Opioids Pain Clinic First Time

[buttershots21]

This is my first appointment ever for a pain clinic and my question is: My GP has had me on 15mg MS Contin ER's and Perc 10/325 for almost two years now. These don't help as much with the pain as I would like. I'm hoping to get away from the APAP with all the stuff in the news about liver damage. I'm freaking, wondering if this pain clinic will actually take me off my pain meds and make me just do spinal injections. This clinic I already know does spinal injections, which scares me to death, but at this point I'll try anything once if it helps. But not to the exclusion of everything else Just really freaking out about the possibility of going backwards instead of forwards.

Has anyone had it where the pain clinic was like, "whoa why is your Dr giving you this?" And taking away your scripts? Anyone's personal stories would be appreciated. That is my biggest freakout about going.......

 

[trippytrojan]

No one can really say what the pain clinic you're going to will do. Odds are they aren't going to give you IV fentanyl but if you have legitimate cause for pain then they should give you something that at least somewhat adequately deals with the pain. If they don't, find a different dr.

 

[poppyplanet]

Generally, pain clinics are more than helpful in giving you what you adequately need. Just be honest, and tell them what worked for you in the past. I highly doubt they will decrease your dose or move you backwards as you stated it. I absolutely hear you on the percocet issue. In my experience and opinion, percocets are garbage. Now, oxycontin is another story. Even though they both contain oxycodone, oxycontin should be sufficient for pain. I would ask them to up the dose of the ms contin and ask for instant release rather than extended. Just my 2 cents.

 

[Titus]

I went to a pain clinic referred by an orthopedist after just 1 round with percocet and a cortizone injection. I did a nerve burn thing as I was wanting to try anything that would help. I forget if I was still on perc's from the ortho when i went there and forget if I ever came off them before doing the nerve burn thing but do remember them putting me on lidocaine patches at one point and they didnt work and I called and went in for an appt and they put me on perc's. I had only soft tissue damage. Saw several dr's and the pain lasted 6 months. They were all telling me it would go away but up to that point I never had constant pain for more than like a week following an operation. Eventually it did go away and I've never felt more relieved in my life. That's my only expereince with a pain clinic, my problem was def not 'chronic', the pain lasted a while but the underlying cause was not with a disk or something serious like that...

 

[Swain]

Just don't go in there telling your doctor what he needs to prescribe you. That will piss him off. Play it cool until the conversation actually comes up. He might be pplanning to prescribe you sweet ass shit.. but if you come off as someone who is interested in the narcotics a little too much, you'll definitely be getting spinal injections lol.

I wouldn't worry. You are on reasonable doses, and I don't think a brand new doctor is goign to force their patient to make a massive change in their life. Detoxing off pain meds is not easy ya know. But I mean you were referred, you have good records, reasonable meds etc.. Unless your doc is anti-opiate I think you;'ll be fine

 

[thelung]

the moral of the story is, don't exhibit any med-seeking type of behaviors at all. Be honest. You'll be just fine.

 

[tricomb]

the moral of the story is, don't exhibit any med-seeking type of behaviors at all. Be honest. You'll be just fine.

This is true, my first experience at the pain clinic was a little intimidating. The thing is, while you dont want to actively want to seek any medication verbatim, DO NOT HESITATE TO REFUSE THE DOCTOR IF HE WANTS TO CHANGE YOUR MEDS. You are completely within your right to stay on your current medication regimine.

My first time at the clinic, I go in, and he asks me what I'm on, to which I reply 64mg Hydromorphone/day, 8 x 8mg pills. He's like "woah man, lets taper you down" and I was like "No, there's no way in hell I'm giving up something that works for me, don't fix what ain't broke".
And, that's exactly what happened. There's no way I was going to allow him, or anyone, to take away the dose and medication that is working for you, what the hell is the point?

@OP, don't be scared, some pain clinics are less awesome than others, but in recent years I have had nothing but help from my team of doctors and specialists, including those down at the pain clinic. They really just want to help you, or see improvement. They really do. I have met some of the best and most helpful resources in ALL MY YEARS with chronic pain, at one pain clinic (my current one).

My advice, if your pain clinic offers classes where they teach you skills instead of just throwing pills at you, TAKE THE CLASSES. I've been taking the same class over and over and over because I have found it invaluable, it is taught one of the clinic's Pain Psychologists, a guy WHO HAS CHRONIC PAIN, and the students, are people just like you, chronic pain patients. I have gotten more support, help, and improvement with living my life from those classes than I have in YEARS of opioid medication therapy.

 

[buttershots21]

Thanks for the input peeps, it's good to hear stories from people who have been there and done that. I know this clinic is big on the injections, and like I said, I'm willing to do it even though it's scary, I want pain relief more than anything else. The psychiatrist I had to see before I got the appointment with the MD says they put you under a "twilight" like anesthesia before doing the injections, so at least that makes me feel a little better. But bottom line, the meds I'm on are not as effective as I would like and I have to take more than I'm prescribed to get pain relief, which means I run out short each month. It's a rat race, and I used to be able to just take my meds on the days I had to work, and abstain on my days off, but I'm working full time now, so that doesn't work anymore.

 

[Titus]

The thing is, while you dont want to actively want to seek any medication verbatim, DO NOT HESITATE TO REFUSE THE DOCTOR IF HE WANTS TO CHANGE YOUR MEDS. You are completely within your right to stay on your current medication regimine.

My first time at the clinic, I go in, and he asks me what I'm on, to which I reply 64mg Hydromorphone/day, 8 x 8mg pills. He's like "woah man, lets taper you down" and I was like "No, there's no way in hell I'm giving up something that works for me, don't fix what ain't broke".
And, that's exactly what happened. There's no way I was going to allow him, or anyone, to take away the dose and medication that is working for you, what the hell is the point?

I hear what your saying but find it surprising that this would work if the dr didn't want it to, particularly over time. I can see the first or 2nd visit, but you can't FORCE a dr to prescribe a certain med to you, can you? Even if the referring dr had you on said med at said dose?

What happens when you but heads and the dr has it in his mind that your on too much meds (for whatever reason, he's on hte very conservative end of prescribing pain meds, his wife just served him with divorce papers and he's taking it out on you, he susupects your a med seeker or whatever, he knows of the referring dr as a croaker or something....whatever? How can you force a dr to write a script for you they do not want to write? Don't dr's ultimately control what they do and don't prescribe? I mean, you don't really have the 'right' to stay on the highest possilbe dose of pain meds that you have ever been on, and stay on that dose for the rest of your life by simply telling the dr. "no, I disagree, keep writing it the same med and same dose" month after month, year after year, do you?

what are the actual rules or the way this happens in practice? Seems common practice, in some states more than others, that dr's fear the dea breathing down their necks (hell, who woudln't at a 3-500k/yr job). So it seems to me dr's want to stay well within the average to below avg when it comes to # of pain pills prescribed per patient, or strenght of pain pills prescribed to patients compared to their peer doctors., no?

 

[tricomb]

Yeah I'm not saying he LEGALLY has to write you the script (like I'm pretty sure they have to if you were addicted to benzos, although once again I don't know if this is a legal requirement or common sense) , I was just saying that you are within your right to stay on your current medications that work for you, and if a doctor won't prescribe you what works, then find another who will.

I just wanted to put this out there because so many chronic pain patients live a life of fear that their doctors will alter their scripts, and they feel like they have no voice. While in the end, it's up to the doctor, I just wanted to remind people that as a patient, you have rights, and it is NOT drug seeking to ask to remain on your current prescription regimine.

 

[ReversiblePulpitis]

I received my fair share of steroid spinal injections as well as spinal nerve radio-frequency ablation (burning) prior to entering the pain clinic.

Anyway, I was never put under any kind of sedation for the injections, other than local to the site. The process NEVER took longer than 5-10 minutes TOPS, and was absolutely painless experience. Don't fret over those silly things.

Now if they do a spinal nerve BLOCK, that is a different story. The relief can be amazing and instantaneous, but is also short lived. Regardless, that procedure IS painful!

 

[BiggDirty01]

As someone who is going on his third lumbar fusion surgery (2 already last 14 months!) and who has gone through the ringer with various pain clinics/doctors I highly suggest keeping an open mind, roll with the suggestions that the doctor will give you. I've been through some unnecessary office procedures (epidurals, rhizotomy, facet injections) and while most of them didn't work, it nevertheless shows the doctor your commitment to non-medication solutions to your problems.

I tend to feel nowadays with the epidemic of scheming with younger patients (im 26) and pain docs getting the book thrown at them legally or financially, you definitely DONT want to go in to a new pain doc and start professing your familiarity with the various high-strength narcotics and muscle relaxers. Basically, LOL, you don't want to take any knowledge from here on BL with you to a new pain doctor. It is likely to freak them out and demonstrate your intentions as drug seeking.

But as TRICOMB suggested, definitely feel confident in informing the doctor of your experiences with the medications and procedures and what has worked and hasn't. Doctors are generally very sensitive and somewhat egotistical so a somehwhat passive and almost submissive attitude in regards to the narcotics are likely to get you further in terms of adequate pain relief.

OP, good luck!

 

[tricomb]

I've never had a problem with being open with my extensive knowledge about opiates with my pain doctors, or with benzos with my psychiatrists.

I don't think people should have to dumb themselves down when they go into the exam room, but I mean, if you go in there and say "I have these symptoms" and basically list wikipedia, yeah, that's different.

But if you legitimately know about the medications you've been on for years, like I have, I've never hesitated to correct a doctor when they give inaccurate information, especially when doing opioid conversions when I have to rotate opiates. But I've been around the track, it's not like doctors can really expect you to take these pills for years and years and pretend you know nothing about them.

 

[BiggDirty01]

Not dumb down per se, but I think if you go into a doctors office spouting off about "bioavailabilty" or potentiation of your medications that a new doctor might be scared off treating you. If its a doctor you have experience interacting with a doctor thats one thing, but I was just relating to the OP asking about seeing a new doctor.

But then again, I have been through 5 or 6 pain doctors in the last 4 years and had varying degrees of success with them (1 committed suicide, 1 over prescribed procedures, 1 over prescribed meds and 2 others were just assholes) and I think I might just be gunshy.

 

[Tommyboy]

Yeah I'm not saying he LEGALLY has to write you the script (like I'm pretty sure they have to if you were addicted to benzos, although once again I don't know if this is a legal requirement or common sense) , I was just saying that you are within your right to stay on your current medications that work for you, and if a doctor won't prescribe you what works, then find another who will.

I'm sure that you can probably sue them later on if you switched doctors for whatever reason and they refuse you a benzo script after you have had one for years, resulting in a seizure or something from withdrawals.

I was put in this situation a few years ago. I was away at school (at least an 8 hour drive from home) and the psychiatrist in the town kept cancelling on me. I called up my old psychiatrist and he said he would send 1 script up to me, but he didn't feel comfortable doing that again. Well, the psychiatrist in that town cancelled two more times, and I had already had to make a 1 month script last over 2 months, so I went to the student health center as a last resort. Even with my file in their hands, which documented that I was prescribed benzos for 4 years, they told me that if I wanted them to drive home or goto a detox. After a lot of arguing, I got a prescription for 30 pills, down from the 90 I normally got, although I had been forced to get down to 1 pill a day before that since my appointments kept getting cancelled. They told me that it was the only time that they would ever write a benzo script, and to never ask for one again. That's when I had enough and finally found a legit doctor to do a valium taper.

The funny thing is, whenever I went to the student health center after that, whatever doctor or nurse was seeing me would open my file and say "oh, so you're addicted to benzos?" I had to explain the difference between dependence and addiction to people that had been around medicine for 30 years. One of the nurses crossed it out on the file after our conversation about the incident in which I came to them in desperation, and one of the old nurses too it as me being a junkie begging for a fix.

The moral of the story is they didn't legally have to do anything for me, but I'm sure that I could have sued them if I wasn't able to get the script and something bad ended up happening to me.

 

[ReversiblePulpitis]

ha, student health! Im shocked you got the 30 from them. My issues began while in school, back before I knew anything about anything. I first got sent home w/ Relafen, calling back the next day to report no improvement. I was then reluctantly given tramadol, but not prior to passing a drug test. It was ran by NPs, so not sure if they had the authority to write a scheduled narc. Regardless, I was opiate naive and was blasted into space by a single 25mg Tramadol. Granted my condition did worsen, but therein began the slippery slope.

 

[tricomb]

Seriously, that's what I love about my pain clinic tommy, they understand the difference between dependence and addiction.

It's startling how the issue of dependency is so difficult for some medical professionals to understand.

 

[Tommyboy]

ha, student health! Im shocked you got the 30 from them. My issues began while in school, back before I knew anything about anything. I first got sent home w/ Relafen, calling back the next day to report no improvement. I was then reluctantly given tramadol, but not prior to passing a drug test. It was ran by NPs, so not sure if they had the authority to write a scheduled narc. Regardless, I was opiate naive and was blasted into space by a single 25mg Tramadol. Granted my condition did worsen, but therein began the slippery slope.

At a different school I had no problem getting my normal dose from the student health center, and even after the problems I had that one year at a new school, they hired a psyciatrist on campus and she prescribed me benzos as long as we tapered each month.

Depending on the state, NPs are allowed to write prescriptions for CII drugs and lower. The law is that they have to do it under the supervision of the Doctor, but all that means is that the doctor can look at the prescriptions written if he feels, and question the NPs actions if he feels they were not right. Also in NYS they are trying to do away with the "having to work under the supervision of a Doctor" rule for NPs. Most NPs that I have seen never had me see the Doctor, but he was in the same building which I guess they count as "under the supervision."

 

[buttershots21]

When I saw a NP, I never saw the actual Dr, but all my scripts had the Dr.s name on the bottle when I picked it up from the pharmacy. I always wondered why, now I know! Learn something new every day I guess.

 

[tricomb]

At a different school I had no problem getting my normal dose from the student health center, and even after the problems I had that one year at a new school, they hired a psyciatrist on campus and she prescribed me benzos as long as we tapered each month.

Depending on the state, NPs are allowed to write prescriptions for CII drugs and lower. The law is that they have to do it under the supervision of the Doctor, but all that means is that the doctor can look at the prescriptions written if he feels, and question the NPs actions if he feels they were not right. Also in NYS they are trying to do away with the "having to work under the supervision of a Doctor" rule for NPs. Most NPs that I have seen never had me see the Doctor, but he was in the same building which I guess they count as "under the supervision."

This is all true, I have many relatives that are NPs, doctors, nurses, etc. Nurse Practitioners are basically just as qualified as a doctor, oftentimes even more so than doctors in my experience, and probably the biggest difference between a doctor and a NP is salary.