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Unhappy with PM

avonldyaavonldy Posts: 61
edited 09/19/2012 - 2:21 PM in Pain Medications
I was referred to a PM by my Rheumatolegest for injections into my lower back and SIs.They injected both SI joints and 2 facet joints. On the next follow up appt. I saw the PA, instead of the Dr. He said that the Norco(10/323) I had been taking 5-6 times a day for my Ankylosing Spondylitis was giving me too much Tylenol. He recommended that I take MSContin with Norco for back up pain. Up until now, all my pain meds were taken care of by my GP for the last 25 years. The last time I had asked about increasing my pain meds because I was having problems with pain whenever the AS flared up, he gave me a script for Prednisone. He said I could just take a short course of Pred whenever the AS flared.I got the feeling then that he really didn't want to deal with stronger pain meds. So what the PA was suggesting sounded pretty good.

I walked out with a script for 15mg MSContin twice a day and 2 Norcos for breakthrough pain. They also asked for a urine test, for the first time. It somehow didn't seem right to ask a 72year old grandma to do a drug test. I had a little bit of trouble with sleepiness for the first week, but the meds worked well. I could sleep through the night without waking up in pain. Two weeks into the new program my AS flared up and I was in pain. I used ice packs, I started upping the Pred. Two Norcos were not enough! I called the pain clinic and talked to the PA. It seemed reasonable to ask to have the Norco increased a bit until I saw him in two weeks, You would have thought I was some druggie asking for some strong drugs. He said I would have to stick to the meds he prescribed until I came in for my next appointment. I had told them at the start that my pain varies according to how much inflammation the AS was causing. Some days I am almost pain free, other days, the pain is really bad, I expected some flexibility.

Right now, I don't know what I am going to do. I am debating on calling my GP and having a talk about what to do or if I should wait and see what they say at the Pain clinic. I do have enough Norcos on hand to keep me from being too uncomfortable, I prefer not to use an more then necessary because I want enough in case of an emergency, I do not want to ever have to go through withdral.
I would appreciate any suggestions in dealing with pain clinics. I just can't get over the fact that they would leave a patient to suffer in pain.

I have Ankolysing Spondylits, Ulcerative Colitis, DDD and a bit of OA to make things fun. Most of my problems are due to inflation of many joints, tendons and ligaments. I see a GP, a Rheumatologest, an orthopedic Dr and a wonderful PM.


  • It is normal for a new patient to be told to wait until they see the doctor before allowing an increase in dosage. It sounds like you are brand new to this PM doctor's practice and while you may have had some flexibility with your GP, this new PM doctor expects to see that you are giving this new medication protocal a good try and that you are following his directions. If the pain is that bad and the meds aren't allowing you adequate relief, you can always call and ask to see him sooner.
    It is truly important that you follow the directions of the doctor or go see him if the pain is so severe that you can't function on the current doses, otherwise, if they do another urine screen they can tell if you aren't taking the meds as they prescribed them, especially if they send the tests out to a gc/ms testing. So even if you do have a bit of meds leftover from your GP, don't use them.....you don't want to chance the tests showing that you are taking more than the PM doctor told you to.
  • avonldyaavonldy Posts: 61
    edited 09/22/2012 - 7:14 PM
    Because my condition is caused by inflammation, it responds well to steroids. Both my GP and my Rheumatolegest have given me scripts for prednisone tapers in case I have a flare. I don't like to take them because of the side effects. A few days after starting pred, I am doing better. I am able to stick with the PA's plan. I still think it is wrong to leave a patient in pain. I was not given the option to come in sooner.
    I have Ankolysing Spondylits, Ulcerative Colitis, DDD and a bit of OA to make things fun. Most of my problems are due to inflation of many joints, tendons and ligaments. I see a GP, a Rheumatologest, an orthopedic Dr and a wonderful PM.
  • LovetrotravelLLovetrotravel Posts: 296
    edited 09/23/2012 - 8:16 AM
    Glad to hear that the Prednisone is working.

    The key to chronic pain management is using a lot of different modalities to help get one's pain to a mangageable level. With chronic PM...about a 5 on the pain scale is what they shoot for. Not pain free.

    In regards to how they treated you is as mentioned, perfectly appropriate. Asking you to do a urine test has nothing to do with your age or being a grandmother. It has to do with laws/regulations for controlled substances and prescribing laws that your Dr. has to follow. So this is something you need to be aware of that it's not personal in that regard.

    Secondly....as mentioned, it is very reasonable that they will not do any type of medication change over the phone or within just a few weeks of putting you on the new medication.

    Morphine is a stronger medication than Hydrocodone. So by adding the 30mg of a day of MSContin...but then still allowing you up to 2 Norcos a day at 10mg....you are essentially on "more" medication than you were previously. So when you called up asking to have more Norcos...this is a bit of a red flag to them that you are all of a sudden needing more opiates.

    Most Drs. will move a patient to a long acting med (like MSContin) if someone is needing more than 2-3 short acting meds a day. So the move to MSContin was long overdue if you had been taking 5-6 Norcos a day, every day, for awhile now.

    And back to my first comments....when a person has a flare of pain....it's not just about reaching for more opiates. The Norco is only meant as "breakthrough" pain and not to be taken every day, the max amount or else it won't be there for you as BT med.

    And as you found out....a treatment with steroids can be very effective to help calm the inflammation down. This is where opiates don't help that at all. They are not an anti-inflammatory.

    You may also want to speak with the Dr. at the next visit about whether or not a nerve pain med like Lyrica, Neurontin, or Cymbalta would be helpful. Same thing with a muscle relaxer like Flexeril, Robaxin, Skelaxin, Baclofen, or Zanaflex. Both of these types of pains (muscle spasms or nerve pain) are usually not helped by opiates.

    And then there is use of daily exercise, yoga/stretching, aqua therapy, injections, massage, ice, heat, acupuncture, physical therapy, counseling, TENS unit, etc.

    To name some other modalities that may be helpful.

    And as mentioned...please don't ever take more medication than prescribed as this can get you dismissed from a practice without any medication and hurt your chances for any Dr. to ever prescribe opiates again.

    Chronic pain management is a marathon and it needs to be where you figure out the most "tools" to have in the toolbox to help manage your pain. A PM Dr. is usually going to be your best bet as most GP/PCP Drs. are just not experienced in treating chronic pain.

    So...just some thoughts/suggestions....and again...glad to hear you are doing better and hope it continues to go well with your treatment..
  • Hi Avonldy. When I first started on MS Contin, I had to go back to my Dr. in only 2 weeks as it just wasn't the right dose for me so my Dr. actually increased it to every 8 hours as for some people MS Contin doesn't last 12 hours if you take it twice a day. I was glad my Dr. saw me as I don't know what I would say to a Dr. that didn't want me to come in.

    I'm glad the Prednisone is helping you for now though. I use a gel cold pack and just put it in my pants in the back for about 20 minutes and it seems to help my back pain a lot. I also take Baclofen a muscle relaxant and Naproxen when I get a flare up.

    I think in the States or some pain clinics here in Canada ask for a drug urine screen each time or at random so it's pretty standard for everyone to do it. Hope you're doing well. keep us posted. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • was that the PM Dr wanted me to try to get off the pred. I was taking 5mg every day. I will be seeing my Rheumy tomorrow and I know he doesn't like me taking pred either. I would have been happy to go into the office but I wasn't given that option. The PM is the only dr that I have that has PA make those kind of decissions. My GP, GI, Rheumy do not have PAs. My Ortho has one just to recheck patients.

    I hadn't mentioned that my pain had gone from a 3-4 to a 7-8 overnight. I just needed enough meds to help me get over the flare. My flares usually only last a few days to a week. In the past, I would take an extra 1/2 Norco once or twice a day for a few days. This has always been ok with my GP. It just bothered me because I went to them to control my pain and they didnt.

    I have Ankolysing Spondylits, Ulcerative Colitis, DDD and a bit of OA to make things fun. Most of my problems are due to inflation of many joints, tendons and ligaments. I see a GP, a Rheumatologest, an orthopedic Dr and a wonderful PM.
  • sandisandi Posts: 6,343
    edited 09/25/2012 - 1:50 PM
    If you didn't mention to the staff when you called that your pain levels had escalated to double, then how are they to know what to tell the PA or doctor for that matter? The failure to mention the escalation in the pain levels is most probably the reason that you weren't offered the option to come and see the PA or the doctor. Pain management means that the patient must inform the caregiver all of the information regarding their condition, flare ups, contributing factors, etc...
    And as to what the GP always allowed, that doesn't matter to the PM doctor. He is not there to continue the same treatment that your GP gave you, he is there to do what he feels is best to treat your pain.....
    I'm sorry that may not be what you want to hear, but it is the truth.
    Best wishes to you,
  • I ment to say that I hadn't mentioned it in my prior posts here. I do think they should have warned me in advance about them not changing your meds in between appointments. They were totally inflexable and heartless. This was a
    complete turnaround from when I was getting injections
    I saw the PM then.
    I have Ankolysing Spondylits, Ulcerative Colitis, DDD and a bit of OA to make things fun. Most of my problems are due to inflation of many joints, tendons and ligaments. I see a GP, a Rheumatologest, an orthopedic Dr and a wonderful PM.
  • LovetrotravelLLovetrotravel Posts: 296
    edited 09/26/2012 - 6:54 AM
    Wanted to also add that most Drs. will not want you to stay on Prednisone long term. It's really meant to be used a few times a year where it will be more effective like with a Medrol dose pack that starts off with 6 or 7 pills in a day, then 5, then 4, and so on. Or getting it in an injection.

    So, unless it is the last resort of treatment, Drs. will try and stay away from having you take steroids long term.

    Again...I don't see how the Drs. are being "heartless" when this PM prescribed you more medication than what you were on previously....They have upped your dosage.

    And as I wrote earlier....it's not always about grabbing an opiate when you are having a flare. And as Sandi wrote, just because your GP allowed you to take more than prescribed is not something that many Drs. will allow and you need to ask them first and if they say no, then use all the other modalities I mentioned in addition to the pain meds you are being prescribed.

    I hope things settle down for you soon with this flare.
  • ellencalieellencali Posts: 162
    edited 09/26/2012 - 8:09 AM
    As a responsible chronic pain patient we expect our PM doctors to treat us with the respect we give them in manging our care. What seems to happen most of the time is we are held to strict protocol and end up feeling left to deal with our pain when a change in pain levels happen. I know I am having the same problem right now. I am 8 weeks from an 8 hour 3 level fusion and my breakthrough pain meds are not cutting it. I called this morning to ask to see the doctor to discuss my prescription...and was told that I am taking more than enough meds from his office manager. The frustration is maddening. Not to mention I was unable to see him directly my last appointment because he broke his leg. He just wrote scripts and handed them the window. When I left the hostpital for the second time, I was on breaktrhough 1-2 10mg oxycodone every 4 hours for pain. Guess I didnt notice the change when I picked up my meds because now its 1 10mg oxycodone 3X a day. I recently started PT and my pain has escalated. I need the 2 10mg to keep my pain at a 5ish. I was told under no circumstances will he see me or make changes until my appointment on Oct 11.....While I understand protocol, I still have such frustration when Im told Im taking "plenty of medication for being 2 months post op!" Im honest, responsible and what that gets me is suffering until October 11....there is no way around it...it is what it is. With the current dose, my PT is hindered, I can't sleep, therefore my healing slows down. My point I think is that the PM game is something we are all at a loss to understand. We are not seen as people just "cases" that fall into the "you should be fine at this amount at this place in the game. What helps me is that I know if the pain goes off the charts I have the option of the ER...since my surgery I have not used the ER as a pain management tool but prior to it when I couldnt get out of bed to pee....I went, and they took great care of me. Keeps the panic from taking over FOR ME!
    I wish you well...try and be patient, this too shall pass and maybe you will get lucky and get the relationship with a PM doctor we all hope for. I don't have it YET....but boy am I determined to get there. Oh yeah, I do use all modalities of treatment to mange my pain and am not seeking opiates to be my problem solver...I just so badly want my PM doc to partner with me and help me get back to my life!
    3 level fusion L3-S1 July 23, 2012
  • ellencali, You took the words right out of my mouth. I feel the same way as you. Your words to Avonldy were very nicely put.
    Avonldy, I hope you are feeling better, and we are here to listen when times are tough.
  • The PA at my PM office has been playing around with my meds and doses for months now. At one point, she tried Opana ER. Well, I started having shortness of breath. I stuck it out for 2 days, then called the office. I called at 9am and left a message. I called again at 11am. I waited for a call back until 2pm, then gave in and called a friend to drive me to the office (it was a Friday afternoon and I was worried about them leaving the office without seeing me). I walked up to the window gasping for breath and said "I have called 3 times today because I can't breathe on this new med. I need to see somebody now or I am going to the ER." They had me in a room with the dr within 2 minutes. My oxygen levels were at 76.

    I had an appointment about a month before my surgery was scheduled. I explained to the PA that the new regimen she'd had me on for the past 2 months was not working, and my pain had been hovering between a 7 and 9 for weeks. I couldn't get out of bed 3-4 days a week. You know what she said to me? "Sorry, but you're just going to have to suck it up and deal with the pain until surgery." Keep in mind I still had 4 weeks to go until then.

    Because they had been under dosing me, I didn't have a baseline. So when I came out of surgery, they didn't give me enough to handle the pain. They didn't realize that my pain wasn't managed coming into surgery, and they based my dose on what I had been taking. For the first 36 hours after surgery I was miserable. I cried non stop and couldn't eat or sleep. My pain was at a 10. When the PM at the hospital finally realized what was going on, they promptly increased my dilaudid dose in my iv, gave me an extra bump through my iv line and started me on an oral dose of dilaudid on top of all that, every 3 hours. I had just assumed that that much pain was to be expected after surgery, not knowing that they were dosing me based on the inadequate meds that my PM had me on. When I told the PM at the hospital about my regular PM's comment about just sucking it up, she was pi$$ed! She said she was going to call her and have a chat. I guess she did, because ever since then, my PM has been way less stingy. If I tell her I hurt, she will do something about it.

    I'm afraid to switch PMs because I don't want to be accused of doctor shopping. My case is workers comp, so everything I do is really scrutinized. I talked to my attorney about the under dosing and he told me it wouldn't be good for my case to change doctors, so I guess I'm stuck and have to just "suck it up."
    L5-S1 Fusion, Discectomy on 7/10/12
    Herniated Discs at L3-L4-L5-S1, Spondylosis, Spondylolethesis at L5, DDD, Partial CES, Lumbar Facet Arthropathy
    Chronic back pain since 12/2010 (slip and fall on ice)
  • I agree with ellencali, in that we, as responsible pain patients want to be treated with respect and caring by our pain management doctors, but, and this is something that all new patients to pain management need to learn- you can not expect a new doctor to your care to continue on as your previous doctor did, whether it is meds, or treatments. Each new physician is going to do his own exam, his own tests, make his own determinations based on what he or she finds. And as far as meds goes, once you enter pain management, it takes time, months, and months of building a level of trust with a new pain management doctor. It never happens overnight, and it shouldn't....You need to show them that you will follow the directions that you are given when it comes to using medications- not just the opiates, but any of the others that they might prescribe as well...you won't take more and expect to be filled again early, or loose the prescription or adjust your dose on your own without their permission.
    Ellen, as to your situation, is there some reason that your surgeon is not handling your post op meds? The reason that I am asking is that doctors around me handle the post op meds for the first three months after surgery, after that, you are referred back to pain management. The other option that I took was for my surgeon to handle my post op meds, while I had my PM doctor handle my regular meds. So, my PM handled my usual meds prior to and post op, whilst my surgeon just gave me different meds for the 3 months post surgery. It worked well, but I arranged this with both doctors prior to my surgery so that we knew who was handling what.....and when I would revert back to PM for any ongoing needs.
    The thing is , that those who are new to pain management or going from their GP or other doctor writing their pain meds need to understand that the world of chronic pain management is a whole different ball game and once you are in it, you need to read the rules and follow them very carefully so that you can start to build a long lasting trusting relationship with the PM doctor.
    Anytime that a pain patient is in pain, they need to call the office and either make an appointment if their pain is out of control or get permission to increase their meds before they do anything, other than using other non medication based modalities to try to bring the pain levels down on their own.....
  • ellencalieellencali Posts: 162
    edited 09/28/2012 - 5:27 PM
    I dont know the answer, Sandi...I think i just did what I was told in the post op haze. I have been with this PM doc maybe 9 months. I have always followed his care to a T...when I came to him I was so overloaded with percocet, he said stop immeadiately, that I was taking dangerous amounts of tylenol/acet * I never remember which one is what. I stopped, have never taken another percocet since that day...I think I feel that I earned some trust. I get it though, I dont like it, but I get it...just very hard when Im honestly suffering...today has been rough. I am tempted to take meds I have on hand...again, my irresponsibily as the patient, but I have neurontin on hand...since my surgery they have not put me back on it....I want relief from the nerve pain so bad right now...I have contemplated taking it on my own tonight...it might get me some sleep. But I am so aftraid to take anything that he doesnt have me on currently. I know I am not being very clear, my thought are very scattered...pain really takes a toll on me that way. Im watching Dora the Explorer trying to smile with my kids....its hard, I know you guys know...hard to be the good mom, when you feel like you want to scream..I try so hard for my kids to not see me in pain...scares my 8 year old...so we trudge on...I have the hospital bed with my legs elevated...lots of pillows, ice and i keep saying ...this too shall pass....look how happy and carefree these little kids are....all is right in the world.. HA! Peace to all..E
    3 level fusion L3-S1 July 23, 2012
  • Your story just breaks my heart. Have you tried talking to your surgeon? With so much pain, you can't possibly get as much benefit from the PT. That will slow down your recovery. This is something that your surgeon should know about.
    I have Ankolysing Spondylits, Ulcerative Colitis, DDD and a bit of OA to make things fun. Most of my problems are due to inflation of many joints, tendons and ligaments. I see a GP, a Rheumatologest, an orthopedic Dr and a wonderful PM.
  • He agreed with me that I should have taken the Pred to stop the flare. He gave me a tapering schedule to slowly get the dosage down. He also ordered PT to help with some of the problems that were causing the pain. Why couldn't the PM do that? I will be going to the pain clinic Tuesday and also see my GP on Wednesday. I hope I can get it straightened out. When the weather changes, my pain and stiffness goes up. The meds they gave me are fine for the good days, but not on the bad days. I have to take care of my 84yo hubby who is very thin and frail. When I was having that flare, I couldn't fix dinner or do any cleaning or laundry.
    I have Ankolysing Spondylits, Ulcerative Colitis, DDD and a bit of OA to make things fun. Most of my problems are due to inflation of many joints, tendons and ligaments. I see a GP, a Rheumatologest, an orthopedic Dr and a wonderful PM.
  • Spanx ? What is Spanx ? Lol.
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • MballardMMballard Posts: 101
    edited 09/30/2012 - 5:00 AM
    You wear them under your clothes to slim your body, hide lumps and bulges and cellulite. They come in all different styles, depending on your "problem area." And yes, they make them for men as well.

    google the word spanx and you will see them, they have their own web site.
    L5-S1 Fusion, Discectomy on 7/10/12
    Herniated Discs at L3-L4-L5-S1, Spondylosis, Spondylolethesis at L5, DDD, Partial CES, Lumbar Facet Arthropathy
    Chronic back pain since 12/2010 (slip and fall on ice)
  • Hi All,

    First, I would like to comment on the urine test. Not only does it monitor your use of your scripts, but also how your body is absorbing the chemicals ... especially concerning liver and kidney functions.

    Secondly.I read all of your posts above and can say I have been there for about the last six years. In 2010, we relocated so I had to find a new provider. During that entire period, I have only actually seen the Dr four times ... my initial visit and injections. I have been prescribed some of the meds of which you all are speaking, experienced the same sort of responses when phoning the office, etc. My question is when you go to your PM appts, do you see your Dr or a PA and how do you feel about it? I would very much appreciate your responses.


    Rassy's Story
    Under House Arrest Without the Ankle Bracelet :-)
    The remarks I make are strictly my own based on my personal experiences.
  • DaysleeperDDaysleeper Posts: 19
    edited 10/02/2012 - 8:13 AM
    When I go to my PM appointments, I see my doctor. My practice doesn't have PA's, but I have been to practices that used PA's and despised them. Not the PA's, but the fact that the practice used them to the extent that a patient cannot see the physician when there is a problem. I think that PA's are great to have as physician extenders, but in my state, they cannot prescribe schedule II narcotics, so if I needed to increase my pain med to a sched. II, it had to go through the physician, if I wanted to see my doctor, often the appointments were booked so far out, it would have taken an act of congress to get in to see him.
    And I did have problems that the PA overlooked; sometimes, too, PA's dabbling with your meds are like having a brand new practitioner handling your case. Oh, wait...it IS putting another person between you and your doctor. As many here have acknowledged, the relationship between patient and provider is one of patience, trust, honesty and integrity. I think it complicates things when you put another provider in the mix, unless they're going to be your primary provider.

    Personally, I avoid practices in general that use PA's, and im talking about my primary care physician, my neurosurgeon, etc, not just PM, and fortunately, living in a less populated area of the state, I can get away with it, but they'll be everywhere soon.
    Mother, wife, Southern farm keeper, chicken lady, beekeeper, anesthesia provider. L5-S1 PLIF 9/2013. Visit PLIF blog at http://www.lumbarfusionfusion.blogspot.com
  • My PM just hired a new PA. I love my doctors medical assistants and nurses. They are second to none. I had the chance to meet the new PA last week and she came across as very thorough and inquisitive. I'm pretty much in what I call maintenance mode. I have my ups and downs. My next appointment is with the PA because my PM will be on vacation. I don't see a problem getting in touch with my PM if I need to as I can easily email him or just call him because I have his cell phone number. He has actually answered an email from me after 11:00pm. Now that's service.

  • For me, my first few visits were with the Dr. the PA acted sort of like the intake nurse, for the Dr. only. After that I've been seen by the NP, whom i absolutely LOVE, but the doctor is always there in the office in case something is needed.
  • Just FYI but regular screening urine test in pain management are only testing for medications/substances in your system. It is either sent to a lab that uses GC/MS that will be able to tell the exact amount of medication someone has in their system. They can tell if someone is taking their medications as prescribed or any less or any more. It does not test for any type of liver or kidney function.

    Same thing with the urine dip stick test in the office that some Drs. use. That is basically a yes/no answer on medications/substances.

    You would have to ask your Dr. to a liver panel blood test to make sure things are ok there. Or a specific urine test sent to a different lab if needing any kidney type of test.

    So...people need to be aware of this so they don't assume their Dr. is keeping an eye on their liver or other organs through that test.

    On the subject of Drs...I have been going to mine for 6 years now and have always had an appt. with him. He sees every single one of his patients. The PA/Nurse may greet you and take your BP and ask a few questions, but then my Dr. comes in and does a 30 minute appt. at least...Even after 6 years...he is always thorough. For new patients he takes an hour or more. He gives out his email and cell phone as well.

    I am very lucky!!!
  • avonldyaavonldy Posts: 61
    edited 10/03/2012 - 7:04 PM
    He was as nice as could be. Offered to change the 15mg2/day to 30mg2/day. I asked if we could try 15mg 3/day and he said yes. It turns out that I had talked to someone else on the phone. I have not had time to get to know all the staff. With the 8 hour schedule, I was able to sleep through the night. I didn't even need one of the Norcos for breakthrough pain.

    I was asked to do another urine test. I thought that they were to be random. I don't understand 2 in a row. They are sent to a lab a I was asked to sign off on the lab slip. If they were wanting to know how I was metabolizing the drugs, they would have used a blood test, not a urine test. Urine tests are not that sensitive. I used to work for the drug company that developed most of the urine drug tests for the military in the 70's and 80's.
    I have Ankolysing Spondylits, Ulcerative Colitis, DDD and a bit of OA to make things fun. Most of my problems are due to inflation of many joints, tendons and ligaments. I see a GP, a Rheumatologest, an orthopedic Dr and a wonderful PM.
  • sandisandi Posts: 6,343
    edited 10/03/2012 - 7:52 PM
    If you were asked when you took the last doses of your meds, then it was probably sent out to a lab that does gas chromotography, mass spectrometry, which does in fact, show the exact levels of the meds you are taking into your system. It is not just a confirmatory test, as in, yes these meds, X, Y, and Z are in the urine, but will show that X med is showing metabolites at this level of that particular med, Y is present in this amount, and Z is not present- many doctors offices are now using not just in office confirmation testing but are sending out the urine tests for gc/ms testing instead.
    Avonldy, I am glad that you were able to get your meds adjusted so that they are working well now, but a random test is just that, there is no announcement or definate period of time that is supposed to pass between testing, it is done whenever the doctor requests it- it may be for several months in a row, or not at all for a year.........it depends on the doctor and the practice's policies.
    Mine has it listed as random, but I have only been tested twice in over my 6 years there as a patient.....I only just had my 2nd test done this past week........Drug testing is much different now than it was even last year- the advent of the gc/ms testing allows for much more accurate testing- in fact, the error ratio is now next to zero for that particular type of testing. Poppyseeds are not picked up as heroin anymore and metabolites can be traced back to it's parent drug via this type of testing......
  • Sandi explained it well...the GC/MS tests are as sensitive as they come and the most accurate of any around. My PM only sends it out to a lab that uses GC/MS for this very reason. Two years ago our state started requiring yearly urine tests for those on long term pain meds...

    Because you are still fairly new to this PM...they are probably just being extra careful with you right now but since you don't take any meds you shouldn't or more than you should, there is nothing to worry about...

    That is good you moved to the lower dosage 3 times a day instead of just doubling the dosage. My PM gives me prescriptions for both the MSContin 15mg and the 30mg so this way I don't have to take the full 90mg a day but can use the 75mg on better days. I also dose 3 times a day as this covers my pain better.

    I've been on this dosage for over 3 years now. So hopefully this will work for you to where you can stay at this level for a long time...
  • I am almost in tears reading every post on this subject. I was with the same PM Doc for almost 9 years, then a new NP came in and she was awful to me. Very "in your face" and did not like Chronic Pain Patients at all. So 4 days before my next appt. I got a letter saying I was Dismissed... They wouldn't give me my meds and basically said "tough luck, find another DR. if you can't live without opiods". It took me another month to find a new Dr. and that was the hardest time in my life. I have Spinal Stenosis, DDD, 4 bulging discs, very thin discs, Type 2 Diabetes, and Hypertension. Also Osteoarthritis in rt. knee and rt. shoulder. I started at this new Clinic in August. They put me on 4 percocet 10/325 a day... it didn't work, so when I went back in 2 weeks later I told the PA about it and she wrote me another script for the same thing... a month later and after calling and telling them that this wasn't working as long as it should, I went back in and they gave me the same thing again. This time they added 2 15 mg. Morphine ER but still no relief... I have Caudal Steroid Injections scheduled for Halloween...and that's when I get my scripts again... I just called their office again to let them know that I will run out of my meds next week because I have started PT and the pain gets so much worse now. I can't sit, stand, walk, or lay for any length of time... I am so frustrated and sick about this. I also have had 2 back surgeries, countless injections, and PT in the past.. so I am not a newbie to this... I know I can't expect to be pain free, but I do expect to have a little bit more relief than this... I have been dealing with Chronic Pain for 20 years and I am 45 now... Why can't I be treated like anyone else in pain? Just because this is something that will go on forever doesn't mean I have to be in pain all the time. I just want them to look at the pain and evaluate it and make changes in the meds...not continue to give me the same meds just because they want to...My situation changed when they told me about the 4 new bulging discs at my last appt. and yet they changed nothing... What am I to do? It seems like they don't listen.... I have no idea what will happen, I will most likely run out next week and be miserable... I just want some help...
  • 1ofmanyinpain11ofmanyinpain Posts: 60
    edited 10/18/2012 - 10:34 AM
    I forgot to mention that at my first appt. at the new PM I found out that the same PA had been fired from the office 2 months prior because of how she treated the patients... then she went to work at my old office.... Small World???
  • Are you taking more then you are supposed to? I count out my pills each month and figure out how many I can take/ day without running out. I would rather take less and have some extra pain then risk running out. If you run out,you might have withdrawal problems that is a lot worse then the pain. I have been taking pain meds for at least 15 years and I have never run out. It takes discipline, but I am terrified of running out and I plan ahead so I don't.

    It might help to keep a pain journal everyday. List when,where and how bad your pain is. List when you take your pain meds, what you take and how much. List anything you take, like NSAIDS or muscle relaxers. List what helps/hurts you, heating pads, ice, etc. Bring this journal with you when you see your Dr. This might help you Dr to see why you are in so much pain.
    I have Ankolysing Spondylits, Ulcerative Colitis, DDD and a bit of OA to make things fun. Most of my problems are due to inflation of many joints, tendons and ligaments. I see a GP, a Rheumatologest, an orthopedic Dr and a wonderful PM.
  • BkinsBBkins Posts: 364
    edited 10/23/2012 - 4:02 PM
    sounds like you need to have a heart to heart with the doctor and to take anything his helpers say with a grain of salt. He is the one to say yay or nay to any increase or change of meds. If you don't like the way they are treating you move on to another. I would flat out ask the doctor how he deals with chronic pain patients and go from there. I have found the direct route is best withour having to wonder how things are going to be done. I don't believe a doctor can discharge you without giving you time, and meds, to find another doctor. I would report a doctor if they did that to me. Have you had failed drugs tests at any point?
  • sandisandi Posts: 6,343
    edited 10/25/2012 - 7:34 PM
    I was going to ask the same question, why are you running out of meds so early? If you are taking more than the 2-15 mg extended relief morphine pills and still taking all 4 of the percocets on top of the morphine, then all you are accomplishing is that you are increasing your baseline meds. Percocet is a short acting pain medication that contains both oxycodone and tylenol, it's onset is about half an hour after taking it and lasts anywhere between 4-6 hours...that particular medication should only be taken when you have increased pain that can not be controlled after using other modalities to ease the pain- ice, heat, massage, stretching, over the counter pain creams, etc...if none of those things help, then you should try the breakthrough meds...but if you are taking them regularly- every 4 or 6 hours, then it just raises the baseline amounts of opiates in your system and basically becomes part of your every day pain medication regimine...and leaves you nothing to use when the pain levels are super high...
    The morphine ER is an extended release medication, which means that it should last for 12 hours....this is your base pain medication- which should help ease the normal , day to day level of pain that you have....this medication should be taken each day, 12 hours apart...
    You don't say why you were dismissed from your previous pain management doctor, but it does take time to establish yourself with your pain management doctor. And it takes time to find the right combination of treatments to help reduce the pain levels, physical therapy is part of that treatment, as are TENS, massage, swimming, regular excercise, over the counter pain patches, heat, ice, accupuncture, etc...all of these become part of your toolbox at reducing the pain levels...guided imagery, relaxation techniques, all play a part in some small way at reducing pain, as does resting when necessary, adjusting the way that you have to do things.
    You asked why they just don't adjust the medication to a higher dose to bring the pain down, and part of the reason is that the pain medications are not the only way to reduce pain- relying on pills solely to reduce the pain isn't the answer, especially given how young you are...you need to use all of the tools available, not just rely on the pain medications . There are also nerve pain medications that you might find helpful if there is compression of any of the spinal nerves that might be far more effective than opiates at reducing the pain, as well as muscle relaxers. Cymbalta, Lyrica, Neurontin, and some of the old tricyclic antidepressants do wonders to relieve nerve related pain.
    You said that you also have 4 bulging discs that have changed things in your opinion, but we all have bulging discs. In most cases, just because a disc is bulging does not necessarily mean that they are a cause of pain. Most of the population , if they are over the age of 18 have some discs that bulge. It is only if the disc is in touch with a nerve root that it is considered to be painful- then because of the contact (impingement ) of the nerve root...
    Hang in there, and talk to your doctor...see what he recommends. And give each adjustment in meds a month to see how it will work to treat the pain before trying to see about getting the dosages changed. Most PM doctors prefer that their patients give each dosage adjustment that long to see if it will help or not. Talk to him/her about trying some of the neuropathic meds to see if that helps reduce any nerve related pain.
    Good luck,
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