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Chronic Pain
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Posted 5/22/2009 7:34 PM (GMT 0)
Hi all,

I've not posted in a while. I'm the one suffering with the ankle OCD defect.

Had the artho surgery this past April and went to see my first PM dr. since the Ortho advised me too do so and not wanting to treat the pain himself.

Went well with my first PM dr. visit. Helped that I brought copies of my last 5 prescriptions for percocet along with all MRI/CT reports. Also scope photos and surgery report.

The PM dr. prescribed me 30 days at 2 per day. I never have nor will I take more than 2 at one time but my ankle kills. I don't have good days/bad days...I have bad days/worse days.

Question is that a couple of days I took an extra one (6 hours before or later, not in addition to the 2) due to increased pain so I may be 3 days short of the 30 days.

Am I going to get in trouble for that or are we allowed a little extra for those really bad days?

Also on my last visit with ortho, I told them again, and I've been saying since day one that my constant aching pain is lateral (outside) of ankle but the lseion is on the inside. So they listened (finally) and got me another MRI with lateral views. They just called and said I have chronic degenerative peroneal tendinosis and will discuss that on my next visit in 2 weeks.

Thank god something finally explains the lateral pain I've been complaining of since day one but sucks I have 2 bad conditions in this ankle but at least I still have hope of one day being pain free.

Anyway, appreciate any advice on running a couple days short on prescribed meds.

Thanks

TB

 

Posted 5/22/2009 9:22 PM (GMT 0)
TB,
Are we allowed a little extra for those really bad days? It's up to your doctor, that's the long and short of it. Plus it depends on the medication. It sounds like your pain is still being undertreated and what you need to do is report that to your doctor and see what your options are. Technically takiing that extra one on your own is abusing your meds and in some cases can be dangerous but in all cases can put you at risk of a pain management doctor refusing to see you. So I'd strongly advise you not to continue that practice unless you call your doctor and ask if it's ok to do until your next visit. And that would mean you'd run short a little early. I'd suggest calling your pm doc and reporting your symptoms, and ask if there is something else you can do for the pain. It might help if your pm has a copy of your new reports, which would document more reason for pain.

I'd also suggest trying any other remedies - heat, ice, elevation, anything like that which could help until you can contact your pm doctor.

PaLady
Posted 5/23/2009 3:06 AM (GMT 0)

Thanks PAlady. Yeah I'm definitly not abusing them. It's strickly for the pain. I just have days that 2 in one day doesn't cut it for the pain. It was my first visit with a PM dr. in my life so i'm still learning all about this. She just told me to keep her informed and I plan to on my next visit. I took a copy of my MRI orders and appt card. I plan on being completely honest. I have all along with this thing. I've been telling the docs since day one my pain was lateral and have always felt the OCD was masking the real source of my pain and finally got them to look laterally and confirmed the other problem. Just too bad it took over a year for someone to really hear my complaint of "lateral pain". It's just hard getting someone to truly understand the real pain you're in, I'm finding, even though I have enough confirmation/documention of my medical problems. I just thought I heard of others on this forum running out prior to their next appt. Again, I'm new to all this and truly in pain, not an abuser simply because I was in too much pain to not take one extra a couple of days and as I said I never have nor will take more than 2 at one time. They were 6 hours apart. I have tried everything. Have had 2 scope surgery's on it in the past 8 months, ice, elevation, cortisone shot, PT, all of which does nothing for the pain.

Thanks again for responding.


Posted 5/23/2009 5:29 AM (GMT 0)
Tb,
It didn't sound like you were abusing, but it could technically be seen that way. Since it was your first visit to your pm, she probably is starting you out at the lowest dose and wants to hear from you if that's working. Since she said to keep her informed, I wouldn't hesitate to call and let her know what your pain is like, and that the medication isn't covering all of it. I don't know how long before your next pm appointment, but please don't suffer in silence. This is the way your doctor can know what your needs are.

Are you taking the 5mg or the 10 mg percocet tablets? It sounds like you still have room for increases, but I'm not trying to give you medical advice. Your doctor may have someone on call (or may be on call herself) over the holiday weekend. But at any rate, I'd call by Tuesday, or leave them a message.

It sometimes takes awhile to find some relief, especially since you're still (finally) getting accurately diagnosed. So keep up the good fight and ask for help!

We'll be here to support and listen!

PaLady
Posted 5/23/2009 5:44 PM (GMT 0)

TB,

Welcome....It usually takes more then one visit to get the pain meds in order...It took me several years before the Dr. finally gave me Methadone and Lortab 10 for BT pain...Now I take Oxycodone 15 mg. for the BT pain along with 120 mg. Methadone a day....Just keep telling them how your pain is...if needed, call them in between visits...That's what they are there for...

Good Luck..

Me.

Posted 5/23/2009 8:09 PM (GMT 0)

Thanks for the advice guys.

PAlady, they're 5-325. I'm not out yet and i'll still have a few days left even after my 2nd visit on thursday. Just will be a couple days short of the 30 days that the prescription says so I won't need to call them. I'll just tell her I feel I need to be allowed more than the 2 a day every so often. The more I walk or have to stand on my feet the more I hurt. Literally feels like walking on a broken ankle at times and the pain at rest is even more severe.

They didn't say anything about bringing in any unused meds so don't know if I need to. Just wondered if they do tell me to them bring them in and i'm like 2 days short of the 30 days I don't want to be shut down already. And 2 days short isn't bad IMO considering I have let myself suffer pain more than I feel I should have to but only have enough for 2 a day which doesn't allow me the occasional worse days.

Another thing and forgive me cause I'm new to this PM doctor thing. At my first visit I asked will I have another visit and she said yes in a month then after that 3 months and that's the law.

What does 3 months mean? If I get another prescription for my pain then it runs out in a month, then I have to suffer 2 more months? Is this true?

Thanks again for your responses.

TB

Posted 5/23/2009 9:41 PM (GMT 0)

TB,

First off....No, you will not be left hanging without your pain meds... Usually after you see your PM Doc the first few months they will switch you to once every 3 months....giving you 3 months of scripts, usually post-dated... I have never had to bring in "Unused meds" to an appointment.  But don't hold me to that.  It does take a while before u get on the right kind and amount of pain meds. so don't be too anxious about it.

Me/

Posted 5/23/2009 9:49 PM (GMT 0)
TB,
You know, something sounds odd to me, too, especially about the 3 month thing - at least until your pain is adequately managed. That's why your communicating your real pain levels and that you hope to be seen regularly until your pain is at least managed. Then it's possible she has a system where you have to go in and pick up the refills without being seen, which would be fine - except some people report doctors charge for this service. I have been very lucky, but my lucky isn't going to last forever. My neurosurgeon has followed me for over a year since my double fusion failed, and they are 3 hours away so his nurse (I love her and want to cling to her for life as I read all the horror stories here) mails me my percocet and other needed scripts once a month. I just have to remember to call her with enough advance time for her schedule (she's only available on certain days) and mail time. I think a few others have doctor's offices who will mail them Rx refills if they live a distance, but a lot of people have to go in and pick them up. I would suggest making a list of all these questions next week when you go, so you know the system your pm doc uses. The more you know about who to contact when, the easier it will be on you.

Now I can only share my experience and am not trying to provide medical advice for you, but I take 6 of the 5/325 percocet/day. I need two to cover the pain, especially as the day wears on, and I also take neurontin and effexor and god knows what else! My head spins sometimes. So your pain may be very undertreated, and if this pm isn't willing to work closey with you until your pain is adequately managed (and it may not be gone, just minimized) then look for another pm. That's just my opnion, but others here can add their thoughts. If your doctor changes the # of percocet you can take/day, it shouldn't matter that you're getting the refill early, as the doctor has ordered it and you're not anywhere near a maximum daily dose.

Hope this helps a bit.

PaLady
Posted 5/23/2009 10:10 PM (GMT 0)
TB hope you don't mind me, but what's OCD?
and second it is possible to have foot pain on the outside of your foot, I ruptured
my pb tendon two years ago and my foot still hurts from it although it's much
improved, (no more redness, just some occassional swelling), so pain can linger
and it has me questioning your foot doctor....I sure hope you get some low
pain days soon...
(((((((((((((((((((((((((((((((((((TB))))))))))))))))))))))))))))))))))))))))))))))))))
soft hugz..
are you using ice compressess???
Posted 5/23/2009 10:15 PM (GMT 0)

Thanks so much PAlady and uniquelyme. Your responses help ALOT. I just don't know what to expect of this PM stuff. 48 yrs old and first time I've ever had chronic pain in my life.

It's just so new to me. I've had to see 2 ortho docs in the past 12 months, the first one gave up and referred me to the one in the big city and they were both understanding enough of the pain my condition causes to provide me relief for the past 9 months. The ortho I have now is the one that told me to see a PM doc. I just feel uncomfortable seeing one but have no choice with the constant pain I have.

I'm just anxious for next ortho appt in june now that they found another condition. Just praying I won't need yet more surgery on it.

Posted 5/23/2009 10:19 PM (GMT 0)

Hi Chartreux,

OCD means Osteochondral Defect. I have a quarter sized crater 5mm deep on top of my ankle bone. Basically a chunk of my ankle bone is gone. Had 2 scope surgerys on it in past 8 months and now just found out this week I also have chronic degenerative peroneal tendonosis (wearing away of the tendons, I think) in the same ankle.

Posted 5/23/2009 10:20 PM (GMT 0)
PAlady I seem to be always posting behind you...lol

TB I just had my second official PM appointment. I brought my pills with and pee'd in a cup and came up positive for Oxy...lol Oh what a shock...LOL They did not count my pills and didn't seem to concerned when I told her I was off by one day. On a rare occasion I take an extra at 2 am for extreme pain with my kidneys and bladder. With having nerve damage some reason at night when my bladder gets full the pain hits 100x stronger and 200x stronger as soon as I release my bladder.

Hearing about the pain in the early AM she put me on a 24 hour time released pain med along with my 4 perc 10/325's. With option of an increase with the 24 time release med.

You doctor should work with you and tweak and peak your meds for up to 6 months before they release you to every three months. At least thats how the pain group is where I go to in Nashville. How they set up my appt for refills is 2 - 4 days before you monthly script is up. My doctor told me that how they do it so if you need one or two more pills a month they will be available for you to take. My doctor also starts the countdown for your next appt based on the day you come in within 24 hours give or take. I really didn't understand to well, she then explained that if I were abusing I would be out long before my appt and I would come up negative on the test.

I was also confused on all the in and outs so I just wrote down all my questions and asked her. I was very upfront and she was also and it ended up being a very informative and helpful appointment.

You might want to approach her on a few of your questions.

I hope something in this post you might find helpful.

Laurie
Posted 5/23/2009 11:02 PM (GMT 0)
TB,
As you can tell, this is confusing for all of us. And everytime we have to change doctors - especially for pain management - you can't assume it works the same way!

And each state is different in some of its regulations. Just heard a story on the nightly news about prescription drug abuse (here we go again, more attention on the negatives) and how some states are tightening their regulations to track controlled substances. Florida was mentioned by name (Pete will live this, and not find it surprising!).

So, TB, keep asking and we'll keep trying to help but know that you're not the only one confused! :-)

PaLady
Posted 5/24/2009 1:01 AM (GMT 0)
Hi TB,

As the others have mentioned, everyone's PM has different rules. Usually, if they are going to prescribe narcotics to you long term, they will make you sign a pain contract. In the contract it will state all the rules that you are required to follow, such as random urine tests, med counts, etc, etc, etc. I know some people are required by their PM to bring their meds with them every time. When I saw one, mine did not. But he did have signs all over the office stating that any time you changed meds, you had to bring the remainder of the old med with you so that they could dispose of it. They would count them out in front of you & then make you watch as they flushed them down the toilet. I remember being so scared of those signs when I first started seeing the PM (and was not on any narcotic meds) that I would bring in the rest of my old cymbalta, elavil, or other non-narcotic meds that we tried & didn't work so they could dispose of them. I don't think that the sign applied to those, but I just didn't want to do anything that would get me in any trouble or misunderstanding. It takes some getting used to, but hopefully the PM will help you!
Best of luck!

Skeye
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