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New to pain management

DogfoodDDogfood Posts: 5
edited 06/11/2012 - 9:00 AM in Neck Pain: Cervical
Hello. I'm new here. My question is multi-fold. 1. I'm new to pain management and just went to the "intake." 2. I went over on my prescription for pain meds last month due to a tremendous increase in pain. 3. My MD wrote a new script, and referred me to pain management after going over. My MD was understanding and confessed they didn't know what to do - as pain management isn't their specialty. 4. This is chronic and has been going on for 8 years. This last bout has landed me on Percocet for the past 7 months. 5. When I showed up to the intake, I had already gone through my 1 month (new) script in 2 weeks (2 days worth remaining. So I had only a few). 6. At the intake, the doctor stated they do not prescribe on the first visit. They called my doctor to see if they would fill another script. 7. I have to wait a week before seeing my new pain management doctor.

What is the most likely outcome? The pain is already intolerable. I'm trying to use the few remaining pain pills for when it's really bad. But, there are no "good times." I don't want to hound either of the doctors. I had to sign a PM contract with my new one. I don't want to appear as a pill seeker by calling. Being in limbo and not even knowing if I'll get a call with a "yes or no" is driving me nuts. Please advise, and thank you.


  • dilaurodilauro ConnecticutPosts: 9,878
    Could you provide us with some details regarding your medication situation?

    - When did this start? How long has it be going on for?
    - What diagnostic tests have you had and what are their findings.
    - List of all medications you are currently taking.
    - What treatments have you had? What were the results?
    - Have you had any surgery? If so, where and when.
    - What has your doctor(s) recommend?

    The more information you can provide us with, the easier it will be for other members to contribute and respond to your thread.

    If I read your thread currently, it appears that you are taking more pain medications than what was prescribed for you. You should never increase your dosage intake without getting your doctor's approval.
    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
  • Sure... This started in 2004.

    2004 - 2006 chiropractic / on off low doses of Ultram (which I can't take) and flexeril (which I've recently found I also can no longer take.) x-rays, supposedly diagnosed arthritis from the chiropractor. Very misaligned vertebrae, abnormal curvatures...

    2006 - 2007, much of the above, supplemented with on/off Vicoden, some physical therapy.

    2007 - 2009, so many chiropractor visits I was scared I'd lose my job. Robaxin (muscle relaxer) 12+ weeks physical therapy in 2009, hit and miss on pain killers (no large scrips, just intermittent 2 week scripts when bad - Vicoden, Lortab.) MRIs x 2 in 2009. Again told I have arthris by my former MD.

    2010, my chiropractor told me his work wasn't helping me any longer, and that I was just as bad as the first day he saw me. New doctor, another MRI. This time told I did not have arthritis by new MD. Sent me to a spine specialist.

    2010 bilateral epidural "blocks," (I think C2, C4, C6 - but I know there were 4 injections on each side...) Robaxin since 2009, Lortab pre and post op. Surgery successful in that it lasted about 7 months of being mostly pain free. 8-10 weeks physical therapy.

    2011, Radiofrequency ablation, same joints. Lortab pre post op. Rovaxin switched to Skelaxin, post op. Lortab switched to Percocet post op. surgery made pain worse and was a complete failure. Physical therapy early 2012.

    Currently, Percocet 7.5, 5 times per day, just changed when I went over last month from 4x per day. Skelaxin 800 mg? 3x per day. Stretches multiple times per day and traction almost every day.
  • I do understand the comment about not changing my own script. What has been frustrating is trying to work with my MD that admits they are not a pain specialist. When I went over on the prescription of Percocet, they changed my script. I am thankful they were understanding. But, should they have prescribed more, as they asked specifically how many I was taking, I most likely would not have gone over on my script again while waiting to get in to pain management.

    What I do not want to do is make an already bad first impression with the new pain management doctor worse by calling them to ask about pain medication (even if they don't call me.)

    I do tend to over analyze things... But, if the pain is that bad, doesn't it make sense that I would call to ask about pain medication? I don't want to send out false signals in either way; meaning if I do call, I'm a pill seeker. If I don't call, then I must not really be in pain.

    What do you all think my new pain management doctor will think? Or, do you have thoughts to share concerning my own about calling?
  • I died forget to add... I had to get a new MD in 2011, as mine moved.
  • I have made myself hold out as much as possible with taking the remainder of my prescription with the mindset of; if this is bad, there may be a worse time coming. It's been pretty uncomfortable.

    I'm curious to know if there is some *unanimous answer concerning how this works, as I don't know - I'm entirely new to the process of pain management.

    Would somebody mind sharing their thoughts with me about the above? If this isn't the proper place for such awkward questions let me know that as well.

    Thank you in advance.
  • dilaurodilauro ConnecticutPosts: 9,878
    The purpose behind pain medications is to manage (not to eliminate) pain levels. That means taking these medications on a regular basis (as prescribed) so as to not allow the pain to build up beyond control.

    If the pain starts to increase, then the need for more pain medications arises.

    There are two basic types of pain medications. I am not talking about the various drug names , but

    ER Extended Relief. These are medications that provide a constant level of pain relief over a period of time. An example is Oxycontin. I was on Oxycontin (various dosages) for several years. I would take one in the morning, then one at night. In between, if the pain increased, I had breakthrough medication to help.

    IR Immediate Relief. These are the ones that act quickly, provide you with strong pain relief, but the duration does not last all that long.

    Many times, a doctor will prescribe a ER medication along with an IR type. For many that is the best combination.

    The most important aspect is establishing a solid relationship with your doctor, pain mgt specialist, etc. These are the folks that can understand your pain level and determine what is the best action plan. Having the trust, you will be able to discuss the situation. This works, this doesnt, How about this, etc. But that takes time to develop a level
    of confidence and trust. But that is SO VALUABLE
    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
  • Hi Dogfood :wave: & welcome to SH :)

    Just putting this right out there to you - don't call and ask for more pain meds. Sorry but it is a huge no no. Especially since the PM Dr already said "not yet" more or less.

    The world of PM is a world no one wishes to find themselves in. There are so many bad apples out there that us good apples get lumped right in with the bad. The Drs are kind of forced to do this to cover their own behind - CYA ;)

    I have been in this new world of pain & Drs for about 8 yrs now and I as most of us do - still have to "toe the line" when it comes to our meds.

    I have been called in for pill counts - the Drs office just called me and said we need you to drop by with your meds at some point today. I asked why and they said "is this a problem"? I said "well no". I still was clueless. I went and I was taken into a room with a nurse who took my pills and poured them out on the exam table (covered with clean paper lol) and started counting. Then pulled out a calender and calculator, did the math and said "you have 4 extra pills here, so I guess you don't need this many from now on". I explained I worked the midnight shift and had just got up a few hrs ago so I would still be needing those 4 pills before MY day was over.

    I have been with this group of Drs for many years. It does not matter - you still have to prove your doing what they say to do.

    I feel bad that you hurt & that you need more/better pain meds, but I am trying to help you understand all this so you don't end up out in the cold altogether :)

    Please keep us posted how you are doing...
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • Dogfood,

    Ron is so correct. The relationship you have with your physician and his staff is, to me, the key to getting MY pain managed. Please read my story below and you'll get an understanding of some of what I have been going through. Currently, I am under the care of a Pain Mgmt Doc. He and his staff are so good about listening to me ... notice I said listening, not telling. I have been with him for about a year, only because we made a move Oct 2009. So far I have had Epidural Steroid Injections (ESI), Facet Joint Blocks, Botox Injectios and Trigger Points Injectios in conjunction with trying to find me the right medication combo to relieve my chronic cervical pain. None of the injection procedure afforded me ANY relief. After about 9 months of different med combos, we finally have me on one that I almost feel human again. Don't give up. Just stay stronp and keep us posted.

    Rassy's Story
    Under House Arrest Without the Ankle Bracelet :-)
    The remarks I make are strictly my own based on my personal experiences.
  • I can tell you first hand that if you try to refill your pain meds early they will deny your request and some doctors will even stop giving you the script for them especially if you are going through a months worth in 2 weeks. I recently had my car broken into at a friends house and when they stole my back pack not only did they steal my laptop but they got all of my meds too. I called my doctor to request a replacement for the stolen meds, I showed him the police report and even with that I was denied. also since I requested a refill so early I was immediately drug tested to make sure I was not abusing them and now because of all this I have weekly drug tests instead of only random ones and random pill count appointments with 24 hour notice where I have to bring in my script and the nurse counts the pills I have to make sure I have the correct amount or more at the time I am called in. they don't mess around when it comes to a monthly opiate prescription. If they do end up going that route be prepared to have to sign a legal contract and have random drug tests to make sure you are taking it exactly as prescribed. also some pain clinics require you to have the pill count checks done as condition of your contract. It's really too bad that the people that abuse these meds do so in such a way that now because of it the people who actually legitimately need them to treat severe chronic pain have to jump through all sorts of hoops in order to be able to get them for the pain relief we so badly need.
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