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  • BDD Moderators: Keif’ Richards | negrogesic

Questions & Opinions on what my PM Dr. Has me on and am I in trouble

R

Rt11371

Greenlighter
Joined
May 21, 2015
Messages
11
Well first off I would like to thank anyone reading this and giving your opinion or advice. I have had 2 back surgeries over the course of the past 4 years along with other treatments and procedures and in my opinion they were 25% successful in my pain reduction at best, some days I don't know if they did any help. Anyways after about a year of going through the system and getting referred from dr to dr I found one that actually cares and wants to do what he can with my PM. Before I went to him I was on 10mg IR Oxycodone every 6 hrs and 600mg Gabapentin every 8 hrs, it was not working well as it was only taking my pain levels down a point or two at best down to a 8. I then switched dr's and my new dr increased my Oxy to 15 every 6 and kept me on the same amt of Gabapentin, after two weeks I didn't notice much if any more relief so he increased it to 30 mg Oxy every 3-4 hrs and kept the Gabapentin the same. After two weeks it started to get better I would say my pain level was at a fairly constant 6. He said his goal was a 3-4 so he then jumped my Oxy to 45mg every 3-4 hrs, tapered me off the Gabapentin and put me on a 25mcl/hr fentanyl patch along with 5 mg Valium every 6 hrs for muscle spasms. After two weeks I did feel better I would say down to a fairly constant 5. Then after two weeks he asked me how I was doing and I said it's getting a little better but it's still mostly a 5 sometimes a 6 depending on what I did that day. He then kept my Oxy at 45 mg every 3-4 hrs but jumped my fentanyl patch to 50 mcl/hr and added 10mg dextroamphetamine one when I wake up and one at noon since he said there have been studies saying that was helping pain control. So now I'm taking my 45mg Oxy every 3-4 hr, 50mcl/hr fentanyl patch every other day, 10 mg dextroamphetamine in the am and noon and 5mg Valium every 6hr and I'm still at a 5 or sometimes 6. Now let me say, I'm not doing much of anything on a daily basis as I'm self employed and 95% of my work is on the computer, I don't know what it would be like if I was doing more physical activities. Do you think what I'm taking is a lot and do you think why it's not working as well as it should is because I've become so tolerant to the meds. I understand that I'm never going to be pain free but living with a level 5-6 pain and not doing any physical activities scare me because if I start to do more physical activities and my pain level jumps up to a 7,8 or 9 again idk what else I'll be able to do. Has anyone ever been in this kind of situation or does anyone have any opinions on this matter. All replys are greatly appreciated.

Thank you!
 
Its sort of a lot, especially the oxy but not crazy. Tolerance for sure is why you have varying levels of pain relief and had to increase your meds but remember, there is no upper limit on opioids. It is a matter of what an individual can tolerate.

I am amazed you got some d-amp. It surely has evidence of efficacy in conjuction with opioids for pain relief but you just dont see it very much. Kudos to your doctor for thinking outside the box.
 
You need to tune into the meds a little more IMO. You have a lot of medicine. Maybe get Gabapentin changed to its potent older brother Lyrica.
Another thing is adjunct therapy that you can do on your own. Naproxen/Alieve is a great NSAID that will add to the analgesia of at least the oxycodone, but probably the fentanyl as well.
Make sure you don't push the doctor too much.
If you have balls, you can try to go up to Opana or Opana ER.
Sedatives although dangerous, in minimal dosages can add to the relaxing aspect of pain relief, which may end u kicking up your meds up a notch.
When I said tune into your meds a little more, I was reffering to/ suggesting paying more attention and possibly timing your dosing better.
I hope something out of this helped you.
 
I would say your doc is being pretty liberal with your regimen. You are definitely getting a good amount of potent pain meds. I'm amazed that you're still in that much pain considering the meds you're on but then again you've been on pain meds for four years so your tolerance is probably sky high. Have you considered the spinal stimulator implant? I've heard that some have success with that. IME oxy is a superior pain med to Opana however everyone is different. For example I can take one Opana IR 10mg and not get very good pain relief whereas 30 of IR Oxy kicks the pains ass. Everyone is different though.
 
Amd might I add be thankful that you have a doc who isn't afraid to write the good meds. I have a friend who has in her words a broken lumbar spine in three places and her PM doc will only give her Norco 5s twice a day which don't touch the pain. The sad thing is she's a recovering meth addict who has gone back to the meth to get some relief from her pain. Of course her doc is a MediCal doc. Go figure.
 
I agree with a few others that your doctor is pretty liberal with the meds he's prescribing. You really should be getting pretty decent relief from those meds, even with a little tolerance taken into account. You'd be hard pressed to find another doc willing to do what this doc is doing for you, more than likely. At the end of the day, I think the meds you're on are going to take you about as far as pain meds can. You may want to think "out of the box" to add some other pain relieving activities to take things to the next level. Your doctor can probably suggest a few things for you. Good Luck!
 
Thanks, I don't know how to approach my dr about tolerance and changing meds to try to get to a better pain level. I have never once asked for a specific medication or a jump in my meds since I know that's not a good thing to do. He just kept trying to get to the meds that work the best. I believe my dr is very understanding but I'm not going to push it since I can manage most if not all my daily activities but like I said it scares me since I'm not doing very much physical activities other than mowing my small lawn with my rider which it hurts a fair bit more after I'm done but I try to plan out my med schedule around it. I would like to be able to do the things I used to like doing such as going fishing, camping, traveling and some DYI projects around home but I don't think I can chance it at this time, I have a dr appointment tomorrow and I would like to talk to him about this more. I also do try to do some minimal excercises at home on my better days but I limit myself on those as I don't want to make things worse. So like I said I want to talk to him tomorrow but I don't want it to sound like all I want is more pain meds.

Thanks
 
Good luck to you. We can't give advice on what to say to your doctor bur just be honest. Hope it works out. Pain is a horrible thing to live with.
 
If you don't want to sound like you want more pain meds, don't ask for them.
I know how that sounds, but what I'm saying is talk about everything else. Tell him about how you can't do household chores or go out and enjoy life by doing various, outdoor activities that brought joy to you. Try to be as honest and obivious as possible. Definitely let the doctor know that your quality of life is very bad. Use the words "this ( as in pain level) is lowering your quality or life
The Icing on cake would be that the fact your medicine has been adjusted so much, your tolerance has risen a bit. After all that, you should be ready to talk shop about medicine(raising, changing etc). For the record, you are on some pretty strong pain medicine. I think a possible adjustment you might try is upping the fentynal. I personally got the most relief from it. The oxycodone is the medication that will fuck with your tolerance. Either leave the oxycodone where it's at, or try to have it switched to something nice like Opana, or Dilaudid. Oxycodone is great, but it will jack up your tolerance IMO.

Now, I hope to have a pain management doctor as cool as yours. A doctor in his position gets audited. Somebody checks the amount of scripts he is writing , especially narcotics. This doctor is not going to screw himself on your behalf.

All I'm saying is first, really be happy with what you have prescribed. You have great meds. Some people don't get close to that. Secondly, be calm, to the point and patient. This will help you very much.
If you ever want to talk, PM me.
Speed King
 
Speed King, you hit the nail on the head! You never/rarely ever want to say to a PM doc that you need more narcotics, no matter how you phrase the statement. It needs to be approached in how your pain is affecting everything you do. Concentrating on "Quality of Life" issues is the way to go. If your doc is willing to change or up your meds, hearing what you're saying is going to work, period. If your doc is not willing to change or up your meds, no matter what or how you say it is never going to work. So, say your peace, and let the chips fall where they will. Doing it as Speed King has suggested definitely gives you your best shot. Good Luck!
 
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