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How do you "approach" new meds/procedures suggested by your doctor?

JessaJJessa Posts: 22
edited 06/11/2012 - 8:31 AM in Pain Medications

Two questions really --

1. When your dr. recommends a new med to you, what is your response? Do you come to the forum to ask about it, do you start taking it, no questions asked? I'm curious about how other people handle this issue.

2. If you decide you don't want to take the med (could be a risky procedure as well) your dr. recommended, how have you handled this situation? There might be side effects you doctor is either unaware of or discounts (like weight gain), or there may be research that suggests the med could pose short or long term risks to your health - Your dr. might not be aware of the research or might disagree...I think this 2nd issue is more critical in pain management b/c CPers can be cast as uncooperative, drug-seeking, not trying to do everything to possible to reduce their pain using meds and methods other than opioid based meds, etc.

I'm interested in how people address these two inter-related issues - particularly the 2nd one, since it's a difficult situation; you and your dr. disagree about the best way to approach your health care.

My thoughts follow -- I orginally wrote this as a response to someone else's post and realized that I was interested in how other people approached these issues in PM - especially since being well-informed or knowing "too much" is sometimes viewed with suspicion by PM doctors. Also, being unwilling to try everything recommended is a way to show that your are "real" pain patient rather someone who is just interested in meds. I've written about how I resolve the first issue, which seems like the easy part to me, but I don't think I have a lot of strategies to handle the 2nd issue. I'm interested in how other people deal with these issues.

When everything is going well (ie, in an ideal world and I am not slammed for time, in horrible pain etc,
1. I research the med on a couple reputable med. sites, and try to find out if any new research of interest has been done.
2. I look at forums to see what users say about it.
3. I search for reports of withdrawal symptoms with the med (regardless of what the doctor says. At least I know the range of possible responses to the medication even if I don't have the idea how often people experience what has been posted.
4. I might also ask my pharmacist, but it seems like I can get much of the information he has acccess to on the internet.

I think the reason I go to all this trouble now (that is, when I have time) is b/c I have lost so much time and money from taking meds that had side effects, short or long term effects, or cause withdrawal - none of which my doctors told me, even when asked. I'm not talking about the majority of times my doctor has prescribed a medication for me - it usually goes well. I'm talking about the times when it doesn't.

I wish my doctors had said, "I'm not sure, let me look that up. .," but I realize that isn't part of the culture. I also realize that they really don't have time to memorize the short and long term effect of every med they prescribe or read up on the latest research. Some/A lot (?) of the info they get comes fro pharm representative whose self-interest isn't to present the pros/cons in a balanced way to doctors.

I have not, however, figured out what to do about disagreements with my doctor. So, far, this hasn’t been an issue with my current doctor, which I appreciate. It has, however, occasionally been an issue with other doctors, and I’m curious to hear how others have handled (or not), these sticky situations (as well as how you approach new meds/procedures.)

Thanks, Jessa


  • IMHO: We go to a doctor for help. From your symptoms, history, they try to suggest a good course of treatment (drug - type & dose, PT, injections) that might be appropriate. Are they going to nail the best treatment every time? No, and they may be biased against one drug, for example, if several of their patients had horrible side effects, but they ARE acting in your best interest. They don't have crystals balls, they will not be able right off the bat to come up with the right program (and as we all now, that program changes over time). The point is you do have to trust your doctor, much moreso that you trust anyone on this website, or you need to find another doctor. If no doctor makes you happy, and you've been to a few, look inside yourself and wonder whether your expectations are unrealistic. There is an "art" to medicine. I can tell you the longer the relationship with one doctor, the more mutual trust develops, the more input they will want into want you think they should prescribe, but be able to explain why. SuzieQ on the internet tried it doesn't fly.
    On the flexeril: I would have called her up and say "flexeril didn't do well by me before because of XYZ", is there something different about this new formulaton?" (sometimes there is a huge difference in efficacy of ER meds and decreased side effects). If your cost is sky high, ask her if she can get samples since you did have the past bad experience. Just thoughts.
  • In my experience doctors are only human, can 'get it wrong', don't know everything but, in the main are always trying to act in the patients best interests. I do believe a lot of the time, it is trial and error - try this medication and if it does not work, or the side effects are too great, then try another one.

    My regular doctors know that I am internet savvy and will research medications, treatments, etc, and that I am very well aware that every drug has some form of side effect somewhere along the line.

    So, in answer to Q1, yes, I do research the side effects of all medications I am prescribed: I ask my doctor to explain the side effects; I read the leaflet that comes in the box (but these can be hard to understand sometimes) and I research on the internet the side effects.

    In regard to your Q2, if I am simply not comfortable with taking a particular med, I will tell my doctor NO. For example I refused to take Lipitor to reduce my cholesterol for several years and found other natural ways to bring it under control, which I did do.

    Keep positive!


    ...an old timer here and ex-moderator

  • Hiya jessa :D , Welcome to Spine health forum >:D< In My experience its about how much faith you have in your doctor :? and if you believe he/she is giving you the best treatment :S , based on the knowledge they have :B , that is givin by the patient :SS . Even if the docotrs are giving you the best medication based on the symtons that you give them 8> , it is still trial and error because each patient can react diffently to certain treatments :& . I do have alot of faith in my pain management team as they seem to be working to there best ability for me :? , not just for the pain but also on the psycological side of things to :D . But saying all that i do still research any new medication that i am given :B , but i do take it as the pain is so bad not to ~X( . I hope this input helps in some way >:D<

    Angie :H
  • For the most part I simply do what you do. I do research to see what has been reported and what to watch for.

    I do not recall refusing to try any med. I simply try to indentify what warning signs to looks for and try it. In my case I have suffered from chronic depression for 10-15 years before I got these last injuries. I have often considered that I could not function as-is so anything was worth trying.

    I have now been through so many trials that I say no a lot more often. Since I have allready taken many meds I can truthfully say, "no, I won't take that one, it does XXX".
  • I agree with what everyone else posted- I trust my doctor and in his judgment as far as treatments and medicines are concerned. If he says let's try this med, I go along with it and I'll ask the pharmacist about it and look it up on the internet. If I have any trouble with it, I'll call if it is really bad. I understand with this type of medication that I'll have the usual side effects like drowsiness, nausea, maybe vomiting, constipation and dry mouth. Also, I know that it will subside in time. But if it's too much to bear, I'll let the clinic know right away.

    They also know what meds I've been on before and if I had problems with it. This goes for procedures as well; I have turned down the option of having epidurals before because of my history of not doing well with them.

    It is all about the trust that is built up over time, and it's also important that you and your doctor are on the same page and have the same goals in mind. To sum it up, I just go with the flow as reasonably possible ;)
  • Forgive me for saying this, but you aren't making much sense. First you say that you have trust issues with your doctor and then you turn around and say that you are happy with your current doctor. If you have trust issues, then how can you be happy with the same doc and why would you continue to trust your care to said doctor?

    For a new member you certainly have lots of experience, navigate and manage the forum quite expertly. You've obviously been on many a forum and do lots of research. So I am assuming that you are coming here looking for a place to vent and possibly find some elusive answers?

    I think the feedback you have gotten so far in this thread and others, has been good and I applaud the members for taking the time to answer you in such a well thought out manner.

    Being an advocate in our own health care is paramount, however one thing that I always have to keep in mind is that I have not attended years and years of medical school and seen countless patients with a variety of problems and seen countless reactions good and bad to specific drugs. Yes pharmaceutical companies pitch their medications to doctors and some doctors will get on board with them on certain drugs. Bottom line is that all drugs fall into certain classes as to what they are or are not used for. Doctors select drugs based on that and based on their experiences and based on a patient's history. They don't just blindly prescribe based on the latest pharmaceutical rep that visited them.

    If you have trust issues with every doctor you come across, you may never be satisfied with your health care. I don't think there's a magic answer for that no matter how hard you look and where you look.

  • Even if I have a deep, trusting relationshp w/ a dr.,he or she has constraints on his/her time that don't have anything to do with trust. He can't keep up on all the latest studies & research- perhaps a few doctors do, but they just don't have time. Pharmaceutical companies & insurance companies influence the doctor in ways that may not be in my self-interest. I'm not suggesting the dr. consciously acts in a way that he thinks isn't in my self-interest. I'm just saying that my interest in my long and short term health is greater than anyone else's , including my doctor, who is subject to other influences and demands on his/her time. To me, taking care of my health means staying informed about the medications I take and the procedures I undergo, and not placing blind faith in a doctor who, as one poster, I think Bruce, said, is human and can make mistakes.

    I need to read the rules thoroughly, but the was an editorial in the NY Times recently about "patient-centered" health care. At some point I will check to see if posting a link to the article is allowed. I' under some time pressure today and allowed myself to get carried away w/ posting. I thought the idea sounded great but I can't see it happening in today's medical culture. I'm afraid that until I find the link and find out if I an post it, I should probably wait to say more.. I think that the description of it might clarify my vision of an ideal relationship between doctor and patient.

    Doctors in whom I have placed my trust have not always made decisions that I thought were in best interest of my short or long term health.On the other hand, I have had some great doctors.

    I am happy with my doctor at the moment and I feel like I can bring up anything I want though there is a very good chance that my doctor won't have any interest in it!

    In an "ideal world," I would be looking for a doctor patient relationship where we could talk about a jointly constructed long term health plan, talk about some of the latest advances in research and consider incorporating them into my care after talking about pros and cons. We'd also talk about how to best care for myself so that my problems don't get worse (or talk about how to slow down the ddd process)...But, I'm pretty happy with things now - As long as I'm not taken by surprise and by an unexpected side effect that resuts in me being unreliable and unable to work, or taking a medication that has risks I'm not aware of, I'm ok.

    Anyway....perhaps more on this later! :-)
  • Bruce,

    I guess I would say that I am on the same page as you are... Or, I should say that I agreed with everything you said.

    I alluded to an doctor/patient relationship in an "ideal" wold, but I think we're pretty far from that at the moment.

  • If 'knowing too much' is viewed with suspicion by PM's then I would have been in trouble from day one,and you are already under suspicion.

    Since this is not an "ideal world" in which we live,I do the best I can with my Dr.I don't just take any medication that my Dr/s suggest,and I have refused to take some because of the side effects.Same with procedures.

    In answer to part 2 of your question-discussion,and honesty has always been what works for me.

    I can't be concerned with how I'm percieved every time I walk in the door of one of my Drs.offices~To me that seems beyond paranoid.Worrying that he may think of me as a drug seeker simply because I have a small amount of intelligence is bogus..and I doubt it if anyone has to be concerned with that if your Dr knows you at all.

    It may true if a patient refuses any treament beyond opiates(to be seen as a seeker),but I haven't met a CP patient like that in my entire life.

    Jessa,are you a Dr? Because I saw you answer in another thread and after a sentence you ended with(at least not by this Dr)

    Just wondering?
  • For over 10 years (1983 - 1994) I'd worked in a large city hospital...6 of those years I'd spent as an E.R. Emergency Medical Technician (acute care) and the other 4 years as a Hemodialyisis Pt. Care Technician (chronic care), so that encompassed both sides of the fence.

    I can tell you that the BIGGEST warning sign that sends up "red flags" to Docs in regard to "pain med seekers" is when patients come in with a self-diagnosis...ALONG WITH treatment recommendations to Docs that include specific types of pain medications. I myself had seen it happen at least 100 times, where a patient came into the E.R. with a specific ache or pain, whom then also told the Doc what was wrong (i.e. a bad ankle or knee sprain) followed by "I think that some Percocet or Vicodin and ice packs would work well for me" and that was all it took for the Doc to catch onto what the patient was up to. 9 out of 10 times the patient would also argue with the Doc if they'd mention any treatment plan that didn't include pain meds and yeah...sometimes the patient would get downright ugly and verbally abusive with the Doc if their exam didn't reveal a physical issue that required/warranted the use of narcotic pain meds as treatment.

    It's understandable that patients whom are in "chronic pain" would have some understanding of their physical issues (and be expected to relate that during a Doc appointment), and that they would also know what works well 9or doesn't work well) med wise...but demanding that a Doc prescribe a certain med or specific dosage is a HUGE mistake.

    We all have to let the Docs be the Docs while we remain the patient, or we're going to end-up not only frustrated...but also in possible pain that wouldn't have to be necessary if we'd just went with the flow and not over-stepped the boundaries of patient/Doc relationships. Like we have to learn to trust our Doctors, they have to learn to trust us as well...and questioning (or arguing) their med prescribing decisions is not going to serve to earn their all important trust...but will in fact do just the opposite.

    Just a word of advice from someone who's been on both sides of the issue.

  • I agree with what most everyone else said on here! When I get home, I research the heck out of everything and EVERY doctor I have had so far actually appreciates that I take the time to read about the meds and appreciate that I am knowledgeable about them as well as my health. I don't know why that would be a problem unless you start saying you want THIS SPECIFIC NARCOTIC! That might be a problem. I always remain fairly open-minded, but I've told my doctor after having tried methadone and gabapentin/neurontin that I won't take those anymore because of x, y ad z. My doctor and I discuss things, the way they are, my lack of money and insurance, and how we can try and approach this problem that is mutually satisfactory. Sometimes he will tell me no, but I'm not going to fight him, he is the doctor and I am the patient. And sometimes after a month or two he actually will change his mind about the former suggestion.

    They do what they can, it's hard for them too, with the drugs we need being "in vogue" and the DEA breathing down their back as well!

    Not to go off topic, I wish those jerks who take this stuff for fun had to live with some of our pain for a while- and only we would know when we would yank it out from under them! MWAHAHAHAHAHA
  • The ER is a totally different story.The few times that I've been to the ER I didn't ask,or think to ask for anything.IMO,when a person goes into the ER and is well enough to ask for something...they probably shouldn't be there in the first place.

    I've only been to the ER a few times in my life(for myself),and once was with spinal menengitis-where I was admitted,the other times were shoulder dislocations,concussions(admission),etc.These things speak for themselves and I didn't have to ask for anything.

    I would think that most CP patients wouldn't be part of the type of patient that you are describing.
  • i do research when i get home. the internet gives far more info on drugs than the pharmacey. there is one drug that I would refuse if it was suggested only because i know of a family member that is going through a terrible time after taking it for a couple of months. unfortunatly lyrica can cause memory loss and sadly this is happing to a family member now off the drug is fine but has lost memories that may never come back. this person is now on other drugs to try and help with memory now as they do not know the extent of damage. no one told her about this possible side effect we started notcing it shortly after she started taking it. although it was the one thing that helped with her pain she nows suffers and is afraid to try anything else. i know drugs effect people differently but because this person is related i would never try this.
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