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queenjillybeanqqueenjillybean Posts: 46
edited 06/11/2012 - 8:49 AM in Pain Management
I am just curious if my shock, dismay and fear are reasonable...
i have been on PM for many years for a 24 year history of massive spine/ lumbar issues... i am currently on 80mg Oxycontin twice a day and 10/325 percocet 4 times a day for breakthrough...i have been on the same exact dose for just over one year. I never have asked for an increase, nor do i complain to my PMDr as to the meds, etc... i have had perfect/ flawless urine tests and am basically the model patient. I have been with this pain clinic for over a year, and yesterday got results from a discogram that i had on tuesday- by my ortho surgeon who has done my previous ALIF and 2 PLIF's- and as it turns out, i need yet ANOTHER fusion at the level above my highest fusion- and i am scheduled for the XLIF in 2 weeks...
So, today, when i go to my monthly med appoint at the PM, i provided all info regarding this upcoming surgery and wanted to discuss the procedure for my post-op meds per my ortho surgeon...and the PA tells me that "whatever they give you in the hospital is fine, and then just stay on your normal meds- maybe take 3 percocet a day before your surgery instead of 4"...I almost tipped over?! Yes, the XLIF is less invasive than the other fusions, but it is still MAJOR surgery with hardware, bone harvest and grafts, 3 incisions and muscle stripping!!!! I was patting myself on the back for not requesting anything extra for the excess pain that the discogram caused and is still causing- and i find it almost inhumane to be expected to have ANOTHER fusion with not a single adjustment to my current pain management regimen for at least a few weeks post-op???
Am i over-reacting? I thought that even an extra 4 percocet per day post op was conservative... i just do not know if i can tolerate this surgery with zero change even for 2 weeks post op???
I did request only 2 weeks worth of my meds today and have another appointment for a month supply just a few days before my surgery so that i can avoid too many long trips in the car so soon after this surgery- as i live in a rural area and all of my doctors are at least an hour drive each way... I am going to discuss this with my health psychologist next week (who btw works with my PM dr) as well as my orthopedic surgeon- and hopefully get feedback from fellow spineys... and then see what transpires between now and 2 weeks from now... any input or comments are much appreciated-
i am a very "tough" patient who is not a whiner, nor am i demanding AT all (probably to my detriment)... however, i just can not fathom going through this with zero accomodations made???
help? anyone?


  • That does not sound okay at all to me. I hope that others will post to give their opinions, but with a surgery like that I am very surprised that your PA thinks that your normal regimen will cover post-op pain. It's great that you're thinking about these things now. Are you going to see the same PA at your next appt., or will you see the doctor?

    I would definitely get a post-op plan together. Can you make an appt. to see your actual PM doctor, instead of the PA?
  • Here is my thought. Same happen to me. The PM didn't do any adjusting for a reason. He is letting your pain determine how much med you need.
    Let me explain.
    He said it was ok for you to take what meds they give you at the hospital.
    So if you have the surgery and are laying in the hospitol in extreme pain. YOU SHOULD ASK FOR MORE MEDS! Which the hospitol will have to react to your request.
    When you return home surgen will have forward the Surgery notes to PM. Your PM will then treat you with the increase the hospitol gave you. Thats one way a doctor determines your true pain without pulling you off meds to find out.
    He/she is letting the pain speek for itself. Most PM are not going to give you more then you currently take before surgery because the pain needs to be evaluated after surgery. Exspecially when you have been holding at your current dose for over a year!

    3 things!

    1. when you return to your PM after surgery He will try to lower dosage back to your original 80 x 2.
    Please note: if pain is still bad he will keep you at your hospitol dose. If not he will decrease back to your original dose. Maybe even lower your original dose if surgery helped.

    2. Don't have your surgen perscribe meds before the surgery if you getting from PM. And after you leave hospitol and have follow up vist with surgen let the surgen know you want your meds to go through your PM and he should send all corrispondance to the PM. The PM will treat you as per the surgen request until the dismisses you back to the PM.
    Then the PM will take over again. Either on your new dose or original dose or maybe even lower dose if surgery is successfull.

    3. Make sure your PM sends your current med history to the surgen and Hospitol. They both need to know what your currently taken or trust me the hospitol won't give you even close to what your currently taking. People think well this is what Im on so they should all know. WRONG!
    Don't forget to bring you own meds hidden. JUST IN CASE THE PM LETTER NEVER GOT TO THE SURGEN OR HOSPITOL.
    Even if the hospitol calls for pre registration and asks you what your meds are, still have the PM contact hospitol and surgen via letter.
    I hear bad stories how people have surgery and hospitols don't medicate correcctly because they were never given a start point from surgen or PM. Then your worst case would be the hospitol waiting for surgen then surgen has to verify with PM. The whole time while you suffer.
    Thats the reason for bringing your own meds. not to take but to have just in case.

    Lastly good luck! and Don't worry. Just remember to do your own leg work because papers get lost and Dr. tend to forget.

    Your current dose is kinda high! Exspecially in the eyes of nurses. So the information you provide will ensure things are handled correclty. by all!

  • QueenJillyBean,

    To follow up a bit one what the others have said.... I get the feeling that your PM "knows" that your surgeon will prescribe a medication level based on your post operative pain levels, and that too, most times the surgeon will prescribe for 2 weeks post op.

    Then your PM would come back into the picture and adjust up or down as needed. I don't think he is ignoring you, he can't "predict" how you will feel after surgery...

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • thank you all for your replies... i go to my PM this week for my regular refills and on monday i go for all my pre-op stuff for the surgery on tuesday- my ortho surgeon DID tell me that he WILL handle my post op meds- his nurse told me that about 50% of the time PM dr's opt out of the post op monitoring... i don't care who does it, actually, i prefer my surgeon to handle it, as he has known me for almost 10 years and done 3 of my fusion surgeries and really respects me as a PERSON... he is also the medical director of the hospital where i am having the surgery... my stress/ anxiety as to the med situation is waning... and i have cut back my BT meds for the past week to try to get my tolerance down a little bit... my other worry is my insurance covering pain meds from my PM and my surgeon- it is so frustrating to work so hard to communicate and give all information to all parties involved making sure that i don't accidentally break any rules or regulations... i really respect the whole PM system, and need it desperately, yet there are those "bad apples" out there who make it very precarious...
  • dilaurodilauro ConnecticutPosts: 9,875
    between what a Pain Management / Physiatrist and a Surgeon does/feels/prescribes pain medications.

    The surgeon is mostly interested in the surgery and your initial recovery. They will prescribe the medications that should handle the situation.
    This may or may not be what you currently are taking.

    Then at some point, the surgeon will discharge you in terms of medication control and turn you back to your Pain mgt doctor.

    Before any surgery, surgeons will review your current medications, list them all and during surgery provide you with equivalents. The pain medications are not necessary since the hospital will provide you with those during your stay.

    However, one thing to NEVER do is:
    DDDBACK said:

    Don't forget to bring you own meds hidden. JUST IN CASE THE PM LETTER NEVER GOT TO THE SURGEN OR HOSPITOL.
    that is about the quickest way to get you into serious trouble with the medical field and only serve to identify you as a potential drug seeker.
    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
  • My doctor told me to bring my meds with me to the hospital. I never got them out of the bag, asked the nurse about them and she said they have you do that just in case the pharmacy doesn't have one of the meds your on. They can get them pretty quickly but if you need it now 4 hours is a long time to wait.
  • I asked both my PM and my neurosurgeon about pain meds. My neurosurgeon was not comfortable prescribing post-surgical meds for someone who is opiate-tolerant, and suggested I have my PM prescribe them.

    In the hospital, I had a pain management doctor working with me. That was the only real issue- the dilaudid did not work well and people were slow to modify anything.

    But basically, my PM gave me 4x 15mg roxycodone on top the meds I had been taking before. Since my pain was worse than I expected (because I had a thoracotomy) I also left the hospital with a prescription for 50 mcg fentanyl patches to replace the 25 mcg patches I was using- I called and OKed that with my regular PM before filling the prescription.

    The combo worked well for me- even in the hospital, I did much better on the fentanyl/oxy/dilaudid mix than I had on the dilaudid alone (although the dilaudid did serve to make me stupid, it did very little for the thoracotomy pain).

    I guess the moral of my story is cover all your bases :) Don't take anything for granted, ask your surgeon what he is willing to prescribe for after you leave the hospital. Your PM might assume the surgeon will prescribe something, but if all they will give you is vicodin you'll need your PM's intervention. Also ask how the pain management in the hospital will be done. And another suggestion from me is asking how they manage your regular medications- the hospital I was at did not allow me to take outside medications and it took a while to get it worked out- and since I was on beta blockers that was an issue!
  • This is terrifing. I'm having my SCS trial in a few more weeks. I'm meeting my new pain management doc this week. I didn't know it was going to be so complicated trying to figure all this out. UGH.
  • Make sure your PM sends your current med history to the surgen and Hospitol. They both need to know what your currently taken or trust me the hospitol won't give you even close to what your currently taking. People think well this is what Im on so they should all know. This is really very important.
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