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Pain Management and the Laws in Different States
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meaningfulc1952 posted:
I have a pain management dr. now for about 2 years. I have had chronic pain for more than 20 yrs. and have seen more than 3 pain management drs. over the past years. When I saw my current dr. last month he mentioned that valium and methadone were a dangerous combination. He prescribes valium, methadone, skelaxin for my pain. My neurologist prescribes phenergan, fioricet #3, sumatriptan and botox treatments for my migraine headaches. Many years ago I had a different pain dr. and he was prescribing soma 350 mg. along with oxycontin for my pain and then all of a sudden he informs me that he can no longer give me the soma because it has been proven to be a dangerous mix with opiate drugs. I also know that different states have different laws when it comes to prescribing pain meds. I sure do not know what those laws say though. I do know that my current pain dr. will not prescribe enough pain meds to control my pain and that infuriates me. I used to have a dr. that gave me meds for breakthru pain and this current pain dr. does not do that at all. He is just so strange and always telling me how the DEA is watching everything that he does. I do not know what a patient like me is to do when my dr. constantly reminds me about this. My dr. knows all of the meds that I take.

Do any of you have any similar problems like any of the ones that I have mentioned? Also, do any of you get botox injections for migraine headaches and if you do, how do you think it helps or not? I will be having my second set of botox injections next week and they will be stronger than the first time I had them.

Any info would be greatly appreciated about any of the things that I have mentioned.
Thanks
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annette030 responded:
The problems with Soma and valium when mixed with opiates have come out in medical studies and research, it is not a "legal" kind of problem. I do not use those types of drugs with my opiates.

The DEA is a federal agency and its rules are valid in all 50 states, they do not vary from state to state.

I have migraines, they have varied in frequency and intensity over the years. I read the studies on Botox injections some years ago, and decided not to try it, it was very expensive and the success rate was only about a 50% reduction in headaches in 50% of the patients it was used on. I think the important thing for you is how did it work for YOU the last time you tried it? If it helped, maybe it is worth it to try again with a larger dose...

Take care, Annette
 
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Anon_160307 responded:
Hi,

I am on Flexeril (it is a muscle relaxer like Soma), Valium (I have been on it for over 6 years), and I also take Opana ER (60 mgs per day) along with Percocet for breakthrough pain.

When I was on Tramadol a few years back, I was taking 5 mg of valium per day at night for sleep. When I was on MS Contin, I tapered to 3 mg and now with Opana I have tapered to 2 mg. The last taper was a personal decision for me as Opana is extremely powerful. I didn't want any issues. I have slowly added back in a mg of valium if needed once I have adjusted to the new opioid medication.

I agree that methadone and benzodiazepines (e.g., valium) don't mix well AT ALL and it is strongly opposed to use the two together as methadone has a tendency to built up in your system and one night adding valium could be okay, another night adding valium could not be okay. However, with other predictable opiates like Morphine, Opana, OxyContin, adding valium or a muscle relaxer is to be proceeded with caution as it increases the depressive effects of the Central Nervous System which could be fatal if the brain forgets how to breath (i.e., respiratory depression). My doctor did not force any changes in meds on me but I am always vigilant and observe how the new meds effect me and when starting a new med, I am very careful with the valium and flexeril and have on many occasions not taken my full dose because the effects were too strong. As my body adjusted to the new opioid, I slowly added back in the meds until I ended up where I began in terms of dosing, before starting the new opioid.

You are your best advocate. Some may disagree with me but I don't just blindly take pills if my body is saying it isn't a good idea despite the prescription the doctor wrote. Once my body says it is okay, I will start taking the meds at the higher dose prescribed no problem. I also stagger the valium and flexeril at least 3 hours apart from the opioid dosing (I never take them together at the same time). I relay the issues I had when starting the new opioid and I mention how I didn't not take my full dose of adjuvant medications because I was super dizzy after one dose of gabapentin. My doctor is pleased with my vigilance as everyone is different and everyone reacts to medications differently.

I am sorry you aren't getting good pain control with your current doctor. Trust me, I have been in that position many times over the past 12 years and right now I am still in disbelief at how well my new doctor is controlling my pain with the new opioid medications prescribed. He does give me Percocet for breakthrough pain but most days I only need one dose and if I increase my activity level, I need one extra dose and that is it. I know you have had other doctors that controlled your pain well. Could you ask them for a referral? That is how I found my new doctor. I wish you the best of luck and hope you get better treatment soon.
 
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_swank_ responded:
DEA laws are federal and valid in every state. States can also have their own laws regarding how doctors can prescribe. For instance, in Georgia, a new law has been passed that doctors cannot prescribe pain meds for longer than three months without having a special pain management license. This means that most primary care physicians can no longer prescribe to some of their patients and will have to refer them to pain management.
 
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annette030 replied to Anon_160307's response:
I was told by the instructor at a pain management class for healthcare professionals that benzos and ALL opioids, (not just methadone, but all other opiates also) had been shown to interact poorly. She felt within a few years, no doctors would prescribe opiates and benzos at the same time. This research had not yet been released in its final form.

Take care, Annette
 
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Anon_160307 replied to annette030's response:
I disagree with you and your doctors statements that benzos shouldn't be mixed with all opioids and that all doctors will stop prescribing the two together. I have recently switched doctors and my new doctor has no concerns regarding me taking valium in conjunction with the oxymorphone and percocet he prescribes for management of my chronic pain.

Most people know that Methadone has very unique properties that when combined with Benzos can be deadly. I have never taken methadone and most likely never will as I don't want to become a victim of QT interval prologation and end up in cardiac arrest. Personally, for me, there are other more safer opioids out that are just as effective and sometimes more so than methadone for many people. Methadone is cheap but my life isn't and I prefer to pay more for safer opioid medications for management of my chronic pain.

I have safely combined benzos with opioids for over 5 years when prescribed Tramadol, Vicodin, Percocet, Morphine, and Oxymorphone (at different times) and have had no issues. I have severe anxiety/pain disorder accompanied with depression along with severe chronic pain. I need the flexibility from opioid pain medications that allow benzos to be safely introduced in combination with them. I am on a much lower dose than I was on 5 years ago and the Valium is still very effective for anxiety/panic attacks, muscle relaxation, and sleep. There are many people out there than have chronic pain with anxiety/panic disorder and relay on benzos to lead a normal life. Excluding opioid medication from people with an anxiety/panic disorder is a cruel. I don't think everyone requires a benzo in conjunction with an opioid but there are a select few that do which includes me. I have a very compassionate primary care physician that cares about my pain and asks how my pain levels are at every single appointment whether I am being seen for pain management or something else. I feel very blessed to be under such great care. My pain levels are the lowest they have been in 12 years!
 
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annette030 replied to Anon_160307's response:
We are all free to disagree about anything, that is the wonder of America.

I like evidence based medicine, and just repeated information I was told during the class I took a few years ago. I have read and heard more of the same, that benzos and opioids (not just methadone) are not a good mix.

My personal opinion is that benzos are one of those old medicines that are slowly being replaced by safer drugs.

I do not take any benzos, and have not had this discussion with my doctor ever, not sure where you got that. Doesn't really matter.

Glad you are feeling good on your current regimen.

Take care, Annette
 
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Arabax responded:
Hi, you don't mention where your pain is. If it is neck pain (migraines is a hint), I recommend trying botox. I had great results. It relaxed the muscles that were tight because they were trying to protect my damaged nerves - which hurt worse because of the muscles tightening...pain cycle. The botox relaxes the muscles to try to stop the cycle. I had more mobility, less pain (even reduced my meds a bit), more strength in my hands and it lasted for about 5 to 6 months.
My only word of caution is to make sure the dr. performing the injection is equipped with life saving equipment and you trust him/her. I would love to know how it worked for you.
 
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meaningfulc1952 replied to Arabax's response:
Hi Arabax,
My pain is in my jaw, neck, headaches, back and I have RA. In the 1980's I had many jaw joint implant surgeries because then the oral surgeons said if you have TMJ and I did , that is what they recommended and that was total jaw joint replacement. So after 6 major jaw surgeries I have been left with paralysis in my face and can only eat extremely soft foods. These oral surgeons ruined my life. I did my homework before having any jaw surgery too. I saw at least 7 different oral surgeons and they all said that I needed to have this surgery.

My neck has several disk problems and my back too.

I have migraine headaches and tension headaches on a regular basis. Yes, I have had the botox injections given to me by my neurologist. I have noticed that they are helpful many times. I really like my neurologist a lot.

I have a pain mgt. dr. that I have been seeing now for 2 years. Prior to him, I had pain mgt. drs. for at least the past 15 or so years. Some are better than others from what I have experienced.

If you had read some of my other posts you would see that I have mentioned in detail my history of medical problems.

Take care,
meaningfulc1952


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