenting yourself at the ED for an acute flare-up of pain (which the hospital must treat or you can have there JCHO accreditation revoked for failing to do so).

be a Good patient but do every thing you can to advocate for yourself and keep your name on your Dr.'s mind until he starts an active effort at realistic pain control for you, thats ultimately your goal and once that occurs you want to back off and be a turn key patient always on time for visits always perfect on pill counts is courteos and respectful to the staff etc.. just blend into the backround where he sees you chart and thinks ah good patient easy 150$ visit and on to the next.

i hope this helps you!!

Peace
i have no small step for man, but i have 6 tires for mankind,Watch your Toes!
 
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CTBeth responded:
Hi from CT,

I empathize with you, but the pain management MD did make referrals to the neurologist which is a good thing for your treatment.

I do not have any neuropsych consults in my history, but I do know that they perform a vital service. You may find the consult of tremendous value.

Many MDs just treat pain without much diagnostic research or referral. Although the waiting it out is not fun, ultimately it may- possibly will- be in your best interest.

One "clue" in what you posted is that your diagnosis presents atypical symptoms.

Perhaps the MD is doing the 100% best thing he/she can to get you properly diagnosed and rule out more serious neuro problems before deciding on proper treatment.

I'd urge you to be patient (no pun intended) and trust that referring you to diagnosticians is, ultimately, a good thing.

Meanwhile, be easy on yourself. Maybe it's not the best time right now to build the wall-to-wall closet. If you can, ask for help and accept help when offered.

CTB
 
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annette030 responded:
I would comment on a couple of things right off the bat. If your doctor has prescribed three pills per day as a maximum, you should not be taking five, it is a trust issue with a fairly new doctor. You should also not be doing any kind of construction work, it clearly is not good for your pain control.

Being on short term disability is about making time to get your health care needs met as much as possible without worrying about the money abruptly stopping all together. It is not the same as a paid vacation where you get all the household chores caught up.

Call the doctor's office make an appt. to see him and tell him face to face that the meds are not working to control your pain 24/7. Let him know that if he can't do it, you would like him to refer you to someone who feels more qualified. Explain that there are certain things, list them, that you would like to be able to do that you cannot do now because the pain overtakes you. Doctors like to see concrete goals that you might be able to meet and move on with your life. Be willing to try other options should he suggest them.

Increasing the dose of hydrocodone will not increase the amount of time that it works, that is part of that drug, it only lasts 4-6 hours. It might well increase the amount of relief that you get during that 4-6 hours. That is a good thing. Just a comment regarding that drug.

I think seeing the neurologist and the neuropsychologist is a good thing. The FMS diagnosis seems to be a tentative thing since you don't have the usual pain on palpation of the tender points, perhaps you have something else altogether??? I have seen both those kinds of doctors and found them both to be very useful. They will also be useful in your claim for SSDI if you need some long term disability.

Like Bet said, you may win out in the long run, even though you are in pain right now. Have you approached this PM doctor for increased hydrocodone on a short term basis? Perhaps suggest a couple of months to see how the other pain management treatments he tries on you work out? Or ask for some kind of long acting opiate instead? I wouldn't name brands or anything, but you could tell him someone else mentioned it to you as a suggestion for an alternative. (Me.)

Take care, Annette
 
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annette030 replied to TDXSP08's response:
The ED is not required by the Joint Commission to give you opiates for pain, they are only required to assess and treat your pain at that moment. They can give you an injection that may only last a few hours, or they might just tell you to use a heating pad, or do back exercises and see your own doctor in the AM or in the next week or whatever.

One person cannot have anyone's accreditation revoked for not treating their acute pain properly. The requirement that the hospital "treat" pain is purposefully left pretty vague so the doctors are free to do their jobs as they see fit.

I would not put the ED that might save my life, in a fight with a doctor over his lack of control over my pain.

Other than that, I agree with you, call the doctor in the middle of the night if you feel that is what will get this doctor off his behind. But keep in mind that if you just make him angry, it might not serve you best in the long run. Think the whole thing through and do whatever you can do to advocate for yourself while being polite and respectful. I like my doctor to walk into the exam room and see me, and be glad to see me.

Take care, Annette
 
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cweinbl responded:

All of the medications you have tried are lightweights. I could chew Hydrocodone all day and obtain no relief. And while Lyrica and Cymbalta are often prescribed for Fibromyalgia, they do not always help. It is an axiom that people with chronic pain should always use an anti-depressant. They inhibit the reuptake of Seratonin, one of the body's natural pain fighting chemicals.

First, follow through with the pain clinic. Although most of the non-invasive options won't help, some will. I can reduce my chronic pain by up to 20% with biofeedback alone. Keep an open mind and try everything. What have you got to lose?

With chronic pain, you need a long-acting narcotic, such as Kadian, Oxycontin or Fentanyl Transdermal. Then, use your Hydrocodone (or Oxycodone) for breakthrough pain. Pain research is very clear in noting that chronic pain responds best to a long-acting drug. You need it in your bloodstream, 24/7. Fentanyl Transdermal is good for 48-72 hours at a time.

It can be difficult today to find a physician willing to provide you with a long-acting narcotic. Sadly, many doctors are more motivated by fear of the FDA than by their patients' needs. If your PM physician won't prescribe it, ask your internist or family doctor. Sometimes there is enough long-term trust there.

Good luck.
 
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TDXSP08 replied to annette030's response:
no you are right anneette opiates are not required but some method of lowering your pain score is and the "patient" needs to feel a little better when they leave than when they arrived, and sometimes thats a placebo and someone to talk to, and in others its Medication and advice to call your PMD in the AM about a followup appointment.

And with me my Doctor is always very happy to see me(even when i showed up 1 day and 1 hour late for my appointment) she said its weird He never misses an appointment unless he has to and he always calls way ahead of time we could not figure out what happened, so my nurse saw you in the waiting room and rushed in and said He's here a day and an hour late but he's here, and my Doc was like allrighty make room in the schedule for him he drove all day to get here,lets not send him home empty handed!

Peace
i have no small step for man, but i have 6 tires for mankind,Watch your Toes!
 
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CTBeth replied to cweinbl's response:
Hello Charles,

Regarding your statement,

"If your PM physician won't prescribe it, ask your internist or family doctor..."

Do remember thatTerrell65 has signed a medication agreement with his PM doctor.

Just a thought.

Bet
 
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annette030 replied to TDXSP08's response:
It is great that your doctor made time to see you.

That is the sign of a good doctor. I think those of us with good doctors should be very happy to have them. I know I am.

Take care, Annette
 
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annette030 replied to CTBeth's response:
A good thought too. I know if I got opiates from other than my usual internist without telling her, she could drop me from her practice. It is in my opiate consent form.

That is what the new database is all about, making sure that patients are not getting pills from more than one doctor without telling them each what the other is prescribing.

Hugs, Annette


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