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Posted 10/12/2012 6:52 AM (GMT 0)
Hello everyone! I've been on this board before.
I am so grateful to have found this support here.

I have so many illnesses, but the one thing that is bothering me the most or rather I'll say 2-3 is my: Ankylosing Spondylitis,
Sacroli*** and Chrons disease (not sure if they are spelled
correctly).

I currently cannot take any NSAIDs b/c my stomach just gets torn
to shreds.
I do take SOMA (muscle relaxer), Celexa, Tramadol and Vicodin.

During the summer months here in the state of Virginia that was fine! Sometimes i could go a few months w/out needing the Vicodin. Now that the season has changed and it's colder
now, I am MISERABLE. I am treating everyone that loves me with such anger b/c I'm in so much pain and so depressed.

Here is my issue. My Rhem. DR doesn't use any other medication but Vicodin. Which is FINE for the Spring and Summer. However my Primary Care uses stronger meds to control my pain. I don't like to take those meds on a long term basis though.

I am reaching out to all of you to see if you think I should consider having my Primary Care treat my pain for the Winter and let my Rheum. DR treat me with all the rest of the meds he gives me such as my Celexa, Gabapentin and Soma.

Any thoughts on this would be helpful!!! I am seriously falling
apart both mentally and physically. The pain is taking over
every aspect of what little life I have left.
cry
Thanks!
Jul
Posted 10/12/2012 7:14 AM (GMT 0)
Hi Jul...

Welcome back here to the CP forum. Feel free to visit us anytime.... I'm glad you found your way here.

I'm sorry you are suffering from so much. I've got so much of my own going on as well, so I can completely empathize.

And the whole medication thing is tiring to think about. So - let me say what I *hear* you saying......

Bottomline - you need something stronger for pain - primarily for the fall/winter months when it's colder and you have increased pain (which is a completely legit thing... many of us have this).

Could you explain this exact situation to your PCP.... and have him treat ALL of your med - from a stronger narcotic, the celexa, neurontin and soma? Do you think he would do that? That might be the easiest thing to do - as it would all be under one doctor, etc.

Second best options - is to talk to the PCP about taking over the narcotic portion - saying you need something stronger to cover those months - but the Rheumy will continue scripting the others. I would just something in writing though (just to CYA) - saying that the Rheumy is stopping the Vicodin scripts for now and understands the PCP will p/u with the narcotic scripts.

And.... very last thought.... have you ever considered see a Pain Management doctor. I get ALL of these drugs from my PM doc. 3 different narcotics, muscle relaxer, nerve medication, lidocaine patches, injections when needed.... I'm about to get botox injections, etc.

I'm sorry you are falling apart mentally and physically.... let's hope we can all figure out how to help you feel better yeah

Take care.... --Tina
Posted 10/12/2012 12:48 PM (GMT 0)
 

     ...morning Jul! ...thats a tough question, and I really do not have a good answer for you. However it would be nice to see only one DR for all meds if possible. If narcotics are inolved, then I think I would seek out a PM, as this seems to be the trend for scripting pain meds. PCD are getting to where they just do not want to mess with it anymore.

    Let us know what you decide and if it works out for you.

  Take care,

 SE

  

Posted 10/12/2012 3:42 PM (GMT 0)
Dear SE-

My biggest issue is that my Rheumatologist does NOT PRESCRIBE
ANY NARCOTIC OTHER THAN VICODIN. EVER. He even has a sign
in his office when you first come in. It's been like that since I
started seeing him 5 years or so ago.

Therefore, I can't go to him for stronger medication just for these
winter months. I don't want to be on strong medication longer
than I need to be (of course until later down the line when I may
not have a choice). Then that's fine b/c I hear AS pain down the line can be severe (which I can't imagine it even more severe than if it is now).

Anyway, I really am at a cross roads here b/c If I go to my Rheumatologist I am stuck with all his meds which ALL are great
except the fact that he will not ever give more than Vicodin.

I guess I could talk to him first about it and then go to my Primary Care if he says he won't break any rules on this considering my condition. My Primary Care has always been OK with prescribing stronger pain meds. So that's good.

Thanks so much for your reply and input! I appreciate it!!
Posted 10/12/2012 3:55 PM (GMT 0)
Dear Tina,
Thanks so much for your helpful reply!! smile I appreciate it
very much.
I talked to my Rheumatologist secretary this morning(Just now) and he just cannot break his rules on what he gives out. So I
wont' be able to get anything other than either Tylenol 3 or
Vicodin ES. My Primary Care used to treat me and give me all
my medications, including stronger pain medications. However he would make me come back every 28 days for refills on EVERY SINGLE thing!!!!! My Rheum. doesn't do that. He gives me
refills so I don't have to keep coming back except for every
2-4 months. Or if I need to come in for something.
He even refills my Vicodin via fax from the Pharmacy.

So, that is the issue I am facing........

Any suggestions- I'd love to hear them!!! Please! smile
Julie
Posted 10/12/2012 4:23 PM (GMT 0)
Hi Julie and welcome back to the forum. Sorry to hear you are having some problems with the weather changes, it has a way of knocking a lot of us down.

It sounds like you are going to have to speak with your primary care and about rxing something stronger for pain during the winter months if he will. If he agrees, count yourself very lucky, so may primary care drs have stopped writing pain meds for more than 10 days. Even then, it is not anything stronger than hydrocodone. Unfortunately since the DEA has their fingers in the pie they have ruined it for CP patients that once had their primary care dr taking care of them. I believe there should be limits and control, but it needs to be within reason. CP patients have enough of a stigma attached to them. This is why so many people end up under the care of a pain mgt dr. and even they are becoming very conservative. Sometimes it seems like a no win situation.

Anyway, I wanted to pop on and tell you hello & welcome back. I hope you have a good weekend. Take care...Susie
Posted 10/12/2012 4:31 PM (GMT 0)
Julie,
I have both vicodin and oxycodone for BT pain. In my opinion, 5mg of oxycodone is = 10mg of vicodin. The effects are slightly different for me -- oxycodone is more sedating, but in terms of pain relief, a stronger opioid per mg is pretty much equal to a higher dose of a weaker opioid. That is, I'll get the same relief from 5mg of oxycodone as from 10mg of vicodin. I'd say the same about oxymorphone -- roughly 5mg of it = 10mg of hydrocodone (the opioid comparison charts have oxymorphone at 10x stronger than hydrocodone, but it has something like 1/8 oral bioavailability compared to hydrocodone, so most of the pill never gets metabolized).
Thus, one strategy is to just request more vicodin for the winter months. There are various conversion charts online, and if I recall, the ratio is typically 1.5:1 or 2:1 between it and oxycodone You can discuss your need for something stronger in the winter and if she won't prescribe it, maybe an equivalent script of vicodin.
Another issue is time-release (ER). Most PM's will prescribe a time-release along with break-through meds. Maybe during the winter you need an ER med -- and since there is as yet no ER of hydrocodone, maybe try Tramadol ER? I found 300mg to be quite helpful for years (though not enough any longer).
Aside from opioids, have you tried Enbrel or Cymbalta? The two people I know with RA have found these to be immensely helpful (one uses the former, the other the latter).

Note also that Sched. II opioids (oxycodone, etc.) can only be prescribed month-by-month with no refills and no fax/phone orders to the pharmacy. You need the actual paper script. So, that would likely mean monthly visits to your doctor.

Lastly, I want to emphasize that a stronger opioid isn't a magic-bullet. Even oxymorphone and hydromorphone are pretty much just like taking more hydrocodone. 15-20mg of hydrocodone will likely give you the same relief as about 10mg of oxycodone.
The real difference between them is their side-effects. Some will cause you greater fatigue, some more energy, some headaches, dry mouth, memory loss, insomnia, hypersomnia, constipation, anxiety, increased heart rate, decreased heart rate, headaches, etc. etc. etc. If the side effect profile for hydrocodone is ok for you, that's actually a good reason to just stick with it and increase the dose.
Oh, don't forget that Vicodin is also the coolest of all the opioids:
Posted 10/12/2012 4:42 PM (GMT 0)
That is certainly true. It's not a magic pill at all!! I wish it were! :-) I know I will always feel some pain, but right now I think
I am at an unacceptable rate of pain. :-(
Posted 10/12/2012 10:17 PM (GMT 0)
Hi there...

I also agree that it would be good to ask your Primary Dr. to go ahead and take over your care year round. If he is ok with prescribing stronger medications...then I would think he would be fine with taking over the ones that you are already on.

Just be sure that you tell your Rheumatologist FIRST before accepting any prescriptions for controlled substances from your Primary. This way if there is anything to sign off on that you are no longer accepting meds from your Rheumy, you will be all set before accepting them from your PCP.

This is because there are many new laws/regulations that prohibit people from getting two prescriptions for controlled substances from two different Drs.

As Stray mentioned, it is unusual these days for anyone who is not an actual PM to prescribe controlled substances as part of the new laws coming into effect, a non PM Dr. has to go through more training and certification to prescribe these meds or treat those with chronic pain (anything over 3 months).

So, hopefully your PCP will take over your care completely and you can have something for the winter months.

Good luck..
Posted 10/13/2012 12:20 AM (GMT 0)
Hey Julie,

I would go with what I said about referring to your pcp for the next few months at least. i, too, have to see my PM doc every 30 days... but they are scriptng me 6 strong meds, so it's no issue to do that for me.

Good luck...and let us know what happens. --Tina
Posted 10/13/2012 12:52 AM (GMT 0)
Is there anyway for you to get a referral from your pcp to pain management? might be worth considering
or changing your Rheumy and getting a new rheumy doctor...just something to consider. Maybe ask your
rheumy if he could refer you out to a pain management doctor. My rheumy refers out to pain management
doctors, don't see why your's will not...Many well wishes and hope your doing better soon.
Posted 10/15/2012 12:16 AM (GMT 0)
Julie, are you on any of the biologic drugs for the AS? I forgot to ask you this in my previous post.

Susie
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