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Posted 4/18/2008 3:50 AM (GMT 0)

I am currently going to a Pain Management Doctor for a herniated disc.  We have tried everything from traction to deep tissue massages, from Electro Muscle stimulation to handful of muscle relaxants.  In the end, I was put on Oxycodone 5mg tablets, which didn't even take the edge off of my pain.  He moved me up to Perc 7.5s, but that didn't work out either.  I am currently taking one roxicodone 15 mg tablet, three times daily as needed.  I was thrilled with the change and even more happy that my pain seemed to recede to a manageable level.  The medicine worked for a while, then stopped working, except to allow me a reprieve from crying at work due to the horrendous pain.  I asked my doctor if he would adjust the medication accordingly, but he said "I don't want you to become dependent on the medication, so no."  I appreciate his concern for my future well being but this pain has again become intolerable.  What are my options?  Can I request medical records and a different doctor without upsetting my original physician and getting something horrible written in my files?  What are my rights in terms of pain control, anyways?  It seems to me that if I am brought to tears daily because of the pain, I should be able to get some relief somehow.  mad

Posted 4/18/2008 12:08 PM (GMT 0)
Hey, I am going through a simular situation. My PC Dr. is also my PM Dr. I am on Fentanyl 75mcg pain patches and Oxycodone 5mg every 12hrs for breakthrough pain. I'm sure if I didn't have at least this I would be in even more pain but this dosage just isn't relieving the pain right now. I have been on the same meds for months now and my body has gotten used to the meds and I desperately need an increase. My Dr thinks I am on too much pain meds as it is and says he won't even consider an increase. As I've said before, I don't think he has ever even had as much as a toothache. I wish pain had a color so the Drs could see where and how much we hurt.

We have a new Dr in town that everone seems to really like but I don't know how he is with needed pain meds. I am seriously thinking about trying him. I have gone to the point of asking for my medical records which they "misplaced" the copies before I got them. I am going to have a Spinal Cord Stimulator implant in my back next week. If I don't get relief from this I am definently changing Drs. I don't think my pain is being validated where I'm at now.

The sign says "we have right to be pain free". You also have a right to get your medical records and see another Dr. I'm not going to worry what my current Dr writes in my chart; he's not doing much for me now anyway. I will just have to explain the situation to the new Dr. and go from there. But I wonder too - what if he doesn't deal with pain issues either. Guess it's just a chance we take.

I know I haven't been of much help but I truly empathize with you and wish you luck. And I hope you have at least a tolerable day.
Posted 4/18/2008 12:45 PM (GMT 0)
You can always find another pain doc and then have them request your records to make sure that nothing bad was written in them. They wouldn't have the time. I can't understand why they wouldn't help you with the pain.

When you have chronic pain, I can't understand why they worry about the length of time that you are on a certain narcotic. You will have the pain for the rest of your life most likely. I do know that you can build a tolerance quickly to a lot of the meds, but what can you do? The pain is still there. Maybe he could put you on an extended release form of the roxycodone. Which would be oxycontin. I think. That would probably be better for you and he could give you something for break through.

I wish you luck with this,
hugs, Karen
Posted 4/19/2008 9:39 AM (GMT 0)
Maybe instead of saying "we have a right to be pain free," they should post warning signs like "If you have CP, we're going to tell you to suck it up and live with untreated pain" or "If we can't help you quickly, we will probably stop trying and tell you it's all in your head." That seems to be the message many of us get, anyways.
Posted 4/19/2008 11:13 AM (GMT 0)

redface  This is my first year  in this kind of excruiating pain,..

so Im "singing LOUDLY"

daily....Im wondering as you just stated if they truly : expect  folks to suck it up...

verbally they have validated my pain, then tried some pain meds, which knock me for a loop, so then its nothing,  try tylenol.. its like.......   traditional medecine doesnt HOLD the Keys or answers...

SEVERE PAIN   = the pain makes me scream,  cry , sob, shake    ie) while walking in the mall pubilcally embaressing my kids,... I yelp  loudly when it hits sudden siatic    lighting bolts..

While walking the llas of the nursing home were I work,   I ahve to stop grad the rails... and breathe.... jsut to keep walking..  I am barely functioning..

if Its an aching  back apin.. there is  tolerable.. can deal with it pain &...or i am going to loose it  P A I N .  I know that I know  taht you know what I mean,,,,

and I know  what you mean... totally..

I am seeing a PM  for the first time in the last 2 months, he just did a nerve block..we shall see what happens in coming weeks...I honestly feel there are not enough doctors,

too few   who really UNDERSTAND , and have compassion. to motivate them to help people in Pain

  • In the last few days I was thining I should have gone into medicine...

lol

I have seen a Reflexologyst/ Homopathic Nutricianist,  who also understand   whats needed at the cellular level,.. for the body to heal..   structurally,  metabolically,.. even am receiving help with diet... 

ps:     yeah "The knee bone is connected to the leg bone"...   rememeber that song in coming days //  we are a WHOLE PERSON.... mind body soul //  Im learning to think the BIG picture and right to the tiniest molecule...

we are truly & amazingly & wonderfully made...

Posted 4/20/2008 3:12 AM (GMT 0)
Unfortunately, I have to agree with ryand's post. Our present medical, political, and law enforcement system pretty much dictate that the vast majority of chronic pain sufferers will be under-medicated (or un-medicated) for their pain, and then treated like a drug addict for having the audacity to think they might have the right to a few minutes of bearable pain daily. I've often wished I had some type of disease that was more "visible", so I'd at least be treated like someone who has a disease, not an addiction. I've worked my way off almost all my narcotic pain meds because of the reluctance of doctors to prescribe them, and the treatment I get when refills are due. Funny, my surgeon had no problem doling out all kinds of pain killers when he was still cutting on me, but once he had taken as much insurance money as he could get, I was treated like a criminal. I'm on a whopping 60mg of Oxycontin daily now, and my pain management doc gave me a surprise drug screen test this week, then grilled me over a small amount of Lortab that showed up. The Lortab was administered by a hospital after a provocative discography this week, that I had already told them about. Sorry if I seem bitter, but yes, I am EXTREMELY BITTER!!!

Back to the original subject, I wish I had some advice, but I don't. You may be darned if you do and darned if you don't. I wish you the best of luck.

Anon
Posted 4/21/2008 8:46 PM (GMT 0)
WELL said Gramps..........

NO one needs to cut back nor suffer when they are in pain...........

I am lucky to have a doc ( family doc ) that will not let me be in pain..
I live in Ontario Canada and we have really tough narcotic regulations
I have never been brought to task about the 15 mgs of Valium I take daily along with all the pain meds I take ........My doctor was the one who increased the meds all of them ........

WE have to fight the fight never give in...........I wont
I wish you all the best
LYN
Posted 4/23/2008 12:58 AM (GMT 0)

I absolutely agree, theoretically.  It took me 2 years of pain before I took any narcotic meds, and, frankly, they were a godsend.  Once I got past the the stigma, I found I got decent relief from pain, had few side effects, and functioned MUCH better on narcotics than I did in horrible pain. 

However, I'm still employed full-time (for now), and I have an executive job where I'm in the public eye somewhat.  Because of the stigma imposed by the public, I simply cannot afford to take the stand that I would like to on this issue, which is a sad state of affairs.  It's amazing to me that the medical community is so ignorant of the proper use of narcotic pain medication.  I personally feel it borders on malpractice, particularly for doctors who practice some type of pain-management related medicine, to not prescribe narcotic pain medicine when warranted.  A cardiac doctor would certainly be sued for refusing to medicate someone who had dangerously elevated blood pressure.  Why should excruciating pain be treated differently than any other medical condition? 

Still, I'm preaching to the choir here.  I fear that while politics continues to interfere with appropriate health care, and the media and law enforcement continues to vilify pain killers (particularly OxyContin), things will only continue to get worse for those of us that suffer daily. 

Anon

Posted 4/23/2008 1:31 AM (GMT 0)
I agree, Anon. It is a difficult line to walk - being an advocate for responsible and appropriate treatment of your pain vs. the fear of irritating the doctors who hold the precious keys to our very ability to live our life with some degree of dignity! Your blood pressure example hit home with me in particular since my blood pressure has begun to sky-rocket with my pain. My very own doctors have told me they are convinced this is simply a side effect of my body's effort to cope with severe pain. So.... what did they do about it? That's right - they prescribed a beta-blocker!!! Seriously! I just don't get it.
Posted 4/27/2008 4:26 AM (GMT 0)

Ha ha!  Yeah, I'm on a beta-blocker as well.  The last time they took my BP at the pain doc's office, it was 168/114.  I was in a lot of pain that day.  On another more recent doc visit (when I wasn't quite so distressed with pain), it was 114/72.  This alone should really show doctors what constant pain can do to your body.  I'm a very healthy individual when I'm not in horrible pain, which is pretty rarely these days.  I honestly think most of the narcotics are way safer than over-the-counter NSAIDS.  Oxycodone on it's own doesn't cause stomach-lining deterioration and liver damage!  I have a liver enzyme test run every 6 months because of my tylenol usage.  It's a crazy world we live in.  Take care.

Anon

Posted 4/27/2008 7:35 AM (GMT 0)
What needs to change is how doctors are trained in medical school. Yes, a well-trained pain managment physician understands concepts like pseudo-addiction and physical dependance vs. addiction, but the vast majority of primary care doctors do not. The problem is that for so long, medical schools have taken a very taboo-like approach to prescribing narcotics for pain. All that new doctors in training hear from their instructors are the dangers of opiates, and not the benefits of a society free of pain. Gramps, you're absolutely right, and change is needed at the legislative level. That being said, there are other problems that provide barriers to pain relief. In our country, for some reason, the D.E.A. is largely given the power to determine what is and what is not acceptable for doctor's to prescribe to their patients. Anyone can see the problem with this; The D.E.A. has no charter to operate within the guidelines of acceptable medical practice. Their heavy handed and often gestapo like tactics have created massive fear within the medical community about opiate prescribing limitations. These people have no medical training, but oddly enough are being allowed by our legislative bodies to dictate to our physicians what is and what is not acceptable. The other issue is public perception. American society has largely been given the idea that opiate medications belong grouped with illegal street drugs, and that people that appear to abuse prescribed medications belong grouped with people that abuse illegal street narcotics. How much does our economy lose every year in lost work time because, as Gramps put it, 50-75 million Americans have chronic pain? Those lost work days add up to lost economic productivity for our country. So, we all see, that this problem is so massive that it is going to take an equally massive effort by all of us to change the system. I cannot urge you enough to contact your state and federal legislators and tell them what you think. Many of you that are on this website can go, right now, and click open another window, google your representatives' personal web pages, and email a personal message to them. You might just find, that like I did, that yelling at your politicians really is therapeutic!
Posted 4/27/2008 5:25 PM (GMT 0)
Amen, painKiller. My PCP actually told me that at a recent conference, they were actually told that the DEA is "refocusing" on investigating doctors/clinics that prescribe narcotics. And, since this conversation with him, I have noticed a significant difference in how my surgeon and pain management doc control my medications, which led to me reducing them even further due to my fear of being cut off at some point. My PCP won't prescribe anything stronger than Lortab, and only in 2 week supplies. He said supposedly the DEA looks for prescriptions of large quantities, so he always keeps the scripts at 90 tablets or less. It is truly a sad state of affairs. Medication is available to make our lives better, but fear of a DEA investigation keeps many docs from prescribing it. Even though most docs know they can clearly show a chronic or acute pain condition that justifies use of narcotics, the investigation itself will do enough damage to their lives and businesses that it won't matter if they're cleared of any wrongdoing.
Posted 4/27/2008 5:30 PM (GMT 0)

Hey, back to the original post!  SangreAzul, if you have a herniated disc, why the heck hasn't your PM doc referred you to a spine specialist, preferably a neurosurgeon??  Electrical stimulation of muscle tissue, muscle relaxers and pain killers aren't going to fix that problem.  You obviously have the right to some pain management while you work on dealing with the source of your pain.  Get to the best spine doc you can find ASAP.  Good luck!!

Anon

Posted 4/27/2008 6:18 PM (GMT 0)
hey there,

this thread said it all!  it is a sin that those who are legitimate sufferes are made to suffer further due to the problems w/ narcotics regulations.

i've been under the care of a PM physician who's also an anestheliogist.

it's a clinic inside of the hospital.  now, what i never knew is this: PCP & family practice doc's have the most problems w/ RX narcotics because there is no way to properly regulate the prescriptions.

 

i don't really understand this, but the pain doc i see explained that "patients have an easier time going to a PM Clinic than having their primary care doctors write the scripts." at a PM clinic you sign an OK for random drug testing...something that doesn't happen too often at a PCP office.

nevertheless, peronally it has been better since i've switched to a proper PM doc.

take care 

Posted 5/6/2008 3:12 PM (GMT 0)
Anon,

     I've been to an orthopedic doctor, and a chiropracter.  Both of these doctors informed me that my condiction was enough to "cause severe pain" but not enough to do anything surgical.  That is why we have been trying to other methods of treatment: the spinal decompression, the epideral injections, everything you can think of.  My ultimate goal is to eradicate the pain, not be on pain killers, but in the meantime, narcotic level pain killers is the only thing that has worked so far.

Posted 5/6/2008 3:35 PM (GMT 0)
SangreAzul,

Try a neurosurgeon. I have a herniated disc too & after seeing neurogeon was put in the queue for surgery (after trying everyting else). I must be one of the really lucky ones because my PMC is still prescribing 120 oxocodone/month, I'm allowed 4/day. I've not run into the 90 pill max yet. I'm now being treated at a spine specialist center - referred by neurosurgeon. Don't give up.

Good luck & take care.
Posted 5/13/2008 10:32 PM (GMT 0)
Painkillers will not eradicate your pain, that's sure. Now, unless a definitive solution to your problem is forthcoming, I think you should accept the fact that the pain is there and that it is not going to go away, at least not in the foreseeable future. Painkillers are a "killer" in the long-term (the length depending of course on the type and amount of pain medication you're on). As long as a reasonably low dose of painkillers can prevent you from having serious physical limitations like temporal paralysis, you should stick to that low dose and not seek a higher one. The higher one will almost certain lead you to more pain and problems than you currently have. And believe it or not, people get used to pain. even to the worst pains possible. But as your doctors don't consider the situation bad enough for surgery, I suggest you bite the bullet and learn to life with it. I know this is not what you wanted to hear but you should believe me when I tell you that high doses of painkillers mess up your life way worse than your back could ever do. There is no point in taking out the pain for the next 10 years while the painkillers are taking out your kidneys and liver now is there? Then, in 10 years from now, you'll have to detox, you'll have (for example) screwed up kidneys and a dying liver and the pain in your back will be ... indeed: back.
Posted 5/14/2008 12:39 AM (GMT 0)

Morgoth, I couldn't disagree with you more.  First off, yes some people get used to living with pain but as for someone who has been in pain for over 20 years, I can attest to the fact that some to not get used to living in pain.  I guess you can exist with pain, but when I am in unmanagable pain, I cannot "experience" anything but the pain.  It always amazes me as my pain gets under contol, that my world opens up to me.  I start seeing and paying attention to all the things around me.  Second, I have had less side effects to the pain meds than all the other meds they gave me before the pain meds.  I ended up in the hospital with a stomach bleed from all the anti-inflammatories. It astonishes me that the doctors would rather give me meds that wipe out my immune system, that give me anxiety attacks, that give me a stomach bleed, that hurt my liver than something that when taken as directed is a safe drug with little side effects.  I have been on PK's for over 7 years, I've had some increases, but finally found a dose that manages my pain and have stayed stable for years except for when I am hospitalized and put on a PCA.  This allows me to live my life to the best of my ability with my disease.  I am forever grateful for all the good doctors that fight for us pain patients and sometimes to their detrement. Someday I hope to join them in their fight.

Melissa

Posted 5/14/2008 2:52 AM (GMT 0)
I also disagree with the statement that narcotic painkillers destroy a persons liver and kidneys. That is not true. Literature has proven that narcotics are one of the safest types of medicines for the GI tract, liver, kidney etc. Narcotics are MUCH less toxic to the body than aspirin, tylenol, ibuprofen, etc. Narcotics taken without those adjuncts, and taken as prescribed, do not cause any organ damage in the way implied in the previous post. Theoretically there is no "toxic" level with these drugs if titrated slowly enough to allow a person to develop tolerance (and no co-morbidity exists). In the real world though, most likely respiratory arrest will occur with high enough doses - however to a opioid tolerant person, the levels needed can be quite high - higher than was expected before recent research revealed the effects of tolerance.

There is some emerging research that suggests a person can develop "hyperalgesia" with long term opioid use - that is, that the narcotics can actually cause a person to feel more pain, not less - but that is a situation that is not well described and when / if it occurs, seems to be extremely variable between people - certainly not inevitable to anyone who takes narcotics of any amount for any length of time; Rather it is like any other medication: some people will respond as expected; others will not or even respond in the opposite way than expected (paradoxical reaction).

So when considering the risk / benefit of long term narcotic pain medication for chronic pain you need to balance the real risk to quality AND quantity of life (yes, research has shown that untreated chronic pain can shorten life spans because of organ damage that ensues) with the risks of taking medicine to treat the pain (narcotic and non-narcotic). Taking narcotics in and of themselves - and without ASA, APAP, etc added, does not cause further organ disease down the road, at least from what we know now.

Edited to add the following information from "the American Journal of Physical Medicine and Rehabilitation": Issues in Opioid Management - Donna Bloodworth, MD; 2005.

"Unlike other classes of medications, the potential for major organ toxicity is low with chronic opioid use. New literature reports hypogonadal effects
with chronic opioid use,(73–79) and animal data suggest dysregulatory immune effects,(80 – 83) although the latter have not been demonstrated in humans. As mentioned, mild to moderate gastrointestinal and cognitive adverse effects are common."

Post Edited (Disce Pati) : 5/13/2008 9:40:25 PM (GMT-6)

Posted 5/14/2008 4:01 AM (GMT 0)
Thanks again, Disce, for yet another informative post. I always appreciate the time and thought you take to provide such accurate details.

PaLady

Post Edited (PAlady) : 5/13/2008 10:05:10 PM (GMT-6)

Posted 5/14/2008 8:40 AM (GMT 0)
Morgoth-

With all do respect for your opinion, painkillers are not the "killers"
Pain is a killer, extream chronic pain besides causing brain damage, in many cases has lead to suicide or attempts at suicide just to end the pain.

I'm gathering by your opinions that you have never experienced the levels of chronic pain most of us here have, in that way it is extreamly hard to understand why someone can not just learn to live with it.
Many here have been suffering for decades and if it was posible to just live with it, they would be.
No one would end up losing there life to suicide from pain if that was the case.

You'll notice that there are many mentions on this forum of non-narcotic medications and alternative procedures such as accupuncture, we are all aware that narcotic medications will not erraticate all of the pain. Yet we do still need them to control some of it so that we can live as fufuilling a life as possible, which is what they exist to do.

Higher doses of pain medications are not shown to mess up a life, they help make it possible to live one.
Would you tell someone with MS, terminal cancer or any other painful terminal illness to bite the bullet and just deal with the pain because they will get used to it?
Research shows that non-malignant chronic pain is just as devestating and painful as pain caused by malignancies.
If you wouldnt tell someone thats suffering from maliganant pain to just bite the bullet and live with it, please remember that out pain is proven to be just as debelitating and devestating.

I mean no dis-respect to you only to point out that many of us are here for support because we have not found that we are able to tolerate our debilitating pain without the use of chemical help. There is no shame or weakness in that.
Please be respectful of what other people are feeling and how there pain is effecting them.

I may be on and off pain pills for the rest of my life with Interstitial Cystitis and endometriosis, and in that case will defenitly have to increase my dose at some point in my life. I accept that and feel validated that my pain is worthy of opioid attention. all of us here know of the downsides and the possible risks of the future. But we are chosing to live now in the present and leave the future to the future. All that matters is that right now is that we get back to spending time with the ones we love and experience doing some of the things we love doing. Thats what life is about and we should be able to live it just as anyone else without chronic pain. It is our right as human beings.
No one should ever accept a lesser quality of life if medicines to improve it are available.
We are all very strong people here who have or are in the process of adjusting to what most cannot imagine. None of us are any less strong or capable for depending on narcotic pain medications. Infact I firmly believe that biting the bullet and living without the help is detramental to the life of a chronic pain patient.
Taking the chance of not being able to live with the pain is too dangerous a game for most of us.

Freya
Posted 5/14/2008 4:13 PM (GMT 0)
I'm with you guys...I can not explain it better than Pati & Freya (you wrote that beautifully & hit the nail on the head)...
However, I kinda' understand how a person can have a view like Margoth's...perhaps it's a deeper issue? Which is perhaps just as important. Especially when one witnesses someone suffer an addiction or withdrawel problem or goes through one his/herself?


For example last nite I watched one of those "True Life" things on mtv...and 4 of the people said, "I wish I was never prescribed oxycontin in the first place." Of course they were the ones who abused the drug & used it recreationally. Most of the people in this program did have a pain problem (accident, injury, etc...) but they developed addiction problems.

One thing I don't understand though & maybe you guys have the answer to my question: "How can a physician get penalized for writing pain meds?" This Dr. they showed had written over 1500 scripts for pain meds in one year...how can he get in ttrouble for that? Is it a matter of "over-prescribing"? I don't get it...My doc writes new original RX's for me every month, 2 pain meds...1 month's dose; so that would be 24 precriptions each year. If he has 100 patients with the same RX's he can hit 1500 scripts easy!

Why do docs get in trouble?

Thanks...and take care.
This is a very good thread...and the conversation is a mature one that's being handled with respect.
Cheers,
erin

Posted 5/14/2008 4:45 PM (GMT 0)
Hi Erin!

I really wish I would have seen that episode, sound really interesting.


From my knowlege it is American regulations which are too closly watching over the shoulder of our Doctors actions when it comes to prescribing narcotic.
Although there has been tons of research proving otherwise, The government believes that non malignant pain does not call for narcotic pain management and although it is legal to prescribe that medicine for chronic pain sufferes that belief has sent the law on a mission to stop it from happening.

Because they cannot just shut down pain management clinics for prescribing narcotics to us they closely monitor them attempting to dictate just how many scripts they write and how much narcotic they prescribe.
They believe Doctors to be legal drug dealers and all the patients to be addicts and so feel empowered to take patient care into there own handsm when it comes to prescribing narcotics.

I have heard at any time a Doctor must be prepared to account for why they have written every script and why the amount was nessesary, making all Doctors very nervous that they will be investigated next and the District Attorney will find they are breaking the law and ultimatly snap away there liscense and put them in jail for a minimum of 25 years!
Not to mention the Doctors are the ones liable for there patients actions. A patient abuses the medication, doctors fault. They sell there pills, doctors fault. All because they believe the Doctor should have known better and been able to tell who was scamming them.
Funny, because it seems the law is the one that seems to miss the scammers and instead persecutes the innocent actually trying to help.

A doctor in my town is being investigated right now, for "prescribing too much medication
Its all very unfair and sad for everyone suffering.

I hope that answeres your question, maybe gramps will come by and add to that. He sems to know alot about the subject and Advocates for the needs of Chronic Pain sufferes.

Freya
Posted 5/14/2008 4:46 PM (GMT 0)
Awsome Gramps!! i must have been typing the same time as you!
Posted 5/14/2008 5:35 PM (GMT 0)
Gramps

I have never heard that the DEA is telling Doctors WE are the ones who need it
I'm confused by this. Does it just depend on the DEA and Doctor?
I do know someone(through some past friends) who is on the side of the Law and believes our pain does not warrent narcotics.
is it just that tangled of a situation as to both sides being to blame at times?
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