Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

Advice on approaching PM to alter meds

avery755aavery755 Posts: 17
edited 06/11/2012 - 8:44 AM in Pain Medications
I am curious how to discuss pain medications with my PM. I am in need of surgery but right now I am seeing different surgeons under his guidance to get different opinions (which seems to be a long proccess.) I was trying to avoid a spinal fusion but it seems that it where I am heading. In the meantime I am seeing a wonderful pain doc. I have been taking 10/325 of percocet 4xs/day since November (prior I was on vicodin with no relief) but it is not as effective as it used to be. I find that it helps but wears off after a few hours. I have read on here that a lot of people are on extended meds with break through ones. Is there a good way to approach my doctor about asking for an extended medication? This is the first doctor that has been wonderful and I want to keep our relationship that way. I was thinking of telling him that the percocet is helping but does not last long enough. Would that be an appropriate way to bring it up? He asked me if the pain medication was still helping on my last visit and I just said yes instead of being honest. At the time I also was trying to avoid taking anymore medication but i am in too much pain. Thanks in advance for any suggestions.

L4-L5 herniated disc with tears, facet Arthropathy, SS, DDD,spondylosis
L5-S1 herniated disc



  • Honesty is always the best policy when discussing pain meds. Tell your doc exactly what you said here, that they aren't lasting as long and you are wondering if there's a better alternative that he could recommend.

    That's what I have always done and the docs seem to respect that and respond well in kind.

  • You are right. I will just be honest. I get shy when speaking about medication so I will be upfront and just follow his advice. I am sure it will be fine because he always ask me if I need anything adjusted and I always say no because I was trying not to take more meds but he might have a better alternative. This board has been wonderful.
  • Avery I have to make that same call tomorrow. I need to talk to my PM about disability now that I am having more pain and need to see some more doctors. I feel like a child asking for more cake.
  • Well good luck to you. I have been dealing with this for over 17 years and orginally my doctors just thought I had muscle spams and never ordered MRI's until 3 years ago when I Dr. took me seriuosly. I understand that I won't get total relief but my pain levels reach between a 7-8 when my meds wear off. Through this Dr. we did PT, shots, pretty much everything, and after he did the discogram he immediately took me off the vicodin and out me on percocet without me asking. I just am greatful that he helped relieve more of my pain and don't want to push my luck. I wish I could ask for something that is extended release but will just tell him the meds don't last very long.

    There were a couple of good surgeries that might have helped me but not covered by my insurance. Plus I don't have leg pain. That is also why I have to see several surgeons. I have been hesistant about a fusion but it it will help relieve the pain, I am willing to do anything at this point.

    What problems are you facing? Good luck with PM meeting. Mine isn't until Friday.
  • Another good thing to do is to ask for help in assessing your pain level if you feeling you're having difficulty. I found I was really way off in my assessments. What I was giving a 4-5 was really closer to 6-7, and I was basically giving doctors the idea I was feeling OK when I was very uncomfortable and severely limited (I was telling them I was limited, but my pain scores seemed to be OK so they'd just send me on my way).

    If you tell your doctor you're spending more than 2-3 hours a day at a 7-8, he really should do some major adjustments to your meds, I'd think, if that is an honest assessment (and I have no reason to question that).

    I've had very good luck switching from norco to the fentanyl patch. Side effects are more troublesome, but pain reliefe is signifcant.
  • Avery I had a microD/forenotomy/lami back in January at T1/2. Apparently the mechanics of surgery did some other damage. Now I have a boney ridge, T2 fracture that is healing, T1 endplate issue and severe arthrosis at c7/t1. All this is in the 5 months since surgery.

    I went back to work 3 weeks after surgery and was doing pretty well until March. Then it went down hill. Now I'm back on neurontin and the PM increased the dosage which is making me feel pretty dopey. I'm still having lots of pain across my back.

    Now that I am back on the doctor chase and the pain is worse I am going to ask him to put me on disability. It's just impossible to function at work. Last week I was a zoombie. Now with the higher doses I just can't do it. Also can't sit for long without back pain. And can't take more meds at work.

    I feel embarassed to ask him for this. I don't think he will have any issue with it. Every doctor I see thinks I am not working anyway so they must know something I don't.

    GOod luck tomorrow.
  • That is great advice. He is wonderful about discussing my pain levels so that is one of the first things he will ask me. I will make sure to be more direct because sometimes I down play my pain. I only get a few hours of sleep at night and all I say is sometimes I can't sleep so I will be more specific. I have never asked for a med adjustment and I will not this time either but rather focus on the pain levels. I trust him and know he will do what is right for me.It shouldn't be a problem because after he did my discogram he said he now understood why I was in so much pain.
  • on no. that's too bad. I think you have a valid case to ask for disability and should not be ashamed of it. This happens to people. I am not owrking right now because I sit in a chair all day for work and end up crying after a few hours. I understand how you feel. Let me know how it goes!
  • In keeping in the 'good graces' of my PM, I was in your same predicament and didn't want to come off as 'asking for more drugs'......
    Like "C" says, honesty.

    One very graceful way to approach this with the Dr is to say that you were talking with your pharmacist about your concerns that the med isn't lasting as long as it did at first. He will suggest asking Doc about checking into getting the longer-lasting extended release meds, or even maybe the duragesic pain patch.

    Be very respectful in how you say it tho. Don't sound as tho you were going over your doctor's head, just say that "My pharmacist suggested that I ask you about....."
    Everyone is on the same page with this approach.
    After all, your pharmacist truly IS part of your team in controlling your pain.....but the Doc is the head honcho and must be respected as such.
    Good Luck
  • Avery- I'm in the same boat as you. I'm trying to figure out my meds with my PM. I usually get quiet and don't speak my mind with docs, but lately I'm just trying to be my own best advocate. I am being very honest about my pain because they can't feel what I am going through but I can try explain it to them. They (the docs) are there to help us, so I'm reaching out for his help!!!

    Good luck!! I gotta make my call this morning....
  • dilaurodilauro ConnecticutPosts: 9,856
    to be posted in doctor's offices and hospitals really are just a very subjective way in describing pain.

    Most of the doctors I've have gotten to know, dont even want to hear the pain number. Why? Because it has been abused by so many. People come in and say they are at a pain level 9. Any doctor would know that anyone in that pain level would not be able to take care of themselves.

    Some figure if they give a higher number, then they will get more attention and perhaps more pain medications. Any doctor worth their weight can easily tell what type of pain their patient is in. There are so many detectable signs a professional can pick up on.

    So, to me, when it comes to talking to your PM about your medications, as was said honesty is foremost. Then explain how you are doing throughout the day, what times are worse, what you can do to help, etc.

    That will go a long way in helping your PM figure out what is best for you.
    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
  • thanks. yes usually he can tell the type of pain I am in when I walk in the door. He knows me pretty well now. Good advice because I never bring up pain levels to him. I think he knows I am a little shy speaking about it as well because he always asks if the medication is working well and when I say yes he always says are you sure. Like I said at the time I did not want to alter my meds but now I am at a point where I need to if he decides it is the right choice for me. I trust he will do the right thing because I discuss all surgeon consults with him and trust his advice almost more than the surgeons.

    you are right. I will ask if there is something I can do to help ease the pain and be honest about how I am feeling. I feel better with that approach and really it is just a conversation about how I am progressing so I feel better about it now.
  • It's always easier once you have a relationship- now that I've been through some procedures with mine, he knows if I show pain it's really there.

    Also, make sure you make clear that you're considering the increased side effects as well. There's never any benefit without some drawback as well.
  • Ron,
    Your so right in this. I've had a cervical laminectomy, a 2 level ACDF fusion, and most recently a 4 level posterior cervical fusion just 6 weeks ago. Always they ask you a number and I find it hard to describe because in all honesty, an abscessed tooth or two I've had hurt worse than my back, but it doesn't go on very long. After this last surgery, I learned what a 9 or 10 truly is. I was on 80mg of Oxycontin, plus 5mg Oxycodone IR every 4 hours for break through. The hospital mixed it up and entered in that I was on only 1 5mg Oxycodone every 4 to 6 hours before surgery. I didn't sleep for a solid 48 hours after surgery. I am not a wimpy person by any standard when it comes to tolerating pain and I was actually in tears and couldn't draw in a deep breath without everything sending me through the roof. They discovered the error on day 3 after surgery and changed the meds and I was ready to go home in 1/2 day. Now in only 6 weeks I'm tapered off all meds except a low dose of Neurontin. Your point is well taken; a level 9 or 10 basically means you almost can't communicate and certainly can't do anything for yourself.
Sign In or Register to comment.