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Pill Counts - How are they caculated

Hey folks...New to this forum.
I am trying to find out how Pain doctors calculate how many pills I should have at the time of each appointment.
I seem to come up one or two off every time. Do they take into consideration taking them during the night when pain can hit you after a tough day, and you may need more than expected?

ARE there any calculators that you know of to help keep track.


  • dilaurodilauro ConnecticutPosts: 9,846
    I am sure you will find your stays very rewarding.

    The Pill Count. This is something that the true medical professional knows how to do.

    While this is not a true medical view, this is my view....

    The doctor knows based on their clinical examination and al the diagnostic reports they have for you, can identify the number of pills that should be adequate for your daily usage. Of course this needs to include the milligrams.

    The number that is reached (ie 2 pills every 8 hours for pain) is for normal situation. This generally does not factor in those flare ups or other times when more medication is needed. I've been there and I am sure most of you have also been there. So how is this handled? You have 4 pills per day under normal conditions, but then for some reason, you need 6 to continue to manage your pain. How is this factored in?

    Its really not..... But instead, when you run into those situations, you should always contact your doctor to discuss everything. I have done that in the past and he results worked out fine. I told the doctor that the 4 pills every 8 hours was not helping me. One of two things happened. She would consider this and when it came to refill time, she would either add more 'allowed' pills into the scenario.

    Bottom line, when ever you are faced with situations that will alter your pain medications, contact your doctor to discuss it all. They will do their best to help you,

    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
  • sandisandi Posts: 6,343
    edited 03/19/2013 - 7:33 PM
    The calculations are pretty darn simple- the majority of our prescriptions are given for a 30 day period. The day you fill them is considered day 1- unless you don't take any until the next day, but since we all usually start out on short acting meds, then we usually start using them the day they are prescribed...
    Anyway, let's use March 1 as the first day of a new prescription- and the quantity given is 90 tablets of XZ medication. I am allowed one tablet, every 8 hours. This is 3 tablets per day, for 30 days. This means that I should have enough meds to last me until my next appointment on March 31st. If I get called in for a pill count, on the 16th of March, then I should have enough meds left for the next 15 days plus one or two extra depending on what time I am called in for the count.....if it is 10 am, then I should have 45 doses left plus two additional doses- 47 tablets total....if I am not called until 4:45 pm, then I would have the 45 plus one additional dose for the evening/bedtime still in the bottle.
    Insurance companies consider the date the meds were filled as day one, when we are talking about a brand new prescription. It is different however if you are stable on the meds and doses and have been taking them for some time- they go by the last 6 months previous fill dates- so if I have filled on Dec. 4,Dec 30, Jan 30, Feb 27, and now am looking to fill my april scripts on March 29, the insurance is going to - say nope, no way - because I filled the first time on Dec 4, then again on Dec 30 - according to the dosing directions, I should have had meds to last until Jan.3, so I not only filled the new prescriptions early but also should have 5 days left of the Dec 4 meds in addition to the new prescriptions- then in January, I fill the meds again on January 30- while technically 30 calendar days from my last fill, I still have those other 5 days worth of meds, then I get new prescriptions again and fill them Feb. 27, adding another 3 days plus to my little stockpile of meds that I have in addition to the new months supply....one of two things will happen, they will either let me fill again early, or they can refuse to pay until those 8 days of additional meds are gone- meaning that they will not allow the fill prior to March 7th and/or they can call my doctor and tell him that I am filling early each month-which might mean that they dismiss me...
  • 1ofmanyinpain11ofmanyinpain Posts: 60
    edited 03/22/2013 - 7:18 AM
    They might seem simple based on the 30 days but let me tell u.... One Dr. writes according to 7 days in a week... ie. 28 days...and the other writes per month.. ie 30 days. I have one script that was originally written by Dr. A for the 7 days in a week...so, for one month it's 112 pills... Dr. B writes according to the 30 days... that's 120 pills for one month. As I take both pain meds I end up short on the one. Crazy, Huh?
  • Thank you both for your help.
    Sadly tho when I went into see my pain doctor on Monday I was 3 short.
    He discharged me, and would not reconsider. I've not done anything wrong...They are closed on Fridays, and on
    Thursday night I had a gall bladder attack. Pain/throwing up etc. I threw up my pain meds several times over the weekend. I had no way of calling the office and ask permission. I need to have gall bladder surgery, but the doctor needs the co-pay up front as well as the hospital. I went through the hospital ER, and I wasn't running a fever and they didn't deem it as "life threatening or a "true emergency" So I'm waiting on stones to cause an infection so I can get it taken out.
    I have no idea what I'm going to do about my pain tho in the future. I have torn discs, degenerative disc disease, bulging discs and arthritis, on top of that I have nerve damage in my left leg. My pain doctor is "weaning" me, and is decreasing my dosage over the next 4 weeks. I'm scared of the withdrawal, and the pain on top of that. Does anyone have any suggestions. I get so angry that those of us who need the help have to deal with this because of people who sell or abuse the drugs. I understand it, but it's sad. Back in the day (70's) I hurt my back and my pcp gave me pain meds with refills and said not to allow the meds to wear off before the next dose, that it was easier to control pain before it comes back. Boy not now a days...you need to set an alarm clock and take each does exactly as prescribed. No matter how bad you may be hurting.
  • Hi, I am new on this forum, sorry I will post an intro soon, but after reading this I can relate and feel compelled to comment. I just had a PM appointment to refill my oxycodone, my normal doctor is very empathetic and truly cares that my quality of life is good. However, there is this PA whom I have had to see in my normal doctors absence. I felt like I was standing before the Spanish Inquisition. I was 2 short on my pill count and I told the nurse that I had a flare up on my L4-L5 disc rupture and also have DDD. I was lifting my 2 year old out of his car seat and there went my back. I had to take 2 extra to get on top of it. The PA told me that if I get a flare up its ok to take 1 or 2 extra to get on top of it, but then I have to take however many less the next day to even out the prescription. This whole system makes honest people look like drug seekers and there seems to be no room for leniency and just plain common sense. These doctors are so scared of the litigation and don't want to enable the prescription drug abuse epidemic, meanwhile the very people they originally intended to help and swore the hypocratic oath to help are now either reduced to a life of misery due to under medication and then display symptoms of pseudo-addiction, where they truly are suffering and then treated like an addict and made to sign narcotic agreements.

    My advice to any PM doctor who reads this, if you are more suspicious of your patients and can't relate to chronic pain or be able to empathize, then get out of the PM field. Go work in a lab or somewhere where your risk averse and self preservation attitude doesn't keep good and honest people in hell.

    Sorry again for no intro, will post soon.

    My injuries were from my combat deployment to Afghanistan:
    -L4-L5 disc herniation
    -C5 osteophyte and left neural foramen narrowing, degeneration
    -C5 spinal stenosis
    -cervical spine straightening and loss of lordosis
    - Traumatic Brain Injury
    - PTSD

  • Thank you hechlerdm for your service to our Country! Are you having to use Tricare for your medical coverage? I had to when I got back from Saudi Arabia. My doctor's were fine, but getting an appointment with a real doctor instead of a PA was tricky. Not to mention getting an appointment was not that easy.

    Good luck on your recovery!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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