1st PM Appointment (questions and need advice!)

Hello everyone! I will be going to to my 1st PM appointment next week and have some questions, as well as need some advice. Quick background, emergency eye trauma surgery 10 years ago from a small, thrown shard of wood that completely penetrated the left eye. I have since had tons of surgeries (corneal transplant, artificial lens, cataract removal, eye muscle surgery, eyelid lift, and more). I have always had pain, but ever since my last (failed surgery) last August, my eye gets extremely irritated every morning, as well as throughout the day as I stare at a computer screen all day. At times, my eye is literally so bloodshot that it looks bloody. Sometimes I am left so irritated and uncomfortable that I have to leave work. I have tried several treatments to relieve the pain, but the only thing that has seemed to work has been 15-20mg of Oxycodone. I saw my eye doctor (whom performed the trauma and corneal transplant surgeries) and stressed the pain I endure daily and asked if he could prescribe me something. Long story short, he would not prescribe me any narcotics as he said "he does not have a license to prescribe them", in addition, he said that "I am far too young to get sucked up in that crap since they are very addicting". He advised me to see my family doctor in which I did today. Immediately, my family doctor (whom is the one who has prescribed me over 200 Percocet total for other injuries) said this would be a chronic pain case and wrote me a script for (60) Percocet 5/325 (to get me to the apt) and a referral for a PMS.

Can anyone tell me what to expect at my first appointment. More so, I do not want to say anything that will hurt me at the appointment and what I might receive. Can someone please advise me of my best approach to this to get the medication I truly need? I sometimes can get through the day fine with no need of any kind of medication. With that being said, it is rare so I probably shouldn't even mention that - right? Also, I have heard they normally try to start you on crap (tylenol 3's, etc.) in which I already know from prior attempts do not reduce my pain. Knowing that 15-20mg of Oxycodone has been proven to reduce my pain to about a 2-3, is there a good chance that he will start me off on that? My thoughts are: I am not looking for anything intense or crazy, and also am not needing a huge monthly supply. Just simply 15-20mg of Oxycodone that I can take probably once a day, maybe every other day or whenever I truly am uncomfortable. Also, I plan on going to my appointment in the morning prior to taking any eye drop medication so he can see how horrible and painful my eye looks. Any help or insight anybody can offer would be so greatly appreciated. I just don't know how to approach this. Thank you!

Hey Pirate,

All PM doctors are different.  But the best approach for anyone going to a PM appointment is honesty.  Simply let them know the pain you are in.... how it's affecting your quality of life.... etc.  Let them know what has worked for you and what doesn't seem to work for you.  It's not my experience that a PM will necessarily start you on Tylenol #3....

Everything that you wrote is exactly what I would say.... minus the 15-20mg of oxycodone.  Are you saying that amount because of the amount of Percocet you are using? 

I would go in there w/ an open mind and see what the PM says.  Advocate for yourself by letting them know the pain you are in.... but be open to their course of treatment.  And, yes, I would go minus the eye drops so they can see the true condition of your eye.

Good luck on your appointment. 

--Tina

 

Hi and welcome to the CP forum.The only thing I would add here is make a list of all medications you have tried and say which ones worked or did not work in keeping the pain down and give this list directly to the dr and say this is a list of medications that I have taken. Have him review it in front of you.

As Tina said not all PM drs are alike and who knows he may give you something for pain. If you are out of meds I sure would let him know this. Every time I have changed PM drs I was given a script on the first appt. He is not going to know unless you tell him. Be sure to stress that you are on a computer at work and how it irritates your eyes. Hopefully, he can also give you some drops that will help with this. Just keep it realistic and honest and you should be fine. You gave us a good scoop on what things are like for you every day and I would tell him the same.

Good luck and keep us posted....Susie

Wow pirate. That's quite the story. I'm so sorry to hear the trouble you are having. I have not gotten to the point of a PM doctor, so I can't add anything there. I can relate to feeling like what I can do is limited to how my neck feels on any given day. My physical med doctor just put me on Tramadol a couple weeks ago for my neck and in the 4 or 5 times I've taken it, it does almost nothing for me. I can appreciate what snowbunny is saying about being careful so they don't think you're an addict just looking for pills, but at the same time I would just be up front with them about what you have been through and what you have tried. I would get what I could of your records, but if you can't get them all at least get them enough so they can see you aren't just looking for pills with no reason.

Good luck and please let us know how the appointment goes. Take care.

Thank you to all who have responded. Your advice and tips were absolutely appreciated and really helped me arrive prepared for my first PM appointment. With that being said, it went great! I filled out about 15 pages of paperwork and was asked to provide a urine analysis. After that, I had a full consult with the doctor (whom was awesome and extremely caring) in which we discussed everything you could imagine. He has decided to start me off on 10mg OxyContin sustained release 2x a day w/ Oxycodone HCL 5mg as needed for breakthrough pain. He said I will probably need to have the OC upped but would like to start me at 10mg. I look forward to seeing him again in a month! My only concern is, I told him I need to take 15-20mg of IR Oxycodone for relief for my eye pain. Would taking two of the 10mg OC ER be the same makeup as one 20mg OC ER? I would much rather take both before work and be provided with the proper relief to get me through my workday - cause 10mg is just not going to cut it. I guess that's why he said we can up the dosage at the next appointment. He also said if it is truly not working to give him a call and they will get me in earlier than my next visit to make changes. Also, since I am new to sustained release, does it release 10mg over twelve hours evenly, or does it release 10mg EVERY hour throughout the period? Thank you all, and thanks again for all the help!

Glad to hear things went well. We always like it when people come back with updates..

Because the Dr. prescribed the Oxycontin as one 10mg every 12 hours (twice a day) you need to contact him and ask BEFORE you change your dosage on your own by taking two of them. In pain management with narcotics, we can never change our dosages ourselves.

Oxycontin or any 12 hour medication works by releasing the first half of the medication, (in your case it's a total of 10mg), so that is 5mg by the 45 minute mark. And then it slowly goes from there until hour 6 and then the rest, the other 5mg is released.

This is what I have read on rxlist and other websites about this medication as I used to be on it for years.

And not that you would, but this type of medication can NOT be cut or crushed as it could cause an overdose of the medication in your system all at once.

Most all new appts. with Drs. will be where they start slow on medication and tirate up as needed. How many of the 5mg Oxycodones are you allowed in a 24 hour period?

If he decides to let you take the two 10mg Oxycontins in the morning...just know that you may go into withdrawals after 12 hours and be kind of miserable overnight.

Now, the other thing is that many Drs. will move a patient to taking it 3 times a day (every 8 hours) even though it's off label to do so....but some people don't get a full 12 hours of relief.

All that being said...you may just have to bite the bullet here and start off slow and have him move you up after a month. As mentioned...whatever you do, do not change the prescription on your own as if you did and didn't tell him, and then you show up next month and they do a urine test....at the time of the test it may show the wrong levels of the medication in your system and this could cause a lot of trouble for you...it's just not worth it.

This Dr. sounds really good if he is open to Oxycontin and has already said you will probably go up in dosage so I wouldn't want you to ruin a new relationship with your PM.

And with chronic pain management....it's about adding all sorts of modalities and not relying soley on an opiate to help your pain.

There is exercise, yoga/stretching, aqua therapy, injections, physical therapy, massage, acupuncture, ice, heat, TENS unit, counseling, a muscle relaxer if needed, a nerve pain medication as needed, a sleep med if needed, an antidepressant as needed, eating healthy, not smoking, maintaining a good weight, etc.

To name a few:)

Anyway...I'm glad to hear your update...keep us posted.

Thanks for the replies everyone. Great points, in only one visit I feel like the doc and myself have began to develop the start of a good relationship. What is interesting is that my referring doctor (PCP) is actually his neighbor. Did not know that! Anyway, I definitely would not want to ruin the start of a good relationship. I will take everything as directed and if things go south I will just give the office a call.

@Snowbunny21 - He said I can take up to (5) Oxycodone HCL 5mg's a day in addition to the OxyContin. With that being said, he wrote the script for 180 and the supply states that is a 22 day supply. Wouldn't that be an allowance of 8 pills a day? Either way, I definitely won't need to take anywhere near that amount.

@straydog - To be honest, this was my first PM appointment ever. I was nervous, anxious, overwhelmed, you name it. It simply slipped by me. Oops.

Lastly, when I see him next month, he said he will be on vacation and that I will see his PA. Being new to pain management, will he/she be able to access this situation and make the appropriate medication adjustments if need be? I would assume so but am not sure how PA's work. Thanks!

Are you still in Philly? There is a pain dr at Drexel, Dr Gupta, who I really liked. I only saw her once as I moved away from Philly almost 10 years ago but flew in for a consult with her about 3-4 months ago. She is new there, just transferred from HUP, so she was hard to track down when I was looking for her. Good luck!