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Not sure what to do about this situation with my PM doc. Please help! :D
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An_255317 posted:
Hi all! [br>[br>Just had some quick questions for what to do in my situation. I have degenerative disc disease & this can cause me a great amount of pain. I am prescribed Norco 10/325 (30/month) to deal with the pain. I also go to a Pain Management doctor who is the one who prescribes me this medication. At each appointment, I go in and follow up with him and he asks me how I'm doing on my regimen. I always make it a point to bring the prescription bottle with me at each appointment to show him how well I am doing on my regimen. (I don't have to do this, I simply do this so that he can see that I am a good patient who responsibly takes the medication.) Generally I bring him back around 15-17 of the original 30 pills. Then he writes me a new prescription. So all in all, I use about 30 pills per month. (~15 of the old ones left & ~15 of the new ones.) This time, the time between this appointment and last is longer by a couple days & and my DDD has been flaring up and giving me a lot more pain than usual. There have been 31 days exactly between my last appointment and the appointment I'm going to on Friday. So I have 15 pills left right now. A couple of things are worrying me about taking anymore even though I am in quite a bit of pain. [br>1) The doctor decided to refer me to the nurse practitioner in his practice. You see her after you have a good regimen going with the doctor and you are doing well on it. The doctor himself writes the prescriptions & only sees the new patients. Therefore, the NP lightens his load. I am worried since this is a new person and I only bring in 13 pills (This is if I take 1 tomorrow and 1 Thursday, as I said I have 15 now), that they will not think this is as good as the doctor thought. [br>2) I had to move my appointment back from Tuesday to this Friday. The original appointment was on Tuesday, but I had a scheduling conflict so I moved my appointment back to Friday. I know sometimes they don't like when you move your appointments around because they are suspicious 24/7 but I have so much going on next week that I really needed to make my appt for this week. [br>[br>Anyone with experience in PM please help! I'm in a lot of pain but don't want to take any more of my medication if this could prompt the DR or NP to stop prescribing me the medication. I would rather suffer for a few days than break the bond of trust between my doctor and I and suffer for much longer. [br>[br>Would it be wise to take any more medication? Should I abstain given my situation? [br>[br>Please help! [br>Angie
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annette030 responded:
Take your meds exactly as they are prescribed. You cannot go wrong that way.

Take care, Annette
 
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77grace responded:
Hi Angie ,
It sounds to me like you are doing well with your meds!Especailly if you don't take them all in one month !Right ??
So take them as prescribed and I think you'll be fine !
Have a great week ,77grace
 
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chronic1008 responded:
AN_255317--I totally understand what you are going through. Unfortunately at every turn us chronic pain sufferers are being judged and always seem to be on the defensive when it comes to our meds. I have been on narcotic pain medicine since Nov 2005 due to a work accident. I've had 8 back surgeries and my meds can fluctuate from month to month. I've learned to tune people out and I know how much pain I'm in and how much I need the medicine. Your Dr prescribes the meds for you to use, not to see how much you can bring back to "prove" you are a good patient. If anything, I would be more skeptical of you bringing any extra meds back to me--I would question how much you really need it then. The pain medicine is there for you to try to live more comfortable. Use it. If Dr prescribes one a day, then take one a day and hopefully that will take the edge off. My family Dr once told me that pain causes higher blood pressure. This means your heart is working harder than it should. If by taking a pill that is prescribed you can relieve some pain it just may make your blood pressure better as well. I never thought of unintended consequences prior to this injury I suffered but there are many things to think about when addressing one health problem. Side note-pain meds cause dry mouth. Use Biotene mouth spray, toothpaste and mouthwash. I got 12 cavities one year due to dry mouth from my narcotic pain meds. Use the medicine, take some pain away. If you're worried that your Dr will not like this then ask why it's prescribed in the first place. One mistake I made early on was to not talk to my Dr open enough. I "thought" my Dr was feeling one way but in reality, after being very open and honest--I found out just how much she was on my side and wanted to do the best for me. I think once we start taking pain meds it's almost inherit in us to start feeling judged by others and even start having to go overboard trying to prove to others our true character. I say to heck with everyone else, until they live one day in my excruciating pain--they have no right and I won't give them the privilege of judging me. Hope you get some relief.
 
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ctbeth responded:
Hi Angie,

If you regularly bring back half of your meds, your MD or NP may assess that you don't need that level of pain management.

I'm stepping out of my comfort zone in saying this, but is think your MD and NP would prefer that you're honest with then regarding your pain and med requirements than trying to earn "brownie points" by showing them that you have pills left each month.

Be honest with your care providers and they should be honest with you.
 
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ctbeth replied to ctbeth's response:
Wait. I use re-read what Angie posted:

What is actually, according to you, going on is that you're getting your refill fifteen days early.

If you take ," fifteen from the old and fifteen from the new", well, that's the same thing as one daily.

How about you ask your MD not to refill until you take the second half of the "old" Rx?

That way, you begin the "new" bottle, take one a day as prescribed, get your Rx filled when it's due, and stop the confusion of old and new, filling an Rx and bringing half back then getting another Rx and explaining this as a long, confusing, somewhat obsessive situation.

This old and new stuff shouldn't matter: you get thirty a month and you take thirty a month. If your MD opts to fill your Rx halfway through the month, finish one bottle before starting the other.

You're taking average one per day. Whether it comes from the old or new bottle is of no consequence.

And stop bringing the bottle of meds to your office appts.

This may be causing the same confusion (that you take less than prescribed)

Stop with the old bottle and new, stop bringing in your bottle to the MD unless asked, and take your meds as ordered.
 
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cweinbl responded:
Frankly, I'm unaware of anyone who wants to give back medication, to prove to the physician, "how well you're doing." If you don't call in early for a refill, the doc assumes you're doing well.


Chronic pain patients are constantly subject to tolerance. Thus, physicians expect you to eventually call in saying that the medication isn't helping as it used to. This is normal over a long period of time. The doc with bump up the dosage over time until you are maximum safe levels. Or, the doc will prescribe a more powerful medication (Norco is a mild opioid).


Why punish yourself when you obviously need more medication? Do you think that a doctor or NP will be impressed with your will power? They exist to manage your pain. You should take your medications exactly as directed. If you consistently need more and run out too soon, then most likely you require a higher dosage or a more powerful medication.


The bottom line is this. You should never feel that you must live with additional pain because of some imagined bond of trust. You should tell the doctor or NP exactly how well your pain is being managed. No one will think less of you if you need more or a different medication. If you stop giving your medication back, the doc/NP will assume that you're using it as directed and you'll have a few left over, just in case you hit a bad spell and need them. Right?
cweinbl
csw2@bex.net
 
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An_255317 replied to cweinbl's response:
Hey guys! Thanks a million for all of your help! I really appreciate it! I'm new to pain management (I've only been going for about 3 months) so I don't really know what to do sometimes. That's why I don't want to make any mistakes with my doctor since I feel like as a chronic pain patient, we are always under suspicion especially when we are on opioid therapy. My opioids help me a lot especially when nothing else works well when my pain is terrible at night (not every night but some) and I'm glad that in the general consensus of you guys, I shouldn't have to worry about "hoarding" the medication just to look good to my doc. Also, the meds say "Take 1/day everyday as needed for pain" on the directions on the bottle in case y'all were wondering. The main reason I worried about this is since whenever I come back to my doc he always says "Good job". He is worried about me having "a pain problem & a pill problem" as he says he worries about this with all of his new patients. And he also said, since I'm young, (22 years) he doesn't want opioids to "destroy my life with addiction" or whatever. I understand what he is trying to say, of course no one wants addiction, but I surely don't want pain either!!!!!! Both are terrible!!!! That is the main reason I started bringing the medication is to demonstrate to him that I am not a patient he needs to worry about and that I use my opioids responsibly.

Thanks again for your input guys, as always, I appreciate the input & I hope that you're having a pain free week! <3, Angie


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