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ADVICE for PM appt.


I am fairly new to this forum but I had a surgery on my spine a few months ago. I have had a very difficult recovery and my pain level is worse than prior to surgery. I began pain management two weeks ago and am in transition from IR meds to ER meds which is something I am embracing but I am on the borderline of a visit to the hospital because I am in severe, extreme pain and have very little relief. I am hoping that my dose will be raised tomorrow but I don't know that I and am in a situation where I don't know if I could handle another day. I can't do anything, my legs are trembling and I am hurting so much that I just feel like giving up. I am not that type of person but do not think I could handle this another day.

I have been started on Opana ER 5mg with oxycodone 10mg 1xdaily for break thru pain and I have really no relief other than a couple of hours a day. It has been this way for two weeks and I am losing weight and having difficulty moving around the house. I have called the clinic numerous times letting them know that I am in severe pain and wondering if this is okay or normal. I was prescribed Percocet 7.5 mg 8xday from my neurosurgeon and have had an extreme drop in my overall pain relief and I am struggling. I have to be able to work and I cannot do anything. I am new to pain management and so far have just been honest but I think it is horrible when someone who has had a surgery on their spine cannot be taken seriously when they say, 'hey, it's getting overwhelming over here, I have kids that need me.' I have not asked for anything more but have been honest and straightforward in letting them know that this isn't touching my pain. What is worse is that I can just see going tomorrow and them slightly raising the Opana and totally taking away the break thru med. I am trying to be calm and play the PM game but there's a limit to what a person can take and I have past it and hoping for a miracle. I don't think it has to be this way and I would be so grateful for some advice for my appointment tomorrow. So that I might walk away from it and be okay. I know I can do this but I feel like I have no break from this pain and things are snowballing on me and my life is really falling apart. I feel like if they can't do something to make this better that I will ask to be out of their care and referred to someone else but I don't want that to happen. But at the same time, I can't do this another day, I just can't. I know many have been there, tell me what to do please.


  • is explain that the pain medication at the current dosage is not offering you relief. Part of the problem is that you are a new patient, and while your pm doctor is doing what he should , transitioning you to an extended release medication, and reducing the dosage of the immediate release medications......it is a process to work toward the correct dosage of medications that are going to reduce the pain by 50%, using all of the various combinations of types of medications, nerve pain medications, opiates , muscle relaxers, and even anti depressants to find the right combination of all of the.
    THIS part is going to require some patience on your part....it's not easy, but it does take time. Going up too fast in any medication can have serious consequences, and side effects.
  • Everything has consequences. He raised the Opana 5mg to 3xday, no break thru at all, which has been my only salvation for 2 weeks now, and klonopin so i can sleep at night. I took the Opana to three different pharmacies before I found a portion of what i needed. Insurance would not cover it the way he wrote it for 3xday so they said I should take it back to him and have him rewrite it. I just cannot, my body can't do it. My last bit of relief was at 2pm yesterday, over 24 hours ago and I'm near collapsing. He said that many drs give multiple break thru meds throughout the day but he doesn't , said it lets him sleep better at night. But if I could stay tough for 3 months i should feel better with less fatigue.

    3 months of this and i will be divorced, broke , and bed ridden. I came home and took a klonopin and i am treating myself to a 1/5 of kentucky bourbon for the first time in 8 years. here's to a
    long healthy recovery for a truly blessed patient, cheers!

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  • sandisandi Posts: 6,269
    edited 07/09/2014 - 5:35 PM
    combination........and consuming ANY alcohol while taking OPANA can lead to death........OPANA is an opiate that states very clearly on the labeling NOT to consume ANY alcohol on it's labels.
  • couldn't take the opana bc the script was written worng and i didn't have the energy to go get a new one written after driving all over the town just to find some. I would have thought my dr would have known i would have that problem considering they do this every day. i wouldn't do that if i had the opana even though it doesn't work , it's like taking a vitamin. it is supposed to be one of the strongest narcotics on the market....where's the relief?
  • sandisandi Posts: 6,269
    edited 07/10/2014 - 4:52 AM
    your case. Your insurance may not allow it to be prescribed off label since the dosing is supposed to be every 12 hours so that is the most likely reason that the pharmacist was not filling it.
    Your wife could have gone back and gotten a different prescription written for you. The doctor was trying to help you, only it appears from your writings that you only want him to do what you want him to do, not what he is supposed to do.
    You will have a very difficult time in finding a and building a relationship with the doctor if you refuse to do what they are asking you to do, or follow the directions they give you.
    Going home and drinking wasn't a solution.....and now you are still without pain control.
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  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 07/12/2014 - 9:16 AM
    I'm really torn in responding to your thread. My response would usually be 'hang in there, it takes time to develop the right blend of medications & treatments. Your doctor is doing the right thing by transitioning you to ER medications' etc. You've heard this before & you're clearly in a very dark, frustrated, angry, desperate place. I've been there! I truly understand.

    I honestly believe that I do everything I can to manage my pain, my 'blend' is very varied & I function. Obviously what I consider 'functioning' now is very limited compared to the past. Although I try to stay positive & focus on what I can do the 'can't do' list is growing & it breaks my heart, particularly where my kids are concerned. My doctor makes choices that allow me continue coping while trying to make improvements. We don't take steps backwards to move forwards. I'm currently starting Opana 5mg but I have 4 breakthrough pills a day. My doc knows me very well. Under managed pain has caused serious physical & emotional problems for me in the past.

    I like to believe that doctors are doing their best for their patients but statements like "I will never prescribe breakthrough medications" do concern me. You're doctor might just be saying that because he strongly believes you need to get off of them for some reason you haven't mentioned. I've been dealing with this nightmare for 8 years & I know I can't cope without IR meds sometimes, particularly when I'm trying new ERs. I don't understand why this doctor is leaving a patient in this much distress. I know that some really bad decisions have been made. Not sorting your prescription & turning to alcohol is a huge mistake but we often do bad things when we're completely bottoming out & that's what's happening here. The fact that JDRrobinson has returned & continues to ask for something, anything from us screams of desperation.

    Has your doctor offered any other medications or treatments to manage your pain? Are you on a nerve med, muscle relaxant? Cymbalta or another pain + depression medication could help. If things are really as bad as they seem you need to get some compassionate help in my opinion. Your post surgery pain is clearly still really bad & I'm concerned that all the focus is now on meds (understandably). Are your doctors performing diagnostic tests to find out why you're still in so much pain?

    I know you've only been seeing this PM for 2 weeks but things are spiraling out of control fast. Do you have a good relationship with your GP? Who was prescribing your meds? Is it possible to take a step back while you find a PM who's going to take things slower & manage your pain while you transition? I'm scared that things are going to go from bad to worse. You've got children to care for & I believe you need to do something urgently.

    I know that with time this approach of titrating up will probably work but I know what it's like trying to survive crippling pain month after month between appointments. I'm getting worried for you.

    Osteoarthritis & DDD.
  • Sorry, I've just read your other post & realize that you have had follow-up appointments regarding your pain. I really don't know what the answer is but I'm very concerned about you.
    Osteoarthritis & DDD.
  • sandisandi Posts: 6,269
    edited 07/12/2014 - 4:20 PM
    doctor. He is overdoing it, at home and at work, three months post op. No amount of medication is going to make it less painful to do that.
    The big problem, is that his PM doctor is trying to help him , it just doesn't appear to be in the way that JD wants him to. This doctor has increased his extended release dosage from one per day , to three times per day. JD wants him to continue the breakthrough medications, while adding in the extended release. Most pm doctor's won't do that, with any patient when they are new to pain management. It doesn't matter that he had surgery or not, when starting a new patient on extended release medications, they use one medication, at a time, increasing it slowly, to effect, to achieve a reduction in his pain levels. They don't use breakthrough medications in the beginning because it complicates the picture.....you don't know if the pain relief is coming from the immediate release medications and how much of it is really being taken or from the correct dosage of the extended release.
    No patient that I have ever known has been given both extended release and breakthrough medications when first starting with pain management. They add one medication at a time for a reason, to ensure that there aren't any adverse reactions, over sedation or allergies. Since he is titrating him up on the ER medication, he reduced the amount of IR medication he was on previously, while ensuring the safety of this new patient. He is doing exactly what any other doctor would do in the same situation. Most pm doctors will not add more than one medication at a time, due to the increased risk of side effects and sedation in someone who is not accustomed to those particular medications, especially a new patient. Again , it is a safety issue. Adding too much medication or too many medications complicates the entire treatment program in the beginning. It also significantly increases the risks for side effects, and overdosage in a new patient.
    He didn't say that he wouldn't add a breakthrough med at a later date if necessary, he asked him to work with him for three months to get to the right dosages, medications and treatments to help him.
    Assume that this doctor did what JD wants, the increased pain medications and the continuing of his previous amount of IR medications on top of it.......how is it now that the doctor is supposed to know which medication is the one that he helping him? How is he to ensure that JD is following the dosing directions? He knows nothing about this new patient who walked into his office. Other than what he learned at the appointment.
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 07/12/2014 - 5:50 PM
    I understand. It just seems so hard to take away the breakthrough pill that was giving him a little relief while the Opana was being trailed. I wasn't thinking he should carry on with the 8 pills a day. It's just he's really not doing very well at all. I hate to hear people falling apart like this. It's so sad. People loose so much week after week, month after month, there's got to be a better way of doing things in pain management. These situations can end badly. It's worrying.
    Osteoarthritis & DDD.
  • EG, it's not that I don't feel badly for what he is going through, I do........but, at the same time, part of the increased pain has to do with the activity levels post op, three months out from fusion is just the ending of the acute phase of recovery, and doing too much too soon , leads to inflammation, swelling, and worsening of pain, not to mention the risks of really messing up the surgery outcome.
    Doing things not medically cleared, such as letting your child jump on your back is not a good idea...No matter how old they are, children can be taught not to do those things....Doing too much housework or other things not cleared by the surgeon can and often does ruin what might have been an otherwise successful surgery. Using pain medications to cover those increased activity levels is not beneficial for the person who had surgery.
    After my first surgery, I was put on 10 mg Oxycontin, it was well over a year, before my pm doctor even considered adding a breakthrough medication.....Prior to surgery, I was on tramadol only.....it failed miserably and came home with dilaudid for post op pain, then transitioned to the Oxycontin. He didn't add even a muscle relaxer until a few months after I had my first surgery, then the Lyrica a few months after that. For exactly the reasons that I explained above.
    I know that being in pain isn't easy and we all can't help but feel for someone who is in pain, and at the same time, I understand why the doctor is doing what he is doing. Ice, rest, cutting back on some of the activities and responsibilities he is doing at home would go a long way in easing some of the increased pain he is having. We always talk about the blend on here, and it is because without it, no amount of opiates is going to be enough, when the patient is doing things that their body's just aren't ready for, and too much medication too fast usually leads to further problems, physically or addiction wise later on.
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