Going to ask my pain management doc for a favor - do you think I'm being reasonable?

[John_Burrows]

So I've been scripted 180 dilaudids every month for almost two years now and maybe 6 months ago I switched from my GP to a pain specialist to keep things going.

My routine is pretty basic - I take 2 pills, three times a day and POOF! There goes 180 in the blink of an eye.

But I need more pills - and here's why:

- First of all, depending on how I'm doing, some days when the pain is worse I feel like I need a few extra here and there. It was bad this month, as a new pain came out of nowhere and was so bad I could hardly walk. But I knew for every extra pill I took now, I'd have to take one less later. Having to keep track of every last pill is a pain in the ass, and I hate standing there counting pills, it feels kinda pathetic. And of course I shouldn't have to choose between less pain now or more pain later?

- Insurance is notorious about not letting you refill early. When it's 30 days (give or take a day or two), you can refill. But sometimes the pharmacy is out of stock, so I end up in a bad situation - it takes them at least 5 days to get more pills, but I only have enough to last me another day or two! So I end up calling all over town to see if another place has it in stock. That situation Really blows.

- My doc isn't that close to where I work, so I have to take a 2 hour lunch once a month to meet with him and get my script. It hasn't happened yet, but the day will come when work is busy and I can't take the time off to keep my appointment - but I still HAVE to get the script before I run out.

Basically, this 180 limit gives me a shit load of stress every month and sometimes forces me to just "tough it out" over unexpected flare ups. What I'm going to ask the doc for is a seperate, extra script for like 60 pills that will be my "emergency stash;" if I need an extra pill now and then, no prob. If the pharmacy needs a few days to get the pills in stock, I have a reserve; if I need to reschedule my doc appointment, I'm covered.

This isn't something I'll ask for every month - by the its very nature my extras should last a while, since I don't have issues that would require a significant number of extra pills every month; I figure I'd need a refill on my emergency stash maybe 2 or 3 times a year, max.

Anyway, I'm trying to be good and not just asking for a regular increase; in fact I don't WANT to become dependent on a larger monthly dose, so this seems to be a fair compromise.

I think the request is fair, and frankly necessary. I shouldn't have to deal with stress like that every month and the peace of mind that little extra bottle would bring is def a bump in "quality of life."

But what do you guys think? Is this truly a reasonable request? Maybe some of you have a pain doc and have been through something similar.

I'd really like to hear any and all opinions.

 

[muvolution]

that's tricky. I would maybe wait until you know them better. 6 months isn't too long. In my experience, doctors are more likely to write for 5-10 more pills/ month consitently if you explain a situation like that to them rather than writing one big refill. It just looks sketchy from a doctor/ insurance/ dea/ fda point of view.

So explain the situation to him/ her and just say that you get super anxious and that sometimes there is issues. You always take them as prescribed, etc...

With my psychiatrist, I get 2 doses of a benzo a day for 60/ month and I ask him for 75 because I am significantly less anxious knowing that if I need one for a panic attack, etc, I will have enough to make it through. Same kinda deal.

This is bordering on a "what to tell my doctor post" but as long as it doesn't go that direction, I think it's legitimate. I mean, everyone hates counting out pills, keeping track, etc. I often have pain that I would rather not but can't do anything because I know I will come up short later.

Good luck.

 

[thesomoan]

I think that your doc may be wary as this is a very easy way for you to sell extra pills, or perhaps have pills to use recreationally on top of your maintenance doses. That being said if your pain doc regards you as being trustworthy, and you seem genuine in talking to him (which based on your post you will be) I am certain that he would work with you to ensure that you are never short on pills. Perhaps one way to approach him in a way that would not raise concerns would be to simply state your concerns about occasionally running short on pills, and the fact that you do not want to become dependent on a higher dose. I am certain that he would work with you to find a solution which I am sure would be fairly similar to the one you proposed here.

 

[halfoz]

i so understand where you're coming from. when you have chronic pain, the stress of chasing down your scripts is incredible.

sounds like you need to ask for a script for "breakthrough pain" since that's what you're legitimately experiencing.

make it easy on your doc, and dont ask him to prescribe things that get him in trouble. hard enough if you have "triplicate" prescriptions anyway.

not sure what you should ask for. dilaudid is already about as strong as it gets. i guess you could ask for a fentanyl lollipop, or a morphine injection... i dunno. or just explain the situation to the doc and let him come up with a solution. no matter what, having to manipulate your script is not good and puts you in potential risk.

a good pain mgmt doc - kinda like a good unicorn in my opinion (don't exist) - should be able to help you out.

 

[John_Burrows]

Muv: this is def NOT a "help me fool my doctor" thread. My concern is legit and I wanted to get feedback from people who may have been in my shoes.

HALF: Some good idea, I'll make sure the doc knows I'm open to other suggestions. The "60 extra" was just my simplest idea of what might work.

Looking into a script for a different drug might be a good idea. Also, My insurance DOES allow for jumping from 180 to 240 but the pharmacy has to call and clear it. My old GP wrote me up for 240 on several occasions, but insurance were real sticklers and for one reason or another they only approved it once.

I've asked my doc to let me try a fent patch a few times, and he hasn't flat out said no, but always steers me away from it. But the new pain I have right now is there all the time, so a patch that is supposed to provide relief all day might be a good solution.

I guess the easiest thing is to just ask for 240 as a one-time thing and if I ask for it again too soon, he can just say no (as he should).

If insurance gives me a problem, they can just fill the usual 180 and I'll deal with it next month (my appointment for now is tomorrow).

 

[muvolution]

I wasn't saying it was a fool my Dr. thread, you've obviously been here long enough to know the rules, just for any prospective responses, ya know? Didn't mean any disrespect as I've been in your shoes.

I would still say the best thing is to ask him for 5-10 extra/ month and just hoard those every month so you have em when you need em.

 

[TINK]

a good pain mgmt doc - kinda like a good unicorn in my opinion (don't exist) - should be able to help you out.

It took me 17 years to find a pain management doctor who didn't just throw pills at me and say seen you in a month. She saved my life. I was seriously at the point of going back on opiates after being clean for a lil over 4 years. I knew if I went back on the opiates, I was going to die. She was my savior. This came about by our open conversations about what was on my mind and my concerns. We established a dialog, not typical of a doctor's visit. Usually they say where does it hurt, open and say ahh..etc but they never really talk to you about whats going on. You have to find that kind of doctor.

Funny thing happened the other day. I ran into her and she asked if I could come in and speak to a group of new doctors that are entering the pain management rotation. She wants me to basically tell them about the drugs from an addicts side. The stories we tell to get more, the odd things that happen to our meds.. stuff like that.

Oh yeah, My pain manangement program involved psychologists and physical therapists. It was a full program.

 

[John_Burrows]

Thanks for the insight, Tink. Actually I think my pain doc IS that kind of doc; my visits are more like going to a shrink - I can tell he's looking for signs of depression, he wants to make sure I'm sleeping well - he offers advice for my job and when he hears I'm not dating right now he suggests a few local web sites where people meet up and do stuff together.

He is def interested in more than just dispensing pills. But he does have a bit of an ego problem and he's shown his temper more than once if I seem to be questioning his advice or recommendations - but at least he's passionate

However, in this case, I would like to see him help me out with extra meds since I am really tired of the stress I go through every month when its refill time (not to mention my dilemma about what to do if the pain gets bad).

I think he trusts me and sees I have things together. When I first started he saw my script history and so he knows I've maintained my 180 a month for a long time without asking for more. And in this case I don't want more pills per se, just a "safety net" so i don't have to freak out when my script runs out and there's a delay in getting a refill.

Oh and Muvo, as soon as I go over 180 it requires the pharmacist to call the insurance company and get authorization for more - I really don't want to do that every month for an extra 10 pills (and an extra 10 is kinda pointless when I go through 6 a day).

I'd rather just get the full 240 at once so I have the "backup stash" in one go. And if my doc had any concerns about me abusing or selling the extra, he'd find out for sure if I suddenly needed another 60 next month! That's what a junkie would do, but I think he knows better of me.

Besides, I'm not an idiot - even if I was stupid enough to go through 60 extra pills in a month, I'd have to wait at least 3 or 4 months to ask for another 60 so as not to arouse suspicion. But that would just bite me in the ass because I legitimately want that "security blanket" of backup pills!

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Tink, how exactly did she save your life? What was your situation? I think I have things well under control, but I'm sure everyone does until it's too late...

For the last 2 years I've been on 180 8mg dilaudid a month; first I was plugging, but when my tolerance shot througn the roof, I moved up to IV 6 months ago. I do have daily pain, but I'm the first to admit I probably don't need to be injecting dilaudid to deal with it!

But look, I dose I the morning before I go to work, at 3pm I sneak a 4mg "maintenance shot" in the bathroom (I really had no choice - the idea of shooting at work was kinda unnerving, but I just can't go from 10 till 8pm without a fix - by 5pm my withdrawals get to a point where I'm useless and just watching the clock - when I take my booster shot, I'm much more productive in the afternoon).

Then i fix when I get home and before I go to bed.

Repeat every day for the last 6 months!

I still have my job, I'm doing better at work than I was 6 months ago and I still have a social life.

So, to me, I feel like I have things under control. However, I know that one of these days I'll start dating again and when I do, I'll have to deal with the ins and outs of a drug habit while in a relationship when the time comes...

Anyway, I'll let you all know how it goes tomorrow.

 

[muvolution]

Have you thought about switching to Opana IR?

It has a much longer duration - long enough to get you through the workday.

 

[TINK]

Thanks for the insight, Tink. Actually I think my pain doc IS that kind of doc;
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Tink, how exactly did she save your life? What was your situation? I think I have things well under control, but I'm sure everyone does until it's too late....

She saved my life by not giving up on me and keeping off the opiates. Your body is not designed for long term opiate use. Eventually you will have to deal with medical issues resulting from the drug use as well as the pain issue.

I don't know what sorta chronic pain issue you have or how old you are, but I can tell you that you will not be able to sustain this useage long term.

Pain issues aside, opiates create an emotional addiction with certain persons. As well as, you can actually develop Opioid-induced hyperalgesia or opioid-induced abnormal pain sensitivity. When the opiates are actually causing your pain to be worse but because you are so emotionally addicted you don't care. That is where I was.

Good Luck.

 

[Kindatired]

Most doctors will not give you an extra amount of pills to "put on the side" encase you run out of your normal amount. If they get investigated by the feds (can only speak on this when it comes to Canada or the States) and they find out a doctor is giving out "extra" pills every few months they it will be a pain in the ass for the doctor to explain why...and knowing groups like the DEA they won't believe him anyway and will make the doctors life intolerable.

My advice for you would be to discuss some kind of breakthrough med. Since you are talking about pain that goes above your normal pain threshold while you are on your normal medications then something like Oxycodone IR (you call them Roxicodone in the states) might fit the bill. It works really fast and is fairly strong in the right doses.

You will probably find that doctors are more willing to give out a separate medication to go hand in hand with your normal painkiller rather than giving you extra of one medication every few months, it just looks bad in the eyes of the DEA and other drug enforcement gangs (yes, I think of the DEA as a gang rather than a government agency, they sure act like some sort of rival gang).

So, you might to consider talking to your doctor about going on Opana ER for normal everyday pain relief since it will last you 6-12 hours (when I had it in the hospital one time it stared to wear off in about 8 hours, so depending on your body it might last longer or less, and something like Oxycodone IR for break though pain those times when the pain gets ahead of the Opana ER.

Just be honest with your doctor, you will either find out that he is more willing to switch you to two different opiates (one instant release and one extended release) or he will just start upping your dose of dilaudids a little each month until you are wear you need to be.

In my personal experience it's better to go on a ER and IR routine because you can take one pill in the morning and one pill at night and you are set for the day, and just carry around the IR med with you so if you do something that makes the pain go beyond it's normal amount then pop an IR and your are set to go.

My doctor put me on Oxycontin 20 mg every 12 hours (after months and months of convincing him that I was not a drug deal selling my pills) after being on Oxycodone IR 4 times a day for years, and gave me some Oxycodone IR just encase my back start to really act up. Now my pain is at a bearable level all day and all night long and on the odd days that I need it I have the Oxycodone IR to kill that extra pain in just a few minutes.

So in short, be honest with your Doctor, and ask to be put on an extended release opiate and some instant release opiate for the times the pain manages to get by your main defense.

Good luck!

 

[halfoz]

@Tink: my doctors are starting to think i have opiate hyperalgesia and are suggesting i switch to suboxone from oxycontin. dunno how i feel about that, but i'm not interested in being on opiates forever so who knows.

 

[TINK]

In my experience, the doctors that I have selected don't have any problem giving me extra. All they do is modify the sig or doseage so the insurance will fill it. For example, I have one medication that some days I need one tab and others I need 3. So the doctor writes the script for 1-4 tablets per day as needed and gives the max amount (120). The other example is I get xanax 1 mg bid, at least thats what the sig says. But, I only take .5 mg when needed. So in one month I actually have 2 months, but have extra if something happens.

Now grant it, this is after establishing a relationship with my doctor and being completely honest with them.

I made them put in my medical record that I was allergic to opiates and avoids due to addiction issues, so that no doctor tries to rx me any. So, even if I wanted to fall of the wagon, I probably couldn't.

 

[Kindatired]

She saved my life by not giving up on me and keeping off the opiates. Your body is not designed for long term opiate use. Eventually you will have to deal with medical issues resulting from the drug use as well as the pain issue.

I don't know what sorta chronic pain issue you have or how old you are, but I can tell you that you will not be able to sustain this useage long term.

Pain issues aside, opiates create an emotional addiction with certain persons. As well as, you can actually develop Opioid-induced hyperalgesia or opioid-induced abnormal pain sensitivity. When the opiates are actually causing your pain to be worse but because you are so emotionally addicted you don't care. That is where I was.

Good Luck.

TINK, depending on a persons pain sometimes opiates are the only thing that can make living a normal life possible. If it wasn't for opiates I wouldn't be able to get out of bed in the morning to get to my university classes, that is if I slept at all during the night because of the pain. Most of the people I have met that have severe chronic pain doesn't run the risk of becoming a junkie as someone taking opiates just for fun. And it's quite possible to stay on opiates for a very long time without the "addiction" side effects you have talked about coming to light. If you are taking just enough to keep the pain away rather than taking a certain amount just to get high then you probably won't become a hard core addict.

There is a big difference when you are taking opiates for pain rather than fun. Granted they will lose their pain killing ability over time, but as long as you keep the dose as low as possible for as long as possible you can be on opiates for a very long time and still keep the pain killing abilities of the medication working.

My grand mother has been on morphine for over 20 years thanks to a her weak bones always breaking (had both her hips replaced too) but without her pills the pain in too intense for her to even move. Sometimes taking the risk of opiate side effects are worth it when it's the only way to life a somewhat normal life.

 

[muvolution]

stay away from Opana ER. The 10mg IR's are where it's at, and the last around 8 hours as oppossed to like 2-3 for hydromorph.
Also, I know you IV your pain meds and you can't really beat Opana IR as far as that goes.

 

[TINK]

kindatired - just to clarify i did say in some people.

And trust me I know what it is like not being able to get out of bed because of pain. I was literally bed ridden for about 7 months. I have been suffering from chronic pain for 15 years.

The key is to know that everyone is different. Which makes the pain different, the response to pain different as well as the medication that helps vs hurts.

I am in no way saying I don't enjoy getting f'ed up, but for my body opiates are no good.

 

[John_Burrows]

Well, doc said "no."

He basically said if he gives me extra pills I'll use them all right away and permanently raise the level of narcotic my body needs to fight the pain.

On one hand, it annoys me that he had so little faith in me - my history clearly shows I've stuck to my 180 a month for about 2 years and in our first session I told him that I don't WANT to up my regular dosage (the ironic thing is back then his response was "hey some people develop tolerance and as time goes on they need more pills, there's no shame in that." Seems to have changed his tune).

Also, best I can do is say trust me, gang, i come across as a very responsible adult, so I know I don't give off a "fiend" vibe. I also feel a little like he insulted my intelligence, because clearly I know that if I DID go througn all 60 extras in one month he'd say "told you so" and would never give me extra again!

His solution? Take an "Alieve" in the morning and at night and it will potentiate my dilaudid.

Now I'm no chemist, but I'd bet the farm that's a bunch of bull. If Alieve potentiated opiates there would be a million and one threads about it on here!

Also, to be fair, I AM at the far end of the "bell curve" of the opiate intake of the general population on pain meds. Thanks to some sort of natural tolerance I have (the reason I'm on dilaudid is because it took 3 vicodins or percs to have any effect on me) I have to take much more than the average bear. Let's face it, 180 8mg dilaudid is a shit load of painkiller. If I was on percs or even 4mg dilaudid, he'd probably be more willing to bump me.

But after I discover that fucking ALIEVE doesn't actually do anything for me, I'll ask him for a different script to help with breakthrough pain (thanks for that suggestion guys).

In the meantime I'll just have to deal with extra pain by eating ice cream.

Actually I do end up getting a few extra every month - while technically insurance makes you wait 30 days to refill, there is a grace period of a few days, so by taking my script in 2 or 3 days early each month, I basically I get 30 days worth of pills every 28 days.

So that helps a little...

 

[TINK]

In the meantime I'll just have to deal with extra pain by eating ice cream...

Not sure if you put that in as a snippet, but it is true. Endorphines released by your body are 20 times stronger than morphine. Endorphines are released by doing pleasurable things. Consider sex too

 

[halfoz]

i think naproxen does slightly potentiate opiates, but not in any huge way.

tink makes a great point: exercise is so beneficial to the body its about the closest thing to a panacea that exists. and it definitely reduces the perception of pain.

i'm currently wheelchair bound, in substantial pain from a massive head on car wreck. but i do my daily at-home physical therapy, and for what its worth, i feel better, and i feel better about myself, like i have some control over something that otherwise feels like it has control over me.

my point is, it takes me substantial amount of willpower to work out. but i do it, hatefully at first, but i'm always glad i did afterwards. i think the exercise over time has actually increased my pain tolerance.

doesn't do anything about my like for opiates though.

 

[TheLostBoys]

Maybe you should ask him for 15mg roxis for break through pain. I wouldnt ask him for more dillies.