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Update Pain Mgmt Appt 1st time Drug tested

MingMMing Posts: 1,127
edited 06/11/2012 - 8:40 AM in Pain Management
I haven't wrote my own post in a long time so I thought I would give you and update as to what's going on.

Today I went to my monthly pain mgmt appt and when I got there she handed me a cup and said I need to be drug tested. I wasn't totally shocked cuz I signed the contract the first day of my appt. I wonder what prompts them to decide when to give them. They acted kind of funny towards me until the results came back. I wasn't sweating it cuz I don't misuse my meds or take anything other than what I've told the doc. Nothing more was said to me about the drug test. She also did a pill count but she does do that almost each month.

I was wondering if it was cuz I asked her about letting me try oxycontin last month. She said that she doesn't like to prescribe cuz it's addicting. Doesn't she realize that mscontin, hydrocodone or any of the other pain meds could be addictive if you let them. Like I said before I take misuse my meds or take more than what I'm prescribed.

I also asked about another EMG cuz last one was Feb 2009 and it seems the nerve pain in legs is worse than last year but I only notice it when I'm standing or sitting so it could be something pinching the nerve but that it's not completely damaged. I will find out in 2wks.

Monday 1/11/10 I am getting my 2nd ESI and praying and crossing my fingers that this one will help alleviate the pain somewhat. Last months ESI caused an increase in pain.

Tuesday 1/12/10 I have an appt with the neurosurgeon I went to for 2nd opinion after surgery and was still in a lot of pain. Pain mgmt doc suggested I discuss a stand up MRI with him on Tues so I will talk to him about that.

I'm also having trouble sleeping again so I've been staying up until 2-4am, wake up at 6:30 to get kids ready for school, go back to sleep around 9am until 11 or 12.

I will keep you posted on how I make out with each appt. Sorry this is so long. I got to get off the computer cuz I promised myself I will get off earlier than 2am and put myself to bed whether I'm tired or not.

I hope all you other spiney friends are doing well. Thanks for reading my update and feel free to contact me with any questions, comments, concerns or if you just want to chat.

God Bless all My Spiney Friends,


  • Michelle,

    THanks for the update. I don't go to pain mgt,but sounds par for the course from friends that use pain mgt. Especially if you request a change in meds. All narcotic pain meds are addictive. So that comment from her is surprising considering what you take now. I would think a change might be good to keep you from becoming immune and requiring higher dosages to get relief. But far be it from mortals to question Drs or their staff (sarcasm). I hope they help you one way or another. Gwennie did post an interesting topic on the standing sitting mri. Might want to dig around for it before discussing benefits or waste of time for you.

    Best of luck and keep us updated,
  • The only place I have heard about drug testing for this type of pain management is on this board. I just wondered if it is something that is required state by state, or if an individual doctor or clinic that decided to drug test. Anyone know??

    Were you warned at the beginning of treatment that you would be drug-tested?

    I just noticed Traci's comment. Last week, I went to a neurosurgeon from a well-known neurosurgery clinic. I went armed with two MRIs: one "positional," and one lying down. Much to my amazement, the surgeon did not look at the positional one and when I asked about it, he dismissed the whole technology as "a gimmick." He wouldn't even take a quick look at it -- even after I told him why I thought it explained what was causing my pain.

    I had trouble getting the standing/positional MRI to begin with. Neither of my two surgeons would order one, initially. After many months, my current surgeon finally relented and decided he would fax in an order when I told him I was going to Minneapolis and wanted to have one. (They are not available in my city -- long story).

    So I mention this because there is a certain prejudice against positional MRIs among many surgeons. Particularly when you have already had back surgery, the positional MRI is less clear, even though they do them with contrast, too.

    I might also mention that if you have pain when standing, the positional MRI will be pure torture. You cannot move the entire time it is being done...and this includes shifting your weight. Once they begin, you are not supposed to move even ever so slightly and this was really, really tough for me. I then had terrible pain all weekend as a result...almost ruined my time in Minneapolis!! If you have any questions, just let me know.

  • I've been thinking about you and I'm happy to read your update. I hope your ESI brings you relief too. Will you have a ride to the Tuesday appt? I always feel super sore after ESI's.

    Anyways, it's hard to say what prompt the drug test that day. I'm sure it was already planned for since you have a good reputation and have earned the trust of your doctor. I get drug tested once a year and I can tell that my doctor acts a tad different, like maybe uncomfortable in having to make me do that or something. I go and do my thing and I'm done with it and everything keeps going fine. Will we ever get used to them? That is a good question.

    I know they've said time and time again never to ask for something specific. But if you've tried many different meds for so long, then the next med like Oxycontin is the natural progression. The reason why I've switched meds were cost and severe allergic reaction to morphine. I've taken Oxycontin too and I personally don't think it's more addicting than the next pain medicine.

    Will you still go through the standing MRI knowing now that it may be more painful? I never had it and I don't think I'd like to anymore LOL. Please keep us posted on your ESI and appt at the NS. Hugs, Meydey
  • I had to sign a contract with my PM Dr that said I could be tested as well. I never have been nor have they counted pills. But I dont doubt that it will come to it sometime. Did your Dr say anything about the Fentanyl Patch? I go back to my PM Dr Jan 25. My Ortho has been treating my pain, but says now I need a change and need to have my PM Dr treat me again as Orthos can only precribe certain things. I am ready to try something else, as I dont think the fentanyl is working well anymore.
    Good Luck on your ESI. I hope it gives you some relief. And will be anxious to see how the nuero appt goes as well. Good Luck. I will be thinking of you and hoping for the best for you! Love, Robin
    PS I got my presription of 10 patches or 30 days. It was 297.00. I am really wanting something more reasonable!
  • I don't know you well, but I would like to comment on your post. I find it strange that a pain management Doctor will say that they don't like to prescribe Oxycontin because it is addictive.... That statement makes no sense to me.

    All medications have the ability of getting the patient addicted, not only opiods. Coming from a PM Doc that should know the difference between addiction and dependance, that comment I find really odd. The UA is normal specially when you have a pain contract signed. I go to a pain clinic at a major University here in Florida and there they don't make their patients sign a pain contract, not that I would have a problem with it, but they just don't.

    I hope that your next ESI will bring you some relief. I had 3 of them before my 1st surgery and unfortunately, they didn't work at all! Also good luck with your NS appointment. Take care,

  • Thanks for all of your info, advice and help Traci, Gwennie and Meydey.

    Gwennie, you made some great points about the standing MRI and I forgot about the one you had. I don't think I would be able to stand still for that long w/o shifting my weight from side to side. I don't think I will ask for one especially if the doc isn't going to go by it anyway. I do think I need an updated one though. It's been over 1yr since I have one.

    Come to think of it Meydey, I think it may have been a year since I started going so that would make sense. They did mention in the contract I signed on the first day that they could do random drug tests at any time and random pill counts at anytime even in between appts so I knew it was possible. Like I said, I wasn't sweating it cuz I don't over medicate or take any other meds besides what I'm prescribed or what I've told the pain mgmt doc. She did increase the cymbalta to 60mgs twice a day for tingling in legs and feet.

    I don't have a driver on Tuesday but that might be a good idea cuz I was pretty sore for a couple of days after the last one. My husband is taking the day off to take me to ESI appt on Monday so he wouldn't be able to take the day off for Tuesday as well. I'm not sure if I can get him to take the day off in 2 wks when I have EMG either so I may have to drive myself for that one as well. I don't do well with any type of injection so I have to be prescribed valium to take 30mins before my appt. If not I get dizzy, nauseous, my face gets hot...they call it vesa vay (not sure about spelling?).

    I'll keep you updated next week on how my appts go.
  • I forgot to mention the patches part. I did mention to her and she said to wait to see how the ESI goes and we will talk about it next month when I go for my refills. She actually told me that I could cancel the ESI since the 1st one didn't work but i told her that he mentioned trying a different entry point with the injection so I wanted to give it another try, plus I've heard it could take 2-3 times before it works. It would be silly to give up after the first try.

    Thanks for the well wishes too. I would be so much easier for me if the injection did fix everything. If it was only that easy.

    Do you have insurance for you prescriptions or did it not cover the patches?

    Your spiney friend,
  • Hi Tipper,

    Wow, looking at your history, you've been through so much. My prayers are with you and I hope you have good luck with the pain pump trial. That's another thing I've looked into but doc says she won't consider til I get to the max of pain meds. I'm not sure how much more meds I can take and still be able to function.

    I don't understand her thought process with the oxycontin thing. Everything she's prescribes me is addictive. I didn't want to push the issue cuz I always feel weird requesting a certain type of med. I mean isn't that their job?

    She's going to be the one doing the EMG in 2 wks so if I'm not feeling better from ESI maybe I will bring it up then about trying another med instead of waiting until Feb.

  • I do have insurance, but I have to meet a deductible. Also if you dont get a genaric, the duragesic brand is 600-700. And insurnace wont cover the difference, so I had to pay the 350 for duragesic until I went to genaric. Hope you understand what I am saying.
    Hope the ESI goes well for you. I also understand that it can take up to 3 before it can be effective. I will be waiting to hear how it is for you. Love, Robin
  • I thought I would give all my spiney friends an update since I last posted.

    As mentioned about I had a couple of appointments last week.

    Last Monday 1/11/10 I had my 2nd series of ESI with no releif. Instead I now have increased achyness in my legs and weakness that I didn't have until the injection.

    Tuesday 1/12/10 I had an appt with the neurosurgeon that I seen in March 2009 for a second opinion that found the 2 broken screws. He sent me over to the hospital for xrays flexing backward and forward and standing straight and CtScan. I was actually able to get all this done right away. I go to see the neurosurgeon to go over my results on Feb 5th.

    I do have the written results of the Ctscan but it mentions on there that I may benefit from an MRI instead so I need to call his office to see if he wants me to have one before I go to his appt.

    The neurosurgeon did give me info on the SCS trial and wanted me to look into that as well as a possible re-fusion L5/S1 but posterior depending on the test results.

    I'm also getting another EMG on Jan 25th (next week) so I will post when I get the results of that as well.

    I feel that I'm on the right track to getting to the bottom of my pain.

    Thanks for taking the time to read my updated information.

    God bless my spiney friends,
  • Glad to hear that things are "moving forward" for you.

    My PM does a urine test every month. There are some times I go when they don't do them; and when I asked about the inconsistency, they said they have to by law get one at least every 2 months and that I have to see the doctor (as opposed to the NP) at least 4 times a year. Now, I am not saying this is an actual law; it's just what the office told me. I am sure each facility has their own procedural rules in place just in the event the "feds" come knocking at the door. No respectable doctor wants to be shut down on a technicality...

    Are the screws in your back metal? I'm just wondering out loud if an MRI would be safe if you have metal in your body? Keep that in mind, ok? You wouldn't want that to come ripping out of you during the magnetic portion of the study...

    Good luck, hon. I hope you are able to get your pain levels to an acceptable level. THanks for keeping us posted!

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