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Misc The Pain Management Mega Thread version 3.0

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_scarlett said:
So I have a couple questions about PM.

My PCP had diagnosed my condition as chronic (due to a car accident I was in) and said she can no longer prescribe me my oxy which WORKS and that she is going to refer me to PM. Is this because she thinks I'm misusing it? I'm not comfortable with any injections, and I'm afraid if I go to PM the doctor will say he cannot prescribe me any opioids based on my age (I'm an adult - 22)....but like I said that's the absolute only thing that helps.

I guess my question is: are PM clinics able to discontinue a medication that is actually beneficial to an actual medical condition? Will I need to get injections, and would they couple them with my prescription for breakthrough pain?

I just obviously don't want to live every fucking day in pain. If I don't take my meds, I'm miserable because of my pain.

I'm not asking how to obtain drugs -- I guess I'm just unfamiliar with the whole PM process.
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Because of the new laws pain management places have to be registered.
It looks like once your condition became diagnosed as Chronic they can not treat it anymore. Chronic pain is treated in pm clinics. This is probably why they stopped prescribing it. It went from acute to chronic.

Now every clinic is different. Shots are very benifical. If you refuse then they can drop you for not following medical advice.

Not all clinics are shot happy.

My new clinic puts me under now. My first shot Hurt really bad so from now on I'm knocked out. Idc I get IV goodies then wake up with more pain relief (hopefully) and I'm buzzed for the day. Yes the shots scare me but I have to look for the positive in this.

My old clinic, well it was a tad bit shady. They were cash only. I filed scripts on insurance they treated me very well. I might go back to them. I can do mail order prescriptions. I left because no pharmacy besides cash only filled them. I can not afford that.


Because of all the drug hype who knows if you get to keep the meds that actually work. They may switch them up to see if you benifit from something else. They may keep you on the same things. Talk to them first. See how they respond.

I wish you lots of luck. I hope you find the pain relief you need.
 
I started PM at 25. I went from being labeled a drug seeker with horrible pain to being adequately treated by an awesome doctor. Just go in and be straight up with them.
 
_scarlett said:
I guess my question is: are PM clinics able to discontinue a medication that is actually beneficial to an actual medical condition? Will I need to get injections, and would they couple them with my prescription for breakthrough pain?
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in order: yes, they could. maybe. maybe.

they will likely want you to try injections and they will likely want you to try PT. it's not clear from your original post if you have.

as to why your PCP is referring you to PM instead of continuing to treat it herself, it is likely that she doesn't want any scrutiny over treating someone that is a chronic pain patient.
 
Yeah, it's pretty rare to find PCPs who are comfortable enough to prescribe opioids long term. The DEA is more understanding of doctors who specialize in pain management or anesthesiology compared to a PCP when narcotics are involved (which is pretty much standard at pain clinics)
 
michael said:
as to why your PCP is referring you to PM instead of continuing to treat it herself, it is likely that she doesn't want any scrutiny over treating someone that is a chronic pain patient.
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sadly, that's likely the truth.

i've personally never had to go through the efforts of seeing a PM doc as the nearest is 3 hours drive away and i've a definitive diagnoses so my doctors have never felt too uncomfortable with my prescriptions.

a trend i've noticed is it's the newer, younger docs who are more reluctant to prescribe and instead refer you to a PM doc failing physical therapy adjunct to a short term opioid treatment, and any other suggestions they may have given within that term.

i tried cutting cold turkey going 3 days back and with the worst of the withdrawals over the pain has only intensified and i've been unable to sleep for the most part - spending my nights tossing and turning, sweating, getting an hours sleep here and there. work has been hell to say the least but my boss knows about my use and is pretty cool and understanding about it so i've escaped lightly not turning up yesterday - turns out i wasn't meant to anyway:D

so i caved in today and took a dose because i have to rock up to my boss' house and drop off some gear and do some cleaning sometime today at my own leisure. the diarrhea has certainly settled since dosing:|

i hate sharting :|
 
tricomb said:
Yeah, it's pretty rare to find PCPs who are comfortable enough to prescribe opioids long term. The DEA is more understanding of doctors who specialize in pain management or anesthesiology compared to a PCP when narcotics are involved (which is pretty much standard at pain clinics)
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^Couldn't have said it better.
 
milagro said:
Okay, I see your situation with a little more clarity. I am glad to hear you take the meds via the (ROA) Route of Administration they are supposed to be taken. You are right again about asking a PRIMARY doc for specific drugs like oxycontin. Not a great idea unless you have a great relationship with the doc and he knows you are not a drug seeker, you are simply in a lot of pain.

I do not know how things are where you live but it is becoming more and more the norm for Pain Management Doctors to operate as a specialty outside of General internal or Family medicine. If your doctor is getting recommendations from the pain clinic why not get a referral to the pain clinic? Primary care physicians in my area would not even touch prescribing morphine unless there was a barrier preventing you from being seen in a pain management setting. They stay away from prescribing the types of medications you seem to need due to new laws, regulations, the DEA, etc. etc.

I think it is wrong but it is due to doctors that were prescribing meds like oxycontin without monitoring their patients and some patients began abusing them, selling them, what have you which led to a dramatic increases in OD's and addiction problems. Huge lawsuits were filed against the manufacturer -Different subect.

Doctors will usually use whatever worked for you in the past without much hesitation. If vicodin worked before then hint that you might need something a little stronger for acute flare ups but go with Norco which is the same drug only less acetaminophen than Vicodin. Tell them about your experience with Fentanyl and your desire to stay away from it. Percocet is just oxydodone with acetaminophen (tylenol) and I think acetaminophen is one of the most hepatotoxic medications out there. I use oxy without the Tylenol. I am trying to get away from oxy because of the rapid tolerance I seem to develop and I am tinkering with Buprenorphine, another opioid that is usually only prescribed at pain clinics.

See, I told you I would start throwing a bunch of medications at you. Sorry. I have been through a lot since entering pain management. My orthopedic specialists had exhausted all of their tools to help me and they gave me my first referral to a pain clinic about 7 years ago. I do not know if it is something you want to look into but I will give you a general overview of pain management.

If you can get a referral to the pain clinic then take it if your insurance will cover it. The best pain clinics I have found are run by doctors with an MD in Anesthesiology and further certification in pain management. They can offer injection therapy along with other comprehensive treatments including medication management. They have far more power to prescribe meds like Oxycontin or Opana.

You usually have to be a good little patient and pee in cups randomly and in my case bring my flipping meds in and have them counted randomly. The latter has never happened yet and probably will not as long as I pass all my UA's. But I do not rule it out. I could go on about why things have become so strict but that doesn't help you much. Pain clinics specialize in treating chronic pain and try to focus on the entire individual as relates to the pain they are encountering.

It is up to you to be your own advocate and say "Hey man, I am in living hell and the medication is just not doing the job". I am rambling so to conclude I want to clue you in to this bit about oxycontin not being the same. It most definitely isn't. I remember taking it before the reformulation and it took the pain away faster than anything I have ever used but it made me manic so I stopped using it. They reformulated it for the reasons you mentioned. It can no longer be smoked crushed into a fined powder or manipulated the way it used to be.

After I had been through methadone, hydromorphone, hydrocodone, combining this with that and not getting sufficient relief, my pain doc finally went with Oxycontin, the new OP version. IMO it is not as effective as it was before but it is still, for me, the most effective baseline (extended release) med. I just wish its analgesia would last longer and not create tolerance as quickly as it does for me.

I wish you luck as chronic pain can completely ruin one's life. Again, be your own advocate and do not let the doctors take complete charge of your care. If something isn't working then speak up. Sorry for the megapost. I should have gone into law where rambling is the norm.
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I should've clarified as it would've saved you some typing, sorry!

My PM is essentially putting me in a PM "program" (using it loosely) I have to adhere to all the contract rules, drug tests, pill counts, no early refills, etc. I also cannot get into the clinic because it's a year long wait to get in, it's also a good 30 minute drive each way. The old PM doctor is an hour each way, driving that far is problematic but I'll do it if my current doctor isn't effective.

I'm no PM noobie either, been in 2 different ones before this and it's been going on for 8 years with a couple years away due to no insurance.

I stuck to morphine as it used to work, now? I'm worried because at one time 15mg was good until my tolerance built up. Now from day #1 it hasn't worked, and either the brand of generic is totally ineffective (it's different than my old one) or my tolerance is permanent or something. I'm angry as hell today over it, it's been a month of a NEW back pain on top of all the old shit and I'm taking all 3 morphine and getting nothing from them.

It's fucking...ugh. I'm pissed. Doctor is on vacation and even if he wasn't the contract states if your dose doesn't work, too bad you wait until your refill date.

It honestly makes me want to stop taking them out of anger. What the fuck changed that caused me to just be immune to them totally? Currently I'm on 45mg of Morphine, 800mg of Ibuprofen and 20mg of Flexeril and I'm still in pain.
 
just droppin in, haven't been doing well. today WAS refill day(not early) until the pm clinic decided to drop me. so i get to go without meds again, scheduled an appointment with my pcp for tomorrow afternoon, i hope she gives me something until a referral for another pm doc can get happenin. hope everyone else is doing ok.
 
Ho-Chi-Minh said:
I think pain is more over-treated than under. If people really want pain relief that bad they'll opt for marijuana when opiates aren't available and its overall just as effective. People who aren't adequately treated usually abused their medication in the past.
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Marijuana is not available in all states. Mine is one of them. :( I would live to try it for pain. But I can not. I don't know what will happen in the future. If I smoke today. My pm dr dropped me for what ever reason, I will have to find a new one.
If they drug test then I'm in trouble.

I have never abused pain medication. I know many people who never abused pain medications and and are under treated for pain. But on the other hand, I know many people who take it for the euphoria.

I know one chick who is clear as day a drug addict, she gets everything.

I have known patients who have twisted spines and broken hips who get Advil.
 
zoey what state are you in? here we have the mmj but it did nothing for my pain, however smoking a couple times a month(to avoid detection on a ua) has had me seizure free for seven months
 
I'm in Texas :(

They won't have anything on ballot intil sometime in 2013 from what I have read on medial Marijuana forums.
 
norcophile said:
just droppin in, haven't been doing well. today WAS refill day(not early) until the pm clinic decided to drop me. so i get to go without meds again, scheduled an appointment with my pcp for tomorrow afternoon, i hope she gives me something until a referral for another pm doc can get happenin. hope everyone else is doing ok.
Click to expand...

oh no! what happened?
 
Hey all...sorry I've been absent the past couple weeks...been busy with my outpatient program and in bupe withdrawals, so it's been a bit exhausting...The psych of the program has been giving me .2mg clonidine and 200mg of tramadol a day to work with, so even in one dose it barely does anything...I should be more active now as I feel I'm coming towards the end of withdrawals...been really irritable the past few days though, so I hope I don't go into PAWS for very long...by the way, my pupils aren't blown out anymore, but I've still been having the nausea, frequent bathroom stops and other symptoms, so it's got me wondering exactly how long this lasts? Anyone with buprenorphine experience able to answer that? Thankfully I've been panic attack free for about a week, but still dealing with moderate anxiety (as I was dropped from kpin and bupe at the same time)...gotta love just getting tossed off a drug instead of getting a taper...I guess that's what I guess for sticking with a doctor with the personality of a doorknob...she's really bitchy as well lol...
 
Hi Everyone,
Haven't read any posts, so I apologize if I am butting in at an inappropriate time :)
Just miss you guys tons. Haven't been feeling too hot lately. it started about a month ago with low energy and constant fatigue. finally a couple of weeks ago I started having severe left side pain and found out I have a bad kidney infection. got antibiotics and felt better for the first day and its just been going downhill since then. .
I just feel so useless. Folding laundry makes me so tired I shake all over. I'm not fixing meals for my family, not talking to friends, etc...
sorry for complaining. I'm just really down, and with all the pain meds I'm on, I cannot believe something doesn't make me feel better lol.
by the way, if any part of this does not make sense it's because I'm using the microphone. It's much easier for me than typing right now.
I hope you all are doing well. Thanks for listening.
 
Hi all, it's been awhile since I've had access to the Internet but I'm back:) I was homeless for about a month, but my family and I are in a new place now thanks to the local action agency who will be paying our bills until my husbands disability goes through. I got denied once, getting ready to reapply. Nothing new for me on the pm front. My Dr. cut me off of pain meds back in June, won't put me back on them, and I can't find a pain clinic that works with Fibro patients and takes my insurance. So I still can't work, and I still sit here suffering. I got through the withdrawls and PAWS and so now I'm just back to my ever present pain until I find a Dr. that doesn't have their heads shoved up their ass. I flipped out at my last dr. appt, and she wanted me to start going to counceling and seeing a behavioral therapist. Wanted me to switch to Seraquil and Abilify for depression and anxiety since the magical Cymbalta is doing nothing. The visious circle I'm currently stuck in? My Dr. convinced that my pain is being caused by my depression and anxiety, and I'm convinced that my depression and anxiety is caused by my pain. I've been on so many different psych drugs and none of them have done jack for my pain, depression, or anxiety. I'm tired of stupid doctors. I'm hitting a brick wall here and I'm getting frustrated. I can't even find a support group for chronic pain sufferer's, let alone one for fibro.
 
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Yeah chronic pain does turn into a very very vicious circle. I often believe its just easier for docs to say your in pain because your depressed and not the other way round. I mean surely its more logical to assume that one is depressed BECAUSE they are in pain and are currently being undertreated and made to feel like it is somehow their fault that they are feeling so bad, which in my own personal experience makes the whole thing worse. Especially if your parents catch wind of this pain because of depression theory, that in no way can be proven. Its because they themselves don't have to go through what your having to and so cannot relate, Im sure if they spent 2 months in your shoes they would never suggest such stupid things.
 
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