Talking Pain Medication With your Doc

I have Crohns Disease, and Rheumatoid Arthritis. To make matters worse I was in a car accident (not my fault) in September of 2014. So, my neck and back get so flared up it can be impossible to move. Sometimes I will sit in bed in agonizing pain wailing because it hurts so much.

So I have a pain doctor who gives me tramadol and 30mg of Hydrocodone a day. I've been taking this for about 1.5 years. We tried switching to Hysingla, and Nucynta, but that was really a disaster. So we went back to the original regiment, but I think that it's starting to wear off and I am becoming tolerant.

This isn't really addressed anywhere, and I'm just wondering what is a good way to go about confronting your pain doctor to change your medications and ask for something stronger without 1. sounding like a drug addict and 2. being responsible about it and not getting something overly strong. But on the other hand, if getting dependent on a pill to allow me to function helps, I'm okay with that. My doctor and I have a pretty good relationship, and he seems to trust me. None of my behavior, or past behavior would suggest I'm someone who would abuse anything, which I never have over years and years of opiate medication.

How do you communicate this with your doctor?

Sorry to read about what you are dealing with. Yes, people do become tolerant to their medications whether its pain medication or blood pressure meds. Anything thing taken long term has this potential.

With the new guidelines drs are going by these days people are not getting much of a chance for increases in their meds. Those days are pretty much over. Now a days they are rxing the least they can. Pain mgt & pain medication have been under fire for several years & the patient is pretty much on the losing end of the stick. Better start finding other way ways to handle your pain rather than relying on a pill. You sound young, if this is true that is another barrier with drs. They do not like rxing to young people over a long period of time because of the fear of running out of medication that will work years down the road. It was that way long before everything became so restrictive with pain meds.

The only thing you can do is tell your dr that your current meds are not helping & he will either say ok lets try something different or he will say no. There is absolutely no way you can force his hand. I wish I could tell you something more positive but it is what it is these days.

Take care.

straydog said...
Sorry to read about what you are dealing with. Yes, people do become tolerant to their medications whether its pain medication or blood pressure meds. Anything thing taken long term has this potential.

With the new guidelines drs are going by these days people are not getting much of a chance for increases in their meds. Those days are pretty much over. Now a days they are rxing the least they can. Pain mgt & pain medication have been under fire for several years & the patient is pretty much on the losing end of the stick. Better start finding other way ways to handle your pain rather than relying on a pill. You sound young, if this is true that is another barrier with drs. They do not like rxing to young people over a long period of time because of the fear of running out of medication that will work years down the road. It was that way long before everything became so restrictive with pain meds.

The only thing you can do is tell your dr that your current meds are not helping & he will either say ok lets try something different or he will say no. There is absolutely no way you can force his hand. I wish I could tell you something more positive but it is what it is these days.

Take care.

I am young, I am 27. This whole "epidemic" because of a few punks who wanted to get high, and make tons of money has just totally ruined this for real sufferers like us, and for that I hate those people. It's so disgusting that people have to now suffer on a daily because of a few idiots, and now doctors are all scared and don't trust anyone. When I first started taking opiates, I would be flat out rejected, or made to feel in the pharmacy like I was some drug addict. I will not accept that, nor can I accept that when I know I am in the right.

I met some pharmacists at a party I attended, and they told me the best thing to do foremost is establish a personal relationship with your pharmacist. This way they know who you are, your conditions, why your taking the meds, etc... If something does arise they will not be panicked to fill your scripts or worried because they know you. I have been going to the same pharmacy and know all the people who work there now since I've been on long term opiates. Before I met these pharmacists who told me this, I was just going to the most convenient pharmacy (I knew no better), which made it look like I was pharmacy shopping. I also travel for work, so on top of that I had doctors in different states, so it REALLY looked like I was pill shopping, which of course I wasn't. So the point is when you do get on long term opiates, you must pick one pharmacy, one doctor, and stick to it. Unfortunately this can lead to trouble if you travel (running out, not having someone to go to who knows you, etc...) , so always carry your bottle, even when it's empty so you can show a doctor in case of an emergency. I haven't always been on long term opiates. I use to take Norco back in 2009 sporadically for joint pain in my knees, which was unknown at that time (turned out to be arthritis).

I am blessed to have a very very trustworthy, and honest relationship with my pain doctor. We also discussed (at my behest) the epidemic, and how my age is at risk. He told me I don't show any signs of the usual drug feigns which was early refills, "lost" medicine, and all the red flags that he looks for. I think if he was willing to share that with me, he must really trust me. I'm not sure things are way to the point that I MUST have something so strong like Dilaudid, Morphine, or a Fentanyl patch (which he has discussed prescribing me). I think it may be a wise decision to start opiate cycling, and maybe starting out with Oxycodone. I'm not familiar with opiate cycling, and have only heard it from my doctor. Is anyone here familiar with opiate cycling?

If I told my PM doc I was really suffering, and I cannot continue like this, he would give me something stronger, this I am certain of. I just really wanted to know how to go about bringing the topic up, but I think just honesty is the best route. Also really stressing to the doctors how much you are really suffering on a daily basis so they can gauge the situation. Of course, like anything else that includes liability, they must trust you.

Choose your words carefully. Ask if there is anything more effective. Be willing to try a different combination. I've asked my doctor if there are any other 'modalities' that he would recommend. The fact that Medicare doesn't cover some of them is a bit of a problem. I'd be willing to try acupuncture, but it is not covered. Massage is recommended, but not covered. This means that my choices are limited and pretty much leaves only medication as the primary 'answer'.

A friend has told me about a low cost option for acupuncture which interests me. It just might fit my budget. My neighbor is a certified massage therapist and is willing to see me for free.

Now, if I can just convince my Landlord to let me have a pool! (joking, although that would be great)

There are things that I will resist or flat out refuse. My doctor is aware of my prior alcohol abuse and the meetings that I have been attending for over 20 years. He understands my hesitancy. I am scheduled for another round of epidural facet joint injections May 6th. I avoid the 'big guns' like the plague whenever possible. My arsenal consists of OTC anti inflammatories, heating pad, ice packs, a TENS unit, Benadryl to help me sleep, meditation, distraction techniques, and last but not least, the little brown bottle from the pharmacy. An ounce of prevention is worth a pound of cure.

tidalmouse said...


Being 27 years old,I'd kinda hate to see you taking Morphine or Dilaudid for the next 50 years.So I can kind of see a Doctor's hesitancy.But that doesn't mean you should have to suffer because of your age.

Really,the only thing that I know to do,is from the person that weighs you til the one that gives you your prescription,tell everyone of them that you're in pain.Can't sleep.Shooting pain.7-8 out of 10.

I'm sort of kidding,but not really.Evidently,my way of being quiet and polite doesn't work.

Hope you have a good day.

Take care.

Rick

Actually Rick, you're absolutely correct. The more noise you make, so long as you are polite, and not some drugged up dope feign, if it get's you relief, that's fine by me. As far as the heavy stuff like Dilaudid or Morphine goes I don't think I'm really in need of that just yet. I see the inevitability of me having to be on pain medication for the rest of my life. I mean sure I can try all this naturopathic stuff weather it be massage, yoga, whatever... but at the end of the day, it's not going to help you when you wake up at 3am with shooting pain where you can barely breath.

Quite frankly I can see that my doctor isn't crazy about giving me stronger stuff because of my age, and that's fine, I don't need it just yet. But I have a teacher who was in a very serious bicycle accident at 15 years old that completely wrecked his entire spin. He is now in his late 60's and regularly takes 80-200mgs in a day of Oxy because of his tolerance level. So that got me thinking, who cares if you build up a "tolerance," so long as you continue to raise the dose, and you are responsible?

pitmom, another thing that comes up with tolerance issues and taking a high dosage of a pain med is when you have a surgery such as the knee replacement I had.

I was in terrible pain the first three days because they were giving me what they give everyone. I told them that I had access to more medication at home.

When I was transferred to a Rehab they started giving me what I was taking before the surgery.

So it was a problem getting myself out of pain so I could rehab my knee.

Rick

tidalmouse, your dr might be able to give you something that will help your stomach.

Drs have learned a lot about treating patients for chronic pain with opiates long term. It is normal to only think about now, especially when you're young. But, besides opiates causing problems with surgeries, you don't know what may be ahead of you from the standpoint of cancer and similar health conditions that usually require opiates. Drs see situations like this frequently and they have to weight it along with what we are presently living with. It is a difficult balance for the patient and the dr. Some drs are more willing to put their time and energy into treating the present and having to consider the possibilities of the future than other drs are.