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    In dire need of opinions for my pain mgt roller coaster
    jamesp767042 posted:
    Ok first let me say that I have been around for a while reading all of yalls discussions and they have been so helpful. I finally decided to actually sign up to Webmd and post my own problem and have no doubt that yall will give me great advice. Hopefully the experts will chime in too, as im not sure if you have to post in a specific area for them to come across it. Anyway here goes.

    I will try my best to be a brief as possible. I tore my ACL in my right knee back in 1997. About 5 yrs ago, give or take, the osteoarthrits really became a problem for me and beacuse i am a painter and very active i spoke to my doctor about my options. After confirming the arthritis, he started me on hydrocodne as needed. For several years this was fine until all of the sudden it began to get worse. Fast forward to 2010, and now the osteoarthritis has turned into my ACL being retorn again with extensive damage done to the graph and cartilage and also i have loose bodies, which are peices of bone that have chiped off and just painfully float around. Also around the same time, i started having real bad lower back pain that progresively got worse. So when I had the MRI done on my knee that showed the retorn ACL, they also looked at my back too. That revealed that on top of the knee pain, i had two bulging or hurniated dics on the right side of my lower back.

    My pcp had always been the one to prescribe my pain meds during that time. However he and my wife, who was also seein him, had a falling out (totally unrelated to pain meds) and this brought a rift between them. At my next app, i tried to take up for her and this made things worse and it ended up in us leaving him and findin another docotor. This has nothin to do with my dilema, just explainin how i got to the doc im at now. Anyway when i left him i was taking oxycodone 30mg 5 to 6 a day. My ortho, who diagnosed me and knows my sitiatiuon, was nice enough to refer me to pain managment and prescribe me enough pain meds until i could see my new pcp. Well when i seen my new pcp, he was so nice and after seein my mri results, more than willin to prescribe my oxycodone until i could get in to see pain mgt. Only thing was is instead of my 5 or 6 a day, i had been only getting prescribed 4 a day. But i wasn complaining cause that was better than nothing. well when i finally went to pain mgt, they kept sayin how high of a dose i was on and that for the problems i had that was too much medicine. he also told me that unless i had arthroscopic knee surgery within 3 months that he wasn gonna continue treating me. problem with that is that my ortho said with how bad my knee has gotten that the surgery could actually cause more pain because after cleaning it out it could create like a bone on bone situation and thus have more pain than before. They wont do a knee replacment right now cause im only 30, even they said eventually thats what it will come to. He continued the 4 oxy 30s a day, but only for three months and with the stipulation that i have the surgery. After that he wants to lower me and take me off. my thinkin is what if the surgery dosen help. he seems decided either way that if i stay with him after the surgery im comin off them. i jus didn like bein given an ultamatem (sp?) So now it brings me to my question to yall, what should i do? should i try to find a new pain mgt dr? im thinkin since my new pcp is so nice maybe askin him to take over the pain mgt. all thoughts and opinions would be welcome. Thanks so much in advance
    jamesp767042 responded:
    Some more things i wanted to add is that even if the knee surgery is a complete success, that still wont help with the reason that i started taking pain meds in the first place: the arthritis. To a large degree that will still be there. And ive had the epidural shots for the hurniated disc and for the most part that keeps it at bay, but what about if that comes back with a vengance. and to add to that i also have carpal tunnel. That can make being a painter very difficult.

    The point im tryin to make is that i dont like how i was treated. One thing he said that really bothers me is that he has patients with pins and screws all up and down their spine and they dont even take that much medicine. I said but you of all people should know that everybody is different and what works for one persons pain might not work for the other. He didn really have much to say to that. Then when i told him that havin the surgery scares me beacuse of the strong possibility that my knee could be in worse shape than it was before, his answer to that was that any surgeon who tells me that his surgery is 100% guarnteed, you better run the other way. But we all know that is not the case. were not talkin about a normal circumstance surgery you know. i just dont know what to do if i shud stick it out with him and go ahead and have the surgery or find another dr. i mean even my ortho said i shud probly stick it out as long as i can so what does that tell you. anyway thanks again in advance
    77grace replied to jamesp767042's response:
    Well I get confused with so many Drs. and surgery and stufffbut from what I understand yoiur saying this new Pain management guy is giving you basically a3 month decsion to have the surgery and then go off the meds.!I would see someone else,get another desion or go bck to where you were!AS we know ,Surgery is not a Garentee of anythhing!
    Good Luck 77grace
    jamesp767042 replied to 77grace's response:
    Just wanted to say thanks the advice ms grace. I know it can be can confusin how i write lol but yes your right, its the new pain doctor that is saying 3 months and then no more meds. Even my ortho said that because of the shape my knee is in that this paticular surgery might not help or might even make it worse and i should hold off as long as im able to!! and the pain doc is supposed to have notes from my ortho so you would think he would know this and not act like that. Anyway ive already made an app. with my new pcp (hes actually an internal medicine dr) for next wed. At first i was gonna stay with the pain clinic just for them 3 months so at least that would be 3 months that i wudn have to worry about where my meds were gonna come from. why not right? lol but then i thought that wudn be right me doin that cuz i know im not gona be able to have the surgery like he wants so why stay and take advantage of him. And plus hes a real jerk so i really didn wanna go back and see him anyway. So, at my app next wed, im gonna tell my pcp how it went with the pain doc and how he gave me the 3 month ultimatum and that right now i just cant do it. Then im gonna ask him if he can take over my pain meds for good and keep me out of these clinics? Do you have any suggestions on maybe how to go about askin this? i was jus gonna tell him that theyve been nothin but a headache to deal with. and ive only been to two!! The first one put me on the best regimen of meds ever. but they closed down after my first visit! can you believe it?! So between that one and this new one, i jus dont really have that much good to say about em. What kinda worries me about askin him to do this is this will only be my 2nd visit to him. Even tho on my first visit he acted like he had no problem with giving me the oxycodone. Especially after seein my mri results. So that kinda gives me some hope. Also, like ive mentioned before, im on a lower dose than i previously was on and was also gonna ask him about increasin it back to what it was. But is this too much to throw at him all at one visit? I almost wanna say that i wud rather him increase it and refer me to another clinic than stay with him and have to stay at this same dose. Right now im at 4 oxy 30s a day and i really wanna get back to 5 or 6 a day. I was really excited about the new pain clinic at first because i was almost ceratin that they wud put me back on that dose. but i soon found out that wasn gonna happen. I never even dared to ask!! im a lil envious of these people who are on a long actin med like oxycontin or the patch and then get like the oxy 15 or 30s for breakthrough. The clinic i mentioned earler that shut down after a month had me on oxycontin 80mg ER twice daily and oxycodone 30mg for breakthrough. That was the best relief i had ever had and the first and only time i was on two meds together like that. Anyway this is alot longer than i planned it to be lol jus let me know what you think about it all. Look forward to hearin from you and hopefully some others will chime in too soon
    Anon_10089 replied to jamesp767042's response:

    I hate navigating pain meds with doctors. It always feels like you have to play a game. It's also annoying that it seems like your orthopedist and the pain management doctor are not communicating.

    If you have a good relationship with one of your doctors, I'd talk to that one. I've always found that being honest but not overly emotional gets good results. Keep a pain journal and note your pain levels before and after medication. It seems like you do better on an extended release med, so mention that too.

    It's also good to be open to other types of treatment that your doctor may suggest, so it doesn't seem like you're just trying to get pain killers. Are you on any kind of anti-inflammatory for your arthrits?

    I hope this works out for you!
    jamesp767042 replied to Anon_10089's response:
    Hey Anon!

    Yeah I agree about navigating pain meds. I hate even bringing them up period! The one im most comfrotable with is my new pcp, or internist. But the fact that hes still new and ive only seen him one other time is what worries me, even tho the one time he was so nice and compassionate. Almost like he was jus happy that I picked him as my new doctor. My app with him is tommorrow and im so nervous. Ive been a nervous wreck all week! Im jus gonna do like you said Anon and be open and honest with him. Even if he dosent want to take over my pm I SO hope that he increases my dosage from 4 a day to at least 5 a day. Oh and to your question about if i take meds for arthritis: Yes i do. I take mobic and it does help. I also been wantin to ask him about something like cymbalta too cuz ive read some good things about it. What do you think? you think askin him about that too is a good idea? I would jus be so happy if i could back to that dose and be stable again!!! Anyway, i will let yall know how it goes tommorrow. take care all
    peskypain replied to jamesp767042's response:
    I know that some people who are long time patients get their pain medication from a Primary Care Dr. but I just want to warn you that many states are now passing more strict regulations/laws where only PM Drs. can prescribe controlled meds.

    So, I just don't want you to be surprised if the PCP you are about to see says they will not take over your Oxycodone prescription. And if they don't take it over, it's not likely they will raise the dosage.

    It's also not even likely that a PM would take over prescribing the dosages you have been on because most Drs. move someone that has "chronic" pain over to a long acting medication.

    As well as if your primary pain is arthritis pain....opiates are not the standard medication that is provided to help with that type of pain.

    And if there is a surgery that can help with a lot of the other type of pain (non arthritis)....then many Drs. will encourage you to move forward with this surgery instead of continue to prescribe high dosages of the Oxycodone just to mask the pain.

    Anyway...I certainly hope it goes well for you but just wanted to let you know what may happen...

    I wish you luck...keep us posted..
    jow42 responded:
    where do you live I need a doctor t prescribe some kind of pain med my problem is almost the same with my knee. thanks jow42
    jamesp767042 replied to peskypain's response:
    Hey Yall.

    Well just wanted to take some time to let yall know how my app went yesterday. First,
    jamesp767042 replied to jamesp767042's response:
    Hey Yall.

    Well jus wanted to update yall about my app yesterday. The first thing out of his mouth was "how's that knee doin"? So that made it kinda easy to start it off. So after me tellin him about the normal aches and pains, i proceed to tell him about the not so good app with the PM dr. He says he doesnt have a problem referring to another one. Just to let him know which one. Then i let him know that i would be needin him to prescribe my pain meds again in the meantime. He said he would do it, but only on a temporary basis. So without askin, that pretty much answered my question about whether or not he would take over my pain management full time. But on the upside, I brought up about increasing the dosage from 4 a day to 5 and he said that was no problem to increase it in the meantime. So that was a major plus. Now i jus have to find the right clinic. Easier said than done. Anyway, thats all for now. Im tired lol Will talk to yall soon
    annette030 replied to jamesp767042's response:
    It all sounds good to me.

    Just interview PM doctors like you would any potential employee. Tell them what is wrong, and what your doctor has suggested so far. Be open to trying anything he suggests, but find out for sure how long it should be before you know if whatever he suggests is working.

    If he wants you to sign a contract, this is a normal thing, be sure you read it though, and ask him what to do if your pain gets out of control between visits. Some doctors like to deal with things on the computer or on the phone or in person (like my doctor). If he is like her, ask about how you get in to see him promptly, and what to do on weekends, etc. My doctor can always see me within 48 hours, often sooner, my husband's doctor can see him the same day if he calls promptly at 7 am. They both keep a couple of appts. a day open for emergencies.

    Take care, Annette

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