New to this forum...

I have been posting in the hepatitis forums for the past few months. Hoping to get some advice on pain management.

Here is my story:

I have been working with my general physician because I have a herniated disc in my T2-T3 and a annular tear in my T1-T2 which occurred while squating at the gym. I use to do the injections every 3 to 6 months, they helped some. Unfortunately though, due to some liver health issues I can no longer have injections. I have done everything asked of me, I recently lost 90lbs to help with my back pain. It has not helped to date.

She switched me from vicodin to regular oxycodone HCL, whatever is without tylenol. Anyways, we discussed that it is obviously habit forming. She usually gives me 30  to 60  5mg pills and said to take as needed. I usually only need a prescription a month as I can make that many last. I am not sure what is typical for these, but I usually take 3 a day when in pain. I take 1 in the morning and 2 later in the afternoon, say like 5pm after work. That is when my pain is at its worse. When I do take the 1 pill in the morning it makes it so I can get moving and breathe without pain. In the afternoon I have to take 2. My doctor told me to take 1 to 2 caplets at a time.

Anyways, I called to talk to her about my pain management. It has been 3.5 weeks since I got a prescription. I ran out of meds about 10 days ago. I stretched it out as long as possible, but the pain has been much higher than normal.  She informed me that 3 was to much per day. I do not take them everyday, sometimes I can go a week or so without taking them. I have gone the last 10 days without anything except 1 325mg tablet of tylenol every 6 hours. The pain has been really bad, but I did not want to call or go to my doctor. I do ice, heat, stretch. I slowed down on working out.

I finally called today because my wife told me to call or to sleep in the basement. She said when I am this much pain I get kind of grumpy and it is hard to sleep in bed with me because I toss and turn.

When I called today, I told the nurse I was open to physical therapy, which I always have been open to doing, just not at the place where she originally wanted me to go because it is over an hour drive there. I am in the middle of a surgery evaluation process so I am going to alot of consults and having blood tests done so they know when I level out so they can go in and remove a cyst on my bile duct. I asked the nurse to tell her that after the surgery I would have more time and I could go to this speciality place. I have even mentioned my willingness to go to a Pain Management Clinic, but I need her referral due to my insurance.

I do not want to change physicians, she has been great up until this last month. I do not think I am asking for to much, but maybe I am. I just want to be able to get through the day at work and with my wife and daughter without constant excruciating pain.

Anyways, I was hoping to get some input from people. I know your pain issues are probably much worse than what I deal with, I just am looking for some input on how others doctors handle patients.

Hello. Welcome to HW :)

What exactly does the bottle say?

Without that it's kinda hard to know what they were thinking when they said three a day is too much.

But in general, its always best to follow exactly what the bottle says to avoid getting into these types of situations.

Even if what's written does not take care of your pain, its best to just try and get through until your next appointment.

Because then you can explain, in person, that your pain has gotten worse, and what used to cover it, doesnt anymore.

Drs these days are extremely wary and skittish when it comes to these types of pain medications.

Your best bet is to talk to your dr at your next appointment.

The bottle says take 1 to 2 pills every 4 hours as needed. I keep it to 3 pills a day when I am having pain. I only take anything they give me as directed on the bottle.

I understand about waiting for appointment, thing is I do not have regular appointments with her. She advised me to not add another doctor when I suggested a pain management clinic, I am seeing like 5 doctors for this cyst on my bile duct, and she said adding another one could just be confusing.

She told me my body is not ready for PT due to how sick I got at end of December, and to wait for a few months. I guess I think I am getting mixed messages, I just want to not always have the feeling of a knife stabbing me in the back.

Thanks for your input! At this point, any advice I will be taking.

I do understand not wanting to add another dr, but you also deserve to feel as good as possible. You may have already said this, but is your pain related to the cyst, or are there other problems? When you have surgery, is it assumed that the pain will be resolved? If that's the case, you may not need a dr to treat chronic pain. Hopefully your pain is acute and will improve significantly after surgery. I can see why your dr wouldn't want to add someone else in the mix. However, if it is chronic, I would want the dr to explain her reasoning. I call my medical team my "cast of thousands". The number varies, but currently I see 10 drs regularly. It can get crazy, but luckily they work very well together. Many of them are 3hrs away at a university research hospital, but they text and email me, and I have their cell phone numbers to give to drs if I end up inpatient. Yes-adding another dr is a pain, but it can be helpful. I would hate to think that you are missing out on better pain relief.

I agree with lexi-definitely call the dr and figure out what's the deal. It's frustrating when drs write 2-3, as needed, and other vague directions. If you hurt and 2 feels like it's not helping, of course you are going to take 3.

What I said for the days were estimates when, not exact I apologize.

My bottle that was prescirbed was filled on the morning of Jan. 14th when I went to see my Doctor. I got 60 pills on that day. I take 3 a day, but as I said nothing has been agreed upon on what she wants me to take. It did not come up when we talked on the 14th because I was also catching her up on my cyst. I ran out of pills the week of Feb. 4th. I am off a week on my schedule, I just got back from a week in Texas for my best friends wedding. I cannot remember the exact day, I want to say the last pill I took was on the 4th. Anyways, its been close to 2 weeks since I have taken something.

My bottle only says 1 to 2 tablets every 4 hours. It does not say any max dose. When I called and talked to the nurse today, seeing as I could not get in I brought that up. I told her I would like to get a max daily dose that the doctor is comfortable with me having.

As for the cyst, the cyst has nothing to do with my back pain unfortunately. about 4 months ago I woke up and I was brown. i was told my liver was failing and I needed a transplant. After a second opinion I was found to have a cyst on my bile duct that was blocking flow of my bile and it was backing up in my system. I had 2 stents put in on Jan. 4th and all my labs are returning to normal and my color is normal again. The pain I haev been dealing with for about 3 years, I was getting back into power lifting because I used to that in college. Stupid me, not taking into account I was 8 years older, I had 550lbs on the squat rack and when I went to stand back up I felt a really abd pinch in my lower thoracic spine. Ended up being an annular tear and a herniated disc.

Welcome SyXx to the Chronic pain forum. It looks like to me that your Doc is contradicting herself between what she is wanting you to do and what she is telling you to do and the only way to clear that up is to see her face to face,messages get you nowhere in cases like this.

I have one question here and that is asuming your Dr didnt get on the phone when you called the office to request a refill and the nurse/receptionist or whomever told you that was too much? Or did you specifically talk to the DR?

Far too many times I have seen the front desk person or the nurse take it upon themselves to tell you that is too much meds and not what the Dr actually says.

If she did not put a max daily on it then I dont see how they can say you shouldnt be out and in all reality a total of 15mgs of oxy per day is a drop in the bucket for most CPers,its not alot of medicine for chronic pain,the the way it is written sounds more like it since you dont have a base med on board and that is where having a PM Dr comes in. If this is something you are going to have to live with and it look as if you've already put in a fair amount of time in pain getting on a long acting base med is going to be much better coverage for you.

Here is the thing, regular Drs,primary's,internal med,PCPs they dont like to write those meds and its worse with all the hoopla over opiate abuse going on and the powers that be trying to get better control. I also think with your liver troubles some of the base meds or LA if you will,would be healthier for you. Short acting you take a pill,takes time to work,starts wearing off and your in pain again,take another same thing,no even steady coverage just ups and downs with med levels.

Anyway, If I were you she would be seeing me to get this ironed out and talking to me about that referrel and sooner is better.

Good luck and sorry you had to visit here in chronic pain but glad to have you!

Vickie

I think maybe the nurse is telling you one thing, and the doc another, and thats where the confusion is.

The doc is the one who decided how many pills to give you, and she decided the frequency/number of pills you could take in a day.

If you talk to her, and indeed the nurse is the one who said that three a day was too much, and the doc clearly says something else...then thats something you need to mention to your doc.

Everyone needs to be on the same page when it comes to patient treatment. It's not safe if there is a difference in opinion or differing instructions being given to patients.

Glad you got things straightened out....

This thread is a VERY important one for many to read to show that what is written on the bottle is NOT always what the Dr. expects you to take.

It just shows how imperative it is to get the Drs. exact instructions and how long they want that prescription to last. Most Drs. prescribe a 30 day prescription as it seems this is what your Dr. is saying as well. And as you found, that is much different than what the actual bottle reads.

So we appreciate you sharing your story as it really is something that anyone that is new to pain medication or any type of controlled substances should discuss with their Dr.

Hopefully the physical therapy will be able to help lower your pain levels as well.

Are you prescribed any type of muscle relaxer to take as needed? How about an actual nerve pain medication? These are also types of meds that many of us with spine issues are on to take when needed.

I, personally, like going to a PM Dr. as they are the most highly trained and dedicated in the field of helping those with chronic pain.

Which injections were hurting your liver? If it was the steroid ones then you should be able to get some of the trigger point ones with just lidocaine. There is also nerve ablation procedures that can help some.

And congrats on the weight loss! It usually starts to make an effect if because of that weight loss, you are now more active and exercise each day (walking, swimming, stretching)....This is where the PT can help you develop a good plan to do on your own at home. It's so important to stay mobile and as healthy as possible to protect the rest of our spine.

There are also other modalities like acupuncture, ice, heat, massage, a TENS unit, biofeedback, counseling, etc..

I've had spine issues for almost 12 years now and even after 3 fusions, I still do every single thing I can both medicinal and non to help keep my pain levels at about a 5 (goes to 7 on some days depending on the activity)...

By using as many things as I can to help keep my pain at a decent level, this keeps my opiate dosage low as I'm not just relying on it to do all the work.

Let us know how the PT goes:)

Thanks for sharing more...

The good news is that you have everything worked out now with this Dr. on how much to take each day:)

And as far as other modalities I mentioned, working with your Drs. on each issue when you can seems like a good plan you are following...

Hope you keep posting and letting us know how each appt. goes!