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Frustrated with my PCP/I have a reason to be seeking Pain meds

RwillRRwill Posts: 300
edited 06/11/2012 - 8:44 AM in Pain Medications
I am trying to not be annoyed but my PCP is driving me nuts. I am on 6 Norco per day 100mg of Gabapentin in the am and the pm. Called Doc about my pain not being under control the suggestion was to increase the Gabapentin to 200mg at night. I understand him wanting to try that I guess but I don't even know if the Gabapentin is even working. So I did the increase and it didn't help me sleep nor help the pain. I am trying to get the nurse to call me back but I'm feeling ignored. If he doesn't want to help me with my pain control then just tell me so I figure something else out.

I have an appointment with a pain management doctor on the 16th for my Spinal Cord Stimulator pre appointment. I am wondering if I could ask him to take me on as a pm patient? I just want one doctor that understands what I am going through. I know there is a need to be cautious etc.... but I am at the end of my rope. I don't think I'm asking too much, I just want a little more pain control. I shouldn't have to feel like I want to just crawl in a corner and not move I have 3 kids to take care of so I force myself to function.

Sorry for the rant I just had to get it out!!


  • YES!! You need a pain management doctor!

    Primary care doctors are not prepared or trained to take on patients who will be taking long-term narcotics. They tend to frankly just not like it.

    But you might need to try a couple of PM docs before you find a good one. You need to find one who enjoys helping people deal with their pain. You do NOT want a doctor who is burned out. Nor do you want a doctor who is twitchy about narcotic use because he doesn't want anyone breathing down HIS neck.

    The first PM doctor I saw faxed me a contract to sign that made me feel like a drug abuser before I ever saw him. The second just had an anti-narcotic bias that kept my pain from being adequately controlled. But this one's a keeper.

  • His nurse cld back and his idea of better pain control was to give me Oxy. I will go pick that tomorrow. I was thinking I'd be still using the Norco during the day and something in addition for break thru pain and then maybe something to help me sleep at night....uggg.
  • I thought better pain control was what you were looking for? After hydrocodone (the opioid in Norco) oxycodone (or other drug of similar potency) is the next logical step up the analgesic ladder. If it gives you more pain relief that should help you sleep better. If not, you can always ask about something for insomnia.
  • Hopefully I'm wrong but I remember Oxy wearing off just as quickly as Norco does. Guess I was hopeing for more consistency during the day and not having my pain levels go up and down. It's always hard to play catch up when your hurting real bad and that's all I feel like I'm doing.
  • Oxycodone is stronger than hydrocodone by a bit, so you can give it a try.

    Once you move away from the mixed opioid/acetaminophen drugs, you are moving to a different level of record keeping for the doctor.

    It might help, because if you're tolerant to hydrocodone the oxy might really work better for you.
  • p.s. How high are you telling him your pain is getting in between meds?
  • Is he giving you Oxycodone or Oxycontin? Oxycontin is the extended release version that should give you the controlled released throughout the day so that your levels are not up and down all the time. Oxycodone is the immediate release version that only lasts a short period of time.

  • Rwill, have you tried any muscle relaxants? They might help you sleep better and also provide some additional pain relief. Different ones work better (or worse) for different people, as with other types of medicine. Personally, I often find diazepam or clonazepam to be helpful at night. Tizanidine (Zanaflex) can be quite helpful when it comes to insomnia, too. With gabapentin I always felt zombie-like but could never actually get to sleep, strangely enough. Good luck.
  • I believe she said Oxycodone thanks Hanglandc for explaining the difference to me. I am suppose to try it over the weekend and then let him know.

    HappyHBmom I explained to the nurse that I am still running a 6-7 throughout the day with the current meds I am taking.

    Huggy Maybe I should ask for a different muscle relaxer. I currently have flexiril on hand and I don't get much help from it. I'll call and see if they would be willing to give me a different type.
  • I wonder what your chances are of getting a higher schedule narcotic from this doctor. I'll be interested in seeing how it plays out.

    Anyway, I said the same thing to my doctor. I was taking fewer Norco plus Ultram ER (which might be an option for you?). He took out the Ultram and gave me a Fentanyl patch. And all I can say is Wow. I had one Norco yesterday, my 3rd day with the patch, and was never above maybe a 5. This morning I woke up with almost no pain, even though it's the day I'm supposed to change my patch.

    But, of course, a Fentanyl patch is a schedule II narcotic, vs. Schedule III such as Percocet and Norco. I think it scares doctors who do not have the training to deal with it. And maybe it's better to go ahead and have a doctor who had the training specifically in these medications prescribe them to you?

  • Of course, if one was up on narcotic research, they would know that if the narcotics are prescribed appropriately, they would not result in one becoming a "zombie" because the "zombie" effect only comes after the pain has been resolved. So, only if the narcotics are over-prescribed would someone have that sort of side-effect.

    So, another point for going to a doctor trained in prescribing these sorts of medications. Treating, and not over-treating, is the answer. A good doctor is seeing you often and looking at your affect (how you appear) and making sure you are not becoming sluggish. On the other hand, he would not allow you to walk around with 6-7 daily pain levels (I was there too, it was quite suckish).

    Around here, in Michael Jackson Land, neurologists and orthos do not prescribe, they send everyone to PM doctors, who are usually either Anesthesiologists or Physiatrists (mine is a physiatrist).

  • I love my doc but this is not his strong point. I am definately going to see if the PM doc will take over my meds.

    KrisNY I haven't given up on the Gabapentin yet, at this point I just don't know if it will help or not. I also know my dose is low we are doing baby steps because of the side effects it gives me. My Neuro is in charge of that med.

    happyHBmom Glad the patch works well for you.

    I'll let you guys know how it goes....
  • Good luck! Maybe you'll get a good long-acting med too. It's made a big difference for me. A little drowsy, then again I was under general anesthesia yesterday so maybe I get a pass on that ;)

    Or maybe the oxy will work so well you won't have to?
  • I hope it works. I figure I'll ask for Oxycontin is the codone doesn't last.

    Forgot to mention I'm actually very proud of myself, when I was talking to the nurse yesterday I was very firm and to the point. I tend to get wishy washy, I told her that if the doc was uncomfortable controlling my pain to let me know I'd find someome else. I explained the plain facts I'm in a lot of pain & it will need to be treated for an extended amount of time.
  • dilaurodilauro ConnecticutPosts: 9,832
    is not about the pain medications or the dosage that you are taking.

    Look at our FAQ and under Medical Information there is a thread call "The Blend"

    Many spinal patients talk about their pain medications and that it isnt controlling their pain. Not many medications will eliminate/control the pain, and if there is, it would be so potent, you wouldn't be able to function at anything.

    When doctors realize that their patients are in serious pain over an extended period of time, they might go the route with an Extended Release medication , like "C" mention such as Oxycontin. Those medications are designed to provide you with a even amount of pain control over a period of time. So that you dont have the highs and lows. Oxycodone on the other hand is an Immediate Release type of medication. This will give you the quick relief from pain, but it wears off after 4-6 hours. That is why many pain management doctors like to prescribe an Extended Release medication and use an Immediate Release medication as break through.

    It can be difficult to find a Pain Management doctor that will work with. Unfortunately, its hard to determine that until after your first formal visit with them, which with insurance co-pays could cost you up to $25.

    I have read posts from other members that they have been through 3 or 4 pain management doctors before they found what they were looking for.

    Honestly, sometimes I really don't know if that is a combination of the patient wanting more (ie Pain Meds) than what the doctor is willing to prescribe or if the Pain Management doctor is reluctant to prescribe pain narcotics because of DEA stories.

    Personally, I do as much research as I can before seeing any specialist. I have my PCP who can help guide me. So far, I have never been steered into the wrong direction. And once I hooked up with my
    Physiatrist, I always knew I was in good hands.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I'm going to call them right now and discuss this. I will be being a PM doc on Wed. so I'll see how it goes.
  • Well I picked up my script today...I LM with my doc about using the Oxycotin instead of Oxycodone, he still feels codone is the way to go. So I'm at the point where I'm not going to argue with him about it I'll just wait to see what happens after my appointment with the PM Doc.

    I've taken two doses of 2 pills not noticing too much difference in pain. I'm wondering if it might take a little bit of time to get the pain uncontrol.

    NEW QUESTION: So I can take 2 tabs every 4hrs. Do any of you get up in the middle of the night to take medication?? I'm usually hurting really bad by the time I wake up so I was wondering if it would keep the pain from spiking??
  • Do you ever wake up in the middle of the night with pain? I would if I woke up with pain in the night, but I wouldn't wake myself up to take pain meds.

    Remember to check your tylenol dosage and stay under the recommended daily dosage. How much tylenol is in it?

  • I often wake up during the night in a lot of pain, so I keep my medicine next to me, in case I need to take it while I'm in bed. Unfortunately, I can't get CII analgesics (they are very strictly controlled and only ever used for cancer pain here in Taiwan), so the only extended-release medication available that is even remotely effective is tramadol 200mg. It's not nearly as strong as my Temgesic, which is the one I really need a controlled-release form of, but they don't have the ER version of it over here. Spare a thought for me the next time you guys take your OxyContin or Fentanyl patch or MS Contin or Opana - you are very lucky to be able to get CII meds for non-cancer pain, you know!

    Rwill, I hope the oxycodone helps. Is it straight oxycodone, or oxycodone with APAP (acetaminophen)? How many milligrams? I agree with what the others are saying - if you have round-the-clock pain that isn't being controlled with milder analgesics, one of the sustained-release (12-hour or 24-hour) formulations is the way to go. Your doctor may decide to give you OxyContin next if the instant-release form is ineffective, as oxycodone in any form is a CII medication, even with APAP (e.g. Percocet).
  • If you have the 5/500s especially, remember that you can't take more than 4,000 mg of Tylenol a day, so that's 8 tabs altogether. Hopefully he gave you one of the formulations with 325.

    Huggy, I will think of you. In 2 1/2 years, this was one of my first mornings ever to wake up pain free, as the patch really starts to kick in. I'm not really liking the drowsiness, but man- waking up with no pain? Really? Usually I can't even cuddle in bed with hubby in the morning because I'm just too uncomfortable.

    Rwill, I'd definitely go with the PM dr. I seriously hadn't realized how much pain there was until I started getting it under control.

  • Thanks! I'm glad to hear the patch is working so well for you. It's amazing how much difference a stronger, steadily-released analgesic can make. Hopefully the drowsiness with subside in a while.
  • So I took the Oxy yesterday and today and it is actually providing less relief than the Norco. So I've been doing a couple Norco inbetween the Oxy and that seems to work. Guess I'll call the doc Monday.
  • I noticed you are looking at getting an SCS.
    I've had mine for 5 months now and love it. Go to the SCS section for all the info you want on this unit....

    I just wanted to add that I too, found the Fentanyl
    Duragesic patch to be the way to go. Very powerful med and takes a bit of getting used to, but MAN. You don't have to worry about forgetting to take pills all the time and it pretty much keeps a steady stream of the med in your system.

    I've been on every dose of the patch and found that it's better to stay in the midline range (50mcg) as opposed to the higher doses (100mcg) because then you don't have as many ups and downs(withdrawal) as the patch wears off.

    Good luck with your SCS. I hope you come over to that forum to share. Great folks over there.
    I'm getting approx 70% relief from mine, depending on how much I exhert myself......
  • Yes I'm in the process of waiting for doc appointments etc.... to have the SCS. I have got a lot of good information from the SCS section. I've got my first consult on Wed. The prob is the doc wants an EMG test done and that appointment isn't until July 23rd. I need to ask the SCS doc if I will need the EMG test done before I get the SCS. I didn't know if the EMG test would get messed up from the SCS. Just a long rode of having to have patience.

    The patch- I have wondered about it but I'm waiting for my doc to recommend it. He's trying some other routes first. Having to deal with all the red tape is annoying!!
  • It's all about the 'hurry up and wait' thing :)

    Well I hope everything goes smoothly and that you have a success story to share!!
  • I had my PM doctor appointment this morning and I am happy to report that it went really well. The doctor was easy to talk to and he was very understanding. I actually feel like he listened to me and I was proud of myself I talked frankly with him and didn't forget anything.

    He changed my medication to Oxycontin 30mg 2xper day and 1-2 Norco for break through pain.(Daah PCP) He feels I'm a great candidate for the SCS so I need to get a medical eval before we proceed any further. They need to know I'm not crazy and that I am not addicted to drugs and or pain meds.

    It was a long day but it is nice to feel hopeful !!
  • Glad to hear that your appointment went well and that you're now on longer-acting medication. It's always a nice feeling when a meeting with a doctor finally goes well after a string of disappointments. Hopefully this will give you more relief than the immediate release form you've been taking.
  • I hope you get great relief! I find myself kicking myself in the ass a bit over not being more straightforward sooner, because the relief with the patch is so much better.

  • I've taken both Norco and Percocet and have noticed that Norco had lasted a bit longer than the Percocets (oxycodone with tylenol),why? I don't know but everyone is affected differently. Currently I take the straight Oxycodone (no tylenol in it) and they help me best with BT pain.

    Is this your first time going to pain mgt? I saw on your sig that you have had 6 back surgeries. Ouch.

    I also have a Medtronic pain pump for chronic back pain, sciatica, and nerve damage. I really hope that the SCS makes a difference for you.

    It's great that things worked out for you at your appt; I understand how uncomfortable it is to discuss pain meds but you mustn't feel bad b/c your pain is real. Go ahead and pat yourself in the back (sorry)for having the courage to speak up and convey your needs. Take care
  • Meydey- Yes this is my first time with a PM doc. Luckily it was a good experience. I've seen posts where others are not so lucky. I do need to talk to him about increasing my break thru pain med. He says 1-2 Norco but that is not cutting it. I was getting much better relief with the Norco/Oxycodone combo. I am feeling positive that he'll help me get it figured out. Gotta make a call first thing Monday morning. I'm actually thinking of sending his office a thank you card. When I was having trouble getting my script filled at the pharmacy, I called the office and they put me right thourgh to his assistant. I was amazed I didn't have to wait two days for a call back. Just want to let them know that I appreciate their care.
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