Telling my physician my analgesic regimen is ineffective?

[Thanatos]

Without going into the details of my prescriptions, I'll start his thread stating that I live with chronic pain due to a complete knee reconstruction, a compound hand-wrist fracture with 5 fractures that require pinning, a broken jaw that healed incorrectly, and most of all degenerative spondylolysis/spondylothesis that has a high rate of slippage and induced neurological pain from my L4 down to my toes.

As a drug user I do occasionally seek euphoria from my medication(intentionally asked to be given low doses and less recreational medications) but my symptoms have been increasing in frequency and severity. I receive my scripts through my psychiatrist, who is also a chronic pain patient because I can longer afford to see my surgeon for routine reevaluations and imaging studies that have left me over $35,000 in debt.

Would it be unethical to ask my psychiatrist for a more aggressive form of drug treatment since I've been doing intense physical therapy for about 4 years without significant improvement? I'm really not sure how to approach this situation as its the reason I'm currently unemployed and pursuing disability benefits.

Mods- if this is the wrong forum, I apologize. Please relocate as you feel necessary so long as I will have a reasonably high probability of receiving advice. Thanks you Bluelight.

 

[T. Calderone]

I'm surprised that your psychiatrist can prescribe pain medication for you at all. It can't hurt to ask him to give you something else, if he's willing to help you out. When I was in pain management, it was cash-only even when I had insurance so I know it can get expensive. Sorry you're hurting entheo.

 

[Maya]

^I second, I changed the typo to psychiatrist, OP let me know if I got the correct medical professional term otherwise I can change it again for you.

I am very careful with asking for medication or what have you as I try to do natural methods first instead of going into prescriptions. I have had a different problem months ago about a comedown and Acupuncture has helped me with my suffering. Here is the thread for it if you are interested to know some information about this type of treatment:

http://www.bluelight.org/vb/threads/681145-Acupuncture?highlight=Acupuncture

I have suggested this since you have tried physical therapies which has not improved your condition so i suggest that you look into Acupuncture, try at least a couple of appointments and see how you feel. Goodluck and I hope you feel better OP.

 

[Thanatos]

I was also initially surprised that my psychiatrist could prescribe analgesics but they are all schedule 3-RX only. I'm her only patient she does this for because she is also my brothers physician. She has a clean record with the regulating agencies so she is willing to make the exceptions, especially since she has been in contact with my surgeons, sport med MD, and physical therapists for about 4 years now. She has also reviewed the imaging studies and happens to have a similar knee problem.
Maya- I actually have done about 10 sessions o acupuncture and I found it to be a rather neutral treatment method. No negatives, but nothing to make me persue it much more

How should I bring this up? It's giving me bad anxiety.

 

[Maya]

You could try mentioning that the treatments are not making it better and ask him if there are other alternative medication for pain he can prescribe. Ask.him and see what he says I hope you get better OP if anything maybe try to go to a different doctor?

 

[flyhighk]

Just be completely honest, tell her you've been experiencing worsening pain, and ask her is she can do anything about it.

 

[Foreigner]

It's weird that your psych is giving you pain medication, but nothing surprises me these days when it comes to the state of pharma care in our part of the world. But... it is what it is.

Why are you so nervous to bring it up? If what you're saying is the truth and there's no agenda then there should be no problem. Just tell her it's not working and that you believe you need something different.

 

[Thanatos]

^ my psychiatrist is my general practitioner for all relevant purposes.

Well this week I completely tore a few Zone 5 extensor tendons in my dominant hand, as well as gaining more nerve damage along the way. My surgery is on Thursday, but I have no effective pain management for some reason. Would this be because I already have opiod scripts, or because they don't want my tolerance to skyrocket before surgery. Im reluctant to ask for oxycodone or something stronger but anything less would just be a waste.

Any ideas on my situaiton?

 

[flyhighk]

Anesthesia is more complicated when you have an opioid tolerance. Don't forget to tell your surgeon how much and what you're taking. They'll probably give you other meds after the surgery.

 

[Thanatos]

My surgeon is aware of my tolerance and all relevant prescriptions, I just hope that I'm not left with even more neuralgia than I already have. I go to my psychiatrist next week, I'm not sure how to ask for a more effective analgesic regimen since she is aware that my torn tendon was caused by a physical altercation.
I don't want to seem needy but im also in constant pain. I wish I could just afford a CPM Dr.

 

[Sturnam]

Do you have any health insurance? Are you a student by any chance? I'm a chronic pain patient, and fortunately I've found several doctors that will just accept whatever my insurance gives them, despite the fact that they are exclusively out-of-network only, i.e. cash up front. You could try asking about that, saying that you're a student and on a tight budget, etc. Maybe it's just my experience, but my doctors have been really good about helping me out financial wise, and not bleeding me dry.

As for something stronger for pain medicine, I'm assuming you're nervous to ask for something stronger because you might be a young male, i.e. the prototypical drug abuser in their minds; is this correct? To help with this, I would bring them suggestions for 'less abusable' opioids, although that might be subjective. I'm thinking particularly about tapentadol (Nucynta), which has multiple mechanisms of action, and may help your neuropathic pain better than 'standard' opioids (oxycodone).

There's also methadone, which is cheap, relatively long lasting, and again has multiple mechanisms of action that may help delay tolerance, and be better for neuropathic pain. The starting dose for methadone is either 5mg or 10mg t.i.d. (three times daily), and personally I've found that methadone has been great for my pain. However, this one might be tricky, it seems like doctors are polarized on methadone; they either love it or hate it.

 

[Foreigner]

Would this be because I already have opiod scripts, or because they don't want my tolerance to skyrocket before surgery. Im reluctant to ask for oxycodone or something stronger but anything less would just be a waste.

Hard to know. Surgery necessarily requires pain management so the issue should be brought up soon. They shouldn't assume that your script is already adequate for pain management because even with that pre-existing script, you would need new instructions post-op on what to do. Treating chronic pain is not the same as treating post-op pain, even with the same drug. There might be different requirements.

I would really bring that up with the surgeon. To my knowledge it's standard procedure for pain meds to be issued after surgery.