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Pain Management question. Not passing urine tests.

Hi all,

A little background as many of you already know.

My previous PM doctor prescribed 900 mg of tapendatol for the month. I would always take one or two at night as well which is why I took 900 mg. I take this for muscle and nerve pain from a blood cell disorder that causes neuropathy, muscle and nerve pain that is severe and debilitating. 

My new doctor who I have been seeing a little while now prescribes 600 mg of tapendatol but I told him it is hard for me to stay at 600 mg a day because I am used to taking at night. I mean, sometimes it is either that or go to the ER.the pain can be agonizing. I have even called in times of struggling. 

So I did fail one test and I explained why this is happening before they brought it up with me. He was ok and so we tried other medications to get me through the night to no avail. So the struggle continues. 

I had another recent appointment and had another urine test at the end of the appointment and I know I will fail again. The bad news is that I will have to explain again that I ran out about 3 days early due to this nighttime struggle. The good news is that I finally have it to the 600 mg as this secondary medication is starting to work at night although some nights are still a struggle. I have forced myself to not wake up and take the tapendatol at night so the next time I see them I will be on target. I was even thinking I should bring with me, any of the medication I have remaining and let them know this next test will come back good. He knows I have been struggling with this. I talked about this with my psychologist and my PM doctor knows. The PM is very nice and understanding. I am just worried this will be the end and will be cut off due to me Ben a problem. I should have mentioned something at the last appointment. I just hope I have a chance to explain and another chance. Maybe I should write the doctor a letter explaining the struggle. I know part of this is dependence cause I notice I get tired between doses, as if withdrawal symptoms start.



  • SavageSavage United StatesPosts: 5,427
    I was wondering if doc had you taper down from the 900mg to the 600mg? You mentioned something about withdrawal but should have discussed with doc earlier...I guess.

    It so difficult starting again with new doc.
    As annoying as it would be..for you and doc...you do need to call doc about increase in pain and what does he instruct you to do? That way you don't take meds without permission and he could direct you to med to keep you out of ER....and I think doc wants to hear from you about meds taken on your own instead of from reading lab report.

    I don't know what pain management rules doc must follow... By law...re' urine test.. If your get three strikes and you are out.. Or one strike... I don't know....but no taper, new doc.....might be situations to help you.
    I don't know.....
    Best of luck to you!
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • It's my understanding that there isn't a 'law' about failed urine tests. It's a tool for your PM to use. In my opinion, that's why it's best to be honest & upfront about these things. Taking the last of the meds with you could be a good idea. It sounds like you really need some help with better pain management. Hopefully this doc will get you into a routine of therapies, suggest coping mechanisms for when your pain flares & discuss your prescription options.

    Best of luck with getting better control of your pain. As most of us know there's nothing that will take all of our pain away but there are many different ways of 'managing'. Have you read Ron's advise on 'The Blend'...all the different PM techniques available for us?
    Osteoarthritis & DDD.
  • Realize that FEAR is our worst enemy. Get up & get out in that stormy weather of the real world & kick fear in the teeth. Stare at it dead in the eyes & walk right through it into the storm; because once you're wet, you won’t fear the rain anymore
  • Is your PM a dr, anesthesiologist? Most are there to help you manage your pain but there are those as well that feel pain medication contributes to our pain, and they will lower your dosages and eventually your body will adjust to the lower dosage, I am not a believer in that. But I also agree there are many other methods that can maybe help us deal with the pain we have been given to live with, and if we are young starting out with the big guns what will we have when we are older. So I'm on the fence with the whole PM thing, I'm still looking for a clear diagnosis but I'm in a pain level of 8/10, 9/10 or higher on days I do too much and I'm not taking nearly as much as some on here, but I haven't had a straight nights sleep since the day of surgery. I could also be looking at more surgery in the very near future, but its a big decision, because surgery got me here.... However, these PMs are not the ones dealing with the pain we are all dealing with, without making you feel like they are drug addicts, asking for medicine to help. I would discuss options that could help being in PM shouldn't be a game between you and the dr...pain is subjective, but they also have to understand there are days that can be flare ups unexpectedly and within reason you had to take more and drs should understand that but maybe a call to the office to discuss as I think you mentioned you called? I'm not sure what I said helped but I do understand. Acute chronic intractable pain is the worst.
    This can't be happening
  • PlumbTuckeredOutPlumbTuckeredOut Philadelphia, PAPosts: 325
    That was my motto. I always thought that no one could know my pain but me but the clinic where I go asked if I'd participate in a research study the top doc there is doing. I said "Sure, what not?" So every time I go to the office I fill out a questionnaire, hopefully a few days previous at home on my own computer. They ask about levels of pain, mood, goals. When I get to the office it's the typical weight, pulse, BP. So, I've been going there since July 2014 and have just showed me the graphs made by my questionnaire responses along with my vitals. There is a definite correlation between my bad pain days and my vital signs.

    I had also been an extremely quiet person regarding my pain. I preferred not to tell anyone but I was shown how to detect pain in others and how the docs could tell when I was in more pain than I was admitting to. So, yes, pain is subjective BUT my body gives away my secrets.
    Before all of this I wanted NO narcotics and then the docs sat down with me and asked me to just trust them for a month and I started on a low dose of Percocet. I was sold! I didn't turn into a slobbering addict but my pain was manageable and I did not feel drugged.

    I've studied psychology for so long and the psychology of pain was not something I ever got involved in but it's fascinating. This week was a horror show with a new Physical Therapy eval (and me pretending I could still do all that stuff) but they know my goals and I get to work toward realistic goals I can accomplish while in pain.

    Two roads diverged in a wood, and I took the one less traveled by...... (Robert Frost)
    I still don't know if I should have taken the one that said, "Caution! Dead End" (Me)
  • ...ahead of time when you know you are NOT taking as prescribed. Waiting for the test results will def reflect you not being honest.

    Waiting to see if you pop on the pizz test without you being upfront looks bad. Just call them and ve forth coming or better yet, face ti face and explain the circumstances.
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