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No reason for narcotics?

sunny1966ssunny1966 VIRGINIAPosts: 1,385
edited 06/11/2012 - 8:42 AM in Pain Medications
Hi all. I've been sitting here thinking over my last visit with my PCP.
This is my history: Disc degeneration with large posterior spur and stenosis at C5-6. Severe right and moderate to severe left foraminal narrowing due to uncovertebral joint spurring. Protrusion at C6-7 abutting the left C7 nerve root. Minor disc bulge and spur C4-5. Also have low back/leg/tailbone pain, leg weakness. Tarlov cysts in sacral spinal canal. Meds Wellbutrin, Prilosec, Levisin, Lidoderm patches, Norflex, Tramadol, Flexeril. Cervical ESI March 12 another scheduled April 9. Have tried PT & TENS
I wrote down all the problems I have and all the treatments I've tried through my NS and PM. My doctor read my report from the NS that said basically the same as the myelogram report above. Then he said, I still don't see any reason you'd need narcotics. All he's ever given me is Tramadol and muscle relaxers. Now I'm trying Savella. I've never asked for narcotics. I have told him the tramadol doesn't help much but I'd never ask for a specific drug because I know he'd probably think I only want drugs. It's a shame that we have to fear being labeled as a drug seeker just because we have pain we'd like to control. I'd just like to know if any of you with similar test results have the same problem getting adequate pain management. Am I wrong to think I have a real reason to need something other than tramadol?
I was just thinking about what he said and it makes me mad to think he'd be this way after seeing me for 14 years. It's not like he doesn't know me and know how much all of this is affecting my life. I don't go to his office in tears, that's just not me. I'm a person who tries to be 'tough'. You know that saying that what doesn't kill us will make us stronger? Well, I'm strong enough already! I think a lot of him personally but I feel like if he's not going to take my pain seriously I need to find someone who will. I just don't understand it.
Thanks everyone.


  • If I had a dollar for every time I've heard this story, I'd be a rich woman.

    My PCP is absolutely terrified of prescribing narcotic medications. My dentist doles them out for just a teeth cleaning. It's such an individual thing and I don't understand it either.

    But, in regards to your questions, when my PCP saw my cervical MRI, she didn't hesitate to give me vicodin 5/500. But, when I ran out leading up to surgery and I asked her to control my pain with continuing with the vicodin and flexiril, she had no problem with the flexiril but totally freaked out about the vicodin (I think I've told you this story before). I then got my surgeon involved and he and his PA have never once had a problem with continuing my medications. Of course, I've never asked for anything stronger or a higher dose, other than to change to Norco to lessen the amount of APAP I was taking due to stomach aches. My surgeon continues to manage my pain.

    I guess I can understand some doctor's resistance to prescribe narcotics, but when they understand how painful what you're experiencing can be and especially if they've known you a long time, my understanding lessens.

    You said that you told him the Tramadol isn't helping much, but have you been insistent that you really need pain control because you're having trouble functioning in everyday life, whatever meds are needed, to get through this? Have you asked him that since he can't seem to manage your pain effectively, could he refer you to pain management? I'm a true believer that part of a doctor's responsibility is to help keep his or her patients comfortable and functional, whatever that needs to be. For there to be so much out there that can help us function at a better level, narcotics or not, it should be an option.

    I feel for you, I really do. I've been very lucky that my surgeon and his PA have told me that "they're not afraid to take care of their patients." They've never questioned my request to renew my prescriptions, but then again, I've never run out early or asked for something more powerful.

    Sorry for my climbing on my soapbox here. I've talked with you many times and know the pain you experience and it makes me mad that you can't get something a little stronger to help you function on a higher level.

  • I don't know how other doctors structure their practices, but my PCP wanted my ortho spine doc to handle my meds pertaining to my spine. He gives me the things I take year-round like medication for high blood pressure. But he did not want to get involved in anything that I needed as a result of my back problems.

    Perhaps yours feels the same way? It may just be a matter of some office policy.

    You mentioned going to a pain management doctor. I would think he would be the one to give you medications.

    It does seem like some doctors do not "get the message" that one is in pain unless the person carries on. I remember one time when my husband had a kidney stone. We were in a very small hospital and the few staff that were there, kept ignoring him, and were fussing over some employee who had turned her ankle. When they finally took my husband in and diagnosed him, they couldn't have been more apologetic...and kept saying "We didn't know you were in so much pain." I guess he needed to roll around on the floor screaming to get noticed.

    I would think your doctor knows better, since you have a long-term relationship. I hope it is office policy rather than being uncaring.

  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    It just makes me mad when I'm sitting here hurting and have nothing to help. I did see a PM doctor (the nurse practitioner) and they gave me Lyrica, Lidoderm patches, and scheduled the esi's. The Lyrica I took for about three weeks and had to stop because of blurred vision. The Lidoderm patches do help my neck muscles a little bit. The day I had the esi I asked the doctor if he could give me anything for pain because he told me it may cause it to hurt worse for a while. He said he was only filling in for my doctor and to ask my PCP for pain meds. I still don't know who 'my doctor' is at the PM office and I don't have a return appt with them only for the esi on April 9. Like I said I'm afraid to say, Hey, I need something stronger here! They'd probably be labelling me as a drug seeker. I just can't understand why they can't look at my test results and see that I have a valid problem that needs a real med. Maybe I'm just to wimpy and only think I do?? That's what my PCP makes me feel like. I'm sorry for whining...again. It just gets to me on days like today.
    Thank you both.
    Hope you're doing well.
  • if THEY could feel out pain then THEY would be putting pen to prescription wouldn't they!sometimes the doctor can't imagine just how awful and debilitating this kind of pain is .i have a good understanding doctor but i have been see by a so called pain management specialist that told me i wan st in pain !!! {5 days later i was rushed in for my last operation and you know that i need another operation } my point is just because they are supposed to be qualified in pain management they dont always know the best thing for us ..do you think that you need a strong pain killer do you wake with that ;as if the dentist is blowing cold air on a bad tooth feeling all down you leg;..you know what i mean ! because if you do then you need a strong pain killer because nothing will shift it other than a strong pain killer such as oxycontin .....the only problem with drugs like oxycontin is you will soon get used to them and require ever larger doses to get the same relife ..i hope that you can get sorted out ..one good tip would be to show the pain person this website and let them read some the the posts my doctor found it very interesting ..
    tony x
  • You need to talk to your PCP. Since your pain management doctor appears to be a shots and treatment guy, he expects your PCP to manage your pain.

    This leaves you in a void until you can get an understanding with either the two of them or find a new Pain Management doctor! I'd suggest you call your pcp and ask for an appt asap and explain everything you have just said here. Many of us have trouble saying the words, so perhaps just print out the first post above! Tell him you need help and if he won't do it you need a second referral to another Pain clinic.

    I fought this same battle, it made me feel like a drug seeker, even though I knew I wasn't. I've told the story here before.
    After my second ESI I was in so much pain I called the pain clinic, they told me to call my PCP! They would do nothing for my pain! nothing! So I called my PCP and he said the pain clinic should take care of me and if they would not I should go to the ED! I went to the ED, it was miserable, sitting and waiting. Once I got in the back they left me sitting on a cart in the hallway! One nurse actually asked me, "what works for you". I told him I had no idea that I was only there because I had no choice. They finally moved me into one of the rooms and an actual doctor came in. When I explained the whole mess to him. He said, " I'll be back" the nurse came in and gave me two Percocet! Then I heard the doctor at the nursing station. He called my PCP at home! He told him it was his responsibility to care for me and he should be doing so! He berated him for sending me to the ED and tieing up space and time!

    The ED doc came back, told me everything should be OK and gave me a script for percocet and told me to follow up with my PCP.

    The next day I got a call and an apology from my PCP! I never had an issue again.

    That's a long story, and I hope you do not need to do all that. the simple fact is your not getting proper care. If your PCP is unsure of what to do, have him call your PM. That is what my PCP did.

    I so hope that some of this info helps and you get better pain control.
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I'm glad to hear from you. I hope you're as well as can be. Thanks for understanding. I do know that I can function better when taking at least a little stronger med. A doctor at urgent care clinic gave me a prescription for hydrocodone 5/500 (I think it was) and when I was taking only two of them a day it made a big difference in my pain. I can't take very strong meds without taking anti-nausea meds and then I feel soooo bad. I can take up to 400mg of tramadol and can't tell much difference at all but my PCP wants me to quit taking even that because he says it causes liver damage. I've taken it for over a year and have never even had bloodwork. I swear I don't understand??? Thank you Tony for understanding. I'm just in a mood today. I think it may be the Savella making me moody...that's another post. lol.
    Hope to talk to you soon Tony.
    Take care,
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    Thanks for sharing your story with me. I'm so glad that you finally got some help. You've had a terrible time of it too. I can't see another PM because this one is the only one nearby who accepts our insurance. I've seen my PCP so many times and I know that asking him would be useless. He makes me feel like I'm crazy every time I try to explain something to him. This last time, I had everything typed out for him trying to explain how I feel. He read it, or looked over it, and then read the report from the NS and said he didn't see anything I'd need narcotics for. He also never even discussed what I'd written. He just said, I still think your problems are muscular. Well?? Sorry, I know I've talked about this before on here and I know all of you are probably tired of hearing it. I'm going to have to speak up and tell them like it is or just quit going at all. I'm just paying a lot of copays for nothing it seems. I'm tired of trying all kinds of meds that don't help, have terrible side effects, and have nothing to do with my pain. (Boy ain't I in a mood??)
    Take care Mark.
    I hope you're doing okay. How are you feeling today?
  • I don't think most PCPs are at all equipped to handle long-term narcotic use. There are special regulations, etc.

    Also, treating chronic non-cancer pain with narcotics seems to be something a lot of doctors just have an issue with.

    Can you call the pain management clinic and ask for an office (not ESI) visit with the doctor?
  • I'm sorry that you are getting the run around when it comes to treating your pain. Maybe it's time for a change since you and your PCP don't see eye to eye anymore. You're better off with a doctor who will take the time to really listen and who is also open minded. It's not like you're asking to go from Tramadol to Oxycontin. The Hydrocodones seemed to help you alot and that's good, and it was at a low dose too. Do you also use heating pads and ice packs? They are my best friends. Anyway, I hope things work out and that your pain gets treated adequately. Hugs, Meydey
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I should have called them yesterday but of course I put it off. It's after hours now on a Friday so no chance until Monday. I even thought about seeing if I can get the esi sooner to see if it'll help. Maybe I'll get to feeling better before next week though. I'll admit that at times like these when my pain is so bad I get kind of crazy. lol. Must be the weather here that's made it worse. Thanks for your advice. I hope you're having a good day.
  • I really hope the ESI will do you some good too. Who can blame us for feeling nutty when we have chronic pain anyway? :P Just try to relax and get some rest this weekend so that you can regroup and be ready to deal with things next Monday. I promise I'll do the Macarena dance when you get relief from the ESI, okay? :D Hugs, Meydey >:D<
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I'll hold you to that! I hope you feel good today and have a great weekend.

  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    I think you need a pain management Dr. to handle your case. This going back and forth from one Dr. to the other. Isn't working for you. I think a Pain Management Dr. that you can trust to be in charge of you case. Would be your best bet. And everyone else should answer to him. He is the guy who is not afraid to prescribe. That is his job.(to manage your pain)
    Jim :?
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • You know I will :))( E-e-e-e-h, Macarena! =))
  • How are you feeling today?

    Did you give the doctor a call, by chance?

    I totally understand feeling frustrated, and I have reached the point of wanting to pull my hair out several times. I've had two school functions I had to be MIA at, due to my "base pain" (thoracic area) flaring up. It was nice that Mike took videos for me, but I sure missed being present.

    It really helps when others vent, as it makes you feel less alone with suffering. I want you to be as pain free as possible and I know one of these days, you're going to find the right combination of medications that will work for you.

    Hope you had a better day today.

    Thinking of you,

  • You need to find a new PM. I started with one PM group that only dealt in injections no meds. When I went for my last injection I told them that I was going to a different PM in our area. They told me that I should reconsider because the only difference was that the new place gave out medication. DUH! Obviously, what they were doing with me wasn't working, but I also learned later that there technique for injections was awful. They were done without anesthesia and without the aid of a fluoroscope. Basically, they were trying hit and miss to make my pain better. Imagine my surprise when going to the new PM and having the same injections done the way they should be done. What a difference!

    Anyway, to make a long story short, if you are not happy with what is happening with your standard of care, you need to take a stand and demand the help you need.
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    Thanks. The PM I'm seeing is the only one around here who takes our insurance. I've only been to the office twice. Once I saw the NP and the next time I only saw the TENS unit rep. Both times I was the only one there. I have another ESI Friday so we'll see what happens. I've been taking 400 mg of Tramadol daily plus muscle relaxers. I just don't think the Tramadol does anything for me.
    Thanks again for all your help. I hope that you're all doing well and having a nice weekend.

  • Did you try calling the office to make an appointment for an office visit with the doctor?

    Or did you ask them about meds and they said "we don't do meds?"

    My new doctor didn't really bring up meds (and lord knows we're scared to bring them up!). My first visits were all injection clinic visits. When I asked him, he said "OK, make an office visit to discuss that." It turns out they are just two separate types of visits.

    And I found the office visit really helpful, and I like him, so he wasn't blowing me off either :)

    I'm hoping with some prodding you can get the med management with your PM instead of the PCP who seems to not want to step things up a notch.
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    No I didn't call the office. I'm the worst to keep putting off calling a doctors office. I thought that I'll just wait and see what happens after the esi. I am afraid to even ask about pain meds. That's bad isn't it but that's the way it is. Almost every day there is something about illegal use of pain pills around here so you can't blame doctors for being cautious. It's hard when you have a real need for them though.
    How are you? Are you still having any relief from the esi?
    I hope you're having a nice weekend.
  • Well, you could ask if they'd take over your PCP's management, that's not like asking for meds (since you already have them!). I'm trying really hard to get over my own fear of calling and communicating with medical offices. It's hard!

    The ESIs gave a little bit of relief. On the one hand, every little bit counts. On the other hand, it's not a lot ;) The facet joints are the next step- although the PM dr thinks there are likely many causes of my pain.
  • What does your NS say? My pain meds are coming from my ortho surgeon and I'm 6 months post op. I agree with everyone else you should make an appointment to sit down with your PM doc and discuss pain management beyond ESI's. Tramadol doesn't do anything for me, not even the slightest difference in the pain. I took myself off pain killers at 3 months P.O. and doc got mad because I didn't call and explain my pain levels. He immediately wrote me a prescription and said no levels over a 5 are acceptable. If your not comfortable with your PM doc tell your NS you are not getting relief from your PM or PCP doctors and ask for his advise. I know many don't prescribe painkillers for their patients leaving it to the PM doc but I'm sure he wouldn't want you sitting in pain constantly.
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I hope that something will work for you. You're right that every little bit helps but it'd be nice if it'd last longer wouldn't it? Do you know when you'll have the facet joint injections?
    Good luck.
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    My NS office only prescribe if they're going to do or have done surgery. He said for me to try the injections before surgery but didn't give me a return appointment with him. I've been taking a lot of Tramadol and it doesn't help. I does give me a headache though. Hopefully I'll learn more Friday when I have the esi.
    I've had these neck/head problems for years and started seeing a neurologist in Oct 08 because it's so much worse. Now after several mri's, a myelogram from h***, PT, TENS, injections and all that I'm worse than I was when I went the first time. I'm getting to the point where I feel I'd be better off if I just deal with it on my own...which is what I really do anyway. At least I wouldn't have to pay so many copays and deductibles. I'm sorry. I'm in one of those moods this morning (guess you can tell? lol)
    How are you doing now? Do you still have to take pain meds? Do you feel like your surgery was a success?
    Thanks for your help and advice. I appreciate it.
  • I'm ok. I am on pain meds sometimes. I feel the surgery was a success. Now it's just a wait and see if my body adjusts to the hardware and the new shape of my spine. I take the painkillers when the pain gets out of control, doctors orders. My bones are fused but my muscles will lock up over the top of my hardware and I push until I'm in so much pain I cry. I really hope you find some help soon.
  • Why are you guys finding it difficult to just ask for meds to control your pain? I have been in pain for 12 years and have had treatment from several doctors andhave never been denied pain meds (narcotic)when asking for help controlling my pain. If you have an acceptable medical history and or films that show a definitive problem there should be no problem having a doctor perscribe medication to help.. that is their job.

    Maybe you are worrying about asking when there is nothing to worry about?? If the Doc says no and leaves you in pain then goto the doctor accross the street and pay him your money. Maybe I have just ran into good doctors that are willing to understand and help, I wouldn't return for a second visit if a doctor wanted me to leave his office in pain for sure.
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