Doc just denied darvoset refill...t-minus eight pills to pain

Listen, I know that even being a mild narcotic, physicians have to be careful about prescribing and refilling without discretion, but I have seen such a difference in the way the way that different people are treated for their pain by their specialists. I have only been on darvoset for about a month, and it has really helped me cope during the day at work. When I would otherwise have to go home and get in bed to calm the pain in my gut, I could take a darvoset and at least finish out the day. I take an average of 3 a day, which in nowhere near to the extent as the rx allows (1-2 every 4-6 hrs as needed). It's the weekend thank goodness, and I am fine as long as I don't have any responsibilities, but the work week is rough on me and I have pain most days at work. Has anyone else dealt with this? I don't want to tell my GI how to do his job, but if he's not going to do it maybe I need to find someone that will. Is this his job? Does anyone see a GI and a pain mgmt specialist? Maybe I need to find someone that is more experienced in treating chronic pain with different qualities.

I am sensitive to the possibility of addiction. I have a family history of substance abuse, and do not want to go that direction. My ex-girlfriend, who has chronic pack pain and has been taking vicodin for the last couple years, was recently give a rx for oxyconton for her pain by her specialist. I begged her not to even fill the rx cause she just came off the vicodin and had a real hard time with it. I just think it's bizzare how some people are being given legal heroine for their pain, and some are being told to gut it out.

I haven't even bothered to ask my GI for pain meds. He's made it very clear that he doesn't feel they are "good" for Crohn's patients. Evidently, he says they deter healing. However, as a patient, I cannot stand to feel the pain. It's more than a pain tolerance. It's a continuous reminder of being sick. It interferes with work and day to day life. When I take the pain meds (not at all in excess), I am more able to go about my life. As you put it -- it helps me cope. So, I have developed a relationship with a family doctor who prescribes Vicodin and Ativan as I need them. I know he is watching my usage, and that's ok. I also know that by taking 2, maybe 3, per day during these really bad times, I am not abusing them in any way. It's a fine line that I know they need to walk. But, I also get frustrated. Tylenol just doesn't work. If I take aspirin or Ibuprofen (which I occasionally do just because I don't want to take more Vicodin or tylenol), I bleed even more. It's not fair to ask us to deal with pain and discomfort. They can just moderate us and watch us. That's my thoughts, anyway.

I take pain meds and my family doc RX them for me
Like Nanners my GI is very hesitant to rx the pain meds.......

If I need to take them I do plain and somple as I will not live in pain and not function
IMHO no one desreves to live in pain but it is up to that person ........Take care....Lyn

I would ask your doc or see a pain mgmt spec

BTW..I was on Oxycontin I am taking MS Contin now but I take the dosage RX and I am able to cope ....I wish you all the best.......

Mark, before you address the issue of how to get pain meds, I think you need to come to terms with the use of them. Once we have used narcotics for a long time, our bodies become DEPENDENT on them and stopping treatment will result in physical withdrawl.

DEPENDANCE is not the same as ADDITION.

Your girlfriend built up a TOLERANCE to the Vicodin she had been taking for several years. This meant that she needed to be prescribed a stronger narcotic in order for her to obtain the same level of relief.

TOLERANCE is not the same as ADDICTION.

After several years, she NEEDED that increase. In fact, most people with Chronic Pain are better off with an extended release medicatoin like Oxy which allows us a minimum of 12 hours relief without having to pop pills and wait for them to kick in. Often, these meds cut out the constant ups and downs we get from the shorter acting meds and this alone can help reduce overall pain by keeping the pain level from shooting up as it does when the 4 hour med wears off.

By the time I got Dx, my Primary was already giving my scripts of Vicodin to help with the pain, so I never really asked my GI for pain meds. As you can see from other replies here, GIs don't like the use of narcotics and many use the excuse of their constipating effects as the reason. Although there are some Crohnies who suffer primarily with constipation, most of us do actually benefit from these constipating effects. I certainly do!

When my joints got bad, I discussed the issue of pain relief with the Rheumy who had just Dx me with Spondylitis. He gave me some samples of Ultracet and said he wouldn't give me anything stronger. I already knew I couldn't tolerate Ultram because I had a paradoxical effect from it. Where most people would become sleepy, I got the inability to sleep.

I got to the point where I was tired of the Vicodin wearing off and suddenly finding myself in excrutiating pain so I called the Pain Mgmt Center at my local hospital. They have been wonderful and I honestly believe that anyone who suffers from chronic pain be treated by a paim Mgmt Doc. You wouldn't have your Primary treating your Crohn's would you? No, so why have GI treat pain?

The issue of Pain Mgmt is vry important for several reasons. First, these Docs are specially trained to know which meds will help the most with different types of problems. Second, they understand the differences in the words I used above: DEPENDANCE, TOLERANCE and ADDICTION. They know how to appropriately treat the first two and avoid the last. Thirdly, once you become accustomed to some level of pain relief from narcotics, you need to carefully address any new pain issue which might arise.

For example, I have been taking 40 mgs of Oxycontin twice a day for about 3 years. I also have a script for Noroc to use when I have breakthrough pain. In several weeks, I am going to have some extensive dental work done. I wouldn't even consider asking the Dentist how to treat that pain because I am already taking more narcotics than he would ever prescribe for a patient. So what am I going to do about my post-op pain? I discusses it with my Pain Doc and was told to take an additional Norco and was prescribed Dilaudid in case I need it. Now I know that I have a way to treat the pain when the time comes.

I hope that you can work something out with your Primary Doc so that either he will prescribe for you or will refer you to a good Pain Doc. Everyone DESERVES treamtent for pain. Don't give up until you get it!

I've been lucky so far. Prednisone has cleared up 90% of my pain. My CD symptoms also include very harsh lower back pain, and mild/moderate pain in most of the joints in my body. Unfortunately, I have a job where the strongest pain meds I can take are ibuprofen and acetaminophen. I feel like I have a mild case of the flu non-stop. Just last week, my GI prescribed Ultram ER to help me deal with the remaining lower back pain i have at night. OMG, it has just been unreal the difference. I have zero pain at night now, and can sleep 8 hours straight, waking up in the same position I went to sleep in. Haven't done that in years.

So why the long diatribe? It's all about quality of life. Please excuse the language, but screw dependency. If a person's quality of life is being degraded because of pain, then whatever they need to take to deal with it is fine, IMHO. Even if it means addiction. Going through life in pain with low quality of life is far worse than an addiction to prescription pain killers. My mother has severe RA. She suffers every day. Needlessly, IMO. She's so afraid of "getting hooked" that she doesn't take any pain meds at all. Honestly, is that any way to spend the sunset years??? I would just love to throw her a bottle of Oxycontin, and tell her to get busy. Life is hard enough, why do we insist on putting this huge stigma on things that can make it tolerable for those in pain? I'm not saying that everyone in the world should have free access to morphine, but those that are in pain should get the relief they need, even if it means an addiction. I dunno, maybe I've seen one too many episodes of House, but anyway... it often seems like too much emphasis is placed on "addiction", and not enough on Quality of Life.

Crohn's Daddy - YOU TELL'EM! Way to go! I hope that somewhere along the line, either you or your mom's docs can convince her to try some sort of pain relief. Perhaps the new Ultram ER would be something to start with since it's not technically classified as a narcotic??????

The problem really is in the stigma that had previously been attached to narcotics. Your Mom grew up in an era where people just didn't use pain meds. Doctors were Gods and the Gods were afraid of having addicted patients. Younger Docs are more likely to prescribe narcotics for the treatment of chronic pain and older Doctors are more likely to tell a patient that they just have to learn to live with their condition. Isn't that a shame?

In any case, I'm glad that you've finally found some relief. I would suggest tho that you consider a complete evaluation froma Rheumy since you have a family history of RA and also have Crohn's. It's possible that your back and joint back is from Spondyloarthropathy (SpA), which is an inflammatory arthritis closely related to IBD.

 

Oh - and I'm all for the quality of life argument, too. I know some are scared of things like Remicade and Humira (and pain meds) because of the (small) risks and what ifs. To me, it doesn't matter much. If my life consists of being in the hospital on a clear liquid diet, then it's not a life I want. I'll gladly trade the small risk for the possibility at a fulfilled normal life. It's never been a hard decision for me to make, honestly.

Keah said...
Crohn's Daddy - YOU TELL'EM! Way to go! I hope that somewhere along the line, either you or your mom's docs can convince her to try some sort of pain relief. Perhaps the new Ultram ER would be something to start with since it's not technically classified as a narcotic??????

The problem really is in the stigma that had previously been attached to narcotics. Your Mom grew up in an era where people just didn't use pain meds. Doctors were Gods and the Gods were afraid of having addicted patients. Younger Docs are more likely to prescribe narcotics for the treatment of chronic pain and older Doctors are more likely to tell a patient that they just have to learn to live with their condition. Isn't that a shame?

In any case, I'm glad that you've finally found some relief. I would suggest tho that you consider a complete evaluation froma Rheumy since you have a family history of RA and also have Crohn's. It's possible that your back and joint back is from Spondyloarthropathy (SpA), which is an inflammatory arthritis closely related to IBD.

::Blush:: I do tend to get passionate about this subject. I've seen Mom (and others close to me) suffer from severe pain needlessly. Mom is currently taking Ultram ER. I told her all about the stuff after I had tried it and researched it on the web. It is giving her at least some relief.

Yes, I really do need to do a full workup at a Rheumy, but if I did, it would mean a bunch more time off of work. Time that I just can't afford to miss right now. It's lookiing like I'll be able to return to work next month after being out since October 1. Anxious to start supporting my family again, so the Rheumy visit is going to have to wait.

CD *WILL* certainly qualify you to see a pain specialist. I only got a suggestion to try that route last summer. Fortunately, my pain doc has 2 days a week allowed for walk-ins. Well, they did the workup & my joint & back pain is now (mostly) controlled.
Do try this if needed, it can make a world of difference!

Sincerely,
Matthew

Crohn's Daddy, could you get in to see a Rheumy before your expected return to work? There's still 2 weeks left of this month. Just asking because I really do understand about putting off MD appts and tests that NEED to be done due to my own responsibilities at work. By the time I finally had to stop working, I was so sick. In hindsight, I am amezed that I lasted as long as I did. Besides the Crohn's and Spondylitis, I was also in thyroid failure thanks to Hashimoto's Thyroiditis, yet another auto0immune disease. Sigh.

FYI Ultram ER is often initially prescrobed at 100mgs per day, but it can be taken at 200mgs or even 300mgs. I'm glad your Mom is finally getting some relief, but if she's on a lower dose, there may be room for improvement. (I just got my Mom up to 200mgs & working towards 300 soon, I hope)

I think that each of us should have the lattitude to decide on the risks of pain medication.  I've had crohns for years.  At 68 years old, I'd rather be addicted than live with the chronic pain.