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How to ask for increases in dose

dmoonchildddmoonchild Posts: 383
edited 06/11/2012 - 7:25 AM in Pain Management
Ive been seeing my new PM since July. I really like him. He has increased my meds each month and the last time he said he doesnt want to go higher, but the problem is is that its just not enough. Im in complete and total agony. I cannot live my life thike this. Im losing my mind. I go to work all week and Im in bed all weekend recovering. ( I have 2 little kids too) My husband has been doing everything and its really taking its toll. My father is in the hospital again and My Mom is not in the best of health either. She needs me. My meds are 40 mg Oxycontin 2times a day and 5mg oxycodone 3 times a day. Its just not sufficient for me to lead any sort of normal life. How do I kind of insist on good pain relief without sounding like a drug seeker or a bi##h.


  • Thats a truly tough one, I am not in PM, so I will just tell you to be honest first and foremost.It seems like your PM has set a "ceiling" dose, so it would be in your best interest to decide whether you want to risk it all at the moment.I know thats a vague answer, but as even you see the doctors treats us like addicts when we want more even when its the truth.

    BTW: I have a contract with my PCP, we have a long term relationship and my last visit almost cost me my meds w/o even asking for more(though I seriously need them esp. winter time) just for being on them for 6 months.It sucks to say the least.
  • Its not fair for us that are truley suffering. WHy did you almost lose your meds? I know for most of us we depend on our meds for our life.
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  • DMoonChild

    I'm sorry your current medication regimen is not sufficient in controlling your pain. I am a mother of 3 boys (18 - a Sr. in school; 16 and 11) who are each involved in their own extra-curricular activities, taking care of 2 households and holding down a full time (40hr/week) job as an Administrative Assistant. My mother has been treated for lung cancer since April 08 and has gone through chemo and is currently undergoing radiation - she also has horrible back problems and is receiving treatment through pain management; my Dad is 83 (in 19 days) and is frail and not in the best of health himself - I am transporting them back and forth to appointments, doing their grocery shopping, cleaning their home, and at times preparing their lite meals. The saving grace with them is that they purchased a trailer and moved it on our property which is "pert near" in our back yard. So I can walk back and forth (thereby getting some exercise, I guess!). To compound things, my husband broke the big bone in his right leg at work and had surgery in 09/08 so that adds a teensy bit more stress... He just got his walking boot, but is not full weight bearing yet - not for at least another month.

    I said all that to say something.... but lost my train of thought... oh yeah. My meds at times work well, and at other times, well, frankly seems like I've taken duds.

    I would explain to your doc that you have a busy and hectic life - and feel the current combo of meds is not sufficient. Could he maybe suggest some other medication that would be more affective? You could ask him/her whether he thinks physical therapy would benefit you. That way, he sees that you are interested in alternatives to medication and/or you're not just wanting a higher dose of what you are taking, just something that works better. And that is what you want, correct? Better pain control?

    This is delicate territory you are getting in to and have to be careful your doc doesn't label you. You have to be sure to be sincere in that better pain control is your ultimate goal, nothing less-nothing more.

    Good luck, sugar. I hope you are able to accomplish what you want - a better quality of life. Let us know how things work out, would you?

    Take care!

  • Jeaux, Wow, Im impressed and Im sorry your family members are suffering. You are a saint for what you do. I have asked about Physical therapy and because Im receiveing injectios every 3 months he doesnt want me to do it right now. I guess being honest is all I can do. I know Im not seeking drugs to get high so hopefully he will see thru it. Thank you for your incouragement and I will pray for you and your family.

  • The reason was because of hospital politics, my doctor even told me that its policy to avoid "narcotic" based meds as much as possible.I am fortunate to have a great relationship with my doctor, but policy stands in the way.I am grateful for what I get, but my new years goal is to get a 2nd opinion after I save some $$$.
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  • I have been called MANY things.... Saint has never been one of them! :))( :))(
    I do live in SAINT Amant, though, and have stayed at the Best Western in some states..... :?
    Seriously, though - I am NO saint (but thanks just the same!) I am just doing what I have always thought family is supposed to do for each other. "Be there for them" if possible. At least that's what all those cheesy sit-coms from the 60's and 70's said....
    I will humbly accept your offer for prayers, though. Can never have too many people praying for your loved ones I always say!
    Well, it does look like you are travelling the right path with your care. My pain management doc is a mother; as such, she is more empathetic (I find) than male doctors when it comes to the treatment of women.
    (OOPS! Was that a sexist remark? Hope not!)

    Frustrated 1 - NOW I understand your handle TOTALLY. Don't you hate that POLICY dictates your treatment plan? Geesh! I bring a purple marker with me where I go so I can change all the red tape to purple tape. Yeah - if only it were that simple....

    A good relationship with the person in charge of your care (such as what you have Frustrated) is worth millions in my opinion!

  • My first PM doc would not prescribe anything stronger than Mobix and Ultram post surgery. I did not think he was listening to me nor did he understand (evidenced by his utter confusion at what a 360 ALIF was) the procedure I had. As much as I hate to say it, he was a dumba$$.

    Instead of picking up the phone and shopping for a doctor, I consulted with my PCP and NS to get their recommendations for a new PM doc. I explained my concerns and they gave me a recommendation of who to see. The doctor I see now sits on the drug diversion task force in my home town. What I like about him and his staff is that they don't pre-judge anyone. They will evalute every patient and see where they are in regards to pain. Trust me, I've been in the medical field a while and most doctors can see through a drug seeker. The best advice I can give is to tell your doctor everything including the meds you have taken in the past and what has or has not worked. Be open to new therapies and tell him/her what you think.

    I would caution everybody on one thing - if you go to a PM and ask for a drug by name and dosage, that is a huge red flag! Tell the doctor what you are going through and let them complete an evaluation to see what will work best. When I was pre-op, the only thing that helped me was 10mg of Lortab. My doctor asked me what I took before surgery. I told him everything to include how well it worked, how many I had to take to even include the side effects I felt.

    Today (2 yrs post op), I am having to take Darvacet PRN and Lortab 7.5mg PRN for when my back really flares up. I have a limited number of pills. When I get low I call the PM and explain the pain I'm having. I've yet to have a problem getting appropriate medication. I think the relationship I have with my doctor shows mutual trust in that I've never run out of meds "before" I'm supposed to, and I've been willing to try other medications in various forms to see what else besides narcotics will help my pain.

    I think if you speak with your PCP and explain the problem, he/she might be able to refer you to another doctor who will work with you.

    Good luck!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Dmoonchild,
    Keep a record of your daily pain level 1-10 every day and make a graph to show when it does increase and what you do as a consequence, and the medication taken when and why, what activity you were doing and how it made you feel with the same scale, find some pattern that supports your evidence for an increase and use this as a starting point, to improve your quality of life through negotiation with him or her.

    Addiction only relates to 1-20000, make your case and be strong, ask him why he would not advise any increase and what other strategy may be of any use.

    Bye John =D>
  • First, let me say I'm sorry to hear about your troubles. It sounds as if you're in a lot of pain, so I really feel for you.

    Although you're on some reasonably powerful meds, you're far from the "ceiling" in general....Maybe his ceiling for you right now, but not overall. I'm no pain Doc, but I'm betting that the BT meds he has you on aren't strong enough. Given that you're on 40mg of OC every 12 hrs....A 5mg IR pill isn't much, IMO. Either you need something stronger in the Oxycodone line, or some other med overall.

    I think you just have to be honest with your Doc and take it slow. He has increased you every month. Maybe he just wants to see how you'll react after saying "no." I'd go back and see what happens, and reaffirm what you've already said and be passionate about it, not bitchy.

    Best of luck to you.

  • dilaurodilauro ConnecticutPosts: 11,347
    Hi dmoonchild,
    I am sorry that you are suffering from chronic pain. The dose of narcotics you are taking daily should be enough to help you through the day.
    But I know, when I was basically using the same dosage a while ago, I felt I needed higher dosages. We tried that for a little while, but I did not like that since I still am holding down a full time job as a programmer and I needed to stay as clear as I could.
    Instead of increasing the dosage, my PM and I worked out a plan. I am convinced now, more than ever, that pain medications alone many times are not enough to control the pain. What is needed is a 'blend' of different medications that address specific areas plus some other treatments that together should make your days easier.

    Medications such as:

    Nerurontin to address any nerve pain. Once I started taking that, I could eliminate my middle of the night Oxycodone IR for breakthrough. I started at only 300mg a day and now up to 1600mg a day.

    Zanaflex addressed my muscle spasms which so many times would just tighten up other muscles, so that pain seemed to radiate in other areas.

    Ambien To help me get a good night sleep. Your body needs a deep REM sleep so that it can help in reducing some of the discomfort.

    I then go for Aqua Therapy sessions twice a week and see the man who does my Deep Tissue massage every other week.

    It was only when I started all the above and continued for a while, did I see a difference. I didnt need any higher
    dosage of pain medications, what I needed was the
    correct 'blend' for me.
    The medications I identified were something for me, work with your doctor see if something along this lines could help you.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
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