Frustrated with Pain Management

Hi everyone, my name is Charlie and I am new to the site.

A little about me: I am a 30 year old male with a herniated disc, Ankylosing Spondylitis (an autoimmune disorder like Rheumatoid Arthritis but AS attacks my lumbar spine, hip, knee and ankle joints) as well as Sciatica.

I have been going to a Pain Management clinic for almost a year now and everything started out well. My first few appointments were with an MD, but getting an appointment I can go to with him has become next to impossible. So, I have been seeing one of his two Physician Assistants. Normally, I do not like to be seen by PA's because in my opinion, some of them lack the experience that an MD has and delay treatment or are not willing to do very much. However, I have been wanting to build a medical rapport with this doctor/clinic and so I become comfortable with them and vice versa.

The doc first prescribed me 7.5 mg Percocet and asked me to do a series of steroid injections over the course of three months, which did nothing, but I understand his course of treatment. I was then bumped up to 10 mg and it seemed to be working just fine until six months later and a career change. Due to a downsizing, I had to take a different job that was more physical and required me to be on my feet a lot longer resulting in a lot of breakthrough pain. During my last appointment with the PA, I explained this and offered the solution of increasing my dosage from every six hours to every four hours. She was not willing to do this and said that I needed a long acting medication and keep the Percocet where it is as breakthrough relief.

I reluctantly agreed and she gave me MS Contin 15 mg. I absolutely HATE the MS Contin!! It does not work, it makes me very drowsy/sleepy and I am pretty sure that there is something in the long acting part of it that makes me nauseous and itchy! I have had IV Morphine before in the hospital and never had a problem. I gave it the benefit of the doubt and have ridden it out for a little over a week hoping that the side effects would subside when my body adjusted to it after a few days but no such luck.

Here is my problem: I do not want to go back to this PA in another 10 days at my scheduled appointment and have her A) want to keep me on this med given the side effects and tell me to ride out the side effects or B) want to increase the dosage because I said it doesnt work.

I have done a TON of reading online and I have come across a lot of people who share my views about MS Contin and how they hate it and say it is not nearly as effective as Oxycontin. I am tempted to call and change my appointment to the other PA (who I have heard good things about) and see what she is willing to do for me.

Anyone have any thoughts/ideas/comments?? Any and all feedback would be appreciated!! Thanks!!

Hey tallcharlie.Welcome to H.W.

I'm in Pain Management also and the most my Doctor is willing to write,it seems,is 4 Norco(HydroCodone) 10 mg a day.

120 Pills is all my Insurance will cover.

The Pain Management I was at last year had me on 2 ER Meds a day plus 4 breakthrough pills.And she didn't think medicines with acetimenaphen(sp) belonged in Pain Management.She was shut down 2 Months ago.

Doctors in the N.E. AL City I live are scared to prescribe anything effective.

After 5 months of asking for an increase I've just given up and tell them"Yeah,I hurt.But that's just the way it is."

If they're willing to put you on an Extended Release Med it sounds like they would probably be OK with changing it.

My experience,it's usually not good to ask for a specific Pain Med,unless you're asked what has worked in the past.

I've been at this Pain Management for 8 Months and today was the 1st time I've seen the Doctor since the Initial visit.That was just because he had to go over the results of an MRI with me.

Take care.

Rick

Thanks everyone for the warm welcome and positive feedback.

I am pretty sure I will keep my appointment and go in with an open mind.

I have been fighting depression and anxiety over the past ten years and I have had some ridiculously frustrating experiences with Nurse Practitioners and Physicians Assistants who do very minimal and are very dismissive. After years of fighting and waiting, I finally got in with a Psychiatrist and within the first few appointments, he had all my problems addressed and had me on the correct medications and they were all working. It is amazing what a properly educated and experienced professional can do.

Because of that, I may be a little biased and afraid of what she will/will not be willing to do. Bottom line, I do not like the MS Contin and I will be adamant about not wanting to continue it, however I will leave it up to her as to what to put me on next. I have done a lot of reading on other medication forums and have come across a lot of other people who are on or were on MS Contin and said that it either did not work or they had adverse reactions to it as well. I have also read that there are some formulations, depending on manufacturer, of the time release portion that causes an allergic reaction or side effects similar to what I have been experiencing.

Thanks again!!

Post Edited (tallcharlie) : 9/29/2016 9:21:03 AM (GMT-6)

Charlie:
I think you will do well in your follow-up appointment.

Be firm and explicit to the nurse practitioner as to how the MS Contin is affecting you.

I always type a one-page bullet-pointed summary of my primary issues and needs prior to each appointment and hand this to my MD at the start of each appointment. I am more fluent in writing than in talking and this helps make sure that the appointment does not get sidetracked.

I share with you skepticism of medical practitioners. I have received more poor care than good care and have been misdiagnosed and prescribed medication at improper doses - leading to serious consequences. Never has a single MD said a simple "I am sorry."

I cherish that the internet has made available medical journals and publications that have made me a much more informed and knowledgable patient. I appreciate the blossoming of support groups and forums, such as Healing Well. MDs hold much less formal power over patients than they once did.

Always feel free to use this forum as a sounding board. Sometimes it helps to simply state how you feel . . . to express one's true feelings . . in order to find a better place both physically and emotionally.

You are on the right pathway. Continue on. Best wishes.
- Karen -

Straydog made a good point that Seashell made in her Post about making the most out of our appointments.

I get 15 minutes at the most,every 2 months,to talk to a NP/PA(?).

If I had something that was effecting me a lot,then I've got that one small window of time every 2 Months.

Take care.

Rick

Post Edited (tidalmouse) : 9/30/2016 2:55:15 AM (GMT-6)

You mentioned depression. Just wanted to also point out that sometimes antidepressants can also help with pain -- in fact some, like tricyclic antidepressants, actually do more to help pain than to help depression. I was having a really rough go of things & have horrific reactions to almost every single medication on the market (not just pain meds & psych meds, but antibiotics, hormones, pretty much anything). But after trying who knows how many options, I found that for me, Paxil actually helps with my stress/depression & also gives me about 3-4 hours of decent pain relief in the morning. Not saying that would definitely work for you. Every person's body chemistry is different -- just encouraging you to try different things & not give up.

Also, just because MS Contin maybe isn't a good match -- or is going to require a period of adjustment -- doesn't mean that the only other option is breakthrough pain meds. There are plenty of other long-acting meds on the market. If the PA's aren't cutting it, then I agree that scheduling an appointment with the MD is the way to go ... just be prepared that doctors really don't give a flying leap whether or not we're able to hold down a job or buy groceries this week or whatnot. Their main concern is our health. If your pain is causing you to be so ill that you can't sit up, are wetting the bed, vomiting on yourself & can't keep down fluids (I've been there), then pain meds are an appropriate option because the alternative is a serious threat to one's immediate and/or long-term health. More & more, it seems there just aren't PM's out there willing to prescribe pain meds just so their patients can go to work & support ourselves & our families. It's a really harsh truth and I'm sorry to be the one to tell it to you, but with all the vilification of pain meds going on, I think it's only likely to happen more and more in the coming years.

Hi there- I will just share that I cannot tolerate any form of morphine except the true extended-release capsules. Other forms, including MS Contin, cause me extreme nausea and itchiness.

I can take the extended-release capsules before bed, so that I will sleep through any initial sedation, and then have pain control through the rest of the day.

I feel thankful that I can even get these capsules, because all other pain meds cause bad side effects for me - methadone, fentanyl, dilaudid, oxycontin, and all regular forms of morphine.

Good luck!!!