How to lose your pain treatment in a few easy missteps

I keep seeing threads popping up of patients who , for whatever reason are running out of their meds, or taking medications not prescribed for them currently by their treating pain management doctors/GP's/ surgeons, so instead of saying the same thing in multiple threads, I am going to post and ask those of you who have other suggestions for those doing these things to post in this thread.

Maybe we can get the mods or the site owner to add it to a sticky at the top of the forum for those who come in and want to know how to loose your pain management in a few simple steps. If you have anything to add to this list, please feel free...

I am not putting this thread up to be sarcastic, but I keep seeing the same issues cropping up far too often here lately, and honestly, it is tiresome to say the same thing over and over to new faces who are making mistakes that they have already been cautioned about. Maybe seeing a list in one thread might make it more obvious that doing these type of things is putting their treatment in peril and not just with their current doctor.

If you get dismissed, it is going to get much harder to get another doctor anywhere to be willing to take another chance in treating you. With the real time prescription monitoring in most states, it is not going to be easy to stop a doctor from finding out who you have seen, what prescriptions you have taken and when:

1. Take more of your prescribed medications than you are allotted per day. In other words, self medicate. Taking more of your pain medications, for any reason , without the express consent of your treating pain management/treating prescriber will get you dismissed. Adjusting your doses of medications on your own, for any reason. It is NOT okay to take more than you are prescribed for any reason. If your pain is escalating, then contact your doctor and ask him/her what you should do. He may recommend some anti inflammatories, or ice, and heat, or a simple over the counter topical ointment, or he may tell you that you can take an extra dose or two , however do not do that on your own.

2. Taking old medications for another medical condition that you happen to have in your cabinet. Those medications are supposed to be discarded after that medical condition resolves. It is NOT okay to take old medications to either supplement or replace your current medications. Old medications can be dangerous, delivering more potent amounts of medication or breaking down into another substance that can be dangerous, depending on how old they are. Even if they were prescribed for you by another doctor, or they are meds that your current treating doctor prescribed at one time but no longer has in your current treatment list, then it is NOT okay to use them.

3. Taking medications from a friend or family member or neighbor, for any reason. It is not only dangerous, it can be deadly. It also can cause legal problems for both of you. It is illegal in all 50 states to give medications prescribed to you to someone they are not prescribed for.

4. Call for early refills. There is no reason for you to run out of your meds early. It is your responsibility to keep your meds in a secure location so that no one else can get ahold of your meds. Loosing the prescription, or having your meds stolen is not a reason that your doctor is going to find acceptable for any early refills.

5. Multiple ER visits for pain. Most PM doctors want the patient to call them first. If the pain can not be brought down in other ways, they may tell you to go to the ER, but most ER's these days will not treat "pain". Do not accept a going home prescription from the ER. If you need more medications, then call your PM doctor the next morning and go see him for an emergency visit.

6. Visiting urgent care centers or your GP for out of control pain= medications because you ran out, or your doctor can't see you is likely to get you red flagged both with your pm doctor, but also with the urgent care doctor or your GP. Both will likely not provide you with pain medications.

7. Urine testing is random for a reason. Just because you were tested last week does not mean that your PM doctor can't call you in at any time and tell you that you are being retested. Random is just that, random. If you show up and test with medications not prescribed for you, or not enough of your currently prescribed meds, it will likely result in your dismissal. Don't count on your doctor only testing you when you come in for an appointment.

Post Edited By Moderator (Blessedx8) : 2/12/2013 9:39:04 PM (GMT-7)

Hi Tina,
I don't mind at all , in fact, I encourage it and encourage everyone to add to the list...it is just something that I keep seeing crop up again and again, in various forms, missing meds, falling off meds, med changes too often, excuses of "tolerance", and on and on.. the misuse of breakthrough meds is another one that I forgot, asking and getting recommendations on dosages from message boards or med recommendations, in my opinion, those should only come from your caregiver, for many reasons but one of them and the biggest one , is that they are the only ones aside from the poster asking for the recommendations in dosage or medication to have all of the information regarding the medical conditions, testings, results and findings, previously tried medications and reactions, and most importantly, what the treatment plan is that the doctor has in mind....and I'm sure that there are many others that I forgot to include but that's where I am counting on the rest of you who have been around awhile and know the ins and out of pain management.

MRSM, this is a great thread as we seem to not be getting the point across to some who ask for advice re: whats what with PM and your responsibilities as a patient concerning opiate use.

I carry a copy of my PM contract with my medical records just for easy access and to provide for other Medical personal to refer to in treating me.

I just want to add as you have done a good job covering this topic, that no other meds without prior approval means just that! I see many times folks here that had some procedure or another done and didnt realize it was something they needed to alert their treating MD of.

A Dentist or Oral surgeon is a MD and he does prescribe narcotic meds and they do need to be prior approved or at the very leasy depending on your agreement with your treating Dr. Twilight sedation generally means you are given a small amount of a narcotic and benzo meds but either way it needs prior approval if at all possible or at the very least as soon after,also make sure the dentist has your PMs name and address and sends them a copy of the procedure protocol used and any meds and copies of scripts he may have given you.

Also any tests ordered by another MD that requires sedation counts,if your having a proctoscopy an they sedate you it needs to be sent to or called into your PMs office.

I knew someone that lost her PM and had a very hard and long road to find another one willing to take her on after having a ingrown toenail removed by a podiatrist as she was given a low dose of demerol and before the initial procedure of removing it since she was scared to death and it hurt so bad because it had set up infection and was really wicked to touch. She however didnt mention to the podiatrist she was a PM patient nor did she think to let her PM know before and didnt offer any details until her scheduled urine drop came back positive and she got a letter telling her she would no longer be treated by that clinic due to a violation of her contract.

I asked her why she didnt tell them and her response was " it was a foot DR" not a real DR? How silly of a remark and a mistake on her part. The cost was hih for that mistake.

There is a reason your asked on the paperwork about any OTC meds you may have taken Many meds like this cause opiates and narcotics to show a miscued amount or mask test results in urine so if they only do urine testing and you have taken an otc that interferes with levels of a certain narcotics in the urine you be trying to explain after the fact or trying to figure out what went wrong as you know you have been taking it correctly but yet your amounts are off in the labs.

No matter what it is or where it came from report it to your PM,better to have a boat load of trivial memos in your chart then to miss that one that could make you lose your PM.

My contract says clearly that I am responsible for my meds and if I lose them or they get stolen or damaged or dont stay on then they will NOT be replaced but a withdrawl protocol will be put into use until which time my regular meds are due to be filled.It tells me not to carry the entire bottle with me as if something happens I lose them all. It states my responsibility to lock them up and to not give them to anyone for any reasons.

What happened with the going back and taking an unfinished med I previously had would not happen since if my meds get changed for any reason all remaining meds must be turned in first and are destroyed with myself,the Dr and one other person to witness. Its in my contract it has to be this way or I have the right to seek treatment elsewhere. Always the contract allows me to know thats my right if I dont agree with or like any of it

It warns of dependance,tolerance and addiction can occur and this is fully my responsibility and I am accepting the risks that opioid/narcotic long term use can bring about in treatment to my chronic pain.

I hope this enlightens many and hopefully a few folks at least will see something they didnt think about before reading and put it into good use.

Things are going to get tougher and believe me that if alot of those rule making folks would love nothing better then to take away our rights as Cpers of non-cancer pain to use narcotics in our pain treatment.

Vickie

Thanks Matt and Vickie and Nini,
All of the items you posted are good additions to the list...see I knew there were things that I was forgetting (LOL).

Refusing treatment suggestions, and even surgery if surgery can be done to repair the injury makes no sense, when opposed to taking pills for an extended period of time. Pain meds are not meant to be a means to avoid surgery, but to help a patient in severe pain to cope while waiting for and recuperating after surgery.

And, again, telling the doctor what medication or dosages of a medication you "need" is going to get you red flagged. So is claiming to have a faster metabolism or because you weigh more, are taller than most people, all might get you to the same result, a introduction to the door, along with a skeptical look or two.

 
Vickie,
Yes, going to another doctor and especially a dentist, if he gives you or rather offers to give you a pain medication because of whatever reason, it is simple enough to have the dentist call your pm doctors office while you are in the chair, and discuss what medication if any , the pm recommends, and what dosage. It also gives you the added protection of having another physician able to back up your contacting your pm doctor for permission...or have your pm doctor write a new order for a different med if the dentist feels it is necessary. But one way or another , contact your PM doctor if you are having any procedure done that will require any pain medication or sedation...protect your pain management care.

Post Edited (mrsm123) : 2/13/2013 10:02:44 PM (GMT-7)

I do think that this is a very important topic for all CPer's on medication. You sign the contract for a reason.

I did want to say that I don't think that it is always bad to ask about a specific medication by name. I recently relocated to another state and therefore had to get a new PMD. I told him specifically what I had been prescribed with my previous pain contract. Of course, I have been able to manage keeping 5mg oxycodone since 2004 when I first began taking it, so I ask for only the 5mg because I have to be able to work without feeling to cloudy, which oxycodone makes me feel. However there are times where I need to take 2-3 when my pain is worse, but I prefer the option of taking only 1 5mg regularilly so I do not want a higher dose pill. I don't know if this is why my new pm decided to trust me, but it seems he does. I have also had to turn down treatment before because I couldn't afford the out-of-pocket expense,  but I explained that this was why I had to decline. Within weeks though I had to go ahead with the procedure because of pain levels. Also, by the time I was able to get in to see the PMD, I had been completely out of medication and was only given vicodin and flexeril to maintain until the appointment. Man alive, that was a tough time.

I think that honesty is very important, and many of these docs have seen an addict or two and learn the signs quickly. If you seem to fit that in any way, it could cause you problems.

S2TC..Thanks for sharing more...I just still believe as a rule of thumb, it's best not to ask for something by name as in, "I want Oxycodone" as it's best to err on the side of caution with any new PM. I think there are always exceptions to any rule with anything in life, but this is actually one of my PM's pet peeves...

We are friends outside of our appts...(We've been out to lunch, coffee, I've met his family...etc) and we discuss a lot of things in the abstract as he would never violate HIPAA....but he sees a definite red flag when a brand new patient comes in and says that they only want to take "x" and that this is what their other Dr. prescribed so this is what they want.

He will joke with me and say, "Gee, I guess I wasted these last 25 years of medical school, Board Certification, and all my years in my medical practice as the patient knows more than me and they just want me to sign my name on a prescription and that's all"....LOL

Again, this is completely different than having a patient who absolutely communicates well about their pain levels in a "honest and realistic" way. (As in not saying their pain is a 9 or 10!) who can express where it hurts, what type of pain, what they do that makes it better or worse, and who really wants to be part of the process in helping get the pain levels down. As well as having medical records that clearly state that you have been on "x" med for all this time and you would like to continue if possible but it's still "asking" them instead of "telling" them.

As well as if someone is not even TRYING to lose weight if they are truly at an unhealthy level or not actively trying to quit smoking or wanting to continue drinking....he feels that they are not engaged enough in their own health and are just wanting a "pill" to fix things. My PM is one of the most caring Drs. (my Neuro as well) who will bend over backwards to help someone as long as they are willing to help themselves as well and pitch in:)

I also wanted to add in general to the part about using someone else's pain meds or giving someone one of theirs being illegal...but wanted to make sure people know it is a FELONY. And if someone were to get sick and even die by taking a med that isn't theirs, the person who's bottle it is could easily be charged with premeditated manslaughter as anyone who is prescribed these meds absolutely is told by our Drs. as well as it is clearly written on the bottle and in the literature that comes with the meds they are NOT to be used by anyone else.

I guess I have just never undestsood the mentality of thinking it's ok to just take "one or two" more meds than prescribed when having a bad pain day. People would never think to do this with heart meds, thyroid, blood pressure, etc.....But for some reason there are a lot of people who treat these meds like Tylenol.

I also think too many people think that the patients bill of rights which includes a Dr. trying to do all they can to help them when in pain, means that they have the "right" to be prescribed opiates for their pain. A lot of those under 30 have just grown up in a different medical world than what it was like out there just 15 or 20 years ago. Only terminal cancer patients were prescribed the type of meds that many of us get now.

It used to be that after any type of surgery, even the major ones, you would be given a week or so of 5mg Percocet and that was it. But now people come in to their GPs or an Ortho with a sore back or knee, without having any type of surgery done yet or even any imaging and they want to be given pain meds and are very upset if they don't get them or the Dr. wants to try other things first.

I only came to PM after years of surgeries, lidocaine and/or steroid injections/patches, physical therapy, traction, you name it...And even to this day I STILL use all of these things and more as if something gives me even a tiny bit of pain relief, it gets added to the mix so it all adds up. It's not about trying it once to see if it works. Most everything works better in combination with others.

The biggest mistake I see is that people expect the opiate to be the "thing" that brings down their pain levels the most when I only take enough to have it work just like any other modality I use. This is why I haven't had to up my pain med dosage in over 3 years now. And even back then, a lot of times we rotate meds instead of increase the dosage.

Just some thoughts/suggestions from someone who has been in PM for 7 years now but has been dealing with chronic pain and health issues for about 26 years. Not an expert, but hopefully a few hints that people can tuck away:)

Sore,
In some situations, I fully talk specific meds with my PM doctor, but that is because we have built a relationship based on mutual trust. He knows beyond any shadow of doubt, that if I am excessive amounts of pain ,and I call him, I have done every thing that I can think of on my own to bring the pain down some so that I can tolerate it. He also knows that he will be the first to know if another doctor wants to or suggests adding another med to my mix. He knows that I don't ask for early refills, or replacements, don't take more than I am allowed, in fact, I only take about half of my breakthrough meds even on my most horrendous days.

I can understand the reasons that you want to stay at the 5 mg oxycodone, I would be the same and I wouldn't hesitate to talk to my doctor about doing that, but again, it is because he trusts my judgement and my ability to follow the rules.

In the posts that we are talking about, we are talking about a patient who has either been on meds previously and firmly believes that they know better than the doctor they are paying to treat them, what medications are best and what doses, but comes to a forum like this, and "researches" what med is next up on the spectrum of pain meds- it becomes the never ending cycle of if one med is good, the next one will be better- same thing that happens when someone chooses to self medicate, by taking more than they are allotted at a particular dose.

Or someone who takes their breakthrough meds regularly- when they are not supposed to be added to your baseline medication . The person has what most of us would consider to be a minor increase in pain but they can justify it to themselves that they are in flare because of weather, stress, work, or whatever reason and then take more than they should, figuring that they will just take less on another day to make up for it...the problem with that type of circular thinking is that your body quickly acclimates to those increased doses and will step in to tell your mind that you are in more pain- therefore the cycle continues. Then when they truly do need the additional medication that their breakthrough is supposed to be, it doesn't work.

Susie, you are absolutely right, by the time someone comes here and is talking about taking that extra dose, they already have in most cases. So when we tell them not to, to call their doctor, we are essentially wasting our breath.

We, or myself rather stick around to try to guide new patients in the right way to have their pain treated with all of the rules in place , contracts, urine testing, pill counts , and the right way to use their medications for the best effect, but it is frustrating to see how misuse gets justified and even condoned in some cases. We are still being treated for our conditions, no matter what the causes are, because we are compliant patients and follow the guidelines, so we try to prevent newer posters from making some of the most common mis steps in their treatment and try to keep them from getting their own treatment terminated because of common misuse problems.

And SB, the medications , as you , and most of us know, are only one small part of the overall management of any chronic condition. You repeat that all of the time because it is so true. It is each small part of our overall approach to treating our pain, and learning what works aside from relying solely on meds that helps us to stay on track and keep our relationships with our providers good. Acceptance and adjustment are two big hurdles in learning to manage our new normals, physical activity , no matter how we may be feeling is so critical to our overall mental health and outlook , and over time, it also helps keep your body's endorphins active and that also contributes to the overall reduction in pain.
Thanks all of you, you are some truly smart people.

Sandi

Post Edited (mrsm123) : 2/13/2013 10:04:01 PM (GMT-7)

GaPeach...It's really more about the states passing new laws as this is much easier to to than get a new amendment to be added to the CSA which is the Controlled Substances Act.

That was passed back in 1970 (Obviously this is all just for those in the US)...and certain amendments have been passed over the years, the last being in October of 2008...Nothing has changed since then with regards to that specific federal law.

However, the DEA is responsible for monitoring controlled substances so they are the ones working with the states to shut down all the actual "pill mills" out there along with any rogue Pharmacists.

Each state has their own laws about controlled substances so it's important to pay attention to what is being passed or is coming down the pike. Like in NY for example, a new law was passed that starting on 02/23....Hydrocodone will be a Schedule 2 med. So people will no longer be able to have refills on this and now only certain Drs. can prescribe this medication.

There is really nothing to worry about for those of us who take our meds exactly as prescribed, don't give them to or borrow from others, etc.

This thread is NOT saying to take your meds any differently than what your OWN Dr. is telling you to do.....it's about people who are constantly running out of meds, missing appts. refusing to do anything else or take any other meds and "only" want opiates...

To Cloudweller, I don't know of any reputable PM Dr. out there who is "worried" about the DEA whatsoever...they prescribe responsibly and know what to look for in a patient who is abusing their meds....I also don't worry at all about the DEA or any of my state laws so far as nothing has passed that affects me in a negative way. I see my PM every 3 months and bring in bottles for a pill count and I do a urine test once a year. That is really no big deal to me at all.

I don't happen to agree with you on taking meds to "mask" the pain....that's not really how they are prescribed. They are usually given after a diagnosis has been made and testing/scans have been done, or after sugery......As well as most all PM Drs. are going to use other modalities to help someone's pain. If all they are doing is relying on an opiate long term...I can guarantee their tolerance is going to be such that the person needs higher and higher dosages every few months.

So, GA....you should do exactly what your Dr. has told you to do in regards to your medications....

Just FYI but I don't have refills on the majority of my meds...But my PM will give me two prescriptions when I leave. One to fill immediately, one post-dated for the next month, and then I drive by and just pick up at the front desk my last one which takes me to the next appt.

Our state just started a few years ago requiring the yearly urine test and pill count but I think that my PM also does this more often for those whom he doesn't know yet. I've been going there for 6 years now and even though I bring my bottles in he never looks at mine..LOL

Sounds like everything is going well for you so that is great:)

You can check your state laws on this but most require carrying them in their orginal bottle. If I need to be somewhere and take any medication with me, I put the ones I need in their bottles. I do NOT carry the entire amount with me, (unless I was going to be gone for a few weeks). If a police officer ever needed to see the rest they are free to follow me home and I would show them.

But both my Dr. and Pharmacist don't advise keeping them all as they could easily get stolen.

When I fly, I ALWAYS keep prescriptions with me in my carry on. I would never chance them getting lost with my luggage!

Lexie ask your pharmacy to provide you with a "purse or pocket" bottle. It will be way smaller and reflect the same label as the script showing 1 of 2.

That's the way we were instructed to do and I have not a pharmacy refuse yet. Same as if your flying,you do not want all your meds in your suitcases out of sight in the cargo hold as the temperature Ooooo there can be changing and cause your meds to undergo changes as well.

If you carry one of the med dispensers say a 7 day or even a 30 days ask your pharmacist to print an extra set of labels and attach them to the back of it. Usually most scripts have multiple or at least duplicate labels in or on the bag but remember to write 1 of 2 on it.

This is acceptable to any law enforcement as long as if required you can produce the 2nd one and total count is correct.

Vickie

Post Edited (nvrthesame98) : 2/13/2013 8:57:58 PM (GMT-7)

Quick question... To anyone that wants to answer... Y'all have so much snow there. How does the pharmacy even get their deliveries of the medications?


Also, what do you guys do if you are snowed in and can't get there?
We never have snow where I live, so I'm just curious.

I have only had a problem one time and that was when I first started going to pain management. I called to get my prescriptions filled and they said the doc was on vacation. It was after I had been there one time. The nurses told me to go to my PCP and they called him.

I had been seeing him for so many years that he just asked me what to write. It all worked out but I was terrified!!!!!

This large of a snow is an abnormality. Mostplaces that get snow are used to clearing it, with very little interruption to services. There was likely a lag of a day or two, in the hardest hit areas of the ne. But by Monday, places were up andback to business. Again, they are used to it.