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Hasn't everyone at some point ran out or short on their medication?

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Comments

  • When you live in a small community it isn't always an option to seek another PM Dr - however, I'm well aware its my fault and wouldn't blame anyone else for it either doesn't make the next week anymore fun now. Lesson learned well.

    I have issues being "heard" all the time with Dr's. I don't know if I come across as naieve by smiling/nodding asking questions, what. For instance my Loratab was changed because I inquired if the other 12 hours were Tram was not working could we try Ultram which I had been on in the past or would that be too much aspirin? He assumed I was worried about actemenophine and reduced the Loratab aspirin. That wasn't my concern - my concern was could it be a Loratab, an Ultram, a Loratab.............................. which it couldn't because of too much aspirin. Yet the script was still aspirin reduced.

    Anelson to my experience in 1. No because they have given you a plan to follow and at my office any deviation in said plan, request to take more would result in an early refill they don't allow. Discuss it in a month. It sounds like others have better experiences in that.
    2. if the tear is showing up on the scan, then they have some idea to the degree it is and if it is the cause of your pain. I don't think anything is very accurate until they put you through some of the more common alternatives as a "test". I don't think you'll find a chronic PM patient that hasn't at least tried one injection in their time for example.
    3. Yes and No - a non PM will try to find a therapy that works but in my experience were also more understanding about what did and didn't work. If my pain was terrible and I took 3 pills and wound up refilling 2 days early, there wasn't as much hoopla about it because there was no contract. On the other hand, with a verbal contract and a family physcian you run into other problems sometimes. For instance, I refused a dental script on my verbal agreement with the doctor. Called his office, was told no problem increase as needed. When I went to fill my new script the wording was such my insurance didn't want to pay for another 5 days. Called them. Called the doctor. A huge mess because he had to basically reword the instructions for that one refill to be done as needed.
  • terror8396tterror8396 Posts: 1,832
    edited 05/28/2013 - 5:33 AM
    aaron
    as you might or might not know, i have nothing but good things to say about pain doctors. since i have established a relationship with my pain guy, it is not hard to get in. i go every 2 months. they call and remind me and i have had excellent relationships with him and my other one. he retired and gave me the new one's number. so i have had 2 pain doctors over 12 years. i go by the letter of what he wants not only with contract but what he feels is necessary, ie injections. he is understanding and accessable for the most part. the only issue is that i have called the front desk to get a message to him or to have him call me and sometimes that does not happen. the only things he gets upset at are the insurance companies and some pharmacies. he is pretty open to utilizing compound meds. they are cheaper and the pharmacy has to be specifically liscensed to make them. the guy i use to compound my meds is rated number 1 in nothern california but he is more expensive than a guy 35 miles away. the problem with going to the cheaper guy is that i have to drive over a mountain , santa cruz to get to him and one can't get their meds until the very last day. he charges $75 for both scripts. the other guy days the dea gives a grace period up to 4 days early to get meds but he charges $425 for both. i don't know why one is more expensive and i have not asked. their meds are checked out by the dea so they have to be up and up. i have had no quality problems with them at all. it is funny because when is sit for my pain doctor, they get calls from people with all sorts of excuses about losing meds, they were stolen, i dropped them in the sink, they disappeared etc. the office states that they need a police report if someone took them. i don't know what they do if one drops them down the sink. i asked what do you do if a guy gives you an excuse like i lost them. the office stated that they give the benefit of the doubt except for when it happens over and over again. once is good, but when they hear it 3 times, there is a problem. they said if there was an issue such as losing them, call them or come in. since i don't have a history of missing meds, there would be no issue with me if something happened. but when you hear from the same guy with the same excuse, they tell the guy that hey have to come in the office.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
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  • sandisandi Posts: 6,269
    edited 05/28/2013 - 7:06 AM
    As a newbie to pain medicine






    As a newbie to pain medicine a couple of questions I have:

    1. Do all PM make themselves available to make changes to meds during weekend/holidays

    No, not all of them do but many do have someone on call covering in the event that there is an emergency, and they also have open appointments for those patients who are not doing well to be seen if needed for a flare or emergency.


    2. IF there are diagnosises such as fibro and things such as annular tears that do not show up, and you doctor is going off scans to rate what is needed how can this be accurate, at least in begining

    The decisions are based on many factors, the most important one, is not necessarily the scans but the examinations done by the physician, coupled with the patients reports of pain, intensity, location and of course, any testing results. Patients who rate their pain levels at a constant "10 " or higher, or claim nothing works to ease the pain but opiates themselves , and having testing results that show minimal or normal findings are going to be under more scrutiny.

    3. IF it is not a PM persribing can you expect the same treatment as stated in above posts by jon and sandi, becasuse many times its months before can get in ( esp in small towns).
    I live in a small town, and my physiatrist/pm doctor is part of a group of surgeons who came from NYC to my area since their hospital bought out our small town ones. The best advice that I can offer is to contact the other towns surrounding you, or the hospital if you are kept waiting for an appointment- talk to the anesthesiology department. Their anesthesiologists usually also do some pain management or can refer you to someone.....


    I really dont have the experience with these questions and its something I would like to know also. I have left multiple messages at PM for things such as muscle relaxers and inflammatories and never heard back so Im curious and playing devils advocate a bit. But Im sure others might have same questions. And thats a pretty good piece of business Jon , 12 years is pretty good but in your honest opinion ( being serious) do you think that it has more to do with exceptional doctor, your own diliegence or a combo. Would it be a stretch to say you have a good one and there might be some out there not as good , same for patient. But i think it would be good to know about your original visits to PM and how you worked out initally the doctor patient relationship, were there growing pains, did things run as smoothly as now? I think it would be a good thing for newbies to see the begining rather than be compared to the end, be a cool guide what to expect.

    I am not speaking for Jon, but it took time to develop the relationship with my PM doctor. I first went in because of an adjustment the day before that went horribly wrong.....left me with legs that I was unable to control for several episodes due to damage the chiro did, on top of an already bad case of sciatica. I was sent to get my MRI's right away because of the exam results, and saw the surgeon within the hour of returning....in less than a month, I had two more MRI's and CT scans, followed by two myelograms and off to surgery once all of those were done in less than 10 days....my outcome was not good, needless to say if you read my recap of my journey, but over those months, and the years since, my relationship developed because I trusted my physiatrist to do his best to manage my pain levels, and I always was honest with him.........if I needed an increase, I called him and explained, if I didn't need as much medication, I let him know that too, if something caused a flare or I was struggling, he knew that whatever I was tellling him was truthful. I never overexaggerated my pain levels, never ran out of meds, or had some come up missing, or needed early refills....I look at it this way, I am trusting him to do his best for me to manage my pain , and I need to allow him to do that as best he can......so I do what I am asked and am always honest and forth right with him........it's not always easy to wait out a new medication or a new dosage. when the pain level flares but if you give it a couple of weeks to see if a dose adjustment is going to make the difference in the pain being better managed, and learn that it is a journey, not a destination, and hold up your end of the agreement, you will find that you have a doctor that you can trust to manage your pain to the best of his ability and you will earn his trust and respect as well for being an honest patient.
  • it took me a while about 6-8 months of tests from the discography to the mri to the first prescription of meds, methadone to changing it to oxycontin and the lollipops. i saw him at least once a month to sometimes once a week to get results, to determine best treatment to referring me to a surgeon to do my back surgery. i still saw my pain guy before, during and after my fusion. he came into the hospital to adjust my meds and to look at my piv pain pump. so to be brief, i had an extensive work up with my pain doctor and my surgeon. i still see both, surgeon at least once a year and pain doctor at least once every two months. it was not a slam bam thank you mam type of service with my doctors. after seeing them and talking to them, you do establish a relationship with them. i am not confrontational and i try to work with them. if i disagree, i let them know about it and they take my input into account. i was comfortable with all of the above and i think i have a great relationship with them. it has not always been smooth and comfortable but for the most part it is and continues to be. one needs to work at establishing a good relationship with all of their team.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • dilaurodilauro ConnecticutPosts: 13,584
    Yes, when I was about 29, wasnt paying attention to all the rules and regulations. So when I hurt some more, why not shorten the time span between dosages. Short, you bet about 2 weeks short! Talk to the doctor, no problem, so he changed the script to shorten the time between dosages and increased the pill count!

    That was 1979.... Since then, I have never come close to running out of any of my medications. Narcotic or not. Many folks here need to sign pain contracts with their doctors. Essentially, you are promising your doctor that you are taking your medications as prescribed, no more and that you will not be short.

    I've never had a pain contract. My doctor does use them for many of her patients. I am a lot smarter than I was back in 1979 and yes I have had a multitude of surgeries and problems since then..... BUT, I placed my well being into the hands of medical professionals. In return, I have had nothing but complete two communications, trusting relationships

    Along the way, I have kept (and still do) a spreadsheet for every pill I take. I know the date the script was filled, the dosage, the recommended dosage, etc. I have about 7 years of data for every pill that has been written for me (for Spinal, Joint and Arthritis situations)

    I keep track of the number of pills taken daily, how that rates against the prescribed number, when I should be running out, etc.

    So, even if a situation might happen that I would run out before, I would know well in advance and have time to discuss this with my doctor.. I might be taking this a bit too far, but the results speak without any debating.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
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  • Well in addition to being a week on a lesser med that doesn't work as well for my mistake - I learned in communicating today (without saying what I'd done) that had I been forthcoming with what my issues were the first time I had the procedure done I could have added another medication to help ease that issue. So I was not only wrong, they would have adjusted/added a temporary medication to address just that pain. So now I feel dumb.

    I think for some of us it only takes once or twice to learn a lesson. Others never break the rules and that is admirable but I always had a little inner bad girl. Just a little one though because she learns pretty quick :)
  • The only way for any patient to approach pain management is to first understand that chronic pain is just that- chronic. It is not going to go away, although it will change over time. There is no way, when dealing with any chronic condition that it is going to somehow return to where you were before the injury or condition occurred.
    In the early days of pain management, yes, there will be some medications that work wonderfully, and others that don't work so well but they all offer some level of pain relief. Maybe not as much as the patient would prefer in the beginning, but the biggest mistake that I have seen personally over and over again, is the patient thinking that they know better than the doctor. If they are given pain medications in the beginning- and they are told to take one every 8 hours......and for some reason the pain levels are a bit higher than they would like them to be, they usually do one of two things- I have a bottle of pain medications sitting here, why should I be in pain at all? so they either take more than they are allotted, or they take them off schedule......meaning that if they took one at 2, they aren't supposed to take more until 10 pm, but they decide at 6 that their pain is out of control so they take more at 6......this has two negative effects...the first is obvious, they run out earlier than they should have......the second is that they drive their tolerance up when this becomes a habitual pattern....the thing to do is immediately is to use the standard over the counter remedies- ice, heat, showers, baths, heat wraps, and rest....stop doing the activity that created the pain escalation.....if that doesn't help, then try the over the counter icy hot or bengay or something similar......if that still doesn't help, call your doctors office. Explain what is happening, and ask him or her what you should do......you can tell them all of the things that you tried on your own to manage or lessen the pain, and it shows your doctor that you are willing to follow the rules.......
    If a pain medication is given to someone who is being treated for pain, doctors have the expectation that you are going to give each medication a fair trial...this means, a week or two, or even a month and at least one dosage adjustment before you call him complaining that "it isn't working"....or you need an increase.......it may very well be that the patient does indeed need an increase, but it is for the doctor to determine not the patient...
    The patient who works a desk job with chronic neck problems must come to the realization that it may not be the best choice to continue to work in that field. One of the biggest issues is that some times the patient is complaining of needing escalating doses of pain medications but refuses to make adjustments for the condition...they want to continue the same things they did prior to the injury and then compensate for the pain levels with escalating doses of meds.....it doesn't work that way.
    No one likes having the injections, but they are in part diagnostic, and in the other part therapeutic, in that if it relieves some of the pain , it helps the doctors come up with a far more effective treatment plan, if not, it helps to rule that particular area out.....that's one of the basis' behind going for the injections......same thing with the radio frequency ablations or the myelograms or spinal cord stimulator.
    Maintenence of a pain patient on long term opiate therapy is a process of elimination- one that begins with the least invasive treatments- physical therapy, walkin, swimming, TENS, biofeedback, followed by injections, multiple types usually, maybe radio frequency ablation depending on what the cause of pain is , emgs , MRI's and CAT scans, myelograms, or discography, then various types of medications may be introduced..........usually starting with the least potent, tramadol, ultram, anti inflammatories, steroids orally, and possibly one of the lesser potency but short acting trials of opiates such as hydrocodone or percocet........it is a process for all of us, no matter how old or young we are.......and it is at least incumbent on the patient to talk to their doctor and ask questions such as what do I do if my pain is out of control? If the patient takes the time to really talk with their doctors about their questions, you will find that it serves two purposes, one is to establish a good working relationship with your provider, and it gives the patient some guidelines about how and when to use the medications properly.
    That is how to build a good relationship with your pain management doctor.
  • Sandi, very well said!
  • dilaurodilauro ConnecticutPosts: 13,584
    Sandi's super post touched on something that is worth repeating.
    sandi said:

    The patient who works a desk job with chronic neck problems must come to the realization that it may not be the best choice to continue to work in that field.
    I started with IBM in 1974, had the first of my many spinal surgeries in 1978. I continued working in the field of programming and Data Center Management. Many days I was spending 8 to 12 hours by a computer with little breaks in between. Add an hour commute each way, years of doing this took its toll.

    Finally around 2001, did my body finally start to reject this type of work. I had to slowly start working from home 1 day a week, up to 3 and finally around 2005 I was working from home full time. That also counted numerous amount of different Short Term Disability periods.

    Who knows that if I switched career paths earlier in my IBM career would all the follow on spinal surgeries have been necessary. That answer I will never know, but for those starting out like this, please look deeply into it.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
  • paininohio said:
    Sandi, very well said!
    Thanks Pain........it really is a journey, one that we all have had to travel, and age is not the factor, it is the behavior and the willingness to try the options presented to us to see if they might work. We never know what may be the one thing that works this time that might not have at another. Chronic just means that it is always present, but it doesn't mean that it doesn't change over time.
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