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How do I handle medication quandry between doctors??

Hi all- I am hoping someone can shed some light on this seemingly-toucht subject of medications prescribed for back pain. Trying to keep a long story shorter, I will briefly describe what has happened so far.

Aug 2009 discectomy L5-S1- very successful

Oct 2011 first recurrence of back/leg pain L5-S1- MRI shows 2 bulged discs, DDD, facet arthritis and spinal stenosis-PCP prescribed oral steroids, Percocet, and anti-inflammatory

Nov 2nd episode of same pain - same prescriptions- recommended visit to neurosurgeon & signed pain management paper

Nov neuro saiid try steroid shots first and refused pain meds

March 2012 3rd episode same pain - PCP seemed angry at me for "reinjuring" 3rd time- reluctant to give pain med but did.
March- started getting steroid shots from pain mgmt Dr/clinic (had no insurance til now). Told them I got my prescriptions from PCP. They did give me Neurontin which I accepted since non-narcotic.

March- Aug- have had 4 steroid shots and 2 rhizotomies. Have/are on Neurontin, Diclofenac, Celebrex (useless!), Percocet (PCP), and Vicodin (pain mgmt after rhizotomy)

Jun 2012- 4th recurrence - returned to PCP- angrier now (why does he get angry at me?? It's not like I want it to keep hurting! I do have to work for aliving, and take care of elderly parents...), says time for surgery, insinuated this is last time he is prescribing pain meds. I take half of what is prescribed amount. Also, he saw that I accepted Neurontin from pain mgmt Dr.

July- had 2- 2 level rhizotomies - Dr. had asked about pain meds, and I told him story and added that his PA had refused even a weeks worth of pain meds and oral steroid that I requested last visit til steroid shot kicked in. He said, don't worry, we will take care of that for you from now on. I told him my PCP wouldn't prescribe any more.

Aug - saw first neuro- he says I need 2 level laminectomy- no fusion- I said I was going to try one more shot.

Aug- had 4th shot today. So I told Dr. I had 10 Vicodin pills left from presciption from 7/24 they gave me after rhizotomy. Prescription was for 45 pills...30 days and I still had 10 left but worried about shot not working, and if I decide on surgery, it won't be til October when my sister can come up and help with my folks. He said, sorry, you need a fusion- no disc left at L5-S1- no pain meds!!!

So, you see my frustration?! What is it with these Dr.'s?? I know there are people who abuse them but obviously, I intentionally take less than what I really want to so they will SEE that I am NOT abusing them! It is so hard to go to work and sleep and try to help around the house, and now I gotta worry about who is going to help me relieve this pain! So what do I do now?

Any thoughts welcome, and thanks!



  • I would try to get just the PM Dr. to take care of your meds. They don't like to see/hear you have not taken what has been supplied for pain. It doesn't look good for you to be asking for more pain meds when you still have meds left over from 7/24. Learned a long time ago to take the medicine as perscribed or they tend to get squirmy with giving more.

    Hope your able to get this worked out.
  • I drive an hour to work, have a physical job, then go home and watch elderly parents (one of whom almost burned the house down a few weeks ago!) I can't be all loopy on pain meds! I can't even take the Neurontin as prescribed because it makes me so sleepy! I got the feeling he just passed me on to the surgeon and doesn't want to see me again.
    Thanks for your input
  • You are in somewhat of an odd situation.

    They tell you that you have no disc left and you need surgery but won't provide meds to manage the pain before your surgery? Hmmm.

    Usually PCPs will prescribe pain meds a couple times then refer you to pain management or a surgeon.

    Maybe your doctors are upset that multiple docs are prescribing your meds? I know that in my pain contract states that only my pain doc can prescribe controlled substances for me unless the pain doc tells the PCP what to prescribe and they do all the prescribing.

    I hope you can get relief. Remember, you can always get a second opinion, BUT make sure all docs know everything you are prescribed or you will get in big trouble!

    ACDF C4-5 June 23rd, 2011

    Another surgery in the near future. I am 26 years old.

    Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg
  • besides having to deal with the back pain, then having to worry about not being able to get relief....anyway, I go to neuro again on 9/4..will see what they suggest and will ask for a contract from him since I won't be going back to either PCP or pain mgmt doc again.
    Thanks for your help
  • Part of the problem that I have seen, not necessarily with you but with any chronic condition that involves pain medication use, is that once a patient is told that they need surgery, postponing the surgery is not seen as a reason to continue to give pain medications. There have been patients who will use the I want to postpone surgery as long as possible, while continuing to use pain medications as a means to try to keep getting prescribed pain medications but not "treating" the mechanical problem that is causing the pain.
    In your situation, you were getting pain medications for almost a year on and off from your PCP for pain, but didn't see a PM doctor until 7 months later. Then the PM doctor told you in July that they would take over your medications for you but apparently didn't get a prescription from him/them until you had this last shot. Did you ask him for a prescription for pain medications, or remind him that he said that he would take care of your pain medications since your PCP won't anymore? That's what I would have done, remind him that he told you that he would prescribe your pain medications and ask him for recommendations for your pain until you are able to schedule surgery with the neurosurgeon.
    As for not taking the meds ( neurontin) due to the sleepiness/drowsiness- usually , those type of side effects will go away or diminish significantly after taking the meds as prescribed after a few days to a week or two on them. They won't go away if you are only taking the meds prn- as needed or as often as you feel they are necessary. And you won't get the relief that taking the meds as prescribed offers over taking them periodically or intermittently.
    Once a patient is referred to a surgeon and the surgeon recommends surgery, the PM doctors will wait until after the surgery to see how the procedure helps to diminish the pain.
    Good luck , with trying to get this straightened out but I wouldn't plan on the surgeon taking over your pain medication needs until the actual surgery and then for the first three months post op. Many surgeons are now only handling pain med needs for patients in the time period immediately after surgery and for the first two or three months out, after that, patients are sent back to pain management for ongoing management of pain.
  • Thank you for the input. I am going to call my PCP tomorrow and request that he contact the neurosurgeon (who he knows well) and agree that he will continue to prescribe for me as per our contract. I will schedule whatever surgery he decides is best for Oct. when my sister can take vacation days to come up and help me out afterwards.

    This just has me so stressed out, worrying about this. I feel like I am being held hostage by pain and the threat of no relief.
  • I went through something similar and gave in and had the microdiscotmy and when it didn't work the surgeon dump me like a hot potato my PCP wasn't too happy with it either if though the PCP is an Internist with a side specialty is a Pain Doctor but doesn't do pain management?? I know it's weird.
    Now I am in PM and all of sudden having trouble there.
    I am beginning to see Doctors in the same light as lawyers and that is not to trust them anymore.
    I know a woman who husband recently has retired and they are moving to Panama for the PM down there. Pitiful that someone has to leave the USA for pain management. Her problems are well documented too, auto accident fracture neck and low back over the years it has developed into curvature of the spine and so much arthritis her Cat Scans look amazing and horrible at the same time. Yet the PA at her PM Dr office said she just cannot understand her level of pain and has even tried to refuse her from talking with the Doc directly. Which she told me specific in the pain care contract that any question concerning her medication are to be take up directly with the Doctor the PA has left her sitting (which is one of her big problem areas, sitting straight up and standing) for up to 2 hours she told she went into the hallway and snagged the Doctor who said I thought you had left with your prescription hours ago.
    Some of these PA's are such jerks.
    C3-4-5 fusion 2005
    C-5-T-1 disk bulged
    L-4-5 bulge to the right, with Microdiscectomy, failed
    L5- Bi-Lateral bulge
    Pain in right foot -loss of feeling
    Left butt, hip and front thigh pain with bad shooting pain into inside ankle sometimes
  • Yes, Pa's seem to be a big problem in a lot of cases. When did they start having them? I never rremember dealing witht them years ago. But they do cause a lot a of problems for PM...like they think they are the Dr and so cut back or refuse meds becaused they can. Thank God for my PCP...he said he would keep prescribing as long as i did my best to get surgery. After several Neuros rejected m e because I have DDD but no instability, I finally found an Orhto who did the urgery and said he was glad he did bec=ause I had much more arthritis and bone spurs then MRI showed, and had absolutely no disc at the front of the vertabrae. I am 3 weeks out and still in a lot of pain but am walking and have no back pain, only in legs and knees. Hope that goes soon! Thank s for keep in touch!
  • horselady- happy new year, hope you Christmas was good
    On Christmas day I met one of my Sisters in-laws who told us an
    awful about her husband (deceased) anyway His PM Doctors forced
    him into LB surgery and they crippled him for life and made his pain
    much worse. He had bulging disk like I have and similar symptoms
    and pain. After a few years of PM the PM sent for an MRI and they found
    the budge was worse and sent to the back surgeon who said he needed to have
    the disks(2) removed and fused. The insurance company made him get a 2nd opinion
    and that Doc (surgeon) said no to the surgery and that he should stick with the PM and PT to try strengthen his core muscle and to lose his big gut. He was happy about that visit cause he did not want the surgery. So he went back to the PM and told him what was going on, the PM got angry that he went to another surgeon for the 2nd opinion without consulting him so he went to 3rd surgeon for an opinion and that one told maybe yes maybe no but if he felt OK with the PM and since he was on disability (100%) that was probably a good and safe course for him. Plus the 3rd Doc said he would have to lose 50# before his clinic would approve the surgery (non-emergency).
    So he returns to the PM and the PA came in gave him his normal script of Vicodin and told the PM Doc was too busy to consult with that day but talk with next appointment
    2 weeks later he get a letter from the PM office stating because of Doc shopping he was being fired as per PM contract!
    They wouldn't even talk to him on the phone every time he called they hung up.
    anyway he went back to the second opinion Doc cause he liked him and didn't trust these associates of the PM doc the surgeon said he would see him for 2 months only and after that he would have to find a PM to take him and recommended to him a couple. Both would not take him on because of the first PM accusation of DR
    shopping. He finally got in PM but it was in another town 80 miles away.
    His wife said he tried talking to a lawyer about it but was told there was no use.
    These PM Doc are like jailers or at least the bad ones and their sorry staff.
    Something needs to change about this people are really suffering out here.
    Between the government and PM clinics people are being mistreated and suffering.
    This is the United States, this shouldn't be happening.
    Sorry for the long story but I'm just frustrated over this whole thing, hearing all these horror stories, the way they are treating people, my own bad visit recently.
    I wonder if under the new obama care if things will change any, for the good of the patient? I'm not holding my breath
    C3-4-5 fusion 2005
    C-5-T-1 disk bulged
    L-4-5 bulge to the right, with Microdiscectomy, failed
    L5- Bi-Lateral bulge
    Pain in right foot -loss of feeling
    Left butt, hip and front thigh pain with bad shooting pain into inside ankle sometimes
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