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  • BDD Moderators: Keif’ Richards

Does "Pain Managment Specialist" = no more drugs?

If i've been on dilaudid for 2 years, and dilaudid was arrived at after my doc and I tried several different meds before "nailing it," why on earth would a new doctor not simply let me continue with "what works?" I mean I'd be his easiest patient to date (this of course assumes I provide paperwork to prove my script history and the reasons I'm in pain, which I can do).

Unless its simply an ego thing where the doc is going to say "you're my patient now so I'm going to put my mark on you."

I made appointments with 2 different docs today and I lucked out, in the sense that they seem to be polar opposites...

The first one I called was a guy who's part of some pain clinic, and his assistant made an appointment for me for next week. She told me to bring lots of paperwork, MRI results, etc, and warned me that she couldn't promise the doc would continue my current script.

Ok, fine.

The next guy i called's answering machine picked up... He sounded like he was 75 and the background noise - of what almost sounded like a party - was so loud on the machine I could barely hear him. It was surreal and i thought it was a mistake! But he called me right back, made an appointment for this Thursday and told me not to worry about paperwork, proof, etc, "we can always get that later."

He didn't sound slick or anything, more like a befuddled old man who was shocked and surprised that a patient found him (he really did sound surprised and was super curious how I got his name).

I was looking for a morning appointment, but he only had afternoon because he was booked due to the "upcoming holiday."

What holiday?!

Anyway, I have a feeling these are going to be very different experiences.

Any tips and suggestions one what i should bring with me or how to handle myself during the interview would be appreciated.

I'm really looking forward to hearing any good reasons why they SHOULDNT just let me continue dilaudid...
 
If you tell him your pain is well managed he may very well change nothing. But doctors do sometimes have a tendency to favor certain drugs for whatever reason. You never know he might put you on 180 10mg opana IR's a month. That's pretty unlikely but stranger things have happened.

I thinks it's grandparents day
 
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Barring extreme circumstances, you'd figure they'd let the patient have a say in how to manage their own pain, especially if they are already on a plan that works for them.

If I was fresh out of surgey and had no history of pain meds, that's one thing - but two years ago my doctor and I experimented and arrived at dilaudid as a solution that works for me and has no real downside (aside from withdrawals, he firmly believes opiates are easy on the system and have no long term side effects).

But I've also met doctors who think dilaudid - and most strong narcotic painkillers - are the work of satan and simply won't perscribe them.

Do these doctors feel that way not because the drug is dangerous per se, but because of the POTENTIAL for addiction and what they can do to a patient susceptible to the downsides?

In any case, I already have paperwork that shows I've been perscribed dillies every month for the past year, and ive got paperwork that shows a trail of back pain and injuries.

Assuming the doctor interviews me and can plainly see my life isn't a wreck from pain killer abuse, what possible reason could he have for NOT letting me continue what works?
 
John_Burrows said:
Interesting, thanks for the info guys.

Here's my situation: ive had back surgery once, which fixed the pressing issue at the time, but my lower discs are still somewhat degenerated. My back specialist basically said that while my discs aren't in great shape, they're not bad enough that he would recommend surgery.

To me, a diagnosis like that essentially points to pain meds. And I do have daily pain that the dilaudid helps with.

And its not like my doc and I just jumped on dilaudid to start - ive always had a strong tolerance to pain meds, and, at first, we tried vikes and percs, but it took 3 or 4 at a time to have any effect on me. My doc was concerned about all that APAP, so he had me try dilaudid (this is about 2 years ago, before that I had never even heard of dilaudid).

Anyway, that Did the trick, and because of my tolerance the pills never really got me all that high. But they have helped take the edge off the pain, which is ongoing.

I wouldn't worry about random pill counts, because ive been perscribed the same amount every month (180) for 2 years and never ran out. What is the pill counting supposed to be for?

And I don't use any other drugs at all, so they can test the he'll out of me!

I just know that there are plenty of docs out there who are strongly anti-narcotic, so I'd worry that I'd get a pain doc that would try and get me to explore acupuncture and other non-drug related therapies. Again, I have no idea what these guys are supposed to do.

All I know is that I'd be very unhappy without the dillies. I mean its a weird situation, because I know I abuse them since I IV and get withdrawals If i don't dose, etc etc, but at the same time they do fix the pain! And nothing else so far has been able to do that.

I mean what sort of stance would a doc like this take? Ok fine opiates can be evil, sure, but ive used my pain meds responsibly, never go over my limit, don't use other drugs, etc. If i get someone who wants me to quit dilaudid, what am I expected to do about the pain?

Or are these docs simply trying to make sure then people getting the meds truly need them and aren't abusing them? Becsuse I have a stack of MRIs and doctor reports - not to mention my past surgery - if anyone wants proof that I deal with genuine pain!

At the same time, just to play it safe, I'm going to start tapering. I have 60 or 70 pills left, which should be enough to do a slow taper, just in case i get cut off.

Or am I being paranoid? Would any pain doc just cut someone off who's been on dilaudid for 2 years straight? That seems like it would make anyone far worse for wear.

If anyone reading this is in the Los Angeles area and can recommend a good pain mgt doc, let me know.

I'll see if any of the names on my list turn up in searches.
Click to expand...


The pill counting is to make sure you taking the exact amount prescribed and not a single one more
 
The first one I called was a guy who's part of some pain clinic, and his assistant made an appointment for me for next week. She told me to bring lots of paperwork, MRI results, etc, and warned me that she couldn't promise the doc would continue my current script.

Ok, fine.

The next guy i called's answering machine picked up... He sounded like he was 75 and the background noise - of what almost sounded like a party - was so loud on the machine I could barely hear him. It was surreal and i thought it was a mistake! But he called me right back, made an appointment for this Thursday and told me not to worry about paperwork, proof, etc, "we can always get that later."

He didn't sound slick or anything, more like a befuddled old man who was shocked and surprised that a patient found him (he really did sound surprised and was super curious how I got his name).

I was looking for a morning appointment, but he only had afternoon because he was booked due to the "upcoming holiday."

What holiday?!

Anyway, I have a feeling these are going to be very different experiences.



IMO, the first doc will be more likely the type to bust your balls. He sounds tough to deal with as his assistant is already lowering your expectation, before you even get there.

Now this second one sounds very INTERESTING. Perhaps an old "croaker." If thats the case, I would explain how the hrydomorphone works just great. The only problem that I have from it, is that it don't last a full 4 hrs. I could then throw out the suggestion of 8/day instead of the 6/day. I'm not telling you to do this, I'm just saying what I would do.

I did this in the past. I was getting 6 Roxy 15s per day. After complaining a little, I was raised to 6 Roxy 30s per day.

And I know your happy with the 180/month. But I assume you would be happier with 240/month, if for no other reason than extra for a rainy day.

Finally, you better have a reason that a controlled release(CR or ER) med won't work for you. One good reason is cost. If you had no insurance or bad insurance, CR type meds would be prohibitively expensive. Thus this could be the reason you was first put on the cheaper, IR hydromorphone.

Just some thoughts.
 
I'm really looking forward to hearing any good reasons why they SHOULDNT just let me continue dilaudid...


Well, I doubt I could give you a reason that you would consider GOOD. Many times, though, a pain doc. will be more concerned with the fact that you are on a CR/ER med than the actual mg dosage. In other words, they will prescribe much higher doses, as long as a -Contin. is part of the regimen.

If the need for a CR/ER for you is a must, that could present a problem. Afaik, there is no -Contin for hydromorphone, at least in the U.S. Canada does offer this, but that's no help for you.

I believe I would state for purely financial reasons that a -Contin. is not practicable. Just MO.
 
You could get some ER meds and the Dilaudid for BT pain.

If a dr won't script narcotics just move on. When you call make sure you say you are calling about pain management that you're primary has been covering it for years and reffered you there.. even if your insurance doesn't require it get a refferal from you dr... Usually you will have to write down what you've tried.. what works what doesn't.. ect. Then they will also ask you. My first pain mgt appt was 30 minutes.. dr looked at my MRI ordered more and gave me 150 roxicodone a month. Now I get a long acting and 150 roxi a month. I am trying to get upped to 30's. It won't be that bad John. Also some dr's don't like to script just one opiate so you getting your dilaudid is plausable... Some think scripting different opiates one long acting.. then a different short acting. You will get what you need. My dr does not pill count nor does she drug test BUT they do "theraputic drug tests"... Where I have to have the right amount of medication in my system on my appt day. They don't do it every time. I just take my shit as scripted for 2 days before and I have always been fine.
 
I was once sent to a pain management doctor and first thing he did after I signed all the paperwork saying I would only get my meds from him=no doctor shopping,random drug test sometimes,etc... he increased my OC from 2 pills per day to 3,put me on methadone 3 times a say,and increased the dosage over time,and put me on soma also,I ended up with more pills than I was taking than before I went ,but I got popped on a piss test and blood test he gave me after I was a patient for 6 months,and I tested positive for cocaine and barbitutates,and THC,so he said either enter cocine detox or I will hav eto put you on a taper down off all narcotics in a month thing,and I was not even on coke except for the weekend the month before when they tested me,so I said fuck no,test me now!I am not on cocaine,etc..anyway I left with a fast taper to nothing script from that asshole,and got a new doctor the next day!lol
 
Some good points here, thanks for posting, guys.

Hydro is cheap and I am thinking about dumping my insurance, so that's a good thing to keep in mind.

To be honest, even if given the opportunity to get even more meds, I'd rather not pump even MORE drugs into my system. One reason to stick with dilaudid is BECAUSE it's short acting. My pain changes often, so I like being able to scale my meds based on the level of pain. If it's bad in the morning, take 2. If it's ok in the AM but sux after a long day at work, I can take more in the afternoon. A 12 hour drug doesn't let me scale my meds to "fit the bill."

Does that sound reasonable?

That's one reason pill counting won't work for me, some days I need more or less than others, but an "average" pill count to make sure I'm basically on target would be fine.

Yeah, there are months when I wish I had more than 180, but I find the lower number keeps me from indulging too much.

I mean let's face it, if I had 240 a month I'd find a way to use them all!

Actually it's funny, as I type out my point of view to you guys I realize how incredibly reasonable I sound. If neither of these docs are willing to give me the very basic script I need, screw Em, there are plenty of pain docs out there.

I have plenty of evidence to prove my back is screwed up (including surgery) and I have a print out from the drug store that shows my dilaudid refills every month for the past year.

Shouldn't that be enough for a pain doc?
 
How important is perscription history to these docs?

I managed to get a printout from my pharmacy that shows I've been getting dilaudid every month for well over a year.

It also shows one-time scripts for vikes, percs and Opana, which demonstrates that I tried them but the dillies just worked better for me.

Is the pain doc going to take this history into consideration or is he more likely to just say "too bad, I'm your doctor now and we'll do things my way."

I figure at the very least it's good that I have proof of long term pain meds as opposed to asking them to take my word for it...
 
It all really depends on the doctor.......the first one I saw would not prescribe anything to do with oxycodone or even hydrocodone, so he gave me a medication called embeda (morphine sulfate with naltrexone), an unabusable form of ER morphine......well I said fuck that and saw a different doctor. They ended up giving me 20mg OC 3x daily, 10mg percocets 4x daily, and 3 somas daily. This was all after hip surgery and could not walk for 3 months, so I had a legitimate need.
 
pain management

these guys know what they are doing, just try to go along with whatever they say to do at first. if what they tell you to do doesnt work....then tell them....communicate with them....unless you are in the appalaichan area you should be fine. if you are...then move.
 
unless you are in the appalaichan area you should be fine. if you are...then move ?

Please explain?
 
Ok so today I met with the "befuddled old man" pain doc. He has a small practice and a history as an anesthesiologist amongst other things (he's been a doctor for over 40 years and settled into pain mgt).

I filled out lots of forms and gave him my paperwork, including prescription history and all kinds of stuff documenting my history of back pain.

Overall, I think he was just happy to have lucked into another patient. I never felt he grilled me too hard and I didn't have to ask twice before he was happy to keep my dilaudid script going, so yay. He even wanted to let me know that there would be no shame in asking for more!

It's hard to know if he was just an easy doc or if I just gave him a solid impression that I have my act together, I'm not abusing (hah) and that I have a genuine need for the drugs.

Only thing that sucks is I'll have to make an appointment to come see him every friggin' month just to justify getting a refill. I mean we all know its only for appearances, but I'll still have to PAY for a doctors visit every month now, so that's two co-pays a month, so the cost of my drugs just doubled. I almost asked for more pills just to feel like I was getting my money's worth!

The other good thing about having to switch from my GP to a pain doc is that because I wasn't sure if I was going to be able to keep getting my dillies, I started tapering down over the last week... Went from 6 pills a day to 4.5, so that's a bonus, I felt like I was taking too many anyway so I'm back to a number that makes me more comfortable.

Anyway, thanks for the advice and insight, everyone - when I first found out my doc was going to stop writing narcotics I flipped out, but you guys calmed me down :-)
 
ihatepipes said:
having to go through a pain management doctor for your scripts doesn't necessarily mean no more pain meds, but it definitely means that you will be dealing with alot more scrutiny. Be ready to sign a pain management contract with stipulations such as being required to bring your pills to the office for a count at the doctor's discretion, submitting to regular urinalysis, agreeing not to use street drugs (not sure if you smoke pot but if you do it will be a no no because a dirty urine means punishment of some sort i.e. no meds til you can piss clean), and other assorted hoops to jump through.. More than likely agreeing to do these things and doing them is pretty much the only way you will be able to continue to get your pain medicine.

You might get lucky and the pain management doctor you pick might not require these things, but everyone who I have ever known that obtained their meds through a pain management doctor had to do the things I mentioned above. If you have any more questions ask. I am not sure if I will be able to answer them but someone should be able to.
Click to expand...

For the most part you are right. I don't know where he is but I have a lot of experience with pain management and some will deny you for pot but if you are honest before hand it usually doesn't matter, these days a lot of people don't really care much about weed especially those quacks passing out narcotics. And if you do have an inoperable problem and can prove it that nearly any pain doctor will write your scripts. My is operable but I don't have insurance, my doctor is constantly talking about surgery but I keep saying no and he writes my 180 30 mg oxy, 90 15 mg oxy, and 60 xanax bars.
 
The piss tests are not only to see if you have other drugs in your system, but also to make sure that you have opiates in your system.

I know somebody that got kicked out of pain management because they tested negative for opiates because they ate their scripts too soon, so were clean by the time they saw the doc.
 
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