i went to the pain management doc at my neurosurgeon's office today. i can't take much more. she wants me to taper off oxycodone 10 mg. 3x/day with 30 pills left before my spinal fusion in a month on 3/4. prior to this month for over 2 years, i was prescribed oxycontin 20 mg. 2x/ day.
i tried to be a compliant patient and acclimate to the oxycodone in mid january. the duration is much shorter than oxycontin, so the transition was painful. i honestly feel my level of pain would be managed with a long acting narcotic to get any relief and comfort. this request and expectation is unrealistic! is now a good time to discontinue my pain meds?with a spinal fusion just around the corner, i felt frustrated, angry, outraged and shocked.
here is the pain management plan.... Lyrica 50 mg. once daily for 3 days, then increase to twice/ daily. i will also have tramadol 50 mg. up to 4 x/ daily.
and here is the post-op pain management.... percocet 5/325 4 x/ day as needed and valium 5 mg. 3 x/ day as needed. both of these meds are for 3 weeks only. then i am expected to take an NSAID.
when i got upset during the consult, she said my reaction indicated a physiological dependence on a drug that does nothing more than "dull my brain". i have legitimate severe, chronic pain for years now. struggling every day just to get my pants on and wipe myself after using the toilet. unable to shower completely because i can't bend to do my feet. unable to feed my puppy who needs to eat 4 x/ day, and having to rely on my husband to do every household duty, including cooking. we can't even keep items on the bottom two shelves of the fridge, as i can't bend over to get them. unable to go to the grocery store, as i can't put the items in and take them out of the basket. leaving things that drop to the floor because if i do bend over, it will start the pain up to high numbers, and i won't be able to settle for hours. staying awake until 3 am because i can't fall asleep for the pain.
you know what? i didn't choose this chronic pain- but i have to live it. it runs my life, and has changed me into a sad and desperate person who can't manage to leave the house and sit through a nice meal somewhere without dearly paying for it afterwards. even with the oxycodone, it was still prominent. but at least it made it tolerable for the most part.
she gave me her plan, and i have my own. arizona, like california is a medical marijuana-friendly state. i had a medicine card there, and i will get another one here, too. i used minimal amounts of a saliva that was energizing, yet had narcotic properties. i found i was able to take less narcotic, felt motivated to do light things like fold the laundry and walk more. of course, i used it as an adjunct to prescribed narcotic analgesia in the hopes that it would decrease the frequency of doses. it was effective.
if i am sentenced to a life of chronic pain, i WANT something that "numbs my brain". who cares if i have a physiological addiction? any chance at relief is acceptable to me. shouldn't it be my choice if i decide to take opioids under the circumstances? the likelihood that the pain management doctor who is deciding treatment choices for me has never dreamed of living with this level of pain.
many people share my struggle with chronic pain. it's inhumane to withhold the one thing that might make life tolerable! just like i made an informed decision to use a spinal fusion as a treatment for pain, i should be able to choose opioid analgesia. here's the deal... i got hurt on the job as a health care professional, and i have been suffering ever since. i am a professional who had an accident which changed my life. i am not a criminal. yet, i certainly have been made to feel like a criminal.
nor am i a drug addict. at the dose of oxycodone i was on.... the "high" and euphoric properties were gone a long time ago. yes, i am tolerant- but i always struggled to keep my dose minimal, and not increase despite the offer from my doctor to do so when she could observe an exacerbation in symptoms. the cold hard fact is that i will never be comfortable taking NSAIDS. the unarguable fact is that my pain is severe, and cannot be managed by an NSAID. i really don't need a treatment team to save me from addiction. what i need is a team who will honor and work with the choice decided upon by the patient after all options for management are explained. there was no choice involved here, no options to discuss. i was presented with the decision of the provider which insisted i discontinue pain treatment that is partially effective, allowing me some relief from unrelenting misery. my personal belief is that any pain treatment chosen by the patient who is under contract with one provider is acceptable. legitimate pain that is backed up by examination and diagnostics should be treated in conjunction with the patient suffering the pain. period. to dictate a cookie-cutter plan devised by a particular provider that is utilized across the board with all patients despite their true assed level of pain is dictatorial and cruel. being told 33 days pre-op that you are expected to taper your own 30 doses of medication prior to surgery is physically unrealistic and psychologically unsound. maybe someone can share with me the actual patient benefit in executing this mandate? deciding to undergo a spinal fusion with a less than stellar successful outcome rate is difficult enough. dumping the plan described above on someone who has documented, legitimate pain needs is cruel and unnecessary.
i proposed that the taper be done post-operatively rather than before surgery. i said i was willing to work with a plan to decrease my dosage of analgesia when i was showing some signs of positive response to my surgery with the hope that the target symptoms would be diminished, making a taper more acceptable and realistic. NO. with no offer of assistance or guidance in attempting a taper which was supervised and supportive, i have to choose the best way i can figure out on my own- knowing my pain levels will dramatically increase at a time when i should be as stress free and comfortable as possible.
i have never doctor shopped, diverted, bought on the street, bought on the internet from canada or lied about my pain to get narcotics. i worked with my pain management/ physiatrist in california collaboratively to determine the dosage i required to achieve a decrease of pain to a tolerable level. an environment was created where i made the choice to accept opioid tx. despite the almost certain result which is dependence. even with a spinal fusion, the success rate is only roughly 60 %. the best outcome one can realistically hope for is an increase in mobility and decrease in pain. it never truly goes away completely. the fusion placement often places pressure on nearby discs, so the notion of being "pain free" from this level is not likely.
medical marijuana is legal. i do not plan to obtain drugs illicitly, or even search for a less conservative physician who will prescribe the dose that i need to manage some relief. i will confer with the doctor at the MM clinic to assist me in maybe finding another strain that may work better than the one i have used. if my surgery leaves me with residual pain, my hope is that i can manage it with MM.
i am completely disgusted, insulted and as a health professional i fail to see the plan given to me as effective, fair or humane. chronic pain is a medical diagnosis that warrants effective treatment. i am tired of under treated pain to be deemed acceptable in the medical community. enforcing a narcotic agreement should be a safe enough umbrella under which the provider can safely practice, and ensure the maximum comfort and least amount of suffering for their patients with intractable pain. we feel badly enough as chronic pain sufferers to be a burden on those around us who are forced to watch our suffering. demanding that patients be forced to self detox prior to surgery is unacceptable. i always admired physicians as gifted professionals who treat the sick and alleviate suffering. my faith in that role has been severely challenged. .