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

[Snugg]

Back when I was in pain management [as useless as it was] I had to have a referral from my doctor to get in. It didn't have to be a written referral, but I had to have one.

So I just had my doctors office call the other doctors office, and I was good to go.

 

[MgmtBlue]

I went to an Orthopedic doctor recently and had the worst experience. I found him through my insurance and there were many references to him being this top notch doctor with numerous accolades. I get to the appointment and the place looks like a crack den. Then, he comes in to see me, asks me some questions, barely does an exam on my knee and prescribes me Oxaprozan for arthritis. So I proceed to ask him questions about the drug, specifically about side effects and its interaction with my current regimen. He says "this is fine to take with your other meds". I go home and research it and it turns out it has horrible side effects including intestinal bleeding when taken with Cymbalta, which I take daily. After two calls to the office, he still hasn't returned. Needless to say I won't be going back.

I went to my GP today and he agreed to treat me for the pain. I'll be sticking to my light exercise regimen along with glucosamine, healthy diet, ice/heat, and Percocet as needed.

It amazes me how these doctors throw around drugs that could kill people and don't even think twice about it.

 

[Jabberwocky]

Actually, there is an ER version of hydromorphone now. It's called "Exalgo ER."


Here's a link:

http://www.pharmabiz.com/article/detnews.asp?Arch=a&articleid=54369&sectionid=14

Edit: And another one:

http://fdb.rxlist.com/drugs/drug-15...rugid=153887&drugname=Exalgo+ER+Oral&source=0

do you have any idea if they're anything similar to the Jurnista formulation of continuous release hydromorphone?

jurnista use the L– OROS technology 9

To over come the drug solubility issue, Alza developed the L – OROS system where a lipid soft gel product containing drug in a dissolved state is initially manufactured and than coated with a barrier membrane, than osmotic push layer and than a semi preamble membrane, drilled with an exit orifice.

from - http://www.pharmainfo.net/reviews/r...rolled-sustained-release-drug-delivery-system

this gives a better look of the technology

 

[littlegirlblue]

21 years old, 50 year-old spine...

I am a 21 year old female who has had two microdiscectomy surgeries since I was 18 on two badly herniated discs (L4-L5 and L3-L4). The last surgery, on L3-L4, was an emergency surgery due to the fact I developed drop foot on the left side. This surgery happened in September of last year and while I know I did some permanent nerve damage, the pain I am experiencing now is becoming more and more intense. I will be seeing my neurosurgeon soon and I fully expect to undergo yet another MIR to see if another disc has degenerated. I'm scared and incredibly tired of sciatic pain. I'm tired of blowing through 50 Norco in 7 days and still experiencing pain 75% of the time and crying myself to sleep. I don't know how I should go about trying to find a better way to manage my pain without seeming like a drug fiend. Any advice? I do go to PT and use an Empi unit when I am at home.

 

[Jabberwocky]

are you seeing a pain management specialist or are you just going through a GP? my advice if you're not seeing a specialist is to get a referall to one - it's the best way to go about it. your GP feels a lot more comfortable having a specialist oversee your condition and liase with your doc to script you adequate pain relief.

just talk to your doctor and tell him you're experiencing the pain you are, that's all we can really tell you to do. we can't tell you what to say as that's against the rules, aka doctor shopping.

best of luck

 

[littlegirlblue]

Not my GP or a PM...

It is actually my Neurosurgeon who is prescribing me the medication. He is of the opinion that due to my heritage, I will be diagnosable with degenerative disc disease within the next few years. We have a really good working relationship and I think he is hesitant to send me along to a PM specialist because he wants to keep a closer eye on my spine. I am happy with this arrangement because honestly, I KNOW my Neurosurgeon believes in my pain. He can clearly see my crushed nerves on the MIRs and has stated to my family in post-op that the size of my herniations are the worst he has seen on a patient under 65 years old. Would it be beneficial to ask him to send me to a PM? Or should I wait until we determine if I have another herniation? Bah, I have enough problems and these issues with my back might just send me over the edge . . .

 

[Jabberwocky]

well if you say you have as good a relationship with him as you say then you shouldn't feel any pressure asking for extra pain relief - though i know the anxieties of it all, having dealt with it many times before.

if he doesn't want to up your dosage or put you on an alternative (stronger, lesser dosing) opioid then i'd be pressing to see a PM or alternate doctor.

are you on any kind of neuroleptic to help with the sciatica? such as lyrica or gabapentin? they're worth checking out.

 

[endEMBEDA]

Hey...So i'm at a loss...I've spent thousands of dollars and seen so many doctors and no one will help me....I'm 27, with AS, DDD, herniated and bulging discs and just alot of pain...NO doctor will believe me or properly prescribe me pain medication without INSANE guidelines, like having a full lab drug test every 2 weeks (hour drive away) random pill counts etc....i can't be tied to something like this and don't have the time or money to return every 2 weeks and beg for help. I live in the Raleigh/Durham/Chapel Hill area of NC and am just out of hope trying to find a doctor who can prescribe me just enough medicine to get by every day without being terrified of being given the boot /cut off. I have been through hell for the last 6+ months, if someone knows of a good pain doctor who understands and will help me in North Carolina, please shoot me a PM...again, I'm a legit pain patient and really need help...thanks so much...

 

[shadyMyster]

if your so legit you should be able to comply no problems. If they don't believe you, get xrays, mris, and more tests, you can't fake those. It may suck to drive an hour away, but you might as well if you really need the meds. Not many people would voluntarily like to be strictly monitored but it's necessary for several reasons.

 

[ThePharmicist]

Sorry to rant, but I am so sick of the doctors I've been seeing. I cannot find one caring or compassionate doctor that is willing to listen to me. The rheumatologist I've seen twice now has said the exact same thing to me both times. Despite the fact that I've followed his instructions on everything except exercise (he wants me to do low resistance work in a pool, but I prefer light cardio on a stationary bike and low weight - high rep work outs).

On top of that, my Vitamin D is low and he thinks that's the ONLY problem. Pain that's a 7-8 and all you can suggest is Vitamin D? How do you account for swelling and all the other problems! So so ridiculous, I could barely contain my anger today at his office when I came in on short notice for a "re-evaluation." He has wasted my time and money, it's time to find someone that cares. But I am rapidly losing hope.

 

[shadyMyster]

Many here can relate. I'd suggest try a different approach. He doesn't want to hook you up if you're angry, or bitching at him, i'm sure.

If you have records try an online doc maybe, or try being nice and upfront.

Thousands maybe even millions go untreated every year, and even in nursing homes. It's revolting and sick.

 

[endEMBEDA]

Sorry to rant, but I am so sick of the doctors I've been seeing. I cannot find one caring or compassionate doctor that is willing to listen to me. The rheumatologist I've seen twice now has said the exact same thing to me both times. Despite the fact that I've followed his instructions on everything except exercise (he wants me to do low resistance work in a pool, but I prefer light cardio on a stationary bike and low weight - high rep work outs).

On top of that, my Vitamin D is low and he thinks that's the ONLY problem. Pain that's a 7-8 and all you can suggest is Vitamin D? How do you account for swelling and all the other problems! So so ridiculous, I could barely contain my anger today at his office when I came in on short notice for a "re-evaluation." He has wasted my time and money, it's time to find someone that cares. But I am rapidly losing hope.

This is exactly how I feel...I've HAD every test done, but I've moved around so much and these PERMANENT diagnoses have been made over 10 years ago and other various contributing injuries and complications , well, documented all over...i'm not on my parents health insurance anymore...i just had a lumbar MRI 6 months ago (they messed up should have been whole thing) but never pre approved it with my insurance and cost me 1000$...the pain doc i last saw said my only option was meds and that even PT was bad for my condition...i just had to have my first piss test come back and i admitted to having smoked weed and she said it was cool cuz i admitted it and she could write me next time...and, yep...went in second time and it was like being interrogated for murder...i stood up and walked out. oddly, the most concerned doc i've seen thru all this was a young indian woman at an urgent care i went for a cough, just mentioned I had AS, and she looked at my back and saw stuff yadda yadda, asked me about my pain in depth and was actually concerned and gave me personal references and even said i could come back and see/call her...odd...i'm fucked most likley...have to goto the dominican republic for girlfriends nephews baptism and can't bring suboxone i 'found' international. i'm in pain NOW, badly and how is it ethical, at all, to allow someone to be in pain like that, and obviously not a drug seeker/vouched for by other docs etc....its a travesty...
so...speaking of...what are the pharm laws like in the dominican republic? I know being in the "upper class" there, about as much money or less than you would spend here on one appt. will get you a multifaceted and coordinated examination and diagnosis...and obv. with pretty much family there, have a doctor i can be sent to, but, what are you able to purchase over the counter there/how different is the control compared to the US, and if anyone knows well, what can i expect seeing a good doctor there for pain?

 

[edgewise1]

I have just experienced my first herniated disc, the L3 and L4 vertabrae. I had my first appointment back on 5/27 with a neurosurgeon, and my first epidural on 6/01. I've had backaches before but I have had nothing like this before. The disc is pressing on the nerve that runs along the top of my right leg. I have had constant pain in my thigh since this happened on 5/02. My shin and ankle also hurt, especially at night when I go to bed. I had heard people talk about slipped/herniated discs, and about sciatic nerve pain, but never thought much about it until I became affected by it myself. The pain is really depressing as I can walk only with a cane and trips to local stores, especially walmart/grocery stores require that I use the motorized carts the stores provide. I'm 54 and I hope I don't have constant pain to look forward too for the next several years. I had to go on disability, I am a middle school teacher, due to the pain and will the next two months to recover and get ready for the new school year this August.

Anyone that's had an epidural; how did your's work out for your pain? I really got no relief from from the one I had, and have a second one scheduled for the end of the month

Sad to say, or am I ;-) the only thing that has worked so far to reduce the pain are the oxycodone 10/325's I have been prescribed. My first prescription was for 120 of these, to be be taken every 4 to 6 hours as needed for pain. Well that has turned out to be every single day! The sligest wrong move will bring a burning, stabbing pain in my right thigh that would bring me to knees without the cane. I've never experienced this amount of pain for such a long period of time. As a result I usually take 8 percocets daily, instead of the prescribed 6 a day. Even that doesn't take care of all of the pain. I still take tramadol, so I get help from it. I run out of the percocets tomorrow, but it will be Wednesday before I get another script for them, but as I said, I have tramadol and that should hold me until Wednesday.

Just curious, but anyone else that has/had something similar; how long did it take to heal (without surgery) and did you have this constant daily pain? If so did your dr have any problem keeping you on pain meds for several months? The doctor has already told me that it will probably take at least 4 months for this to properly heal and no longer cause me the constant pain I'm experiencing.

 

[ThePharmicist]

Many here can relate. I'd suggest try a different approach. He doesn't want to hook you up if you're angry, or bitching at him, i'm sure.

If you have records try an online doc maybe, or try being nice and upfront.

Thousands maybe even millions go untreated every year, and even in nursing homes. It's revolting and sick.

I wasn't bitching at him, I was simply upset because he wasted my time.

Here's some interesting news, I grabbed my physical therapy/deep tissue massage (oh yeah) order today and was going to call up to schedule the appt. This order is from the doctor that I was really pissed at in my last post. I actually called a patient care coordinator and told them he double books, pushes meds on me, and wasted my time and money. They're refunding me! Anyway, I grab the physical therapy order and on the DIAGNOSIS line it says "Fibromyalgia with Myofascial Pain Syndrome." What!?!? When I asked him when I was in there last time what he thought the problem was, he said "low vitamin d." Yet he's ordering physical therapy based on a diagnosis of Fibromyalgia. I'm really confused, yet relieved, to finally have a diagnosis. Even if he hasn't explicitly stated what the diagnosis was.

I think it's time for me to find a doctor that can help with Fibromyalgia...
Does anyone here have it? If so what can you tell me about treatment options?

 

[shadyMyster]

lol....horray to the diagnosis. Now you can go get meds (possi-bly) if thats what you want. Don't try to milk it to hard ....yet

 

[ThePharmicist]

lol....horray to the diagnosis. Now you can go get meds (possi-bly) if thats what you want. Don't try to milk it to hard ....yet

Called the Doc to confirm that's what the diagnosis is today. He said that what I have is a generic form that he filled out that way just so insurance would cover PT. You've gotta be fucking kidding me. I'm dying here. I have no idea why he wrote that. It just doesn't make sense. I'm seeing another rheumatologist next week. Getting an MRI tomorrow. Gotta figure something out here.

 

[FasttimesNY]

It is actually my Neurosurgeon who is prescribing me the medication. He is of the opinion that due to my heritage, I will be diagnosable with degenerative disc disease within the next few years. We have a really good working relationship and I think he is hesitant to send me along to a PM specialist because he wants to keep a closer eye on my spine. I am happy with this arrangement because honestly, I KNOW my Neurosurgeon believes in my pain. He can clearly see my crushed nerves on the MIRs and has stated to my family in post-op that the size of my herniations are the worst he has seen on a patient under 65 years old. Would it be beneficial to ask him to send me to a PM? Or should I wait until we determine if I have another herniation? Bah, I have enough problems and these issues with my back might just send me over the edge . . .

yes you are absolutely right.

 

[ThePharmicist]

So I'll be going to get some physical therapy tomorrow. Then off to a new GP on Thursday. I'm going to have to tell him that I'm on Suboxone, because of the prescription monitoring programs in MN. So if I was to get a script for anything they'd look me up first and realize that. I'm going to see a new rheumatologist on the 15th, and I'll have to divulge my information to them too.

I'm worried for two reasons, the first reason being that I'm automatically going to be labeled a 'drug seeker' and not just someone who's had problems in the past. Truthfully I've never gone to a doctor to try and get opioid medication, it was easier to come by on the street. I don't want them to treat me like my pain is all in my head either. Just because I've had a problem doesn't mean I'm not in pain. My second concern is if the need arises for me to be prescribed opioid medication. I'm willing to try pretty much anything to manage my pain, but if opioids seem to be the only solution am I going to get turned down? Are they just going to say "You're too high-risk of a patient to be prescribed opioids, sorry, you'll have to stay in pain." I'm seriously really worried here. If opioid pain management is my only option I'm willing to do it, and I feel that I'd be a lot better with it if I had a constant supply and a caring doctor who could check up on me.

I don't want to live in pain because I made some mistakes in the past. Does anyone here have experience being addicted and then doing replacement therapy and then having pain problems? I'm just going to be as honest as possible, and hopefully the doc will understand where I'm coming from. Any suggestions?

 

[edgewise1]

Just do what you stated and be honest from the git-go. Let him know that it was a problem and one that is in the past, and that YOU recognized it for the problem it was and YOU voluntarily sought help, you were forced by courts or anything like that to seek help. Now I assume everything I have said is the truth? If not, still go with the truth as you definately don't want to be caught in a lie!

I would also volunteer to take ua's at every appointment, along with pill counts.

Basically anything and everything that would show you are serious about following the instructions to a T.

Good luck and let us know how it goes!

 

[ThePharmicist]

Just do what you stated and be honest from the git-go. Let him know that it was a problem and one that is in the past, and that YOU recognized it for the problem it was and YOU voluntarily sought help, you were forced by courts or anything like that to seek help. Now I assume everything I have said is the truth? If not, still go with the truth as you definately don't want to be caught in a lie!

I would also volunteer to take ua's at every appointment, along with pill counts.

Basically anything and everything that would show you are serious about following the instructions to a T.

Good luck and let us know how it goes!

Thanks Edgewise. I really appreciate the advice. Yes, everything you have said is to the T correct. I sought help on my own, poured literally thousands upon thousands of dollars (out of pocket) into treatment for my addiction. I think opioid pain management may be a ways down the road for me, obviously I'm going to have to get through all the other hoops before I get there. If there was something non-narcotic they could do to help that would be even better, but so far I've had no luck.

I'll let you know how my appointments go! Thanks for the advice.

Edit: I guess another one of my concerns is the fact that I'm still ON Suboxone. I'm not sure if they'd want to switch me or what, but I'd need a pretty sufficient dose of another opioid due to my tolerance.