Question about pain meds

It is not unusual for a pm doctor to increase an extended release medication and decrease the amount of immediate release meds in either dosage or quantity or both.
Immediate release meds are not meant to be taken on a regular basis, they are meant to be used for severe flare ups of pain that can't be managed by other means. Taking them on any kind of regular schedule only increases the amount of opiates your body quickly adjusts to having in your system and leaves you nothing to manage really bad pain days. It also increases tolerance issues quickly.
Nerve pain isn't typically treated with opiates because it doesn't work well at treating those symptoms in most people. There are other medications that are far more successful at easing nerve pain you may want to talk to your pm doctor about.
Also, calling in early for refills is an absolute no no in pain management.
One last comment, medications given to you by your pm doctor are only meant to be used to treat the condition you are seeing him for, not to treat every other diagnosis or condition he is not overseeing your treatment for. If you have other conditions and diagnosis' that require treatment, you need to talk to him about treatment recommendations and options, not use meds given to you for your spine issues to treat carpal tunnel or small fiber neuropathy.

Post Edited (mrsm123) : 11/29/2015 9:54:20 AM (GMT-7)

I am a feminist. I have spent my life encouraging people to speak up for equality and equal rights. I have fought for change. Now, I am a CP patient. I have changed my tune with respect to this category, lol.

I encourage compliance. This is the way to get help and manage pain in today's landscape. I believe the future will be more restrictive in terms of options for us. Learn the ropes, follow the rules and accept them as gospel. If you want help as a CPer you must become a model CP patient, comply.

Hope this helps.

I was given a28 day supply and he thought it was a thirty day supply therefore I was only six days early and I explained that I requested them online when I thought about it so I wouldn't forget. I just think the cut was too much at one time. I go to this dr but have been going to this practice for two years. They treat all my pain ..I dont know why but the morphine helps my back pain but the pain in my right leg is horrible day and night. Percocet seems to be the only thing that helps it.. I have a bad disc in my back. There are so many things wrong but this dr treats all of it. Im 58 and feel like the quality of life right now sucks. I understand im lucky to have a dr but now im always afraid hes going to just stop them all. Why cut me down when a month ago I was offered fentanyl patches.

Unfortunately with the guidelines these PM drs have to deal with calling in an early refill is a quick way to get dismissed from care.

The fact he mentioned Fentanyl really means nothing. If you were complaining of the Morphine not helping everything he thought possibly of switching you to something different. That is normally what they do, or they can increase whatever the person is currently taking if there is room for an increase. With him adding an extra dose I am not surprised he reduced the Oxycodone. I seriously doubt insurance would have paid for it.

Your leg pain sounds much like you are having problems with nerve issues. Has your dr ever tried you on anything like Gabapentin or Lyrica? There are several medications used to treat nerve pain issues. Narcotics have little to no effect on true nerve pain.

You said you were new to the area but had been seeing this clinic for 2 yrs. If the dr taking care of you now is pretty new to you it sounds like he has tried helping you & believe me that says a lot in the environment of pain mgt.. We see people have a new dr come on board & suddenly the new dr cuts their meds in half or changes them up completely at much lower doses.

I know you are not happy with your situation but believe me, we have seen things done to people a whole lot worse. Take care.

You keep referring to Fent as though you were offered a secret to the lottery, its a med just like the others and honestly your on a high enough dose of the others that the starting point for the fent would have been a step down for you. Why did you refuse the Fent? It's a better delivery system especially if your caring for a child? At the moment and the way your prescribed your constantly clock watching to take meds and at least assuming your not taking the MS and Percs together your having to take pills every couple of hours throughout the day. No matter how tolerant we are with these meds the peaks and valleys of absorption can cause more issues. Lethargy and drowsiness being at the top of the list if only for a couple of hours.

With Fent dosing that eliminates that clock watching and all but a few times a day of taking meds should you need them and need being the key word here.

Just because a Dr is writing a b/T med for 3 or 4 times a day does not mean your suppose to take it that way. It's given to use when your base med is going through those peaks and valleys and your pains breaking through. If you are taking it every 4-6 hours everyday its nolonger a rescue med but rather a scheduled med like the Morphine and of course your pain will now increase when it gets close to the time to take the next dose,that's what it's grown use to and why we don't do it.

If he's writing on the 28day you should have extra left each month if your not taking them as a scheduled med because technically your filling two days early every month. He likely does not expect you to use up the entire amount every month and regardless of 28days or 30 the six was far too early and raises questions. Your lucky because many PM drs at the point of your calling earlier would have and could have asked to see your left over script for pill count before writing a new one, checking to see if your out at this point.

As for your pain its certainly common for the leg pain to be there with spinal issues such as yours and again why the opiates are not working for that but do so for your back, narcotics have little to no effect on nerve pain. You have not mentioned being on a med that does.

One Dr is required to treat all your pain and you would not be able to have different prescriptions from other drs for narcotics and even having scripts of non-narcotic nature written for pain from a Dr other than your treating one can raise issues at the pharmacy level.

We are not trying to be difficult with you but the cut in dose was not as drastic as your making it out to be considering he added a entire dose of LA med, its what would normally be done.

I am on cymbals too. I don't know why my leg hurts so bad. I made appt Friday to discuss it with the dr. The reason I don't like fentanyl patches is my friend son died chewing one and have you read all the ingredients? I agree I'm being tapered but the dr never said a word to me about it when I had my appt. There was a dr one time who changed my meds and I had a grand mal seizures and I don't wish to have one again.Before my dr left I had gotten to the point that my pain was almost non existent so why change things. It's people who sell, snort and shoot narcotics that make drs scared ,not asking for script two days early when you need it. Well thanks for all your comments

Like everyone on this site, I, too, have chronic pain. Most of it is related to auto-immune disorders (Addison's disease, Mixed connective tissue disorder) and side effects related to long-term use of corticosteroids which are wrecking havoc on my bones and soft tissue integrity (avascular necrosis of the hips; extensive intestinal perforation with subsequent ileostomy). Each of us here lives with pain.

My concerns on reading your posts is the level of pain control that you are wanting and/or expecting from medication (specifically narcotic medication).

It is not realistic, for most of us at least, to expect complete pain control. I consider it to be fair/average day when my medication schedule dampens my pain by 50%. I consider it to be a good/excellent day when my medication lessens my pain by more than 50%.

Taking breakthrough medication on a regular basis (taking a pill every 4 hours, every day, for example) defeats its purpose. Breakthrough medication is meant to be taken when pain spikes beyond what is tolerable, pain that "breakthrough" your long-acting/time-released medication.

Taking breakthrough medication on a regular basis will increase your physiological tolerance and physiological need for opiate medication. That is, over time, you will need an increased amount of opiate narcotic to achieve the same degree of pain relief. Being able to tolerate a certain baseline level of pain is part of living with chronic pain because the ability to continue to increase dosage of breakthrough medication is finite.

Using other modalities to dampen pain is part of living with chronic pain. I do needlepoint, simply as a diversion, or watch NetFlix movies. Yoga, long walks, cuddling with my tea-cup Maltese dog, Molly, swimming, quiet mindfulness.

Active movement is important to keep pain at bay. Muscles and soft tissues (ligaments, connective tissue) shorten and atrophy without adequate use and contribute to pain more than most people recognize.

My humble advice: Keep working on developing additional tools in your tool box to best manage your pain.

I've been on Fentanyl for years. It's a great long-acting med since it's a pretty steady coverage for 72hrs. When I've been really struggling, it's been increased to 48hrs.

It really truly is a pretty safe meds, all things considered. All meds have their pros/cons in regards to ingredients. Even Motrin can cause severe GI bleeds. It all comes down to your quality of life-and only you know what you can deal with.

Not to beat a dead horse, but it is frowned upon to call about a shortage-even as little as 2 days late. There are members who think they've been shortened by a pharmacy, ones that have accidentally dropped just one or two, and they actually do get dropped by their Dr. I hate that it's like that, and you are 100% correct: it's the action of a few that end up punishing us all. It's completely ridiculous that patients are treated that way, but it's the nature of the beast.

I know you are in a hard place right now and very frustrated. I would give the fentanyl a try. The short acting meds cannot provide you a steady relief. Chasing pain with those meds becomes a vicious cycle. The constant relief of a long term med may be the answer you need.

Ann, no one is calling you a drug addict but the bottom line is, calling in a script early as you have just found out is not acceptable with pain mgt drs.. As a chronic pain patient it is our responsibility to stay up to date on the politics that is involved in treating chronic pain. You apparently have not done this or you would not be griping about the dr reducing the dose of your BT meds, after he increased your ER medication. He had no choice except to reduce the BT meds since he made the increase in the ER. He apparently believed you when you said your pain levels were not reasonable. Yes, you are taking the BT medication incorrectly. Trust me, you are not the first one that has come through here complaining because their dr refused an early refill or they were kicked to the curb because of making that phone call or they are not getting the same dosage as before. We do our very best on this forum to educate people like you that have not kept us with the political part of pain mgt & yes empathy & compassion is what Healing Well is about. However, with that being said we are not going to sit here & lie to you & tell you the good dr was wrong in making the choices with you that he did.

In all honesty, I don't think you have a clue just how lucky you are to have a PM dr that listened to you when you told him you were still in a lot of pain. Change is tough on everyone, especially with all the changes made in the past 3 years with treatment of chronic pain patients. The days of calling the drs up & asking for this or that are gone. The drs are just too afraid of the DEA showing up & auditing their files or having their license suspended. There is a monitoring system in place on rxing the pain medications so yes, they are under the microscope just like us.

There are several other medications on the market besides Cymbalta or Lyrica that treats nerve pain & if these are the only ones you have tried ask to try something different.

Good luck with your endeavors.