Dr reducing pain meds~I have fear of withdrawals

I am i constant pain from two cracked vertebra. My doctor Is making me gradually stop my use of OxyContin. I was at 60 twice a day. He's moved me to 40 twice a day for the past four days. Today, I think he will go down to 20 twice a day but I do not have the new prescription yet. I am very worried about withdrawal symptoms as eventually, probably within ten days, I will have no meds. Please post any thoughts as to what I should prepare for. Also give me any suggestions for over the counter meds I can get.
Jim in Pain

Snow bunny - thanks for the reply. I was in very bad pain and took more than the prescription, two a day, at times. My Doctor, a GP, was angry about this and said he was going to taper me off but would not supply further meds after that. He also wants me to find a new doctor. He will refer me to a pain clinic.

Thanks for being honest about the situation...I was afraid it was something like this.

Unfortunately the Drs. are under such scrutiny with the DEA and the state laws/regulations that they can't provide early or more prescriptions when a patient takes more than prescribed.

This is a hard lesson that sometimes people learn when handling chronic pain. If you ever have greater pain...then you need to contact the Dr. (even after hours) and ask them what to do.

As well as with chronic pain, a good PM Dr. will provide you with a comprehensive program to help keep the pain manageable and this includes so much more than opiates.

So when there is more pain...you can do things like take a hot bath, use ice, heating pad, a muscle relaxer, or nerve pain med (all depending on type of pain), TENS unit, biofeedback, relaxation, stretching, possible steroid treatment like Medrol dose pack, etc...

Just to name some modalities.

Thankfully they are referring you to a pain clinic where hopefully you can find a good PM Dr. to work with you finding the best plan of treatment.

Can you share what are the causes of your chronic pain and what treatments or surgeries you have had?

The bad part about having them dismiss you for taking more than prescribed is that it may be on your medical records and make it harder for the new PM to prescribe any opiates. You may have to wait a few months for them to build up trust in you.

And know that many PMs now have you sign a pain contract which says that you will take random urine tests or bring in your pill bottles for counting. This is pretty standard now for most chronic pain patients. So it will be very important to not go down this path again with taking any more than prescribed.

Believe me....we all understand the awful pain and what it's like to live like this 24/7. I had a terrible experience with a fusion surgery and PM Dr. until I found the one I have now.

So I'm truly not trying to criticize or judge. Just want to try and help you realize how crucial it is to follow opiate prescriptions to a t and how to go forward getting the best care you can for your pain.

That is why the more modalities you use and other types of medications that they have for you to take as needed....then you can help get to a level 5 or so on the pain scale...

Keep us posted..

Post Edited (Snowbunny21) : 9/4/2012 12:02:20 PM (GMT-6)

Hello Jim, and welcome to our chronic pain forum!

My first suggestion is that if you feel that the withdrawals are too severe for you, then by all means call your PCD and let him know. He should not let you suffer like that, and the weaning process should then be slowed down. It's a hard lesson learned, but I do not blame you totally, as we often see many chronic pain patients under medicated. Patients need to advocate themselves and PCd/PM's need to listen and treat accordling to their needs. In all honesty you will probably be much better off with a PM anyways.

Damudra,
I intend no disrespect but as a responsible adult, we need to follow the rules or in this particular case, the dosing instructions of our medications and use them according to the directions. The problem with self dosing or self medicating is that doing so can cause an overdose and then result in more legal problems down the road for the patient and the doctor. Patients who self medicate and accidentally overdose by doing so, often leave family members who are looking to blame the doctors for giving the medications to the person to begin with. Understandably, in their grief, they are looking to lay the responsibility on someone and that often becomes the doctor or the drug companies.
Self medicating for depression is not a good idea, nor is using the medication to make ourselves feel better about our situations. I am compassionate to a fault when it comes to the suffering of another human being, however, self medicating is a slippery slope- that often leads to doctor shopping, accidental overdose, and many other things.
Addiction is a disease, no doubt , but it is manageable and taking the proper steps to assure compliance when it comes to medications is the only way to truly support someone.
Sandi

Hi Damudra,
In a sense I agree with you, but in another, I think that having the patient tested once a year is a good idea. I've been in pain management on and off for many years since ( since the early 90's), and while the whole concept of chronic pain is treated very differently then than it is right now, I disagree with the idea that after some time, the cp patient should no longer be "supervised" for lack of a better term by their doctor.
My PM ( I have been with this same practice now since before my first back surgery in 2006- started going to this practice in 2005), I am a highly trusted patient, only been tested one time in all of that time, I would find another doctor immediately if my doctor didn't see me regularly, for two reasons, how is he going to know how the medications are working or not, if he doesn't examine me often, or pick up on whether my spinal cord injury is worsening, if he doesn't see me? The second reason that I would leave is if he left me to my own devices when it comes to how much medication to take and how often.....that is not my job as his patient. I view our relationship as a partnership- each having it's own responsibilities to making it work for us- mine is to report accurately what symptoms I'm having, whether there is any deterioration going on, or improvement, how the medications are working or not, what other modalities I use to help keep the pain levels down, follow through with recommended treatments and therapies he might suggest. His responsibilities are to manage my pain medications in a responsible manner, to try everything within his power to keep my pain levels down so that I can function in my life, be aware of my current condition, and follow up after a medication change or addition....as well as make suggestions on any new treatments or referrals that I might need.....
How often is it that you feel would be a good time frame for your doctor to check in with you to see how you are managing? Chronic pain doesn't mean that the condition can't deteriorate, it simply means that the pain is chronic so how is he/she supposed to know if there is something else going on without seeing you in the office? As far as not loosing any pills? I don't know about others but I am extremely careful with my meds. I don't keep the bottles near any sinks or water. I don't leave them out where someone else can find them.....so yes, in my view the doctor has every right to not replace lost or stolen meds. Do you have any idea how many times a day , someone calls your doctor's office saying that someone stole their pills or that they accidentally dropped them in the sink? I have an idea, because I have been there, when the office first opens and the phone rings off the hook with several patients calling about replacement meds because XYZ happened....He has a license to protect, his family's financial well being at stake, as well as the office employees that expect him to watch his back so that they continue to have a job.....I don't blame them....

I'm a libertarian when it comes to drugs of any kind and think personal responsibility should be the order of the day, but that's a discussion for a different time.

I'm currently on 15mg Morphine 3x Daily and it's not handling my pain, unfortunately I just have to take the 3 a day and wait until my follow up appointment to tell the doctor about it. There's no way in hell they'd change the prescription now, because then they're convinced you're going to double up or go sell them or something.

As for withdrawals, tapering as slowly as possible is my advice. I once stopped taking 90mg a day without tapering and it was brutal (did it myself for my own reasons) and I wouldn't do that again. It was 4-5 days of hell, I was miserable.

When I've stopped after slowly tapering for weeks, it's barely a blip on the radar. I felt uncomfortable, had frequent bathroom trips and didn't sleep perfectly but that was it. It was like having a mild fever or something, on that level.

I also went through the same thing. I had a PM doctor just give me one month's scripts and told me I was on my own after that. I had doubled my meds also. I now have a new PM which I like very much and I will never do that again. Thank God that he took me on as a patient. I was very honest when I first went to him and told him what I did. He did end up lowering my meds but I stuck to it and I want to tell you I now have a decent pain med schedule. My meds are lower but they do work. He added some other things to my treatment besides the meds and procedures he now has me on an elcetro machine which I find lowers the pain alot. I think you should find a pain management doctor that deals just with the pain that we feel.

Jazzie

One last thing..With todays technology when you drop a urine your CP doc will know what drug you took, It use to be that you would only show a positive for opiates so they couldn't tell if you took dilaudid,oxycodone or heroin but with todays drug screenings your drug test will tell the doctor what opiate you took. So if you were on dilaudid for a month and you doctor changed you to oxycodone and you decide to take some of your remaining dilaudid it will show up in the test and they can discharge you because of that....

Florida is the cause of the problems we face with opiates, almost singlehandedly too.

I live in Massachusetts, and I've watched documentaries on how all the illegal opiates are prescribed at Florida pill mills. People from all over the country get them there.

My insurance company recently put in their own rule that says if you get a long acting opiate, it requires prior authorization which takes days. If you get more than 1 prescription of a short acting opiate, it requires authorization too.

It makes no sense though, all that happened was I had to pay for my prescription and get reimbursed. It doesn't stop anyone from getting it, it just delays it. So how exactly is this combating addiction? Further, it just makes doctors do more pointless paperwork.

In theory the monitoring systems are good, but in practice since law enforcement has access to them, I'm not a fan at all. I don't think any law enforcement agency should have access to what my doctor prescribes me, or any part of my medical record whatsoever. They say they need a warrant and a current investigation to access it, but I don't believe that.

My state has a monitoring system but barely any doctor uses it, as far as I know my doctor doesn't. Hopefully they have to ask permission first.

The insurance thing is pointless as I described it though, they could theoretically block the prescription but if the doctor prescribed it and I'm paying cash, how would the insurance company have any say?

They're requiring prior authorization because they think it's a deterrent, when it isn't. It' just a logistical nightmare and nothing else. It requires days of waiting, tons of paperwork and an extra trip to the pharmacy to get paid back when it finally goes through.

I think 20% or less of the doctors in my state take part in the PMP, lawmakers wanted to force them to at one point but that's more than a bit messed up. I think the PMP is a good idea, but now when the DEA and Law Enforcement has access to it. It's going to eventually be abused by them, to start witch hunts and attack patients I think. That's how these things always go.

I honestly don't believe rogue doctors are a huge problem. How many doctors do you think there are that go to 8+ years of school, and get out and prescribe obscene amounts of opiates while cackling like villains? They're paranoid of the DEA, and when I read "Doctors give out painkillers like candy!" I wonder where this is happening. I've been to tons of doctors the last 10 years and most are too afraid to prescribe anything.

I don't know who does mind pill counts and drug tests, we all understand the need for them. I'm not a fan of urine testing because it's intrusive and easily beatable, but that's another story.

I think there's miscommunication, I'm not talking about early refills. I'm talking about prescriptions on time, insurance can't really block it if I pay for it. That's why having the new prior authorization nonsense is silly, it's detrimental to people who need it and does nothing to stop abuse.

The PMP in my state is not used by every doctor, barely anyone uses it.

http://www.metrowestdailynews.com/news/x521655032/Bill-aimed-at-curbing-docs-who-over-prescribe-drugs

"The Massachusetts Medical Society last week dropped its concerns about the bill, and endorsed the House changes around automatic enrollment that the society said would address the low levels of involvement with the program. Currently, only 1,800 prescribers out of nearly 40,000 in the state have registered for the monitoring program."

I think my doctor uses the gas urine test too, because it tests for quite a few things. I've only had the initial one which was to make sure I wasn't on anything. I'm not sure if it checks levels though.

The War on Drugs is out of control over all, and every time they pass new laws it doesn't actually fix anything. It's been getting more strict on everything for decades and it's improved nothing. That's a subject for a new thread though.

On a related topic, has anyone noticed less pain reduction since Pharmaceutical companies began reformulating their Long Acting opioids?

I was just reading a thread from another forum where a pain patient was getting Opana ER and despite a very low tolerance, got no pain relief from it. We know it's already driven addicts off of the pills and onto morphine, but I'm wondering how big the impact is on the chronic pain community.

I'm also curious if the fact that my 15mg Morphine doesn't work has something to do with it too.