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Chronic pain patient - with perplexing issue
An_223014 posted:
A few weeks ago I saw a pain specialist who specializes in Spinal problems. I have several bulging discs in my Throasic (mid-spine) along with stenosis. Anyway, he prescribed 5mg of Oxycodone to be taken every 6 hours. I have a follow-up after a month. My concern is I saw a message on his wall that his clinic drug tests. He did not give me one at my first visit but he might my second visit. Now I have nothing to hide because I do not take street drugs or drugs other than what I am prescribed. Here is MY CONCERN. In the past I have bought the 12-panel home tests and everytime I test negative for oxycodone after 12 hours of taking it. Once I went to the ER last year and tested negative for opiates after taking 4 7.5/325 percocets the day before. From what I have read on the internet, if you test negative for the prescribed drug, they will kick you out because they assume you are selling your prescription. HOW CAN THEY MAKE THAT ASSUMPTION??? I do not sell drugs but I always test negative when I take oxycodone. What do I tell the Dr. if he drug tests me at my next appointment? I actually didn't even sign a contract with him but like I said I have heard you are suppossed to test positive for the drugs they prescribe. Does the fact the everything else will be clean at least count for something? I would think their main concern would involve patients taking illegal drugs or drugs not prescribed to them. I will run out the say before my appointment so what do I say if it is negative? Will he take my word for it if I tell him I am taking my medication? Need some advice.......
cweinbl responded:
Doctors know the start, peak and end plasma times for all drugs. They take that into consideration with testing. If you have done nothing wrong, you have nothing to fear.
ebrunson6 replied to cweinbl's response:
cweinble, would like to ask a question. You seem to have been thru a lot, and wise in re: to pain meds. I will see my Dr. in 2 days. I would like to ask him to reduce the amount of opiates in my system. I am presently taking 25mcgs fentanyl and 2 tabs of hydrocodone if needed a day. I have MS and neurotin, tegretol, lyrica have never worked by themselves, but I thought in conjuction with a lower dose of long acting opiate might do the trick. I know your not a doctor, but what do you think?
cweinbl replied to ebrunson6's response:

You're right. I'm not a physician. So, take this with a grain of salt.

Based upon my 40-year experience with chronic pain, and based upon the research I've seen, a combination of long and short-acting narcotics, plus select off-label drugs (anti-convulsant, anti-depressant), plus an anti-inflammatory (ex. Celebrex), all used together - will outperform any of them used individually. That is exactly what you are doing.

You are using the second lowest dosage Fentanyl option. Hydrocodone is a mild narcotic. So, neither of those options should knock you out. You did not provide dosages of the other drugs (I am assuming that you are not using Neurontin and Lyrica simultaneously). So, although you are using many medications, it appears that they are low dose and, except for Fentanyl, fairly mild.

Why you want to reduce the Fentanyl? Are you having unpleasant side effects? If so, they typically dissipate within several weeks. Honestly, Fentanyl should be that last one to reduce. How long have you been using it? Chronic pain patients respond best to a long-acting narcotic, which in your case is Fentanyl Transdermal. If you are having side effects, you can drop to the 12.5 mcg patch. But your pain level is likely to rise correspondingly. Of course, there is no harm in trying this. The worst that can happen is your pain will become unbearable and you will go back up to the 25 mcg patch. Before we go any farther, I'd like to know why you want to drop the dosage. Is your pain level lower? Keep in mind that you will experience tolerance over time.
ebrunson6 replied to cweinbl's response:
Thanks for your reply. Sometimes my mind is a bad place to be. On low "pain days" I start thinking I can simply walk away from all this. Acceptance, is my delima. I sometimes get preaccupied on being the way I was only 2 yrs. ago. Your are a wise man. You wrote this the same day I had a check up with PCP.
He petty much said the same thing. Thanks again for the input.
sweetpea3c replied to ebrunson6's response:
It has been about 6yrs. for me, and I still sometimes try to convince myself on a good day (not too many of those anymore) that I can "walk away from all of this". Accepting the limitations this pain has caused in so many aspects of my life is still the most difficult part of having CP. for me. Usually, an hour or two of intractable pain serves as a reality check. I understand your frustration.

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