Still working on some measure of pain relief

It could be that you are on the wrong kinds of pain meds for the type of pain you are having.

If the cause of your pain is more nerve related then narcotics may be the wrong choice. Most people do not get much relief except in really high doses with this type of pain when trying to manage it with narcotics.

Medications like Cymbalta, Lyrica, Gabepentin, as well as many anti-depressants (meds often used to treat conditions like Fibro and diabetic nerve pain) often have much better results. With these types of meds it takes a while to build up to therapeutic levels in your system and may require one or more dose increases before their full effect is known.

If you haven't tried these medications you might want to talk to your doctor about giving them a shot. Most doctors don't have a problem with giving them a try since they are not narcotics.

And another point I just thought about, requesting a specific narcotic from any semi competent doctor does raise a major red flag.

Unless you are traveling, and have run out of a maintenance med, like insulin or a blood-pressure prescription, and you have the medication bottle with you. That's generally not an issue.

I can certainly hear your frustration...

Wasn't it fairly recent that they upped the Morphine from 15mg to the 30mg? I was just trying to understand your first post and it seemed like this was done just a bit ago..

And is he willing to give you the Percocet for the breakthrough pain with the Morpine? Or either/or...

I have mentioned before that I take OxyIR 5mg for my breakthrough as I don't like the Acetaminophen in each pill of the Percocet. I am also on the MSContin for my long term medication..

I've been on the same dosages for a little over 3 years now. My Dr. believes in rotating meds every so many years instead of raising the dosages to keep my tolerance down...

If this Dr. isn't comfortable with Oxycontin...what about Methadone, Opana, or Nucynta? Have you asked about other options?

I think what you may run into with even other Drs. is that if you are telling them that nothing else works but opiates....then this is going to make your treatment more limited by them...

The nerve pain meds (you say you have tried them all)...are just meant to take an edge off that type of pain. Just like I use a muscle relaxer (Flexeril) when I get spasms....Opiates do not really work on either of those types of pain.

Medications as a whole are only meant to be a small portion of what helps lower our pain levels...

It is going to be a bit of a red flag to them if you are saying that because he is not going to give you the medications you want or up the dosage...you want off all of them. I know for myself...I could not be without my medications or any of the other modalities that I use...

Every single thing I use adds up to lower me to about a 5 on the pain scale. This includes daily exersice, yoga/stretching, TENS unit, injections, steroids, ice, heat, massage, acupuncture, counseling, cognitive behavioral therapy, aqua therapy, and the other meds I listed.

I do think that our emotional state is very important to our physical one as they go hand in hand. Have you tried to see a counselor or someone who works with those in chronic pain?

Congrats on quitting smoking!! That alone is a huge deal to lead a healthier lifestyle....so yea for you!!

It's certainly important to find a Dr. who you think has your best interest at heart and a good PM will want to use both medicinal and non medicinal ways to help your pain. Working WITH you to find the best possible comprehensive program that uses every modality.

So...hopefully you will find another Dr. that suits your needs better. Again...my only caution is that if you go ahead and tell this one you want off all the meds...then starting with a new Dr...they are going to see that you are able to function without them. It may be best to stay on what you are on while making appts. with other Drs. (obviously NOT accepting any other prescriptions) to find a good one...

Just some thoughts..

Cave, so sorry to hear things are not going well for you. But, considering what you are saying about your PM dr, I think I would go to my PCP and ask to be referred back to the one an hour away to get good care. That hour drive is worth its weight ingold if the dr was that good. I drive a long distance to see a specialist for this very reason. I went thru 3 drs before finding him. I got sick and tired of the dr not listening to me or my husband. I know its a bit of a inconvenience to drive but in the long run its well worth the trip to get good quality care. Good drs are hard to come by.

Some of us do have to rely heavily on our medications to have quality life and I am one of them. I have done so much of the conservative measures over a 20 yr span, my drs laugh and say I could probably write a book on them, lol. Yes, a lot of it helps, but it does not help everyone. You have to find what works the best for the person. I am active and that has been our goal with my pump.

Just some food for thought.....Susie

Cave, it sounds like you have one of those drs that rx's certain meds only and never ventures out of the box, probably all of his care is pretty much the same for everyone I am willing to bet. This guy has his head so buried in the sand it sounds like. No BT meds & he says he is a PM dr, scary. I understand what you are saying about not taking meds that do not work. Kind of like what is the point and a waste of money. I would be getting another dr, thats for sure.

Take care....Susie

CaveJohnson, I think you hit the nail on the head with your comment above. The dr prescribing is a primary not a PM doctor!

Many years ago my primary knew I wanted to switch PM docs and she mentioned that she would be willing to continue writing my scripts for me if I wanted. At that point I chose to continued with the PM dr, but fast forward to last year when I wanted to take her up on the offer her tone changed. She said she would write them for a month or two but beyond that she couldnt do it because of the DEA stuff. Possibly your primary doc just wants to keep things basic and low so that red flags are not raised. Its a shame that patient care is comprimised due to the government restrictions and whatnot. Never thought I would defend a dr but they really need to think about all the patients they are servicing, having a liscense suspension or even being investigated could put hundreds of patients in a jam.

Its a shame that a small percentage of irresponsible doctors and patients make it difficult for those that follow responsible methods and dont abuse the system, to get what they need. An effective treatment plan should be between the dr and patient not big brother! Off the soap box now, sorry!

IMHO, getting yourself into a true PM practice would be in your best interests. They should be more willing to experiment with the appropriate modalities, in which meds will just be a part of. Call around, you should be able to find something that you can get into earlier than 2 years, that is just absurd. 2-4 months is pretty typical of a wait for specialists around here, and I am in a pretty rural area. I also need to drive about an hour to get to any specialists. Its a pain, physically and financially, but worth it to see someone that is willing to listen, work on a plan with me based on the facts and is capable of following thru.

I wish you luck and keep us posted!

Hugs
Shell

I did not realize this was a primary dr either. That explains why he is staying within his box on prescribing and that you can count on is not going to get any better. Oh, sorry did not realize this but sure does explain it.

You may have to find a PM dr where you live Cave if you don't want to drive any distance..Susie

I am sorry to be blunt, but that is just my nature.

If I were you, I would tell him that if the pain was in your head (your attitude or anything of that nature) that you would be seeing him for a headache and not chronic pain.

Is he a part of a practice? If so, tell him you would prefer to see one of his partners. You have the right to a second opinion.

Is he part of a medical facility? If so, make an appointment with the head of staff or lead doctor. Let them know that you have been treated without result repeatedly and if this doctor chooses to neglect your medical needs, you want to be reassigned and you want them to be made aware of his mind over matter theory. Chronic pain can cause depression, but antidepressants do not alleviate chronic pain.

Unfortunately, I do travel over an hour one way to see my physician, but it is worth the quality of treatment that he gives. It has a huge impact on my quality of life and for me, that is a sacrifice that I am willing to make. It does not control 100% of my pain or mental issues, but even 85% is worth the trip. I am nearly crippled by the time I get there, but I still hobble into his office. I trust him that much.

I am so sorry that you don't have that kind of doctor / patient relationship, but maybe in making a few demands you just may find one.

Much luck!

To Kaely, you didn't really read what I said and part of the problem is I'm quickly recounting what I've already said so it's far from exact. Example, I mentioned LONG ACTING Oxycodone because he was pushing percocet, and short acting is a bad idea. I didn't actually say "Give me long acting Oxy" at all, I said "Short acting is bad for chronic pain, why not stick with long acting?".

I never once said I'm resistant to anything but that, where do you even get that? I'd rather NOT take it, I wish the morphine worked like it used to!

1. I never refused the mental help, you misread again totally.

2. Going off the meds isn't a red flag considering it's a DRUG HOLIDAY that they do ANYWAY when you become resistant to it. As it hasn't worked from day 1 and he's not willing to try anything else, why wouldn't I do this? I CAN live a very crappy life without them, I was forced to for years without health insurance. So this red flag nonsense is just that, nonsense. I'm fed up, it's like driving a broken car and finally saying "I'll walk, screw it".

3. Has nothing to do with "not getting what I want" it has to do with being run around and ignored.

I know he's not a pain doctor, already explained why this is. The wait is extremely long to go back to the pain clinic (2 years).

Not to be a jerk, but you're labeling me something I'm not based on information you're misinterpreting and making up. Please don't do that, ask for clarification first. I know what a drug seeker is, and I'm not one. It's been months of medications that aren't working for me. Especially when he gave me short acting oxycodone on top of the morphine and that's barely effective either.

Sadly, I am aware of what you talk about. You can see if with most pain doctors if you advocate for yourself and are knowledgeable about what you speak.

"Let us try X first"

"X doesn't work, I've tried it before, etc. etc."

"I'm the doctor, we're going to try it!"

I was on ms contin and it worked well for my pain control, but only if I got the mallenkroft brand. My pharmacy knew that if they didnt have it, i'd take my business elsewhere. It is definitely a tid x3 daily med. Hope this helps, the dosage seems low but I didnt read your diagnosis. I was up to 100mg x3 daily, before that I was on oxycontin 80mg x2 but they had to reformulate it and make it cancerous, which is why mexico and canada will not take the OP's.

I feel the tension and frustration. As we all know, pain can make the emotions a wreck.

I agree about the traveling 100 percent. My NS is way away....as is my endocrinologist. I have a less than adequate PM, but have had no luck finding better yet, but I'm not going to give up.

Also, it took years to find the right Gastro (and she is even now fairly local). My PCP is not the best, but she does all of the tests, gets me in with good referrals for good specialists, and has even become a sort of good friend. Her staff is horrible, so I text her if I have a problem (but I always understand that she has a life too & never bother her with useless texts or calls).

I have found that the right Dr will not have you in the office every month. They will do what they need to and move on to someone else. Waiting times are generally shorter because they don't need to pack the books to get patients, and finally, I find it much cheaper to drive every few months than to be back and forth every few weeks in yet another waiting room of sick people knowing I'm going to catch it.

Here you have to seriously weigh the options and see what works best for you!

I wish you all the best. Merry Christmas!