Why do dr's freak out & worry about us getting "high"?

There are many reasons why doctors tend to think many people are simply wanting to get high or worry about it to what seems and sometimes is excess. It could be having run into these types of people before, not being well versed in pain medications, the sensationalistic news coverage of the prescription drug problem, afraid of losing his medical license if some one starts thinking he is prescribing too much pain meds without sufficient documented cause, etc.

If by FM you mean fibromyalgia I suggest talking with your doctor about trying a medication like Lyrica or Cymbalta. While they don't work for everyone they do work for many. I do suggest you read up on each of these medications and become familiar with how they should be dosed because in order to avoid or minimize side effects each of them need to be started at a low dose and slowly increased until a dose level is reached that provides good results. Some doctors are not overly familiar with the dosing schedules and will start you out on a higher dose. In each of these meds it is not uncommon to have to go through 2 or 3 increases before knowing if they will work for you. My wife has fibro and takes Lyrica for it and it helps the day to day "normal" fibro pain a lot and it does also help to shorten the time she goes through her "fibro flares".

Just a note: Odds are slim that Lyrica or Cymbalta will help with your back pain. While it tends to works for fibro and some nueropathy type pain it usually does not do much for other causes.

I say this all of the time but the goal of pain management is "management" of pain, not elimination of it. Most PM's seek to reduce the patients pain levels to about half of what the patient claims they are- so if you are claiming that you have constant pain levels of say 7, then the goal of your PM might be to reduce the pain levels to about a 4- those easily managed with additional tylenol or motrin , along with your base pain medications.

Breakthrough medications are only to be used to manage pain levels that are substantially higher than your highest "normal" pain levels. They should not be used in conjunction with your base medications to treat everyday pain levels.

I know that you said that you aren't taking any breakthrough meds, yet. So while what I said about breakthrough meds doesn't apply to you yet, it is something that you should discuss with your PM doctor when he does prescribe them to find out when and how he wants you to take them.

As far as why he was upset about you taking extra tramadol, first there are the interactions and potential for overdose that can come with taking more than prescribed, no matter what your pain levels are. Secondly, there is the red flag that taking more than prescribed leaves your doctor with. Thirdly, he prescribes meds for a given period of time, usually 30 days worth of meds. If you are taking more than prescribed, then you will run out before that set time frame elapses. In that case, he can not and in most cases will not refill a prescription early and neither will your insurance or the pharmacy.

Each prescription is broken down by the insurance company into a number of days that the prescription should last- if you take more than prescribed, the insurance company will reject the early fill, and the dea will flag your prescriptions for an early fill. Ultimately, you will find yourself kicked out of the pain management practice and once that happens, you will find it very difficult to find another doctor willing to treat your pain. If you get flagged by the dea, you won't find one.  The last thing that you need to know is that tramadol can be very addictive, just as any other opiate. It is a synthetic opiate, works the same as any other opiate pain medication on the same receptors in your brain. Taking more of it can and will induce tolerance issues and withdrawal if you run out. The right way to handle increases in pain levels is to call your doctor and ask him what you should do, not just take more because you have pain medications there.

Also, you need to consider other modalities to treat increases in pain levels, heat, ice, stretching, motrin, advil, aleve, tylenol, etc all will help to ease the pain. You can alternate ice or heat every 15-20 minutes on and off to help ease the pain. Swimming excercise and there are many neuropathic medications that may help with the pain of fibro. In fact, that is the standard of care, not so much on the pain medications anymore. Lyrica, neurontin, topamax and the old tri cyclic anti depressant medications do far more for the pain of fibro than any pain medication. Physical excercise and therapy are also great at helping the pain of fibro.

It sounds like you are fairly new to pain management but there are many rules that we all have to follow, including drug/urine or blood testing to confirm that we are taking meds as prescribed, having injections and verifiable proof of our conditions  before most of us have gotten anything close to pain medications that we all have had to submit to. If you don't follow the directions of your doctor, you could loose him and any access to medication ( opiates) to manage your pain .

Most of us have contracts that allow our doctors to call us in for pill counts, unannounced urine or blood testing and failure to have the right amount of meds left or not passing a urine screen can mean that we no longer have the right to any treatment with pain medications. You don't want to find yourself in that position if you are in pain.

 

Blondie,

I'm so sorry you're having to deal with this, and an insensitive doctor to boot. Unfortunately narcotic abuse has been a big thing for a long while now no matter where you live.

Like MrsM said, it's not about making the pain go away; it's chronic pain for a reason. But it is about quality of life. The pain will never go away, but you need to find a way to get it to a manageable level where you can function.

Aside from medication there are also oodles of ways to combat your pain. Everything from meditation to biofeed back, wraps, compresses, sprays and creams, etc. I recently sent someone a link to Solutions for a full back herbal pack that you could throw in the freezer, or into the microwave; between the herbs and the semi-moist heat, and the fact that you could drape it down the length of your back, I thought it might help.

For over 3 years now I've lived on narcotics. I've taken Vicoden, Loritab, and now Oxycodone. Alot of the times we switched my perscription because my doctor felt I was getting to high a dose, as one's body can build up a tolerance if you take it all the time. So he would switch me to something else at a lower dose and I would take that till the pain became to great. I use a variety of things to help combat my pain though aside from my drugs. I use BioFreeze on my arm, which is great in the summer given how cooling it is. I use absorbine gel linement that I had originally bought for my horse. I also have a TENs unit, extra-strength TigerBalm, and a few IceyHot sleeves that cover half my hand and all of my forearm.

Being proactive about your pain is also a biggie. If you're on a maintenance dose, make sure you take it on time regularly, using break through only when you positively need it. I have done the whole "but I had a bad day!" and taken extra meds. As a result, I ran out. I had a new perscription in hand, but it didn't matter, the pharmacy couldn't/wouldn't fill my script. And so I went three days without pain meds. I was a wreck! Between pain at full strength and withdrawls... you can imagine what an ugly thing that was. Also between doctors that have you on contracts, and insurance companies, over using your meds is a bad thing and can get you booted from your treating doctor's office.

My pain doctor, while not a fan of perscribing narcotics, always tells me the same thing every month; if you can skip a dose, do so.

Just be aware of what you're taking. Tell your doctor you're concerned about your quality of life, find alternative methods to help deal with your pain. Remember, be your own advocate, and be proactive. *hugs*

Hi Blondie, I too would like to welcome you to Healing Well's chronic pain forum. While I am glad that you found us, I am sorry that you have to be here.

I think you have received some great responses from the other members here at the forum. There is a war on drugs out there alright, it included our prescription drugs as well. There has been so much hype on the tv about the abuse of script drugs, and they are making it more difficult for us people that need this medication. Yes, the drs are running scared, because they don't want the dreaded visit from the DEA taking an inventory of their office. I live in Tx and my PM dr write more narcotic scripts than any dr in this state and she has regular visits from the DEA. However, she is not afraid of them, they have even given her some good tips that she is now using in her office. But, not all drs feel his way I can assure you.

One thing a good PM dr will tell you is, you will never be pain free, you will always experience pain, however, the goal is to allow you to have quality life and you cannot expect medications to take all of your pain away, not unless you were made a zombie with too much medication.

Are you seeing a PM dr or a PCP or even a rheumy? I do know rheumy's treat Fibro so thought I would ask. You do appear to have a very busy lifw and there is nothing wrong with that. However, pain does take a toll on the body and in many ways this could be your body's way of telling you to slow down and give it a little rest too. I am not saying stop your activities because that is the best thing anyone can do is stay as active as possible, but you can overdo.

As far as getting high from medication, I have been on opioids since 2004, and I have never been high or gort a high feeling on any of my medications. If a person was getting a high feeling, then I would think they were on a dose too strong for them. It is not unusual to have to try several different meds to find the one that works for you. But, one thing you will find is pain medication does not work all that well for neuropathic pain. Medications like Neurotin, Cymbalta and such are meds used for that particular type of pain.

I would give the Xanax a chance to work, one pill is not going to do the trick. Many times you have to let the medication build up and let your body become use to it. Judging one pill is not really making a fair call on if it will help or not. You mentioned Suboxen, I believe drs have to have a special license in order to dispense this particular medication. I may be getting it mixed up with another drug, however, you can go on Drugs.com and look it up, it will say if a dr has to have a special license to dispense the drug. Another thing that will send a red flag up on a patient is if the patient asks for medications by name. Drs do not like this and I know of patients being fired by the dr for doing this very thing. Once you get fired by a dr it is very hard finding another dr that is willing to take you on as a patient.

Anyway, I wanted to pop on and tell you welcome aboard. Take care.

 

     Good morning Blondie!

          It looks like you have recieved excellant responces here, so I won't add to them, but I wanted to "Welcome" you to the CP forum as well.

           We look forward to more visits with you.

          Take care,

       SE