Hello everyone. I'm a long-time reader of the various iterations of this thread, but have not needed pain management in about 4 years. Enter October 2013, when I fell off a concrete ledge onto ANOTHER concrete ledge and then a concrete floor while on vacation in a third-world country, and suffered various severe injuries to both legs and ankles (2 fractures, massive hematomas, and so on). With the help of my awesome insurance company and even more awesome airline (shocking, I know, but they flew me home first class for free, the injuries were obvious to the eye and I had medical documentation from the terrifying 3rd world hospital), I was flown home as quickly as possible, but still had about 60 hours between the fall and getting medical treatment in a first-world country. I was met by an ambulance right off the airplane, and at the hospital I was treated well and given adequate pain treatment.
After surgery, I entered a post-surgical rehab facility, where I was scripted six 5 mg. hydrocodone a day. It was keeping my pain at an endurable level (and I know that is the best I could hope for in the current climate). I finished with my PT at rehab and went home to another 6 weeks of strict bed rest under the care of my orthopedic surgeon. I have been steadily refilling my prescription, but getting diminishing results. Despite this, I never refilled early, and never asked for an increase in dose. I know how dangerous it is to even introduce the subject of needing more pain meds, and so I figured if I wasn't actively writhing in pain and managing to get a total of 5 hours of sleep a night, I'd call it good.
In the last two weeks, I've been off bed rest (still on restricted activity) and feeling incrementally better. We are ramping up the outpatient PT and I am still in significant pain, but was starting to see the light at the end of the tunnel. Then, my tooth began to hurt. Then, my tooth began to hurt severely. I made a dentist appointment for as soon as possible with a new dentist (I just moved to this city last year) and was due to see him this past Monday. By Sunday night, I was in a world of agony which I don't even have words to describe. All I could think about was stepping in front of a bus, or finding a gun and shooting myself in the head. There was nothing but pain, everything else ceased to exist. I went to the ER, where after a CT scan I was diagnosed with an abscessed tooth so bad that the infection had spread to my jaw bone. The entire bottom left side of my face and neck was swollen up to the size of a grapefruit. The staff at the ER were wonderful and shot me full of Dilaudid until I could stop screaming.
It was just 6 hours between when I left the ER and had my dentist appointment. i went to the dentist and pretty immediately knew I had made a bad choice - the whole place was open-plan, and everyone seemed tense and angry. I was shown to a chair and the dentist walked over and stood behind me, didn't introduce himself, and said "How did you hear about us?" Once he had gotten his marketing questions finished, he asked me what was going on. I told him about my tooth, the ER visit, the diagnosis, the CT scan, and the fact that I was currently being prescribed pain medication for leg injuries. He said "Well, if someone else is prescribing you a narcotic pain medication, I cannot write you a prescription. So I can send you home with antibiotics (the ER had given me IV antibiotics AND an rx for them) and you can live with the pain for a few more days until I can do a root canal, or someone here can pull the tooth right now and you can have immediate relief." The choice was obvious - if I went home without any additional pain meds, I would've ended up back at the ER later that day. So I let them pull the tooth. When i mentioned to the dentist that the medication I was already prescribed did not touch the tooth pain, he said "So take more of it."
The next part is too painful for me to even really write about, but due to having an active infection, the novocaine did not work. This is apparently a well-known issue in dentistry and as soon as they saw that I was not anesthetized, they should've stopped. But they didn't, and I had an abscessed tooth pulled without any anesthesia. There were other complications during the procedure, and it ended up taking about 90 minutes. During which time I was screaming and shaking uncontrollably. It was torture. They removed all the other patients so they wouldn't hear my screams. (an aside: I have had many, many extractions and oral surgeries in my life and never had anything like this happen; never even shed a tear before - I am not a crier).
I was sent on my way with nary an Advil. I made it through the first 24 hours OK, because I still had a few lortabs left and I think the Dilaudid was still in my system. The pain in my infected jaw bone, however, soon began to get worse. I didn't sleep for two nights. I haven't been able to eat or talk. My refill on lortab from my ortho surg was due today, so I called them this morning to ask for it. They told me it would not be ready until tomorrow. I told them what had happened with the surgery and how I told the dentist about my rx from them, and what he said, etc. I said I was in severe pain but that my dentist had said he was legally unable to prescribe me anything. The nurse at the ortho's office said "That is not right. Call them right now and just ask for even two pills, enough to get you through the night. They are legally obligated to treat your pain." I said I would do so, and called them. They called me back and said "Because you were prescribed lortab over the last 12 weeks, we are legally unable to prescribe you anything to treat your post-surgical pain." By this time, I was just broken. Done and broken. Every conversation was increasing my already unendurable pain and I just couldn't fight it anymore.
So. I live in New York, where we have a new law/monitoring system called I-STOP. This is what the dentist referenced when he said he could not prescribe me anything for post-surgical pain. Could it be possible that if I am prescribed a low-dose narcotic (like lortab 5 mg/ six a day), that no matter what happens to me (lose an arm, break my hip, get in a car accident, have appendicitis), no other doctor can prescribe another short-term narcotic for a different medical issue, even if it is an emergency? Because that would mean that I would have to rely on my ortho surgeon for any and all pain management and he is NOT going to be comfortable (nor should he be) taking care of post oral surgery pain!
Has anyone run into this issue before? Any advice? I feel so confused and screwed over that I did everything in my power to be 100% up-front, honest, and open with both doctors and yet here I sit, my pain untreated, another sleepless night ahead of me. And I get the distinct feeling that this whole thing with the oral surgery is going to spook my ortho surgeon and HE is going to refuse my refill tomorrow. What is pain management in this country coming to? This feeling of powerlessness is maddening.
. But as I get older the Norco just isn't cutting it. Tired of suffering. Can't have sex. My doctor just doesn't seem to want to prescribe schII, is this some DEA regulation or some law specific to Pennsylvania or should I keep trying. I know from exp. that a 30mg MSCotin makes me feel like I used to before the accident, but I can't tell him that. Got another appointment next week. Any advice appreciated.