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AntikoerperAAntikoerper Posts: 5
edited 06/11/2012 - 8:46 AM in Pain Medications
I have a ruptured disc at L5-S1 causing pain in my low back and both legs. And about a year ago I was lifting stuff while moving in to my new apartment and something happened to the thoracic area, though I have yet to get a thoracic MRI. I was on Norco 10-325 1 every 4 to 6 hours. this was after I tried epidurals, Vax-D, multiple types of physical therapy, and more recently, I have had facet joint and trigger point injections. My new doctor started me switched me to percocet 10-325 1 every 6 hours. When I had my most recent visit, I told him that the percocet was not providing relief for the full 6 hours. After more injections, he prescribed me Fentanyl patches 25mcg/hr 72 hour. and upped the amount of percocet that I am allowed to take. I told him I don't think I need something as strong as fentanyl but he made it sound like I needed it. Now I do. Has anyone else experienced over prescribing? I am sure most of us if not all, have experienced under prescribing. I am just curious to see how common over prescribing is.


  • Hi Anti and welcome to spine health. I'm a little confused by your post. You say you have a ruptured disk. I'm guessing this was prior to your incident a year ago when moving. Sounds like you are trying everything to treat that problem. Does your doctor have a plan on what to do about that since meds don't seem to be working?

    Then you had a new injury to the thoracic area, you think. What does your doctor say about that? YOu said you haven't had an MRI - is there a reason?

    Unless there is stuff you haven't mentioned I would think it's a good idea to find another doctor. You aren't happy with these med increases and it doesnt sound like he is taking you serious about the new pain. Also what kind of doctor are you seeing?
  • hi and welcome to the forum! we are here to offer you support and answer what questions we can. i just stopped by to say hello and i hope you enjoy the forum! be sure and have a look around and make yourself at home! i have not had many dealings with overprescribing..most of my doctor's stick really close to a regiment of "as little meds as possible"... i find this works best for me! in most cases you have to look out for yourself in some ways.. this is one of them... be careful of what you take and how many.. i always talk with my pharmacist about any new meds and how they will react with what i now take... i have found overprescribing in the elderly.. this is a big problem i believe!!! both my grandparents were given too much medication, as well as my mother in law. i know of several other older people who have had this problem.. good luck to you! Jenny
  • I am seeing a pain management doctor at the GA pain clinic. I talked to him on my last visit about my pain in the thoracic region and his response was "thats not what I am treating." I am currently looking for a new doctor because I am not satisfied with how this one is treating me. However he does plan to refer me to an orthopedic surgeon. And my L5-S1 problem started from a car accident that I was in back in 2005. It started as a bulging disc and progressively got worse to become what it is now. I am only 23 years old and the thought of back surgery scares me beyond belief, but seeing how much worse my back has gotten in just a few short years, I think the pros may outweigh the cons of surgery.
  • Thank you both for the welcoming. I also talk to my pharmacist about any new medications and interaction. I am also in training to become a register pharmacy tech. So I have educated myself on numerous medications and interactions. I am just so tired of being in pain all the time and its depressing being a 23 year old guy who cant help someone who, for example, is carrying something heavy up or down stairs or anything like that. I dont know, I feel like i am contradicting myself. Maybe I feel that if i get rid of the pain that i will be all better. Even though I know that isn't true. Maybe it's just wishful thinking that I don't feel as if I need such strong medications. This whole thing has just really gotten to me physically and mentally.
  • Anti you need to find an orthopedist or neurologist to give you a complete evaluation. Not a surgeon!! Either of these doctors is qualified to do a thorough exam and tell you what your options are. If they feel surgery is an option they will send you to a surgeon for further evaluation.

    The PM doc is right. He is treating you based on the last eval you had for the lumbar problems. PM's treat pain, they don't do evals.

    As far as surgery, take that one step at a time. See what the doc says. Many have surgery and wake up pain free. Wouldn't that be amazing?

    I hope this helps. You need to get to the proper doctors now. Please don't wait.
  • Thank you for the advice. I am looking for a new doctor. Which do you think would be more appropriate though? I neurologist or an orthopedist? I know each of them has stronger points in certain areas. Do you think I should ask my PM doc about it? I see him again on August 11th so it's rather close. Maybe I could talk to him about how I feel about everything and see if he could recommend one of those types of doctors rather than a surgeon?
  • Talking to your PM would be a great start. Don't be scared by the title Neurosurgeon or Orthopedic Surgeon. Just because they have surgeon as part of their title doesn't mean that's all they do. Your best bet is to see a Doctor or a Practice that exclusively does spines only.

  • Wow! I thought over prescribing was non-existent these days. In fact, I am a member of many support type forums for pain and back issues and have NEVER seen that.

    Honestly, I would get a new Dr. My friends wife was on the patches for years and it took hefty doses of other narcotics to ween her off of that.

    If you don't feel you need it, stop using it immediately.

    The goal is the minimum amount of narcotics possible to get relief...
  • I know that we all have our own opinions here, and I'm going to say that my opinion is if you go to an ortho or neuro for a diagnosis then get referred to a surgeon, you're taking a step in between your PM and Surgeon that is a waste of time and money.

    My PCP handled my x-rays, meds, PT then when that didn't work told me to find a surgeon. After much research and talking to friends, I found a fellowship-trained spine surgeon (ortho, although neuro is fine too) that only works on spines and happened to specialize is severe cervical problems. Yes, his first recommendation was surgery, but if you'd seen my MRI, you'd understand why.

    Now, with my lumbar issues, this same surgeon sent me to his physio for injections and tried all conservative treatments before telling me I needed surgery. By the time I tried all the conservative treatments, even I knew I needed surgery.

    So, my opinion is like Dave - start with your PM and don't hesitate to go straight to a spine specialist surgeon from there. Like he said, that's not all they do, especially if they're in a clinical setting.

  • Well, most ortho and neuro specialists are surgeons, so I don't see the distinction there.

    You never are at the mercy of a medical treatment you feel uncomfortable with. You have two feet that can turn your body around and walk you out of the office. Now, if you're hoping we'll tell you that the fentanyl patches aren't overprescribing- I took a jump similar to the one you would be taking. I have a severe collapsed fracture and it was really acting up and causing a lot of pain. The patch made me VERY sleepy and out of it. It did knock out the pain, but in the end was not worth it, I took a few steps back to MS-contin when the flare-up subsided some.

    My goal, as Ashtona said, is the lowest dose possible. I do not seek to knock the pain out, but just to keep it minimal so I can go about my daily life. There are about a dozen medication options between percocet and fentanyl patches.
  • If you have those problems mentioned you should look at getting them fixed before you hit the hard stuff. If surgery isn't a option then my friend you have know choice.
    To me the patch is a step up from Oxy. And I feel! My opionion! if you are that level of meds there is something wrong that surgery can address. unless the docs tell you surgery isn't a option or previous surgeries failed.

    The patch is synthetic and WD are a &^*%^*&^&. However, they work and work good. Unless you can't get out of bed I would decline. and ask for ER Oxy and maybe a IR oxy for breakthough pain. I know Percs are Oxy! However they are not ER and ER would manage your pain better in a 24 hr course probable at a less of a dose as well.
  • Actually, a patient shouldn't in general ask for a specific narcotic, as that is considered "seeking behavior." It's usually best to allow the doctor to make those suggestions.
  • Difficult one but I would rather have one more lib than too tightm
  • First let me say welcome to spine-health, have a look around and you will find many whom have had or are going through the same as yourself.

    As far as over prescribing if you don't feel comfortable on that level of meds you need to discuss this with your doctor. I for one am not comfortable on very strong meds, but one may argue I take strong stuff but considering what is out there I don't see it. My point is at the end of the day you have to feel comfortable with what and how you are being treated and what all the options are available to you as a patient. One of the greatest things about this board is reading other threads and seeing what others are going through and the type of treatment they are getting.

    You will see some say go to a surgeon, nuerologist or a pm doctor. But in my experience and what I have seen here I think the doctor options are dependent on what part of the country you are in. For the most part my surgeon takes care of all issues relating to my spine. While he may have me at a pm office to maintain me if something were to change, the pm orders the films and sends me right back to him. They pretty much work hand in hand. In my situation there is no nuerologist involved whatsoever in my care nor has there ever been. If you have a good relationship or better relationship with your primary doctor there is nothing wrong with asking him/her their opinion on the treatment being offered up and what they think. But most of all you need to feel comfortable with your care, and I don't get the sense you have that warm fuzzy feeling. It sounds as though your pm doctor is giving you the patch to treat your lumbar sense he is not treating your thoracic issues, which sound like they need to be investigated. It could also be that your lumbar is causing you to compromise in such away that your loading more in the thoracic spine with sleeping and sitting and what not. But I am no doctor but just think you need to get it all investigated and answers to the issues.

    I am not sure if you have had a surgical consult or not, but look in the FAQ section and you will find a list of questions to ask a surgeon or there is a list of questions used to prepare to meet with a spine specialist. So whomever you choose just be prepared for your meeting so you can get all the answers you need and the best possible care. Also don't be afraid to take along someone else for a second set of ears.

    Once again welcome to spine-health and keep us posted on what you do. Take care.
  • dilaurodilauro ConnecticutPosts: 9,875
    Surgeon vs Non-Surgeons

    There are MANY Orthopedic doctors who NEVER perform surgery and Neurologists who do NOT perform surgery.

    These specialists are trained in the fine art of identifying and fine tuning a bone,spinal,and/or nerve related problem. Once they have isolated the problem(s), they turn the case over to surgeons, IF surgery is in order.

    Remember, surgery is NOT the only answer and for many its only the final answer.

    In the subject of over or under prescribing. There is where the relationship between doctor and patient is so very important. The medication(s) being prescribed by a doctor should address the problem(s) that a patient is having. The prescriptions should never over prescribe or under prescribe.

    Us Lay folks as Spine-Health members can only offer personal opinions. The facts, remain between doctor and patient
    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
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