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Posted 9/24/2017 9:07 PM (GMT 0)
We recently moved across the US, in our previous location I saw an amazing pain management practice for just over 5 years; with them we found a great pain management regime. I was on the fentanyl patch @ 25mcg with Tramadol (two/day) for the pain and zanaflex 4mg for muscle spasms. I got regular trigger points and RFA's in my c-spine for C-2 through C-7 disk herniations.

I finally got into pain management here this past week. Upon sitting down with the NP she let me know they do not rx the fentanyl patch. I told her I understood (I knew my meds would be changed as this isn't my first move dealing with pain mgmt), then she questioned the use of Tramadol for b/t since I've had serotonin syndrome twice & I'm on Effexor. I agreed with her on that, as my primary doc has wanted it changed for some time but my previous team didn't get why.

The pain mgmt doctor came in and reiterated they do not rx the patch. He seems like a great doctor but between the two of them they didn't seem to have any idea what to put me on. I ended up leaving with a script for 5mg oxycodone 4x day, a script for 1mg clonidine patches (for withdrawal symptoms) and a sample of Flector patches.

I'm not having any withdrawal symptoms but I'm in an excruciating amount of pain! Even taking two oxycodone at a time with the zanaflex does nothing! Is it too soon to call them & let them know what they gave me is ineffective? I looked up the morphine equivilant & what they put me on is not even half. Anyone else come of Fentanyl to go on an oral med with success?

Thank you!
Posted 9/24/2017 10:04 PM (GMT 0)
My own thoughts on the dr & NP having a hard time trying to decide what to give you is because he probably no longer rx's narcotics to his patients & when he does its on a very limited basis. People are finding themselves without pain medications, drastic reduction in the dosage & being dismissed by the dr without any notice. This has been going on for quite some time now. My thoughts are since he rx'd the oxycodone & Clonodine his goal is to wean you off opioids. Just as a little heads up, there is a good chance of the oxycodone being cut to 2 a day. I am guessing you are not aware of how restrictive things have become.

The increased pain is because of reduction in medication & also withdrawals going on at the same time. Certainly you can call the office, however, I doubt that will yield you any benefit. Even back in the better environment days a new patient rarely got anything stronger with a phone call. You are new to him & he will not be willing to take any chances until a dr/patient relationship has been established.

To answer your question about coming off of Fentanyl, yes it is very much doable. I know of many people that weaned off of it to a very low dose oral medication.

I am sorry that you have found yourself in this situation but there are so many others in the same situation. Take care.
Posted 9/24/2017 10:35 PM (GMT 0)
Oh, I am quite aware of how restrictive things have become. Especially with all the heroin deaths where carfentanyl is in it...

I knew my meds would be changed upon seeing pain management here; I just wasn't prepared to be rx'd 1/8th of what I was taking. I've been dealing with pain mgmt for 15 years now.

If I call, I will only be asking for a script of the Flector patches; I will let them know the oxycodone is ineffective but that's it. I'm not asking for anything else as I know how this whole thing works.
Posted 9/25/2017 1:13 AM (GMT 0)
Anna:
I am on the Fentanyl patch and have had different patch doses over the 2 years that I have been using the patch.

Due to the potency of the Fentanyl patch, even small downward dose changes can be met with withdrawal symptoms and hyper-esthesia/increased central pain syndrome. The severe uptick in pain you are feeling may be due, in part, to the abrupt opiate reduction in going from Fentanyl 25 mg + two Tramadol a day to four 5 mg oxycodone. That is a steep reduction.

The Flector Patch is a NSAID patch. The patch has a slower ramp up to effectiveness than you may be used to with the Fentanyl patch. Patience is a virtue. It may be 2-3 days before you experience positive benefit of the patch. While I have not used the Flector patch personally, I have seen patients with degenerative disc disease and osteoarthritis reporting positive benefit with the Flector patch.

It is a difficult time for anyone with the misfortune of persistent and chronic pain. I hope you find support and comfort here amidst the many good people here who share the common dominator of pain.

With care,
Karen
Posted 9/25/2017 8:12 PM (GMT 0)
Annastazya, did you take a copy of your medical records from your previous pain doctor to the new one ? I'm just curious.

You may have to see several pain doctors before you find one that is the right fit. On the other hand, the political climate in an area can have a lot to do with how most, if not all, of the pain doctors there prescribe.

I agree with Susie about the reason the doctor prescribed Oxycodone and Clonidine.
Posted 9/25/2017 8:26 PM (GMT 0)
Yes, I brought all three volumes of my records plus x-rays, MRI's and EMG's. And a timeline/schedule of all trigger points, epidural steroid & RFA treatments.

I understand not rx'ing the fentanyl, what I don't understand is the dramatic cut in meds. I wasn't even given 1/9th using ME charts. I'm trying to make this work but it's incredibly hard with pain levels sitting at 8 & 9. I haven't hurt this bad in 5 years.

Another note: I've been seen at this pain management clinic, as this is where we lived prior to the previous move. They have my records from when they treated me before.

I'm certain I can adjust to a lower dose medication, it just won't be easy. I wish it had been at least half of what I was on to make tapering down less excruciating.

Thank you!
Posted 9/25/2017 10:41 PM (GMT 0)
I feel bad for you & the thousands of others that has been affected by the "over prescribing" hysteria. Given the fact that you are a prior patient with this dr & provided valuable medical information it just goes hand in hand with the current management of chronic pain for us. Not a good environment at all. Several states now no longer rx pain medications except to cancer patients or end of life for the chronically ill. If you go in saying you are a chronic pain patient, they immediately tell the patient we do not rx medications. They are offered injections & PT, that's it, nothing more. Pathetic.

I hope you can figure out some way to get some relief. It would be worthwhile to consider joining a gym to use their jacuzzi & heated pool. Take care.
Posted 9/26/2017 1:27 AM (GMT 0)
I can totally relate. I moved to a new area and the at first the Dr. seemed great and kept my script, then the next visit he changed me up, but it wasn't enough. I called and went in and he upped my methadone to where I was comfortable and then two months later he told me that the organization that owned his clinic got sued and he was cutting everyones dose in half. I was shocked, stunned and very disappointed. I never went back. I decided that I would rather suffer than put my well being in the hands of someone I could not trust. It's sad that it has come to this. If I were you I would call and let them know that you need a better plan for exiting the opiod world. It's worth a try.
Posted 9/26/2017 5:15 PM (GMT 0)
Thanks, we do have a hot tub so I've been putting it to good use but I'm in unbearable pain so much I can't even vacuum. Forget washing my hair as anything that involves moving my right arm causes extreme pain & spasms.

I just don't know what to do. I finally got ahold of the pain mgmt clinic to ask about more Flector patches & let them know how much I'm hurting. They ordered the patches & didn't seem concerned about the pain.

The next three weeks are going to be very trying until I get in for my 1 month follow up. Wish me luck!
Posted 9/27/2017 1:25 AM (GMT 0)
After much talking with my husband about what I'm going through we decided returning to my previous pain management would be ideal. Yes, it's several states away but we can't put a price on me being able to function. Plus we have lots of miles & tickets aren't that expensive.

Thankfully the state I need to return to is in the same insurance coverage area. So, tomorrow morning I'll be calling them to ensure I can come back & be seen. (I can't foresee any issues as I have a long standing history with them and I'll be straightforward about what they wanted for me here). My PCM has agreed to submit a new referral but after looking through my insurance coverage it looks like I can just change the provider over the phone.

Thanks for all the input. Wish me luck!!
Posted 9/27/2017 12:38 PM (GMT 0)
Anna, I don't blame you a bit. QOL is what we all strive for & when we lose that we are sunk. I do hope this all works to your favor. Please keep us posted. Take care.
Posted 9/27/2017 5:05 PM (GMT 0)
That sounds like a great plan! I tried to do the same thing, but by then my insurance changed to Medicare and the great team I had worked with for 5 years did not take that insurnace so I was not able to return to them. I considered private pay, but they wanted a large deposit and in the end I knew I wouldn't be able to afford them. I hope it all goes smoothly for you and you get back to your comfort level.
Posted 9/28/2017 10:23 PM (GMT 0)
Apparently going back to see my previous pain mgmt has them questioning if they'd be breaking any rules. So I'm stuck waiting to see what they figure out (in excruciating pain, crying & thinking death would be better--no I'd never!)

I have no options until they figure this out. It's not like I can go to the ER without looking like a drug seeker (even though that's exactly what I'd be doing) my PCM won't rx pain meds in fear of losing her license... such a sad state we are in!

I checked with my insurance & they said they're seeing more & more patients returning to doctors where they previously lived...that says so much!

Cross your fingers they decide they can see me!!
Posted 9/28/2017 11:27 PM (GMT 0)
Yes, Annastazya, if you signed a contract with the new place you will have to void it before you can go back (or to any other place) to your old PM. I don't think it is a law, just medical ethics to cover themselves, who cares about the patien. Ugh. Did you try calling the new PM? Maybe just go in tomorrow and sit and wait. So sorry you are going through this.
Annie
Posted 9/28/2017 11:38 PM (GMT 0)
Yes, I called PM here & told them I won't be returning, to void my contract which they did.

I know my old PM is crossing their T's and dotting their I's. it's to the point I'll move back there to get the quality of life I had!

It sucks cause I have no options for relief. If I were to go to the ER they'd label me as a drug seeker, which is basically what I'd be. How can this be? Are we seriously supposed to live like this?! Thank goodness I'm not going through withdrawals (clonidine patch)! But I'm experiencing extreme increase in pain...
Posted 9/29/2017 2:24 AM (GMT 0)
Anna, I suggest that you hand deliver a letter to the PM dr you just released. This is to cover your bases. Keep a copy for yourself. This is something we advise all members when releasing a PM dr. Be sure to put at the top of the letter HAND DELIVERED. Say something to the effect, this letter is in pursuant to my phone call to your office on whatever date that I no longer need your services.

You are correct, going to ER is a joke. You will be told immediately we do not give pain meds. Unfortunately, CPers are being hung out to dry.
Posted 9/30/2017 3:56 AM (GMT 0)
I'm officially discharged from pain mgmt here. I even called to speak with the medical director to let it be known how much they ruined my quality of life. I will file a formal complaint if I have to! To cut someone's meds by 1/10th and expect everything to be ok is idiotic!

When my previous pain mgmt heard of this they were stunned. I have an appt with them on the 8th, so hopefully things will return to good.

Thanks for all the input!
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