Harm Reduction The Pain Management Mega Thread - for all your questions on dealing with chronic pain

bump anyone?

Opioid medications may increase nausea, be aware of that.

Have you tried diphenhydramine for the nausea? Or other anti-emetics?

No but i thought it would make her drowsy and shes already very tired/weak but I will buy some on the way home from work, I should have before! do u ha a dosage suggestion?

If drowsiness is a problem, then start with 25mg and see how that goes. Obviously you don't want to give her too much, it can cause delirium which isn't fun.

thanks, do u think tramadol or darvocet will be obtainable from a doctor she cant eat either unless she smokes!

Well they are definitely less abuseable and so more likely to be Rx'd... I can't say for sure though, it really does depend on the doctor and his opinion on the situation. I hope she does get something good that will help her out.

Well i'll update after the appt. thanks blondie

Physical Therapy isn't working.

Okay I posted a similar topic in this forum about my partial rotator cuff tear, and the bursitis in my knee and shoulder. About 15mg hydrocodone or 10-12mg of oxycodone makes me feel very good for a few hours, this is, imo, a low tolerance to what I am observing. My specialist prescribed me 1 5/500 vicodin every twelve hours and it doesn't do much at all. Any suggestions on what I can say to get more out of him, yet not seem like apill seeker? I seen a few other posts that say Doctors and truth doesn't mix, so how much fabrication should I include, if any at all. As posted before, my knee reaches pain of up to thepoint I want to rip it off and my shoulder is worse (when in use), but both remain around a 4 constantly for the past few years, and it's been getting worse at an accelerated rate since the beginning of the year, so this was my first visit with a doctor for this, or anything at all, in a few years (besides the oral surgeon). Any suggestions?

Appreciated,
PharmToBe

Just tell him that the vicodin is not helping. and maybe he could give you some norco or some percoset.

I wouldn't mentioned the drugs by name though. That is a big No-No. I'd just say the Vics aren't working, is there anything stronger i can try.

Good luck. Let us know how it all goes
Rpg

I have a question regarding pain medication. I used to be on all different strengths of vicodin for the last two years, up to the 10/325 mg. I was on percocet for one or two months. This stems from my shoulder, which came dislocated eight times before I had surgery 2 1/2 years ago, in which they found out I had a partially torn rotator cuff as well as a totally fucked labyrum.

My problem was that after the surgery I started doing oxy and developed a pretty bad habit. I ended up doctor shopping a lot and burning a lot of bridges with doctors. My fiancee called all the doctors she could think of in my city and told them I was an addict and not to prescribe me narcotics. I am happy she did this and I have been clean for a while, but now my shoulder is starting to hurt a lot more.

It has begun making weird noises (kind of like a grinding sound) when I move it, and it can hurt like all hell when I wake up in the morning, sometimes making it difficult to sleep. I still had tramadol and darvocet left over and I tried those, but they don't help at all. What would you guys recommend I do? Some orthopedic doctors have recommended another surgery, but I cannot afford it at this point. Should I try a pain management clinic and just tell them I am an addict? I am afraid vicodin might be the only thing that will work, but then again being in pain could be a better option than risking addiction again. Any advice would be appreciated.

if you go to a pain management clinic and tell them you are an addict, I doubt that they will accept your case.

RoxiPoppyGirl said:

I wouldn't mentioned the drugs by name though. That is a big No-No. I'd just say the Vics aren't working, is there anything stronger i can try.

Good luck. Let us know how it all goes
Rpg

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Hogwash! My doctor was a LOT more willing to prescribe to me when I cut the bullshit and just showed him I knew what I was talking about. I went from getting a handful of T3's here and there and being told to go to the ER if my kidney stones got more serious (T3's FOR FREAKING KIDNEY STONES?!?!), to getting Rx'ed hundreds of dilaudid - literally overnight.

^ One person's experience. Not at all representative of the how its going to work for the rest of the world. In general, asking for a drug by name makes you look like a drug seeker and is not a good way to gain your doctor's trust.

johanneschimpo said:

^ One person's experience. Not at all representative of the how its going to work for the rest of the world. In general, asking for a drug by name makes you look like a drug seeker and is not a good way to gain your doctor's trust.

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Clearly it's one person's experience but so is everybody else's experiences here. You want to show me some study showing the most effective ways to get the drug you want? It doesn't exist, so all I or anyone else can offer (including you) is a personal experience.

But doctors aren't stupid and they know must drug seekers are going to try to be sneaky. You don't know how the doctor will react until you ask, and your options are either to be straightforward, and show you're actually knowledgeable and take your condition seriously, or beat around the bush for months with a good chance of wasting a whole lot of your time. Not saying my way is necessarily going to be the right way, but in my experience the doctor will respect you more for it, and I sure as hell prefer cutting to the chase than wait possibly months with no guarantee of getting what I want.

Even if asking for a drug by name doesn't make the doctor think you are a drug seeker, they might get irritated that you are stepping on their toes. I have gotten better treatment and my doctors are more receptive when I act deferential. I still play a role in choosing my treatment, but most of the doctors I've seen are egotistical and when I would start disagreeing with what they thought and asking for something else, they got frustrated and were less receptive.

I think overall though, to generalize, if patients come in asking for controlled substances by name it doesn't look good. I've heard from many people that this specifically send red flags to doctors, which makes sense.

Cane2theLeft said:

Even if asking for a drug by name doesn't make the doctor think you are a drug seeker, they might get irritated that you are stepping on their toes.

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When I do it, I put it forward as a suggestion, not a demand. A doctor is not going to get irritated if I tell him that vics are not enough, and that an ER doctor had given me oxy/dilaudid in the past and I handled it much better.

There's no reason you can't act "deferential" and respectful while asking for something, the trick is just to not be pushy. If my doctor insists on something else, I have no problem going with the flow. If he refuses to prescribe what you asked for, just ask if he has any other ideas on what to try - there's very little reason the outcome would be changed just because you ask for something that you've had experience with in the past.

Of course, if you're not looking for a particular drug in the first place, it doesn't matter. But I've had 5-6 different ER doctors - plus my GP - prescribe me hydromorphone when specifically requested without any fuss. Most of them were going to prescribe percs, some of them even T3's. And I've never been denied. I'm 22 and I've had this exact same experience since I was 17 - if someone like me can manage, anybody should be able to.

I'm really not trying to talk myself up or anything. Doctors, by necessity, are generally smart people. Playing dumb is such an obvious strategy that it's idiotic to think they don't expect it.

I think every case is going to be different. In my case, for instance, I am in my mid 50's. Doctors believe me when I tell them that, over the coarse of my life, I have been prescribed just about every type of pain medicine and if I tell them what works for me, they believe it and they don't hesitate to give it to me. Someone that obviously has had extensive treatments for a particular condition is also bound to know what works for them, regardless of their age. Your appearance probably has more to do with being branded a drug seeker than anything else.

papasomni said:

Your appearance probably has more to do with being branded a drug seeker than anything else.

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I totally agree

emjay said:

There's no reason you can't act "deferential" and respectful while asking for something, the trick is just to not be pushy. If my doctor insists on something else, I have no problem going with the flow. If he refuses to prescribe what you asked for, just ask if he has any other ideas on what to try - there's very little reason the outcome would be changed just because you ask for something that you've had experience with in the past.

Of course, if you're not looking for a particular drug in the first place, it doesn't matter. But I've had 5-6 different ER doctors - plus my GP - prescribe me hydromorphone when specifically requested without any fuss. Most of them were going to prescribe percs, some of them even T3's. And I've never been denied. I'm 22 and I've had this exact same experience since I was 17 - if someone like me can manage, anybody should be able to.

I'm really not trying to talk myself up or anything. Doctors, by necessity, are generally smart people. Playing dumb is such an obvious strategy that it's idiotic to think they don't expect it.

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This has been my experience almost to a T. I am also 22, have been in the ER and told them dilaudid worked better than fentanyl or something else they prescribed. I have also had a PCP who would ask me based on my experience what I thought I should try/use but my current PCP will not listen at all and will tell me THIS is how it is and deal with it. Luckily, we largely agree on the course of treatment, but if I didn't no amount of respectful disagreement would change the situation.

I think it depends on a lot of factors... your appearance, medical history, demeanor, relationship with doctor, their personal views on medication, and on and on and on. I agree that if they think you are playing dumb its not going to work. Doctors ARE smart and so generally if people are trying to scam doctors, they can tell- unless you're a great scam artist. If you are being genuine, don't look strung out, have legitimate medical issues, etc. then you should be able to successfully discuss with your doctor what medications you think are appropriate/effective.

I think that in the right circumstance, people like you and me emjay can discuss openly with our doctors what we think works but our experience does not ALWAYS translate.