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Do I need a new Doctor?
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MKKBMOM posted:
I seem to have quite a unique problem. My primary care physician was managing my pain for 4 years simply with Oxycontin and oxycodone. When he moved to New York, I was referred to an actual 'Pain Management' doctor for the first time. By then, I had weaned myself OFF of the Oxycontin, because my goal was to get OFF of pills. After a rough start with the partner, I saw the main doctor about my chronic lower back pain, caused by spinal stenosis. I was taking 15 mg oxycodone hci 4 times a day. I told him my goal was simple: to REDUCE the pills I was on, lose weight (at 5'6" 214lbs, I felt my weight was a key factor) and build core muscles through physical therapy. This doctor acted as if he understood, and it seemed reasonable when he told me that the oxy should be used for 'breakout pain' and not main pain management. So he had me START taking Methadone, 10mg, 3x a day. He also started me on something at night only called Zonegran, 100mg, at 2x a night for a week, then 3, and was going to have me at 4 if I hadn't insisted at an appointment that something had to stop. I was falling asleep at work, and feeling generally BAD most of the time. He said I was probably having a tough time adjusting to the methadone and the Zonegran, so he he dropped the Z down to 2 per night and Methadone to one in the am, 1 in the pm. So this is where I am now: I don't have the terrible fatigue all the time, but I feel sick -- REALLY sick -- ALL the time! Sick to my stomach, sick in my bowels...and it has suddenly occurred to me: I TOLD this doctor that my PRIMARY goal was to take FEWER pills, and he actually, got me hooked on methadone! Is this normal practice? Or do I need to find a new doctor? This is new territory for me. I don't know who to turn to; my primary care physician who is still here , sure, but all he ever does is send me for tests - LITERALLY. I really need some advice, please.
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77grace responded:
Hi MKKBMOM ,
I am also a chronic pain sufferer and I'm familar with all the meds you mentioned except the nightime one!
I am also taking Methadone and have been for a long time time!My pain is not operalble (sp) so I will probally always need to take something for pain unless they come out with a way to help or fix me !
Anyway,I'm sorry to hear how tough of a time you are having and I can see how you think that you are taking more drugs than less but maybe you should consider that Methadone is a different type of Pain killer,mostly though have you told your Dr. how bad you are feeling????
I'm here if you ned to talk or need to chat!
77grace
 
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blessedladyptl responded:
This is not common practice...just the opposite. I would find a new doctor.
I'm curious about what the "rough start with the partner," was. Could the partner have written something in your chart that the main doctor misunderstood ?
 
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MKKBMOM replied to blessedladyptl's response:
I doubt it...we discussed it at length. The 'partner' was quite insistent that I try this therapy of his where I come in and have him stick needles into my spine. He said I needed to be awake so I could tell him 'if he hit a nerve'. I explained to him that I had a deep-rooted phobia against needles in my back for nearly 30 years, and in fact because of it delivered both of my daughters natural, no epidural (they are now ages 20 and 29). He saw on my chart that I had Xanax prn for anxiety, so he told me to 'just bring 2 or 3 of those with you'. When I explained to him that you can't CURE a 30-year old phobia with a handful of Xanax, he told me I was 'being foolish' !!! Everything went downhill from there. I am convinced that he is culturally prejudiced against women to the point of misogyny. The Senior partner is better, that's who I see now, but I think I need a new doctor altogether.
 
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MKKBMOM replied to 77grace's response:
I have tried, on two occasions now, to talk to the doctor about how bad I feel. He TOLD me to call his office and talk to him anytime, I have done so twice and have never received a call back.
 
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ctbeth replied to MKKBMOM's response:
Hi MKKBMOM,

Perhaps the pain management MD wanted you to try epidural steroid injections, which is among the first-line treatments for mild degenerative disc syndrome, of which stenosis is a factor.

The therapy should have been better explained to you: it is NOT needles stuck into your spine. The procedure involves injections of steroid, and many times a novacaine-type (lidocaine) numbing agent into the epidural space.

This commonplace procedure is usually performed under flouroscopy, so the MD knows exactly where to inject, and it is a very quick procedure.

The meds are injected into the epidural space that sort-of bathes the spinal nerves and reduces any inflammation.

Some people get long-term relief of symptoms, others get short term relief, and some get no relief at all.

It would be rare for any anesthesia to be used for this procedure.

Ativan, Xanax, or Valuim (if your spasm activity is a problem) may be taken about an hour before the procedure, but it is not unusual for pre-medication to be needed.

Why would you think that this MD is "culturally prejudiced against women" at all? And a misogynist?

Unless he said or responded far more than you've shared, it seems a harsh label to give an MD who was offering you a common, relatively easy, and sometimes quite successful treatment for your condition.

Regarding the oxycodone vs Methadone: You were taking, after withdrawing yourself off of the oxycontin, 60 mg of oxycodone daily.

Oxycodone is a short-acting opiate agent.

As far as the new MD getting you, "hooked" on Methadone; the former MD got you "hooked" on Oxycontin.

The Methadone prescribed is 10 mg twice a day- once in the AM and once in the PM.
20 mg is not a terribly high dose, especially when your former MD had you taking oxycontin and oxycodone, with the oxycontin being the long-acting agent and oxycodone for breakthrough.

Methadone is a longer-actng med, so you're getting round-the-clock coverage, as opposed to the oxycodone every four-to-six hours. That's more pills (as you say) than two Methadone pills.

Most, if not all, pain management MDs would have their patients take a long-acting med, rather than oxycodone every four times a day.
This is not only the standard, but the preferred method.

It is significant to know if once you discontinued the oxycontin and were just taking the oxycodone, how was your pain?

If you want to take fewer pills, you will need to consider if your pain will be managed. Is it less pills, or less opiate that concerns you?

If you want to take less by-mouth meds, the ESI (epidural steroid injections) are a pain management treatment that may enable you to take less pills.

If you'd like to take less Methadone, tell your MD that you'd like a weaning schedule. Methadone can be safely cut in half, so you could take 5 mg less every week or so, if that's what you want.

As far as less opiate and dependance goes, you were taking oxycontin an oxycodone for four years. So, it is not the new pain management MD who got you "hooked".

Methadone at 10 mg twice a day is probably (depending on the oxycontin dose) less opiate than you were taking with the past MD, who did not offer you (unless you didn't say) any other pain management treatments than opiates.

Before you seek out a new pain management MD, please think about what it is that you want.

If you want less meds, then tell your MD. Very few, if any, MDs would refuse that you take less.

Do you want to try non-chemical (non-drug) modalities?
If so, epidural steroid injections would be the first thing that most pain management MDs would perform.

Were you getting enough pain relief with just the oxycodone?

Zonegran is for spasm. If you do not like it, it's not addictive, so you can tell your MD that you'd like to discontinue.

Methadone has a side effect of constipation that can lead to GI distress. Try Senekot-S.

What will you do if you need back surgery and have to have a disco-gram?

Is the methadone helping your pain?

You say nothing about your pain.
?????????????
 
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77grace replied to ctbeth's response:
Hi Beth,
Grace here!Thanks for all you replied to her,I hope she reads it all!That is the best explaination of all the modalities and medications and you make it it vvery simple to understand!!!I though that the needles was exactly what you say,they wanted to do somethign like that on me but I am concerned with my tumors and possible effects 1
Anyway,blessings to all , 77grace
 
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ctbeth replied to 77grace's response:
Hi Gracie,


You'll always be Gracie to me, (private joke


One of the many lessons that I've learned through my pain journey, is that we have to make compromises.


I seem to be especially sensitive to the side effects of opiates.
When I took methadone, my pain was managed pretty well- better than anything else, but the side effect of sweating- and I mean dripping wet sweating, made my life difficult.
I gave up the superior pain management because the side effect was making me so miserable and I became housebound.


I have a friend who has some pain with a bulging disc. He was prescribed Tramadol. He complained so much about the GI distress and constipation that he decided that he'd rather cope with the pain than the side effects and now takes an NSAID and Tylenol.

I know that I, and suspect that many others, have to make this kind of decision on a regular basis: There is no magic wand.

Meds come with side effects.

Injectables come with injection discomfort.

Surgery comes with risks and post-op pain.

Spinal cord stim comes with two surgical procedures, minor life-style (I loathe that word, sorry) restrictions, and down time from dead batteries (with which I'm coping now)

Implanted reservoir (pumps) come with surgical risks and other limits of which I know little.

We all must decide what discomfort or disruption of our lives with which we're willing to adjust, or cope for the benefit that works for each of us, holistically.

Personally, I love my SCS, but would hate having to recharge it daily. This means that I accept that I'll have some down time every year-or-two and that regular re-placement surgery is part of my life. For the benefit I get, it's worth it to me.

Someone else may think that my choice is not one with which he/ she could tolerate.

I could not tolerate the side effects of Methadone, but another may think that the sweating is well worth it, because the pain management is so good.

The tough part comes when someone finds all compromise unacceptable.

I think that if the pain is interfering with our desired lives, we come to make the decision of treatment options based upon compromise.

I hope that the originator of this discussion is able to find the treatment option, or the option of living with the discomfort, like my friend who couldn't stand the GI distress, that works for her.

Unfortunately, making rash judgement about ones MD, especially an MD who is offering treatment options besides opiates, may have been pre-mature.

I wish her well, as I wish you well, Gracie.

Let's "chat" again soon. You can find me on Facebook using my email address, if you'd like.

Bet
 
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ctbeth replied to MKKBMOM's response:
RE: " don't like Africans because of the way they act, "


and just how it is that Africans act?


I have no further desire to communicate with you.


And you blame the MD for being biased?


I am reporting you to the site managment for RACISM!
 
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ctbeth replied to MKKBMOM's response:
You state:

" And it may be prejudice of me, but both are from Africa. Even my black American friends don't like Africans because of the way they act, at least in this area."


There is no, "may be"; you ARE prejudiced.



If your goal is to get off of your "pills", then why are you seeing a pain management MD? Just stop taking the pills.


Since you don't want to take the recommended and appropriate meds, and you don't want the proper treatments, and you have not once mention pain, it sounds as if your best plan is to lose weight.

It is clear that you want oxycodone, and pain management is not a primary consideration.

You are a software engineer; MDs work with female MDs in all areas of practice.

Sorry, many women are professionals and MDs in 2013 are quite accustomed.

Are you suggesting that the MDs are intimidated by your being a software engineer? This is highly unlikely.

These MDs wives are probably also MDs. It seems to work that way.


Yes, you really should get a new MD.

If you really have back pain and you have a phobia of needles, perhaps a psychiatrist is appropriate for your care.

Since you refuse non-drug therapy and you don't want to take drugs, what is it that you want from a pain management MD?


I agree with you that you should, indeed, move on.
 
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77grace replied to MKKBMOM's response:
Hi MKKBMOM,
I know how frustrating that is ,Been there done that!!
But ,like they say "It's the early bird that get's the worm""
Keep calling,unfortunatly alot of Dr.s are very busy and not the best at calling back,thank God this time I have a good one !!!But sometimes it takes 2 or 3 days because he is very busy !
Beth's explanation of that procedure is really good,Maybe it would be woth a lok at ??
Blessingsa,77grace
 
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blessedladyptl replied to MKKBMOM's response:
MKKBMOM,

I believe I know what you're referring to when you say ". I am convinced that he is culturally prejudiced against women to the point of misogyny." It is Not Racism. It is a matter of the dr being from another country where the customs and language vary greatly from ours.
I would change drs and try and find one that is from the U.S. because if you don't you may run into the same problem again.


BlessedLady
 
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ctbeth replied to blessedladyptl's response:
Web MD removed her racist post.

You can read my response to what she wrote, but cannot read what she posted that was racist and horrible.

Obviously, the Web MD management removed the post straight away.

Among other things, this:

" Even my black American friends don't like Africans because of the way they act......"


How do Africans act?

Exchange the word "Africans" to Jews, Catholics, whatever you are, and see how it sounds and feels.

This woman has not mentioned a word about pain.

Something is rotten in Denmark.
 
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annette030 replied to ctbeth's response:
The whole discogram thing is dependent on the surgeon. I have had a cervical disc removed and a second herniated one treated medically and I have never had a discogram. I have heard that they are incredibly painful but give a doctor little real information.

Take care, Annette

PS - Well said, Beth.


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