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KelsiedeeKKelsiedee Posts: 32
edited 05/29/2015 - 9:53 AM in Pain Medications
Okay, so let me preface this by saying this isn't the typical I need something stronger post.

I have three slipped discs, DDD, scoliosis, and recently, pretty bad sciatica. I'm on 10/325 mg Norco (1/2 to 1 tab every six hours). My daily max is 4. So, my issue is that my PM only gives me 100 pills, rather than 120.

Most days I take about 2.5 tablets total. That is the average, I'd say. But we all have bad days and I'll max out at 4 tablets on those days. My dilemma is that lately I've been having more bad days. So I'm scared I'm going to run out in the last five days. My pharmacy and insurance read it as a 25 day script. I haven't run out early this far, but I'm scared one day I'll have to choose between maxing out on a bad day or saving the max for a day that might be worse. I really want to approach my PM doctor about this but I'm incredibly nervous on how to do so. I know it's only 20 tablets, but I think we all know that can make the difference on a bad day. So if anyone can give me some advice on how to approach this, I'd really appreciate it.



  • The best way is to tell the PM doctor the truth on how you feel. That is a valid concern. They will either increase your Meds or leave them the same. They won't punish you for saying what you feel. But just be honest and don't make any excuses. I have been there also, and sometimes he listens, sometimes he just says no. But don't give up.

    Hope you feel better soon
  • dilaurodilauro ConnecticutPosts: 9,856
    You should discuss this with your doctor before you run out. You do not want to be in the situation where you run out of your narcotics before the prescribed dosage as stated in your prescription. Once you do that, you could easily be put under the red flag and trouble may follow you wherever you go (in terms of getting pain medications)

    On the other hand, if you discuss this with your doctor, letting them know that your current dosage of medications does not always work. You have bad days where you feel that you need more that what is prescribed. That way the doctor can determine how it should be handled.

    As wstones stated, sometimes the doctor will hear what you are saying and provide you with relief, but they may be times when that will not happen.
    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
  • Thanks you guys. I'm just always so nervous with my PM doctor. He's an intimidating guy and I don't want him to see me in a bad light by asking for more tablets, which I know he very well may.

    Dilauro, just to clarify, I didn't mean in my original post to sound like I wanted to take more than prescribed. On bad days, I take four tablets ( the max allowed per day), but say I have more bad days than good and have to take four tablets, I would need the 120 tablets to complete the script. As of now, I'm only getting 100 tablets (a 25 day script). Basically my main goal is to have the power to take four tablets on a bad day without fear of running out. Hence the need for a 120 tablet prescription. I hope that doesn't sound whiny haha. I think something just got lost in translation.
  • Into a problem is that the prescription would only be for 25 days, if you are taking 4 tablets every day.
    Even if you are having a frequent number of bad days, the directions say 1/2-1 tablet every 6 hours. Therefore at the minimum , you should be starting with a half tab during a 6 hour period, then only using the second half on those bad days during the same 6 hour period. With the maximum dose of 4 tabs per day, if you are starting with 1/2 tab dosing, you should be using two tabs per day , if a bad, then perhaps a third tab, leaving you with one tab left over for each day.
    All you can do is talk to your doctor and see what he says.

  • SavageSavage United StatesPosts: 5,427
    edited 05/31/2015 - 5:00 AM
    ....all above...just wanted to add.....at the time doctor ordered med, that was dosage most effective.
    You said .........now you are having more bad days.......
    So doc needs to know your symptoms have changed and med is not effective as before....by virtue of more bad days.....

    As above, doc may want to increase dose, not change dosage, or decide on another med to be more effective.
    It is trial.....and try again when it comes to treating chronic pain.....in my experience.
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • dilaurodilauro ConnecticutPosts: 9,856
    interesting is the pill count per month.

    I have been on oxycodone 5mg for almost 10 years now. All the scripts are written PRN, some with 4 max a day and other times 6 max per day.

    With 4 per day, the count should be 120, while the 6 per day is 180.

    I guess I am not sure where the pharmacist/insurance came up with 100. The PRN prescripts are filled taking into account the maximum dosage per day that would be used.
    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
  • sandi123ssandi123 Posts: 456
    edited 05/31/2015 - 8:08 AM
    Is that it is assumed that even though the maximum dose is 4 doses per day, that the OP is not going to be taking all four every day. The actual written instructions are 1/2 tab q6 hrs, so starting with that dose, she should be using a max of two tabs per her baseline dosing....for flares she still has 2 other tabs per day...during any given 30 day time frame if she is taking the baseline meds ,that's 60 tabs leaving her 40 for dealing with flares in pain during that 30 day period.

  • still, though, if her Rx is written as 1/2 to 1 tablet every 6 hours as she states, there is the possibility that 1may be taken every 6 hours to equal 4 per day...and written as such she is allowed that...and that will be 120/month

    If the doctor does not expect the possibility of 4 to be taken every day, then he should not write the Rx that way

    I, too, wonder where the 100 comes from as opposed to 120...geez, I don't know too many people that can survive on 5 mg of hydrocodone for 6. hours, but that is another discussion
  • Hey all, my apologies for my neglect of my own topic. On the whole, it definitely is best to just talk to my doctor and see what he thinks. But just to clarify, I know something's get lost in text. The 100 tablets is what is written on my script by my doctor. When I pick up my script from my pharmacy, it reads a 25 day supply with my max of four a day.

    And Sandi, it's ironic that you bring up the starting at a 1/2 tablet than moving to the other half if it's needed. I actually brought that up when he first prescribed because of all my spine health reading. :) I definitely wanted to make sure I understood the script. He asked how I was taking the med before when my PCP was prescribing. I told him a whole tablet in the morning, 1/2 in the mid afternoon, and one before bed. He said that was fine so I hope it won't be an issue that I'm still taking it that way most days.

    I guess my issue is on the whole is that on the bad days, four tablets do work along with heat and yoga and tens. So I don't feel that I need a stronger medication. I just feel that maybe I should discuss making the script have 120 tablets so that if I need to take four tablets, it won't run me out early. I know it's confusing and maybe a little silly on my part, but I just got used to having those four tablets on bad days from my PCP because she wrote my scripts for 120 tablets but when I switched to my PM, the script changed to 100 tablets. this whole world of PM is just so confusing.

    Quick edit: I too have no idea why my doctor decided on a 100 tablet script. So I'm just as confused as to why the doctor writes it like that. The pharmacy and my insurance read the script with the max taken into account, so they're correct reading it as a 25 day script.
  • Similar thing happened to me. 1) after 7 or so months of the same narcotic I build up tolerance pretty quick and have to slowly increase the dose. I started at 5/325 after about 6 months went to 7.5 mg. told the doctor so he jumped me to 10/325 every 6 hours, however I only took it once or twice a day, I would wait til pain hit a level 6 for me.
    After a year and a half on narcotics the 10/325 was only giving me relief for 1-2 hours and I didn't want to be taking it every 4 hours so my doctor out me on extended release 10 mg Oxycontin and I only take the immediate release for break through pain. That seemed to give me the most help. The nice thing is with the extended release you don't get loopy. At least I don't. So you can function pretty well through out the day. Maybe talk to him about an extended release option? And save the immediate release tabs for bad days?
  • I actually considered extended release about a month ago before my appointment and my PM offered me methadone rather than one of the conventional extended release meds. He swears by it for the non loopy feeling. But I was definitely uncomfortable making that big of a leap. I think I'm going to discuss the subject again and just see what he thinks. I too started on 5mg hydrocodone but eventually it was like taking nothing. My PCP actually moved me up to the 10mg because of the acetaminophen amount I was taking by taking the 5mg every six hours. (She's VERY concerned with acetaminophen).

    I think I'm going to bring up the subject of different extended release meds. I definitely wouldn't complain about less loopiness.
  • I was concerned about the acetomenophen too. That's why they gave me the extended release. No acetomenophen in it. I only take the regular for break through pain. Works well for me, worth discussing again I would say,
    I would be a little afraid to start on morphine too. Good luck to you!
  • My husband has been on the same dose of Vicodin for 8 years, We have been trying to talk to out Dr, and even went and seen a pain management specialist to see if she could help him get better relief. He has had 2 surgeries, and spinal cord implant which doesn't help much anymore after this last surgery. We have done everything by the book, they can take blood and urine test whenever, because he is on ongoing therapy. He has Severe nerve pain from scarring on L5-S1 nerve root.. But we have not been able to get any where, The pain management told him , that they are now proving opioid medications , they are finding now actually are and can make you have hypersensitivity, Say if someone was to touch you , it would hurt.. Which he has never had.. His pain will go up to a 7-9 at points through out the day , with no real trigger.. Does anyone else have this ?? We are desperate for help, How are you supposed to live in that kind of pain day in and day out??? From PA
  • There are known POSSIBLE side effects of long term narcotic use that some may experience. Given a livable alternative I wouldn't take them. There are very well known effects of unmanaged chronic pain on the whole body including increased sensitivity to pain, physical brain changes (reduction in gray matter), all of the deseases common with living in a state of permanent 'fight or flight' stress, heart problems etc. (I had a kind of reverse intervention to convince me that I should take pain medication a number of years ago).
    There are doctors who do not believe that prescribing narcotics is worth the 'cost' in one way or another in my personal experience. After a very long journey I now believe that (combined with many other tools) narcotics allow me a higher level of functioning & better quality of life.
    As long as you do not fill narcotic prescriptions (until you leave your current doc) you can get 2nd, 3rd etc opinions from other pain management docs in your area. No level of narcotics will make me pain free, that's a 'holy grail' that leaves a lot of patients very frustrated. We will build tolerance but that can be manged to a great extent, in my experience, by changing the type of narcotic I take. I can swap meds to a lower dose when I get tolerant to the first.

    It's becoming a controversial subject but that's been my experience. ;-)
    Osteoarthritis & DDD.
  • itsautonomicitsautonomic LouisianaPosts: 1,807
    EG is correct in what untreated pain can do and it actually goes much deeper and is worth reading about. The fight or flight ( under sympathetic nervous system control) and healing state ( parasympathetic state) have a fine balance to keep body at best condition ( homeostasis). If this is broken say by uncontrolled pain and that fight or flight runs away short term it's ok that's what it's designed to do, long term it actually causes damage at the cellular level because an over production of hormones tht become damaging when to much is produced for long term. Things like cortisol, adrenaline can have many adverse effects if over produced . The sympathetic is designed to get you out of immediate danger , and parasympathetic brings your body back to normal and heals. They are studying some testing being done with PTSD soldiers where a sympathetic block has led to curing PTSD symptoms, others where a ketamine coma stopped the progression of a tissue damaging disorder because it shut down and rebooted the brain allowing CNS to function correctly. Anyone in chronic pain should read about the effects of uncontrolled pain .
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • I remember about 4 years ago I was on the floor in a puddle of sweat, shaking & vomiting. Even meditation breathing & trying to be as still as possible I could watch my whole body spasming, twitching & contracting. It felt & looked like every muscle & nerve in my body was firing uncontrollably. I said to my husband that spine pain was "nothing compared to THAT!". I was diagnosed with pretty much every nerve, pain 'syndrome' & disorder I've heard of over those 2 years. Obviously I had the fibromyalgia label...they said I had every one of the 'pressure points' they used to test for the old fibro diagnosis. I was studied extensively by specialists. I slept with a little 'tent' over my legs & feet because I couldn't tollerate the pain of a sheet resting on me. All of my joints were red, swollen & felt like they were burning even when it was freezing cold in the room. I could write an essay on all of my symptoms!!

    It all started with 'normal' spine pain. Diagnostics revealed severe degeneration, herniations, nerve impingement etc in my lumbar. The pain just got worse & worse. I was treated in all the usual conservative ways, shots, nerve & muscle meds which I responded very badly to. Some ESIs, nerve blocks/burning etc helped a little but mostly just flared my pain for a while. I threw myself into physical therapy. Did stretches, exercises, 'perfect diet', aromatherapy, ice/heat, meditation, massage...everything! Everyday! And it just got more & more painful. I had a young baby & a toddler at the time & no support system so I just forced myself to keep going but my level of functioning was pathetic. Even the slight breeze from a air conditioner could leave me in agony.

    A new PM took me off of all of the meds I was taking, slowly titrating some & replaced them with extended release & breakthrough narcotics. It took some time to reach the correct mix & doses for me. I got my life back!! Within months all I had was predicatable pains from my lumbar damage. When my pain is particularly bad & I can't do the rest of my 'Blend' (after surgery etc) all the other stuff starts creeping back in but it's manageable & goes when my pain levels come back down. My vitals are now normal most of the time, my bloodwork comes back ok.

    In my experience having my pain managed with narcotics has changed my life. My level of functioning isn't great but it's acceptable. I can live my life!! I find it very sad when I read studies revealing under prescribing or not prescribing pain meds. I just know I couldn't live my life the way I was before. I'm not being melodramatic. Doctors became very concerned with the state of my heart & internal organs. I think I'm still experiencing the 'fallout' of damage done internally over those years. My private live was wrecked by it all.
    I don't think anyone can live with constant (real) 8-10 pain levels for many years. A lot of it was my fault. I didn't want to be reliant on meds. I believed for a long time that I could handle my pain naturally. I was very wrong!!
    Osteoarthritis & DDD.
  • itsautonomicitsautonomic LouisianaPosts: 1,807
    EG when my pain was at its worse a sheet weighed 100 lbs and burned just touching toes. I still cannot walk moving my arm back and forth , sleep with fan blowing on me or tolerate cold. It pierces right through " pain levels" and ramps up to horrible. I still get nauseous from the pain . Very interesting to hear your story a little more in detail didn't realize had those talked about things in common
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • To be honest some of the symptoms do come back now & again. Even getting my car really hot & wrapping in a blanket with a hot water bottle I can end-up using a sick bowl in the car & have weird nerve twitches when it's winter & the car queue at my sons school is long. I know I'm very lucky. Specialists treated me like this would be a life long progressive thing & it terrified me! I felt like a crazy lady going to normal docs & specialists. I had this 2 page bullet point list of symptoms! Most docs cut me off half way down the first page & started talking about fibromyalgia & depression...I was completely happy except for my agony!! Fibro just didn't 'fit' what was going on. Docs seem to use that diagnosis, particularly with women, far too easily.
    I'm now completely convinced that all my increasing 'stuff' was my bodies way of trying to make me rest & stop. When I met my doc & he started treating just my pain I was amazed how fast all the other stuff started going away. As you know I've got something new (thoracic?) going on at the moment but I've had a few years of mostly 'just spine pain' & it's been wonderful!! Strange thing is my Dad is so similar. My family has always called it all our "Weird Turns".

    Anyway...back on subject... Unmanaged chronic pain can cause so many other problems. I'm not saying that the answer is just taking huge doses of narcotics, it doesn't work like that. If anyone with severe spine damage thinks they can take all of their pain away with meds they're on a very frustrating road but without narcotic pain management it was impossible to do half of my 'Blend'. It's the blend, mix of different pain management techniques, that works for me. If I only took my meds & lay around I'd be in much, MUCH more pain. Dealing with chronic pain means a complete change in life style.
    Narcotics do bring their own problems. If they don't increase your functioning & don't help (as some say) then don't take them. It's not worth the risks but all of the side-effects & possible risks are well worth it for me.
    Some big medical groups don't allow their docs to prescribe long term strong narcotics. Some docs don't believe that that the risks are worth the benefits. If you really believe that narcotic therapy is an option you want to try you need to find a doc that believes in the benefits of narcotic therapy. For me it's been about finding the best meds & doses. Alternating meds helps with tolerance. From everything I've read, being on the same dose of the same med for years & years will eventually stop working. A good PM, who supports narcotic therapy should know & practice this.... Ever increasing doses of narcotics can be really bad.
    Osteoarthritis & DDD.
  • itsautonomicitsautonomic LouisianaPosts: 1,807
    It really is like a war, you have to throw so many different approaches and tactics at it.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
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