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The value of being honest w/PM

I'll try to keep this short, but for the new folks here, I want to illustrate why being painfully honest with your PM is so important. For quite some time, I was on several IR opioid meds. All at once, my PM changed his policy that you can only have one narcotic prescription at a time. By this time, I was on an ER medication (Oxycontin). I explained that I still have pain and issues with breakthrough and asked what should I take. I was told to take a Tylenol.

After a couple months of being miserable, I wrote the doctor a letter explaining what was going on with my pain level. The next couple appointments I had I was always drug tested and honestly felt like they thought I was just a seeker. The PM came in with a couple nurses to address my letter I sent him and my pain issue. He was having a hard time believing my claim of pain. He told me he was going to run a test and my treatment plan may be altered after the test. Essentially, it was a test to see if my body metabolizes certain opioids.

The next month, my APRN came in and said my meds were changing. I asked what was up. The test came back that my body does not metabolize Oxycodone or Hydrocodone, so my claim of poor pain relief was spot on. She moved me to Opana ER which does work very good for me.

During my last appointment, I told her that the med was working but for 7-8 hours not 12. She wrote another script for Opana 10mg IR to cover the discomfort in between doses.

I am absolutely confident that because I have always been truthful with them and willing to do what was necessary to prove it that they trust me with more than one script for pain and spaced my appointments out further apart.

Based on how I've seen some of their first time patients leave totally pissed because they wouldn't write a script based on their history, I feel confident that I'm at the right PM and I can trust them just as much as they trust me. It's a good feeling knowing I can go in and be totally up front with them and get great care.

Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2


  • Do you know the name of the test? Its a subject that interests me. There's another thread here on the subject of metabolism etc tests & I've been reading studdies on-line. Scientists hope that in the future treatment can be individualized not just based on what works best but also how our bodies deal with the waste from different medications. I'm thinking of my poor liver ;-)
    Osteoarthritis & DDD.
  • Honesty does pay, and so does being willing to try all of the other modalities, no matter whether or not, we think they will /won't work , it does show those doctors that our pain is legit, that we are willing to do whatever it takes to get some relief, no matter how much or how little things help or not, we do all of those things they suggest anyway.
    I found that early on, Oxycontin did wonders for me, but I soon found that I required too frequent dosage increases for my own tastes after being on it and it didn't last nearly long enough for it to come close to the 12 hours it was supposed to........it would be okay for around 8 , then it was like it suddenly disappeared and withdrawal symptoms would soon follow.
    I might partake of one of those tests if they are offered at my doctors office. Just curious what the results would show for me in regard to oxycontin/oxycodone .
    Anyway, this new plateau in your relationship with your PM doctor is good place to be , isn't it? Enjoy it, and I know that as much as you value his trust in you , you also know that you now have that same kind of relationship with your PM that I have with mine. I wouldn't trade it for anything or do anything to jeapordize it and I know you won't either.
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  • Did they take a sample from the inside of your cheek ? I just saw one of my doctors and they are going to test my metabolism to adjust my meds. I will know results in two weeks. I get all my meds from my PCP who has known me for a long time and understands my needs. It has been the times I have had surgeries that I had to beg for more relief. The worst time was when I had my Achilles tendon replaced with a graft from my outer thigh. After waking all I got was one 5mg norco every 4 hours. Might as well have been baby aspirin for what it did for me. And despite my pleas I never got more than that.
  • They are getting ridiculous, I don't know which state you're in but Nys is horrible for people who actually need pain meds. I had ACDF surgery, was told no more ibuprofen (which is what I've always used) and they gave me a 5 day supply of norco?? They said after that to take Tylenol. I've never been a med abuser, I've had previous injuries and surgeries and never used them, but this surgery has been painful and it's a shame they make it so people who actually need it can't have it.
  • The test they gave me was simply using a long "Q" tip and swabbing both cheeks and tonsils. They then sealed the swabs in a plastic case and that was it. They were sent off to another lab to be processed.

    WNYgirl - Each state has their own take on drug restrictions. Some are worse than others, that's for sure. Have you tried talking with an actual Pain Management doctor about your pain? My surgeon only covered me with meds until I was cleared to go back to work. I went a while with nothing which created an issue. I asked the surgeons office (since my surgery was WC related, I had to get a referral) for a referral. He first sent me to a doc he liked. That doctor was the most unorganized unprofessional person I've ever seen. I left his office and called my Nurse Case Manager and explained what was going on. She authorized me to get an appointment with the PM I have now. Best thing I've ever done.

    If you can't get into Pain Management, perhaps you can see your Primary Care Doctor for care or a referral. Good luck!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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  • sandisandi Posts: 6,269
    edited 03/03/2014 - 10:18 AM
    will only treat patients for the acute post op period, if the patient needs ongoing pain medications once they are outside the anticipated/normal recovery period for the procedure, they expect that the patient will either go to a pain management practice or their primary.
    NYS recently added a two step process to deter doctor shopping/false prescriptions in the state- now, the prescribing doctor must check the state's database for the last prescription of controlled substances, the quantity, and the fill date. Then when the prescription is given to the pharmacist, they must also recheck the database prior to filling the prescription.
  • RangerRRanger on da rangePosts: 1,033
    Nice post Keith, and as you said each state and even each doctor has a different take on restricting pain meds. I have been very fortunate to have a good communication between my doctors and the dispensing of medication as needed. The problem I have had in the past with opiate meds is the negative effect they have on internal organs thus requiring constant monitoring with blood tests. The good thing for me is that I have always tolerated pain well so I try and stay off or on minimal dosages.
  • Ranger you hit the nail on the head with your comment about meds being hard on the body. My testosterone has gone rock bottom and now have to use Androgel. I think this is a direct cause of being on opioids as long as I have been.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • dilaurodilauro ConnecticutPosts: 13,527
    No question, that when it comes to dealing with the medical field, honesty is the only way to proceed.

    This point always seems to come up when talking about pain medications. Most surgeons will provide their patients with a 'set' time frame of pain medications. That is based on the surgery, the patient, and other variables. I have seen that time period be as short as 2 weeks and as long as 2 months. On the average it is generally 4 weeks.

    After that period, you need to be under the control of a pain management doctor or another doctor that either your surgeon or primary care physician recommended.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
  • I'm calling my PCP to see if I can get him to order this test. This is invaluable for people like us! It's also a "cya" for the prescribing doctors, because of the DEA comes sniffing around, there's concrete proof as to why the doctor is prescribing certain drugs, and/or certain dosages. For me it could possibly explain why I don't respond to anything other than prednisone for my hives.

    My son has an appointment coming up with a pediatric pain clinic. I'm going to request the do this test on him, because I would sure like to know how a 10-yr old who has never had anything stronger than Tylenol with codine a few times in his life would not respond to 8 mg of morphine plus 1 mg of lorazepam! It just makes no sense, he should have been knocked out & it didn't even phase him!

    I think we should all try to get these tests done, look what it did for Keith! Imagine what it would be like to be believed!
    We can't always control the cards we are dealt in life, but we can control how we play the hand
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