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I'm in a Predicament

ToddrickTToddrick Posts: 15
edited 08/25/2014 - 8:41 PM in Chronic Pain
Hello. I need to talk with others about my predicament, because I feel so frustrated and hopeless that I just need someone to understand me. I'll TRY and keep this short, but it takes some splainin'...

I have chronic low back pain, as well as arthritis. I was seeing a pain mgmt place for several years, but we didn't get along that well because I felt they singled me out for being a "young" male patient. They harassed me every month, and belittled me for not magically getting better. They forced me to get shots and always pushed Long acting pain meds, like Kadian or Suboxone. While I obviously sometimes benefit from long acting meds, my body does not tolerate them for long periods, and I need instant release meds to use to skip/stop the long acting ones when I'm having a good day, or to take as needed on bad days. My nurse kept saying that was "drug seeking" behavior, which only irritated me more. So I missed an appointment one day, and they used that as an excuse to terminate our relationship instantly. No refills, no nothing. So I started taking some leftover Suboxone for pain, which works, but it is long acting, and makes me sick.

Fast forward a whole year later. Miraculously, I still have a few Suboxone left, since I've been getting by on a quarter pill per day. Before I run out, I want a new pain mgmt doctor, but I've tried two and both have given me the same shtick. They treat me like a full-on addict. They do a urinalysis on every single visit. Won't prescribe so much as a single Vicodin, and treat me horribly, as if I am some sort of street urchin, begging for pills. And, yes, I have begged them, because I'm in pain, and desperate for even temporary relief--that's the main reason I need to see them, for immediate assistance, but they give none. They treat me like I'm subhuman, and assume that Suboxone is only for addicts. I couldn't even get a hip surgeon to take me as a patient because he was freaked out by the Suboxone. They all have one thing in common, a blank compassion less stare, and shrug of the shoulders when the topic of dealing with pain comes up. It is a topic they can avoid, but one that I must cope with at almost all times.

So that is my predicament. I really don't know what to do because until I get a hip and/or back surgery, I am going to be in a lot of pain. Even if I was a total addict, shouldn't I get some relief? I would never ask if I weren't in real pain. If I am flagged in their systems as an addict or something, then I sure wish someone would talk to me about that, or ask my side of the story. None of the doctors will even listen to me. Are they all just arseholes? Is it just because I'm on Suboxone? Is it just because I'm coming off as too desperate? But why don't they understand my desperation, at least a little bit? How do I go about finding help when every turn is like a hostile environment?


  • LizLiz Posts: 7,832

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Since I don't know how you approach pain doctors let me just make some assumptions that may or not fit your case. If you go into the doctor asking for pain meds, that may be a bad approach. I would go in and complain about the pain that you have and let the pain doctor do their diagnosis. From there, ask them for their suggestions on how to address the pain and if a different treatment plan is more appropriate for you. Pain can be caused by something serious that needs more aggressive treatments. You need a diagnosis of what is causing your pain. If the pain can't be explained, than you need to work out a treatment plan with your doctor to address the pain. At that point, after you have built a good relationship with the doctor, they may help you with pain medications, or better yet, maybe they can come up with a plan to eliminate what is the root cause of your pain. Personally, I would love to eliminate the cause of the pain that I have and not have to use pain medications that mess with my mind or otherwise have side effects that I would just assume not have. Sometimes that is not an option, but it certainly is a more desirable outcome.
  • ToddrickTToddrick Posts: 15
    edited 08/26/2014 - 3:45 AM
    I agree a thousand times over that fixing the problem would be a better solution. I've been on high doses of narcotics for years at a time, and the pain just comes back once my body adjusts to the dose. I do not want that ever again. All I want is some relief. What I said to the pain doc was that I'm taking Suboxone, but it makes me sick, and isn't working for the pain, plus I'm almost out. He counted the pills and told me to just keep taking them...big help. So I said please, please give me Vicoden or something, and he says "what do you think this is, McDonald's?" He mocked me, and now I cannot see going back to him again, because he obviously doesn't like me.

    The worst thing of all is that I hate pain meds, and don't want to be on them, but I haven't got much of a choice. There really is no easy solution, I know. In the past the MRI's showed nothing severe enough to perform surgery on, but now they show perhaps that I need a fusion, and my hips need replaced too. I feel like finally a surgical solution is at hand, but it cannot come fast enough. I've had inadequate pain control for a year now. I guess my only option at this point is to stay in bed and rest, and stop trying to participate in life, but of course my job can't be put on hold.
  • Extended release medications are no different than the immediate release, and to be honest, your "reasons" for "needing the short acting" are what is commonly believed to be drug seeking behavior. If pain relief is your goal, then the use of long acting medications provides far more effective and consistent relief than the immediate release versions of opiates.
    How many doctors have you seen for treatment of pain? You state that all of them made you do things you didn't want to do, injections, and ? ALL pain management programs are about more than just taking opiates to treat pain. They should include excercise, physical therapy, use of TENS in appropriate patients, ice, heat, rest when necessary, injections, and other therapies that may be beneficial for patients. They should also include regular pill counts and urine testing to make sure that the medications are being exactly as prescribed. You are being treated no differently than any other patient who is seeing a pain management doctor for on going pain treatment.
    As far as the medications and long acting versus short acting medications, long acting medications are recommended for patients who need to be on medications long term, because they provide better pain control, with less dosing per day, and there is no variation or up and down in blood plasma levels as there are with short acting medications. The use of short acting medications may or may not be necessary in some patients, and doctors who do use them, use them sparingly in patients, which is the way it is supposed to be.
    Arthritis can be effectively managed with the use of medications such as celebrex, or other prescription anti inflammatory medications. What is your specific condition regarding your low back pain? Have you consulted with a board certified spine surgeon regarding it? Have you had any imaging or testing done to find out what exactly is wrong with your back or hip and what treatment options have you been given?
    Since you state you are young, your best options would be to get those conditions treated and repaired, so that you can resume your life, rather than continue to live on pain medications when you may have the option for a surgical fix.
    You state that you have been on high doses of narcotics for years, and miss appointments? Patients who miss appointments with their pm doctors are not usually continued with that practice, when they do it without notice. Some practices have the policies written in their contracts.
    Who is giving you suboxone? If you were dismissed from your last pm , how did you manage to obtain and stay on suboxone for over a year?
    You aren't going to find a doctor who is going to write you short acting medications because you don't like taking the long acting, nor are you going to find one who allows you to "supplement" your use of medications with suboxone. You also aren't going to find a doctor who will only write you prescriptions without your undergoing other recommended treatments. That's just NOT how pain management works. Urine testing is mandatory across the board.

  • Living with chronic pain is so incredibly hard. It sounds like you've got caught up in life & allowed your spine problems to just fester. In the current medical environment we really need to push & advocate for ourselves. I completely understand your focus on medications & your bitterness over past experiences but if I were you I'd try really hard to start anew with your treatment. If you walk into a new pain management doctors & show your frustrations, then ask for narcotic medications your unlikely to improve your situation. So many 'pill mills' have been closed down in the last few years that many drug seekers are now desperately doctor shopping. It's well worth remembering that when you meet a new doctor. They don't know you. Their primary concern is their license & established patients. They will all be suspicious of you at the start.

    When we're your last diagnostic tests? If they weren't in the last year that's a good place to start. I'd take my medical records to a board certified spine surgeon for a review. Hopefully they will start you on the correct action plan. Hopefully they (or your GP) will then refer you to a new pain management doctor. I'd simply describe your pain & your history & ask them for help. Doctors don't like being told what to do. Wait to see what they suggest. Are you willing to try whatever they suggest? Starting new with physical therapy, injections, RFA etc. could be a tremendous help for you.
    From what you say you're on a very low dose of Suboxone now. From everything I've heard it's a horrible, often misused medication thats very hard to quit. Do you want to get off of it & onto a more common pain medication? I would! See what your new doctor suggests replacing it with. Just explain that although your pain isn't well managed you need to continue to work & function. Most patients have to do urine tests. We know how degrading it can feel but it's the world we live in now. It sucks!

    Many doctors will no longer prescribe instant, breakthrough narcotic meds. They will want you to take an ER (extended release) med. What have you tried in the past? Most people experience tolerance at some point & their medications need to be adjusted. I've found that changing meds, rather than increasing the mg allows me to stay on a reasonably low dose.
    Suboxone is frequently prescribed for addiction & that can lead to judgements & confusion. Why & when we're you first given it? Do you find it effective in managing your pain? Do you have a history of addiction or abuse in your medical records?

    I'm so sorry that you're suffering like this but sadly I don't thinks there's a simple answer. You need to find & establish a good working relationship with new specialists. The sooner you start the quicker you can get your pain managed but it's going to take time. It's highly unlikely that your going to walk out from the first appointment with the prescriptions you want. Hopefully they will prescribe something to help you manage your pain. You've lasted a very long time on your last bottle of pills. You can do it! ;-)

    Please try to let go of your anger & frustrations with the medical world (or at least hide them) it's only making things so much harder for you. There are good doctors out there, I know it can be difficult to find them but once you do things will be so much better for you. This is a great place to vent & complain, the doctors office isn't! I hope you get the help you need. Do you surgery planned?
    Osteoarthritis & DDD.
  • Sorry for any repetition, Sandi post wasn't there when I hit save! ;-)
    Osteoarthritis & DDD.
  • ToddrickTToddrick Posts: 15
    edited 08/26/2014 - 6:40 AM
    Sandi, the problem is I don't feel like I'm being treated like every other patient. I feel like the doctors want me to be naive, and because I'm not--because I've been on meds they don't even prescribe, like Suboxone--they are scared to treat me. They don't want anything complicated to deal with. None of the new docs even let me explain half of what I'm trying to convey here. I don't know how I'm supposed to behave as a "veteran" pain patient, because I've never been one before.

    I feel like they think I'm just seeking meds to continue taking meds for fear of wd, and that is what frustrates me most. I can see it in their eyes. As I explained, I have Suboxone left over from when we tried it off-label for pain at my last PM doc. I could never take it as prescribed because it makes me dizzy and sick, so my PM doc told me to swallow the Suboxone to see if the side effects were better. Suboxone doesn't absorb well when swallowed, so he upped the dose significantly. I still couldn't take it, and this is why I had a ton of Suboxone leftover. [If I was an addict, I surely would have eaten all my pills by now, but the docs don't see things from that angle, they see things through addiction colored lenses].

    Part of my predicament is that I don't want to be on pain meds 24/7, and the other part is that I probably should be. Neither is really happening. I am in limbo, have been for a long time. And neither living with pain,nor living with opioids is a good situation to be in! I realize this is not the doctor's fault, but it is hard not to be angry with them for not doing something to help at least temporarily, when they clearly have the power to do just that.

    Ideally, I at least want to be able to go for days at a time without taking anything, and you cannot do that when they make you dependent on long acting meds, because you'll go into wd sickness. So in that regard short and long acting meds aren't the same thing at all. It is sad and ironic that pain patients who do not want to be on pain meds 24/7 is what we now call "addictive behavior". I think it is so wrong; I think the medical community has it all wrong to be making people dependent, but that is another story. The bottom line is that I would refuse to go back on long acting meds if they offered because I even prefer Suboxone to that.
  • sandisandi Posts: 6,342
    edited 08/26/2014 - 7:26 AM
    First, suboxone is used in pain management for patients who have tried other medications and failed due to misuse/abuse or failure of other medications, or high doses of opiates not working.
    Doctors who prescribe suboxone have to have a special certification from the DEA - it contains an X number which simply means that they have taken the additional training to prescribe suboxone for addiction treatment.
    Suboxone used in pain management has a ceiling effect, meaning that going above a certain dose does not provide any more pain relief benefit than a lower dose. When it is used in the pain management environment, simply for pain control, it is not supposed to be used at doses over 2-4 mg . It is ineffective at doses higher than that. Doses higher than 2-4 mg is used to treat addiction. Too many patients who aren't getting what they wanted from their pm doctors have gone to suboxone doctors thinking that this is somehow an option and unfortunately, those doctors who use suboxone to treat addiction issues, prescribe suboxone at far too high a dose for the strict management of pain.
    You having enough suboxone on hand to manage to get through a year of no pain management says that you don't follow the directions of your doctors. Being non compliant is a no no in the world of pain management, and the fact that you self medicated sets off alarm bells.
    I don't expect you to like what I am saying, but I am telling you how the doctors are viewing this situation.
    You've seen at least 4 doctors, are taking suboxone that is not prescribed to you currently, and are seeking short acting medications because you don't like taking the long acting versions.
    You haven't explained what your conditions are.......so we have no idea of whether or not you need to be on medications 24/7 or not. Arthritis pain flares and recedes, and is normally managed with NSAIDS. As to what your low back condition is, we can't guess.
    Doctors make decisions for patients based on their examination, test results and best medical judgement. Like it or not, you have multiple red flags waving in their face, so of course, they are going to go very slowly with you, and treat you with the least invasive treatment options first. NO doctor, no matter how long you have been in treatment with another has to
    continue or manage treatments begun by another physician. He is going to make his own decisions based on your medical records, and imaging/test results.
    If you can go days at a time without needing pain medications, then you aren't living with chronic pain. You are dealing with flare ups. Anyone who is taking short or long acting medications, on a regular basis will experience withdrawal symptoms if they suddenly stop taking them. It is not just opiates but other medications can cause similar discontinuation effects. Long acting medications are used to combat tolerance issues caused by using short acting medications, along with the ups and downs in blood plasma levels. Long acting medications don't cause withdrawal symptoms simply by taking them. Short and long acting versions will cause the same symptoms if they are not taken once your body acclimates to them.
    The bottom line is that if you want to be able to have pain medication to treat your conditions, then you are going to have to follow the guidelines and treatment plans, including injections, physical therapy, or other modalities that they give you to follow and you are going to have to take the medications as prescribed, long acting versions included , submit to urine screens and pill counts for compliance just as the rest of us have to do.
    You didn't answer the questions you were asked regarding what exactly is wrong with your spine/hips and what treatment options have been suggested for you? What options were you given for therapies aside from taking medications? What other things do you do to help lower the pain levels? Have you consulted with a surgeon and when? What recommendations did he/they make? When was the last imaging done and what was the diagnosis? ALL of those things factor into treatment options both with pain management and surgery.
    If you are unwilling to comply with the rules of pain management and follow their treatment programs, then you are going to have to find other ways to manage those flares.
  • sorry you are having problems with pain doctors I have also been there with one nasty individual I left his office crying and furious .and went straight to my family doctor and I have been going to him for many years as he knows my situation ,have you had a diagnosis of chronic or intractable pain from anyone ? if so you should not have a problem getting your medication ,I don't like it when people with intractable pain are treated as drug seekers just because they are in pain .the pain we feel is just as bad as terminal pain when you have been diagnosed with a poor prognosis and when all other options have been exhausted like heat /ice /TENS {an old favorite of mine but no longer works since my last surgery } I have also has various injections and for many years I was under the care of a very kind and understanding pain anaesthetist who tried all she could to help my pain ..but in the end she has to declare she had nothing left to offer and referred me back to my GP he has looked after me ever since and as I can't take certain drugs narcotics are the only option for me .my level of pain is around an 8 every day sometime going up to a 9 and on a good day a 7 but always debilitating .to the point where I now need help just to get washed and help around the house .I don't like to hear about genuine people struggling to get pain medication when they need it ,.just because its narcotics ..if it was for diabetes there would be no problem ..shine on and smile
  • sandisandi Posts: 6,342
    edited 08/26/2014 - 7:26 AM
    Intractable pain is not the same thing as chronic pain. That particular condition is often thrown around as being the same and it is not. Intractable pain is a central nervous system/sympathetic nervous system disorder, also known as Reflex Sympathetic dystrophy or Chronic Regional Pain syndrome, amongst other names.
    The treatments may overlap in the world of pain management, but there are different standards for treating that condition versus treating chronic pain.
  • ToddrickTToddrick Posts: 15
    edited 08/26/2014 - 11:43 AM
    I have a long history of low back pain (w/o injury) and I need hip replacements I think. I have good days and bad days now, because I'm more of a fighter than ever, and try to keep busy to distract me. I had very severe pain (nerve impingement type stuff) when I first started seeing a PM, and I thought I was going to die from it. I definitely have at least one ruptured disc now, and the doc is doing a discogram (sp?) thing for diagnostic. I don't understand how that will help me yet, but at least it is something. I've can't count how many times I've built up false hope for medicines or procedures, and been disappointed. Most of my hope at this point is on a hip replacement surgery, which could allow me to walk a lot more, which helps with my back indirectly. When I walk now for more than a very short distance both hips become inflamed and burn for days, plus the nerves get pinched or something, and my legs get paralyzed with pain (I have to move my legs with my hands to unfreeze them, its kinda scary). <--The doctors all look at me weird when I describe this, and always try to say it is muscle spasms, which I know it is not.

    I am a human, and have made mistakes at PM. It is hard to believe anyone can be on pain meds for several years and not mess up anything, especially when the rules are so strict. I'm certain that one could look at my history and find justification for claiming red flags. For example, I had a Caribbean cruise scheduled, and I had to leave like two days before I was eligible for a refill, so I called it in, and got the refill early(the only time in several years I did that). I was only prescribed one Percocet a day at that time, which I was doing okay with (although that was miniscule). I was doing okay that is...until I spent 10 days walking around the Caribbean for a once in a lifetime experience. I was miserable the whole time I was on the ship, and had to double my dose just to begin to cope, which obviously caused me to run out early. I did not request a second early refill, because I knew that wasn't allowed, I just toughed it out. When I told the nurse about how horrible the trip was I thought she would be sympathetic, but instead she freaked out over it.
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 08/26/2014 - 12:42 PM
    Hey! When was your last MRI of your spine & what areas of damage did it show? There's a 'Dermatome Map' that shows which areas of the spine relate to what areas of the body. That could be worth checking out to explain your leg & arm pains. The discogram (painful. Ugh!) is done to confirm that a disc is causing the pain. They try to reproduce the pain. Are you contemplating surgery? It's usually done to make sure they've got the right disc before they operate in my experience.
    I'm sorry. It can take a frustratingly long time to identify pain generators.

    I find that walking & staying active helps a lot with my arthritis pain too. ;-)
    Osteoarthritis & DDD.
  • From what you are writing, it seems that you don't have any real diagnosis, but symptoms that you are guessing is related to your hips and spine.
    The FIRST thing you need to do , is to find out exactly what is and isn't going on with your body.
    If the pain is neuropathic in nature, then there are medications used to treat that type of pain, and opiates are not it. Gabapentin, lyrica, cymbalta are just three of the class of medications used to treat neuropathic pain.
    The first thing though is getting a true and proper diagnosis. That starts with seeing a board certified spine surgeon for consult, and then undergoing the proper testing- imaging, emg's if necessary, MRI and possibly CT scans, and then sitting down with the surgeon to go over those results. And to go over suggested treatment options.
    You also most likely need to see a hip orthopedist to see whether or not your hip pain is related to any problem with your hips at all or if it is stemming from your spine.
    That consult will also most likely involve more imaging being done first.
    Once you have a diagnpsis, then you need to explore the various treatment options, research them and give them a try.
    If surgery is suggested, then it is worth getting a second and even a third opinion to see if all of the surgeons agree on the diagnosis and the suggested treatment options.
    I have been in pain management on and off since the 1990's, and I have never once considered taking more of any medication than I am prescribed, nor have I ever filled a prescription early, even when the laws were not so strict.
    A discogram seems a bit premature when you don't have updated imaging or any other firm conditions. It is an invasive test done by injecting dye into several discs to see if there is a tear or leaking of the dye from the annulus. It would be far better to get updated diagnostics done to see if there is anything that shows up on the images first, and if not, an emg to see if there is evidence of nerve damage, before going ahead with the discogram.
  • ToddrickTToddrick Posts: 15
    edited 08/27/2014 - 3:16 PM
    EnglishGirl said:
    Hey! When was your last MRI of your spine & what areas of damage did it show? There's a 'Dermatome Map' that shows which areas of the spine relate to what areas of the body. That could be worth checking out to explain your leg & arm pains. The discogram (painful. Ugh!) is done to confirm that a disc is causing the pain. They try to reproduce the pain. Are you contemplating surgery? It's usually done to make sure they've got the right disc before they operate in my experience.
    I'm sorry. It can take a frustratingly long time to identify pain generators.

    I find that walking & staying active helps a lot with my arthritis pain too. ;-)

    Thanks for not making me feel so alone EnglishGirl, that has helped me feel a little better. For the first time ever, surgery might be an option. I never thought I'd be glad they found a problem that needed major surgery, but I am! I'm afraid a fusion might make things worse though, and then they still wouldn't give me pain meds (LOL, if you think I'm desperate now, OMG).
  • ToddrickTToddrick Posts: 15
    edited 08/27/2014 - 3:25 PM
    Sandi, no, I didn't have a real diagnosis for years, which is why I think my PM was so rough on me. They wanted to treat patients with big obvious injuries, or things that could be remedied. Unfortunately, I've learned that back pain isn't always an exact science. They still don't know what causes pain in some people. I was labeled as having degenerative disc disease--sort of a catch all, because everyone's back starts degenerating at some age--but never really had a diagnosis. I've even been told it is all in my head, or that I am just "weak", but everyone is different and those idiots don't have to live in my body. Now I suddenly have a hip and spine disgnosis pretty much, and doctor's are doing less than ever to help it seems. Sorry if I come off as a jerk anout this, but the days are very long for me, and nights are endless, so I think I am starting to get depressed.
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 08/28/2014 - 5:38 AM
    Lol. Fusion is a terrifying prospect. Please make sure that you get a 2nd or even 3rd opinions. I know what it's like to be desperate for a solution, any solution but you need to be so very sure that it's the very best option of you. It's all so hard isn't it? We all get 'those' thoughts & 'those' feelings. Ron on this forum calls it "The Beast" & it's horrible when it comes to visit. I fight with my brain a lot over all this! ;-)
    Osteoarthritis & DDD.
  • We all understand how hard it is, not knowing what's wrong or what to do to ease the pain, or if surgery is recommended, if it's the right decision. And if it is the right decision, what the outcome will be.
    DDD does occur in almost all of us once we get between the ages of 21-25. The extent of the DDD, and whether it is causing other issues is the determining factor in what treatment options are available.
  • The term Degenerative Disc Disease is used to cover a 'multitude on sins' in my experience & it makes things very confusing for some people. I have arthritis & DDD. Just reading that you have no idea of what's actually wrong with me. It could be anything from a little natural aging too the complete wreck my spine is.
    When I first went to a spine specialist (many years ago) he gave me the term DDD. My disc was nearly flat with bad herniations, one of which was crushing my S1 nerve root. I researched DDD, read it was 'normal', everyone gets it & it's not worrying. It's my fault but I just assumed it would go away. Duh!!
    It's been important for me to learn what my diagnostic tests mean. Ask as many detailed questions of your doctor as you need to. The terms DDD & arthritis are pretty meaningless. It's what they're doing to the structure of your spine & what you can do about it that matters.
    Osteoarthritis & DDD.
  • It's one of the reasons that I really dislike the term DDD, without clarification of the severity of it. Very mild, typical atypical, moderate or severe would go a long way in clarifying for the patient how bad it is or isn't.
    Most of us, when we read what the acronym means, see degenerative and disease and our minds tend to turn to the worst case scenario. Until we can sit down with our doctors and really find out what that term means in our specific case, we are left not knowing what it means for us.
  • It's been a few weeks. I got a second opinion from a neuro surgeon, and he ruled out surgery. I'm a little bummed that there is no fix in sight, but glad I met him because he is running some more tests.

    Also, I have stopped taking Suboxone. My new PM did a 180 and I'm very thankful. I am not taking long acting meds currently. It is rough, but this is the path I want and have worked very hard to achieve.

    I accept my fate of suffering for the rest of my life, because I'd rather suffer than be drugged up. Of course, there are limits to what I can cope with, so I still need assistance, but I never, ever want to be on time release again.
  • I'm a few days behind in responding to your post, but here goes. I have suffered from chronic pain now for over 20 years. My best advice to you is to find a new pain management clinic. There are hundreds out there in every city and some of them shouldn't be allowed to treat çhronic pain patients at all. Suboxone is not a good choice for someone like you. While it is a pain medication of sorts, it is used more widely to treat opiate addiction and not so much a good long term pain med. It requires very specific standards and is not the drug of choice for chronic pain by most doctors. Most doctors that often push the use of Suboxone really want you off opiates. If you have true chronic pain, you should be on a good extended release pain medication, in conjunction with an immediate release drug that works for you to take for breakthrough pain. For example there are several extended release morphine meds on the market like kadian, avinza, Etc., and then for those times when your pain just won't cooperate, you need something like morphine sulfate IR, ( immediate release ) . Any good pain doctor should prescribe those 2 things together for you. Even Walgreens will stop filling scripts for IR pain meds after a few months unless you are also on an extended release drug. Doctors now are leery of doctor shoppers but if you do it the right way and are 100% honest, that shouldn't be an issue. If your dr. is resistant or is giving you a hard time about trying something different, first have a talk to try to resolve your issues, if you can't get anywhere with that, it's time to move on. A good pain management doctor will work with you to find a good solution or mix of options that work for you, offering a combo of treatments such as exercises, medications and possibly an injection(s ) of one kind or another. The one true factor in good pain management is being honest with your doctor and following his/her advice and not doing your "own thing" no matter how much you disagree. If you have doubts or concerns, talk about them but NEVER do something on your own without the doctor's approval. There's no faster way to get labeled as a drug seeker or dr shopper than to do your own thing without your doctor's approval. You may not want to take extended release meds, but with chronic pain, there is no option. I also don't understand your hesitancy as they should not affect you any differently, they just give you longer relief.
    The bottom line is find a doctor you like and are comfortable with, openly discuss your problems, and listen to your doctor's advice. Good luck.
  • Todd, I agree with most of the previous posts. While immediate release meds are great and hit the system right away, you need the extended release meds for a longer acting control to be used along with the immediate release drugs for the best result. In fact, Walgreens pharmacy will not fill more than a few immediate release prescrptions without telling you, you need to be on an extended release med. If you don't comply, they won't fill your scripts anymore. I also agree with telling the dr why you are there i.e., because you are having severe and/or chronic pain wherever and can't function this way. By telling a dr you need meds or a certain type of med tells them that's all you're interested in and sends up red flags. So tread carefully and be mindful of how you are coming across.

    As for the Suboxine problem, I completely get that problem. My own son has chronic lower back pain. At one point in his treatment instead of prescribing the usual pain meds, they put him om methadone. Now, most people know that at one time methadone was used as a pain med, but once it became widely used to treat addicts it became a stigma as to be on methadone meant you were or had been an addict. Now the very doctors that put him on methadone for pain relief in the beginning, now snub him as an addict and won't do anything to help him. He's caught in a circle he can't get out of. I feel bad for him because he doesn't want to be on methadone, but can't get anyone to prescribe something else. So he's been forced by the situation to go to the local methadone clinic and get his meds through them for pain. Of course none of that is covered by insurance so he spends over $400 a month for his meds. Despite all our efforts we don't see an end in site to his situation. So, knowing what he's gone through, I certainly can sympathize with your Suboxine situation. I wish you the best in resolving that problem.
  • jlrfryejjlrfrye ohioPosts: 1,110
    Start with a pain journal. Use it daily. Be honest as you write this journal then after a month of writing give it to your dr. Include what you are doing that aggravates the pain, or if it is constant. Rate your pain scale of 1- 10 daily, hint if you say you are at a 10 everyday chances are a Dr will not believe this. You would be in a hospital at a 10. Don't exaggerate the level. Include in the journal what you did to try and reduce the pain whether it worked or not and the outcome. Stay strict as to how you are prescribed the meds. I personally will have horrible flare ups and instead of increasing my dose on my own I call my pain management and ask what can I do to bring this flare up down. Sometimes I am told to increase my dose until the flare up settles down and other times another med is added to the mix for short term use. It takes a team to help a chronic pain patient and you must be part of that team. With a pain management Dr honesty is the best policy. With the diary it can help the Dr understand what quality of life you are living and can help him or her decide what meds would be best for you. Keep your medical testing up to date. I have had my pain management Drs run more test just due to what is written in my diary. Show the Dr you are working on a goal that will make you more comfortable and as I have done before I have flat out told my DR I need help. What we are doing is not working well. Here is my journal of the last month in the life of me. It is not always meds that can help there are many other ways to control chronic pain then just meds. Yes meds are the most convenient solution but not always the best. Good luck
  • SavageSavage United StatesPosts: 5,476
    edited 02/13/2015 - 1:50 AM
    Posts. Lots of good advice. Years ago I went to xxx clinic for another issue..not spine.
    However I had similar experience and this was with doc I saw once and for about fifteen minutes.

    Can't remember exactly what I said ..but it was a few words to describe pain. He looked at me and said, "Google"

    I was beside myself but I held it in. Who knows what these docs see or what goes through there mind.

    Maybe part is my poor memory or becoming used to my situation...actually content most of the time now. I accept me for me.
    But I go in kind of humble. Not sure if that best word..only one I can think of.

    I go in and talk about how I feel..he asks if any side effects and luckily it is no now. I am pretty stable.
    I add how I feel so he knows but I follow his lead and if suggests different med I comply . Also keep in touch if any bad reactions.
    If one goes in asking for specific meds or even that this or that med worked for a friend...docs don't like that. They are trying to think about your case how to help. The more chatter outside of how you are feeling and reacting..the chatter interfers with their thoughts .
    Not sure if you ever saw psychiatrist or therapist, but that could benefit to share you situation..how to approach doctors more successfully . They could help you work out your frustrations and help you communicate more effectively.
    Just a thought. And best of luck to you!
    That is where the humility comes in also. I don't know what is best...trial and error and eventually stability
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • I was treated by a local doc who ended up in AA. He had a lot of compassion for pain patients. But titrated me up to 100s of mgs a day of oxycontin and short-acting oxycodone. I have been able to almost get down (on my own) to where I can try suboxone myself.

    I had 2 friends who just couldn't stay within their monthly limits. My friend Tom killed himself in 2005 and my other friend is now on Methodone after the doctor retired. I've seen some of the best people fall prey to this forever. I have found that stretching and evertually walking 2 miles a day helps nearly as much as the meds. 
  • Bruce EitmanBruce Eitman Akron, OH, USAPosts: 1,177

    Welcome to the Spine-Health forums.

    This discussion is getting rather old, but glad that you shared some of your experiences.  Can you tell us more about yourself?  What are you symptoms?  What have you done to improve your pain/symptoms/diagnosis?

    Please click on the following link for some helpful information to get you started Welcome to Spine-Health

    Spine-health Moderator

    Read my story at Bruce - My Story
    ACDF C4-C5-C6-C7, and getting better every day
    It has been a process of healing, learning, exercising, and resting - and figuring out when to do which.

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