Pain Management Community

Sounds like South Florida, It seems that your wife does need pain medication but she is abusing the med's she has. Why would she steal her own med's if there wasn't a problem. I know first hand because I was just ;ike your wife for a period of time many yr's ago. I have a disease called avascular necrosis that destroys your joints. I have replaced my left hip and right shoulder and still need to replace 4 more joints so I am a long term chronic pain patient. I give all of my pain med's to a relative who then dispenses my med's for 1 day. This has worked for me and has helped with my pain..Plus I go to a legitamite pain doctor and abide by there rules. It seems that your wifes last pain doctor wanted to do a procedure to help with her pain and your wife wanted nothing but to get her pain meds and thats why they discharged her. Very common among pain patients..Hope she gets some help..Take care RB

It sounds like your wife is overmedicating herself and this is extemely dangerous. Legitimate pain management clinics accept insurance-any that take only cash I would be highly suspicious of, and one day the DEA might just decide to raid the place where she is getting meds now, and the stuff is going to hit the fan! You didn't say what procedure she refused to have, going to take a guess that it was something like epidural steroid injections; many pain management docs want a patient to try these, and if the patient refuses then it looks to the doc like the patient is just drug seeking and they get dropped as a patient. Then when the patient goes to another legitimate pain doc, that doc talks to the last doc, finds out the patient seemed to be drug seeking, and gets refused treatment and gets blackballed by ALL legitimate pain docs-then no more pain management! Your wife is playing a dangerous game and if she continues she could end up dead, or without any kind of legitimate pain management at all. There are many different ways that a pain management doctor can help a patient try and control their pain and not all involve medication. There are also many different medications other than narcotics that are used in pain management. If your wife truly wants help, she needs to be going to a legitimate pain clinic, and has to work with her doctor to get her pain under control. There are rules that have to be followed when dealing with legitimate pain clinics because of the high level of abuse of meds, and if you don't follow the rules, you don't get treatment. I am sorry for what you are going through, you sound like a good person in a difficult position. Get the meds back from her as soon as you can! And get her into a legitimate pain clinic. Hope your wife gets the right treatment, glad she has someone as caring as you looking after her. Good luck, and take care.

I think the two replies to this post were spot on. The only thing that I would add is she seems to want to be pain free. Coming to the conclusion that pain medications and other modalities don't eliminate all the pain is a hard thing for many chronic pain patients to accept. I recommend that she gets some counseling to help her ACCEPT that she WILL HAVE PAIN even with treatment. The goal of pain management is to increase functionality. Falling asleep with a burning cigarette in her hand at night doesn't sound like she is functioning well. She is definitely overmedicated like the others said.

After her regular dose of pain meds, she needs to learn that if she still has pain, she needs to try something else until her appropriate dosing time arrives such as stretching, walking, reading a book or doing something that is distracting. If after following the rules, which includes taking her meds as prescribed, her pain is still uncontrolled to the point that she is not functional...then this is the time she should ask her doctor for other options that may include dose modifications or other treatments.

Despite our sufferings as chronic pain patients, we have to abide by the rules. I've been there where I was in so much pain and couldn't take more pain medication because I would be taking outside of the limits that the doctor prescribed (i.e., self-medicating). We have all had to do it but eventually following the rules equals reward. Not following the rules equals punishment. A good question to always think about when you are in so much pain but don't have anything that can help: Would I rather feel the pain from having no pain meds or the pain I have now while medicated? I know most of us would choose the latter.

Lastly, she needs someone to administer her meds for her. You need to sit down and go over with her how pain managment works, have her agree to counseling...whatever it takes, and then lock her meds up in a safe so that she can't steal them to take more.

Honestly, taking only short-acting opioid medication (aka oxycodone IR) is fueling this fire. Her doctor should put her on a long-acting opioid medication that works for 8-12 hours (sometimes longer) and then the oxycodone would only be used for a really bad pain spike within the prescribed limits. This would also make it easier on you as you would only have to manage 2 pills a day (1 in the AM, 1 in the PM) and maybe 2-3 of the oxycodone pills throughout the day - I am hypothetically speaking here as I don't know how much breakthrough pain medication her doctor will end up allowing nor what long-acting med would be choosen. If her behavior turns around after getting on a long-acting pain medication, it is likely that she was demonstrating a behavior called psuedoaddicition, where the chronic pain patient will act out like a full blown addict due to the pain being very poorly controlled. Once the pain is controlled then the patient becomes compliant. If she fails the pseudoaddiction test, she definitely needs counseling and monitoring. Transferring her to a doctor that specializes in both pain management and addiction would be a good choice as he can help the both of you help her stay within the boundaries set forth by the physician. There are medications out there that are very effective for pain but have a ceiling so that she can't hurt herself by overdosing. The medication is a patch that is worn for 7 days called BuTrans. Many doctors will put addiction prone patients on this med to ensure compliance.

Wishing you the best. Please keep us informed if you are willing. If you have other questions, we are here for support!

Two questions:

1. Does your wife take the medication to get high, or to relieve pain?

2. Is she on the right medication?

Research clearly shows that chronic pain patients achieve much better efficacy from using long-acting opiates. Oxycodone is a short-acting drug. 180 10 mg tablets is a little high, but not necessarily inappropriate. I would ask the doctor if she can switch to a long-acting pain medication (Fentanyl Transdermal, Oxycontin, Kadian, etc.). Then, she could use a much smaller supply of Oxycodone for breakthrough pain. If she really has that much pain, she might benefit greatly from using a long-acting opiate.

If she is using the drug to get high, if she uses too much, runs out too soon, steals it, obtains it from multiple physicians at the same time, etc., then she might be addicted. If so, ask the doctor about rotating to Suboxone or Nalaxone. These are a class of drugs called opiate antagonists. In fact, they are designed to treat addiction. Some people believe that they also decrease chronic pain.

Many people who are "taking too much" really are on teh wrong medication. If your wife takes too much and she takes it for pain (not to get high), then she might do much better on a different drug. Fentanyl Transdermal, for example, is the most powerful pain killer available. Each patch can last from 48 to 72 hours. Many people who have used too much of a weaker, short acting opiate find that the long-acting drug (like Fentanyl) works much better and allows them to return to a more normal life.

Has your wife tried all of the various pain management options, such as TENS, traction, acupuncture, biofeedback, physical therapy, kinesiotherapy, injection of steroids and anesthetics, non-steroidal anti-inflammatories, cortisone, rhyzotomy (radio frequency denervation), spinal cord stimulator, intrathecal infusion pump, off-label medications (anti-depressants, anti-convulsants), combination of long-acting pain medication with breakthrough meds, counseling, hypnosis and meditation?

I can reduce my pain by at least 20% at any with biofeedback alone. For patients with a history of addiction disorder, it makes sense to try all of these non-inasive and minimally-invasive options.

Good luck.

Hello,
The medical conditions that your wife has are very painful. I used to have endometriosis and ovarian cysyts too. That in itself was a horrific type of pain that made it almost impossible for me to walk down the hall when I was still able to work. I finally had a complete hysterectomy at a very young age and if it had not been so very long ago I would imagine that there may be treatments for treating the endometriosis.

I used to have a pain management dr. that did not accept ins. and I had to pay him every month when I saw him. He was a reputable dr. and helped me very much. So, I don't think that would upset me if I were in your shoes.

I do think that it sounds like your wife may be taking way too much pain meds or a mixture that is toxic to her. Those things can happen and then it can get very dangerous. Have you tried talking to her dr. about any of this? Have you thought that maybe you and she might need to find another pain management dr. that would not be quite so "free" in prescribing so many different pain meds and other meds that you mentioned?

Unfortunately, when we pain patients need to take strong meds, we are put in a position where we need to be extremely careful how much meds we take and what we are taking and do they really help. Does your wife write down in a notebook when she takes a med and the time? Over the many years I have learned that by doing that for myself it does help me to remember exactly what and when I took my pills. Not to many pain drs. that I have ever seen have even told me to do this type of monitoring of my own. I just figured this out years ago and found it to be very helpful.

Please do not give up on your wife because she really does need your help. I think that she is on the edge of real danger from what you have shared with us.

Does your wife drink alcohol? I am only asking this because some years ago a very close family member was taking pain meds for chronic pain and had been drinking also. This person was extremely intellegent, but I guess he just did not pay attention that you NEVER drink alcohol when taking any type of narcotic pain medicine and it cost him his life. This was my son-in-law and it has about destroyed my daughter's life. She is the one that found him dead the next morning.

I just wantede to share that with you because any of us pain patients should know better that you never drink alcohol when you take pain medications.

I wish you luck and hope that you can find another dr. for your wife to see. It sounds like she has so many different things going on and needs some guidance with her meds.

Hello An_245897:
I wish one of the physicians would respond, as they may carry a bit more weight in the severity of your situation.
My following statements are my opinion, but I would encourage you and your wife to seek that of a doctor's as soon as possible.

I did notice that your wife was submitted into the hospital because she "had problems with narcotics painkillers in the past..." This does warrant interference on your part.
There is a confidentiality agreement between patients and doctors, so I don't know how much you can discuss with her doctor (he will probably just listen to you). Just be careful with what you say and just offer facts/observations rather than your opinion. As a pain patient myself, I don't know how comfortable I would be with a family member discussing my case with my doctor out of my presence.

You obviously feel her life is at risk, so if approaching her doesn't work, then I would suggest another physician's opinion (if you can manage) seeing as her current pain management doctor is neglecting to follow the guidelines in prescribing controlled substances. If you need more input on how to approach your wife, just ask anyone here. Everyone seems more than willing to help and offer ideas. You do need to act quickly however.

A couple of others didn't see that you stated she takes a long-acting narcotic: fentanyl. What is the dose? If her pain isn't adequately controlled, it's more likely that her fentanyl needs to be adjusted up in order to avoid excessive use of the oxycodone (usually prescribed for breakthrough pain, which most patients don't need to take around the clock.)
In my experience, the mixture of any narcotic and valium should be monitored very closely, if it is absolutely necessary to take the combo to begin with. In the past when I took a very similar combination, I myself would fall asleep mid-sentence. It may be that she could take a different medication (non-controlled substance) that could tackle her anxiety issues.

Like others have suggested, there are many other ways to manage the chronic pain, as there are many variables to be considered. Someone stated that pain management will not take her pain away entirely, but will help to increase her functionality. Many patients don't understand this - it took me a long time to accept that as well. It seems your wife needs to be reminded of that.

For now I would suggest grabbing her medication and dispensing it to her. Lock it up in a safe. If you find her trying to snag pills again, or trying to break into the safe, then she may be at the point where she should be admitted to the hospital again.

I really feel for you as you simply just care for her and want to do anything to make her more comfortable. Hang in there. Many of us are here to offer support. I will keep you and your wife in my thoughts. Let us know how things are going. Best of luck to you.

Well even without your intervention other Doctors of the future are probably going to cut her way down if not off completely, should she attempt to Re-enter the legitimate Pain Management sector because the place she is going is already on the "RADAR" of legitimate Doctors and they will not accept a "former" patient from this place because they know it's simply a "candy store",she would be treated better if she said she never was in PM than by putting this place down as Last Treating Doctors office. Before i became i'll and a patient myself i watched my wife go from Pain Managment To Drug Addict and i was the only one who saw the problem with it , I gave up so much of my life trying to help My wife and in the end sadly it did not make a difference.So for you my Friend i hope that you get help with your journey to save your Wife from herself!!

Peace

An_245897 posted:


Is that normal behavior for someone who is taking pain medication just for pain?? I am really asking that question because I really don't know.


I agree with everything that has been said above AND to answer your question directly, "NO this is NOT normal behavior for someone who is taking medication just for pain." I have been a chronic pain patient for decades and I am a patient of a strict pain clinic. In my experience, my pain meds do not "make me high". In fact, my pain meds just "take the edge off" the pain enough that I can function. It would be a mistake to think that pain meds could or would "make the pain disappear".


Titrating your correct dose of pain meds is really the same as with any medication. You are seeking to find the "sweet spot" where the desired effect is maximized while the undesired side effects remain tolerable. In the case of pain meds the desired effect is "pain reduction" and the undesired side effect are intoxication/fatigue/somnolence/coma/death.


A couple of things you should know. Recent studies have shown that even people with no history of addiction can overuse pain meds and the tight control of meds is a "best practice" for pain clinics. This often means saying "no" to dose increases and often means trying nonpharmacological forms of pain relief. If your wife has already been in "detox" she has already demonstrated that she needs help in using these meds properly.


Depression is often a by-product of chronic pain and studies have shown that the brain responds to emotional pain in a manner similar to physical pain. This is good news and bad news. The good news is that pain meds actually do help emotional pain. The bad news is that using pain meds to address emotional pain is just as counter productive as it would be to medicate a broken leg instead of setting it in a cast. This relates back to my earlier comment. One must set their expectations properly. The pain meds can NOT eliminate pain (w/o causing death). One must settle for simply improving function.


The Hippocratic Oath (never do harm) leads logically to the best treatment of pain. The goal is to achieve best function. If giving more pain meds will improve the patient's function then they are under medicated. If giving the patient less pain meds will improve function then they are over medicated. Once maximum function is achieved then nonpharmacological means need to be explored to maximize "quality of life". Pain patients are similar to others in that they need a "purpose in life" and goals that take them "beyond themselves". The difference is that pain patients NEED for these transcendent goals is even more acute. Having such goals can often literally mean the difference between life and death.

GaltJohn was well spoken especially on goals for people , I can not tell you How many Seemingly normal healthy Men & Women who i ran ACLS ( Advanced Cardiac Life Support) Protocols on just a few days or a week after they retired from their Job,what was supposed to be the time to enjoy life and plan to spend "the Golden Years" was actually an early morning heart attack because they had no goals and felt left out of things now that they did not have to go to work every day(it sounds crazy but it is scientifically validated) so even if you are disabled from pain and do not work you need something to get out of bed everyday for and not just to get pills , I am 43 and never been "High" i am very much a control freak i have had several cardiac catheterizations done and never had a problem until they started putting that hazy swirly plastic box on you so you can't see whats going on around you, and once they started doing that i warn them each time DO NOT use it with me i will FREAK OUT and they think they have sedated me enough that they start and they put the box on and zero to 60 i go in the freak out trying to get it off, so off course the Doctor yells put him down and the inject something and i wake up like 4 hours later saying i told you not to use the box I don't like that feeling of not being aware and in control.

But back to the real patient here, Your wife desperately needs help her behavior is not normal and she is definitely heading down a road to nowhere, as someone else mentioned talking to her doctor will do no good he is getting cash and does not care the damage he is doing. My suggestion though it sounds harsh is to get the pills out of the House totally give them to one of YOUR trusted friends who will not give them to her or tell her where they are and cut her off completely if you have a joint bank account withdraw all but 20.00$ and open an account at another bank so she has no money to buy more pills if you have direct deposit make sure you withdraw or have the money transferred out of the account the same day it goes in. force her into withdrawal by herself or into rehab let her know one way or the other she is getting proper medication for her situation from a Doctor who is an addiction and Pain Management Psychiatrist that takes insurance or she goes thru withdrawal alone and afterwards has nothing for the actual pain she does have, and i know how hard this is to do like i said in my first post been there didn't get the t-shirt but got a Medal of Valor i was told by several professionals things like "i learned more about being a man watching you deal with your wife" and "I never really understood the vows of Marriage until i got to know you" I know This is hard very hard but if you really love who you married and want her back you have to stop this. if you click on my avatar in the bottom of my story is my email addy feel free to write me if there are anything specific you would like to know or ask or want an understanding husband who has been there.

Peace

Well said, I agree with it all.

Take care, Annette