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Is this right? I'm told to tough it out until next appt!

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:44 AM in Pain Management
Help! I had a RFA on the c-2,3 nerve. It went horrible, with much pain 10 out of 10. One week later I am in alot of pain still ranging from 6 to 9. I am going through my meds and will run out at this pace. 2 Norcos every 4 hours. I've been on norco for 2 1/2 yrs and have built a tolerance, of course. Sometimes the 10mgs every 4 hours doesn't cut the edge off the pain. I called today and they said I have to wait, tough it out until the appt. The nurse apologized and said since I signed the narcotic agreement I cannot go to my pcp or the er for more/different pain meds. This seems so barbaric and uncompassionate! I am appalled! I am a mom with three young boys to take care of and I am in need of pain management, not tough it out course! What should I do?


  • You are in a tough position. You took more meds than you were supposed to so you will run out early. You also signed a contract so you can't get meds ferom another doc. ****be careful**** they will find out if you do!

    If the pain gets bad enough I think you can go to the ER to get medicated but you can't get a script from them. Don't quote me on that....call the PM and ask when the pain is out of control.

    In addition to the pain you run the risk of withdrawal as well so you may need to ration what you have left to avoid the withdrawal symptoms.

    You might try making an appt with the PM doctor and explain in person what you did and 'discuss' what can be done. You also now run the risk of being labeled a 'drug seeker'.

    Good luck..........Paul
  • It doesn't sound like you have a very good relationship with your pain doctor, if you've been taking 2 norco at a time (above the dosage any doctor would prescribe), rather than calling for an appointment and telling your doctor that you had uncontrolled pain. Why is this?

    But, yes, it's my understanding that if I did the same, that would be my plight as well. Which is why I wouldn't do so, but would call and make an appointment if my pain got so bad. My agreement with my PM doctor is that I do not receive pain meds from any other source without agreement, and that's necessary for him to keep me safe.

    When I had extra pain after the same procedure, he increased my pain meds, so I do feel for you, and wish your relationship with your PM doctor was different.

    ETA: The time to move up the appointment is before you overuse your meds. Do they not allow that? I admit that it took a while for me to realize that when the doctor says "I'll see you in 4 weeks" that is not written in stone. I started just making an appointment or moving one up a week or two when things were bad. Turned out that was what I was supposed to be doing.

  • sorry for your pain and the rfa not helping..
    Did your pm perscribe 2 10mg of norco every 4 hrs??
    if after the produce you pain has gotten worse you should for sure be seen...
    When you called are you asking to be seen or for more meds??
    I can see building up tolerance after 2 yrs..
    Perhaps if you call and leave message for doc and request to be seen asap..
    I have been honest and upfront with my docs and so anytime i call they call me back or get me in..
    I realize that is rare...but took me long time to find docs that listen..
    I hope you can get in to see your pm soon and hope your not taking more than perscribed cause as paul stated then you will run out and withdrawals can be horrid.
    try to keep calling and see if they can see you sooner or any cancels..
    take care
    neck,bone spurs pain started 04, back issues and fusion l4,l5 06~hardware removed.
    good few yrs. 09 pain sharp, numbness feet,legs, diagnosed fibro, neurop. legs.lung issues.
    daily goal do good thing for someone.
  • if you run out of your pain killers {and i have done twice} you can go to the emergency doctor .the first time i went i took all my hospital notes and my repeat script with me and there was no problem he gave me just enough until i could see my own doctor but the next time i ran out {i had my script waiting for me at me doctors BUT it was a bank holiday so i could not collect it } so again i went to see the emergency doctor but this time i got a lecture he did give me some more pain killers and wrote to my doctor .so what i did was see my doctor and we decided on amount that would last me and i have not run short since .the policy over here is to give you meds if you run out and you are a genuine case .i suppose if you were going every week things would be different
  • The dr perscribed one norco every 4-6 hours. I called and told them I was in severe pain and they told me they cannot get me in any sooner. So I am on my own once I leave their office.
  • Thanks. I have enough so I won't run out but it will be a tough 10 days. What I am taking is not enough. I would have gladly gone back in but they say they can't fit me in. Also today the nurse said if I am in "excruciating pain" I am free to go to the er.
  • Straker, generally over here we're not allowed to do that, it's considered "doctor shopping" and a big, big no-no according to pain doctors.

    Mama, does that sound right to you? THat once you leave their office, you are on your own? THat is what sounds wrong to me, not that you are on your own for overusing your meds (which was a big no-no, you are using a dose that is above that recommended), but that they are not there when you need them.
  • You are right. They are not responsive once I leave the office. I have called with other problems over the months I've been there and I never get past the nurse desk and it's always the same, "you have to wait until you come back in, no we can't get you in any sooner." Prior to this procedure I was very nervous because the blocks preceeding the ablation were very painful. I asked if I needed more pain meds, I asked if it would be more painful. They only said that "it depends on the person." Which is true but they knew I had a rough time w/ procedures, etc. I only have seen the dr three times. ALl my other visits are with the nurse. I've never overused, and I've always used the least amount possible. You say 2 norcos is more than any dr would rx? I've had hydrocodeine rx'd at 2 every 4 hrs, what's the difference? I appreciate your responses & care.
  • Norco is 10 mg which is the max they recommend for Hydrocodone, as far as I know. I've been DXed 2x Vicodin, which is 5mg before, but never 2x Norco.

    Is there any way to find a new PM doctor? Not all are like that. If I had pain, I'd ask to be seen right away, and I'm sure they'd find some way to help me. I mean, imagine being sick and asking to see your primary care doctor, and them telling you they just can't fit you in? Does that sound right?

    The other thing you could do is discuss it with your insurance company, who likely has a contract with certain requirements. Such as them being able to treat you when needed.
  • I have Norco, 5mg ea. with 325 tylenol. If I call my insurance co. will they "force" the PM to see me sooner? I never thought of calling my insurance co but you're right, they are not doing their job (managing my pain).
  • Why would your insurance company 'force' your PM to see you sooner? Be careful here and tread lightly!! If you push the issue the PM could say you abused your meds and stop prescribing to you.

  • While this is to late for this situation, thought I would offer this up to you and something for you to discuss with the pm when you see them. I have needed more meds following something and I called the office and said I am in so much pain what should I do? I made the nurse get the answer from the doctor for me. Now with that said when you see them ask the doctor what you should do when put in this position. I always tread lightly with my questions as not to blame anyone or go over what happened and be negative about it. For example in prior surgeries he deferred to the surgeon to prescribe then had me bring the meds with me to the appointment. I brought them and he was wondering why I had them and I explained that was the orders you had given me the last time. My point is it is so hard for them to get to know a patient and trust them, and it takes time to get to that point. Keep working with this situation and in the end you will prevail.
  • I've only begun working with a PM doc but it has been a wonderful experience. I was very aprehensive when I first went in. In my mind I saw them pushing meds and injections. After waiting and giving a history to the PA the doc came in and said no injections. I was so relieved - I had prepared for a fight since I thought it was the wrong move. He then asked what I take and said the neurontin was a baby dose. When I had to call back the PA returned my call and was extremely helpful.

    So my thought mama is that you need a new PM doc. You should never settle for less than excellent care.
  • You could call your insurance and ask if there is any specific procedure you could go through if you are having difficulty making appointments with the doctor. It seems to me that a pain management doctor should be avaialable when you're in pain, not just when they think you should be in pain.

    But tread lightly has never been my motto ;)

    On the other hand, is there another doctor you could see? I had to see 3 PM doctors before I found one I liked!
  • Thank you all for your insight and support. Today I woke up and I wasn't in horrible pain!(14 dys post)I have hope that this procedure will bring relief. Tomorrow is my appt and I will tread lightly and ask the important questions. I learned of another PM dr and might switch to them depending on how tomorrow goes.
  • When I say I don't tread lightly, I mean I am assertive. I don't mean I am aggressive.

    Think about the difference between being assertive and being aggressive. Assertive means you communicate with confidence and care. That doesn't mean you go over the line to aggressive communication, forgetting about the feelings of others.

    So don't be passive. Be assertive.
  • I beg to differ in this situation.

    She over used her meds. If the doctor choses to he/she can drop her as a patient and make notation of that in here record. Any med PM doctor would ask why she switched doctors and would see her records and might not prescribe meds either.

    Right or wrong you signed a narcotic contract and did not abide by it! Pain management doctors do not take them lightly and DO drop patients.
  • We will have to agree to disagree on that point.

    To me, her doctor did not give her the most obvious option- which would be to come in early and have the pain treated properly. That is what I wanted her to point out to the doctor, in an effort to open a line of communication and avoid this happening again.

    You are right, of course- her doctor could drop her as a patient for overusing her medications. But that doesn't mean she doesn't have a right to expect the office to be responsive to her need for pain medication when she needs it.
  • The tick to getting around the nurse/secretary is to simply ask thedoctor to call you when he gets a chance. If they ask why you need to speakto him/her, just say it's personal. This has worked for me in a few different circumstances, and a few differet offices! Good Luck.
  • I too am with a PM dr. He is a neurologist and I signed a contract. I ended up with a severe dental problem. 3 impacted teeth and the pain meds I was taking was not even touching the pain. While at the dentist's office he said I should be taking something every 4 hrs along with antibiotics. He did pull one of the teeth and I have 2 to go. He personally called my neurologist and they discussed upping my meds from 4 to 6 Percocets per day along with my ER meds. I was then told to keep a log of how many extra I took so they could adjust the date of my refill. PM dr was very understanding and said I handled the situation exactly as I should have. The dentist did not give me a new prescription it was all worked out with my neurologist who is also my PM dr. so I did not violate the contract at all. In no way would I have increased my dosage without permission as I could not function whatsoever if I were dropped from PM. In the future, prior to adjusting your dose on your own perhaps you could make some type of arrangements to say you need an emergency appt. beg them to fit you in whatever it takes. They are very strict and I guess they have to be so getting authorization prior to would be your best bet. You certainly don't want to be left without any meds due to increasing your dose on your own. It is not good for your body to go through the withdrawal symptoms along with the pain issues you already have.
    If by calling the PM dr and there is absolutely no way to get in earlier then it's time to find a new dr.
    Good luck and I hope everything works out for you.
  • I can sympathize with your situation. I have had three failed spinal surgeries and my pain is still bad. I would like to correct someone, though, that after my first discectomy, I was prescribed Norco 10mg 1-2 pills every 4-6 hours. Now, I'm a big guy (230 Lbs), so maybe that had something to do with it. I have also been on hydrocodone for 15 months and I can also relate to the tolerance issue. One tablet hardly makes a dent in my pain. Unfortunately, I don't know what else they are willing to prescribe. It cracks me up when they come back and say they can give me 5mg of Oxycodone every 6 hours in lieu of Norco every 4 hours... Obviously, they don't get the clinical value of that medication. It is not "that" effective. I would take the 10mg Norco over the 5 mg of Oxycodone any day.

    I think the issue is to get to the root cause of the pain. For me, sitting exacerbates my pain, so I'm faced with a tough choice about cutting back my working hours (and my paycheck) or keep taking meds in order to cope. The latter does not seem like the right approach.

    After reading about PM doctors, I have to admit that I'm worried about what sounds like a general lack of compassion. I'm hoping that these are isolated situations?
  • All I know is that Norco prescribing information lists dosage as
    The usual adult dosage is one tablet every four to six hours as needed for pain. The total daily dose should not exceed 6 tablets.
    And I couldn't find a Norco 5 mg- only 7.5 and 10.

    while the dosage from Vicodin can be twice a day.
    The usual adult dosage is one or two tablets every four to six hours as needed for pain. The total daily dosage should not exceed 8 tablets.
  • I don't mean to argue with anyone over what is the right dosage of medicine. Obviously, we need to stick to what we are prescribed, and if it isn't working, we need to say something. That was the main point being made by people in this thread and I totally agree with that. I also think you are correct that doctors will want to limit Norco to no more that 6 pills per day. I was referring to immediately after surgery that I was allowed a higher dose. I agree that it is not USUAL. For all I know, my PA may have made a mistake.

  • So carwreck, how did it go? Any update?
  • I saw the nurse (as usual) and she understood that my pain level was/is more than expected. She said 20% of the patients have more pain for longer. I'm one of 'em. I am not a whiner or complainer- I've birthed three big boys and climbed the highest peak in the western hemisphere, along with many others. I am still in alot of pain post RFA. I would like to know why, I'm sure there is a medical explanation. The nurse said I could keep taking the norco, 5mg, 2 times every four hours, for as long as I need to. She thinks my pain will start receeding soon. BTW, my RX is for norco, 5mg. I'm given hydrocodone, which is generic for norco. I was given norco becz of the smaller dosage of tylenol in it. I brought up the fact that I was not cared for when in pain, she agreed that I was not handled properly and would talk to the phone people. She said that she is "on call" after hours and that would be the best way to get through to her. So I've found the unwritten way into getting heard by the PM folks and I have high hopes that the RFA will help, eventually! Thanks for all your support!
  • Well huh, I guess there is a Norco 5/325. Usually when doctors prescribe Norco, it's for the higher Hydrocodone content.

    But that's why it's important to know the content of what you're taking, not just the name. I also take Norco, and mine is 10/325.

    As I said, I had pain for a long while after my rhizotomy. It's not that uncommon, and it's because the nerves just say inflamed for longer. After all you are trying to kill them, it's not surprising that they'd be kind of angry!

  • I have Hydrocodone 5/325 (aka sub for Norco).

    Kind of odd though that if you get a script for 5/325 then told take them 2x. Should just get the 10/325 and take it 1x. Might be cheaper. You can always cut those in half later to make 5/325.
  • Z, I agree, maybe that would be cheaper.

    HappyHBMom, I have been prescribed Norco 10/325--1-2 tablets every four hours before. That's a total of 20mg. of hydrocodone. If you think about it, oxycodone comes in 30 mg. pills, so for some people who have been taking medications for years, it's used as a breakthrough medication.

  • And I'm not supporting taking more meds than prescribed.

    I was on 2 10/325 Norcos for YEARS....My PCP wrote the scripts as my PM won't write narcotics. My PCP would write the scripts for 150 a month, which ran short. So, he would write me a new script, actually electronic submission is allowed for NORCO in WV. anyway, he wrote the new script every 25 days. He refused to give me enough for a month. Flat out refused, I never could get him to understand it really wasn't changing the amount of meds I took, only shortening the time between my co-pays for the NORCO, which really ticked my wife off!

    I can happily say that I have not taken a narcotic pain meds since June of last year! YAY! <:P

    Sometimes doctors can do strange things and you just have to live with it. The last thing I wanted to do was lose my PCPs care as pain management in this area, sucks...
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