Dose - Obtaining prescriptions

[Vitamin Airplane]

SWIM suffers from severe back pain, and has had his 3rd surgery. SWIM's doc has prescribed a lot of low doses of different things. Currently, SWIM is getting irritated because doc does not think SWIM should be taking more than 2mg of hydromorphone per day, which does absolutely nothing for SWIM. SWIM likes to inject at least 6mg, so his prescriptions go fast.

SWIM's question is, how can one get a doctor to prescribe something better or at least give a reasonable dosage? SWIM has been very careful not to ask his doc for pain meds, since they tend to get weird about it, but he's getting frustrated with the low doses. SWIM has told his doc that he just seems to have a high tolerance to most pain medications. (which is completely true, whether SWIM has been on them or not)

SWIM would appreciate any advice or experiences from others. SWIM couldn't even get his doc to prescribe more than 5mg oxycodone, before and after surgery. He did prescribe Oxycontin, but only the cheap ones that turn to gel. SWIM is wondering how anyone can get any doc to prescribe such high doses as 80mg! How is this done?

[trannyboy]

SWIM just goes to their doctor and says please write a script for X at X dosage and the doctor does. However SWIM has a very good doctor. My best suggestion is to be straight forward and tell the doctor this isn`t working and you need higher doses/ different medication. If your doctor isn't listening then maybe you need a new doctor. Sorry I can't be more help but that is what I would do.

trannyboy

[Vitamin Airplane]

Yeah, it's getting hard to find a decent doctor these days.

[OhCasey]

You might want to try keeping a pain diary. Mark down when you take your meds how much pain youre in after taking the meds and if your sleep is interrupted by the pain and you wake up in the middle of the night make sure to mark that down. Overall just try and convey how much your quality of life is affected by the pain youre in. The pain journal could be faked or exaggerated if one wanted to but its useful since doctors love seeing their patients be proactive and they usually eat the journal type stuff up.

Reputation Comments on this post:

	the journal idea is the right idea, they do work
	Great idea! Good suggestion to help the OP out!

[soft.assasin]

Originally Posted by OhCasey

You might want to try keeping a pain diary. Mark down when you take your meds how much pain youre in after taking the meds and if your sleep is interrupted by the pain and you wake up in the middle of the night make sure to mark that down. Overall just try and convey how much your quality of life is affected by the pain youre in. The pain journal could be faked or exaggerated if one wanted to but its useful since doctors love seeing their patients be proactive and they usually eat the journal type stuff up.

Brilliant plan. SWIM has personal experience with this. Was in car accident in Oct 07 and suffers from major back pain until this day. In the beginning it wasn't hard getting stronger doses of pain medication, but as time wore on the doctors started to hold out a bit. SWIM explained that she was in a great deal of pain still and had a high tolerance to pain medications (also true). SWIM kept a "pain journal" for roughly two weeks, explaining how the current medication wasn't helping enough and took it to both her GP and an orthopedic specialist who subsequently increased dosage. The best thing, SWIM has found, is to be straight-forward. Explain that you understand the consequences of using narcotic pain medications regularly and why the doctor is reluctant to dole out. Sometimes being too closed-mouth on the subject makes one seem more suspect. Good luck!

soft.assasin added 2 Minutes and 23 Seconds later...

[QUOTE=Vitamin Airplane;620757] This is why SWIM is getting pissed off. Neither MRI's nor X-rays have ever showed much. But each time, the surgeons have always found a definite problem when they opened him up. Things can't always be seen in MRI's, apparently. QUOTE]

This happened to SWIM too. Really frustrating.

[Vitamin Airplane]

Very good idea! Like a scientific documentation of pain levels and the effects of the meds on that pain? That might help SWIMS disability hearing, too. Thanks.

[trannyboy]

The pain diary is really smart idea. Other options might be to bring a partner, parent, sibling, close friend or another loved one with you to your appointment who advocate for you and help the doctor understand the level of pain you are in and how ineffective the medication currently is. You might also want to request a referral to a pain specialist if you want to keep seeing this doctor for day to day stuff but also get the meds you need. If I think of anything else I will let you know. Good luck and I hope you will be out of pain soon.

trannyboy

[MEKONE]

Being honest with your Dr. is the best advise SWIM can give.Tell him that you have been currently taking his prescribed dose of meds for "X" amount of time,and that it is NOT working.Ask if there is anything else he/she can prescribe or better ask if they "Know" of anything else that might help(that would put him/her in the drivers seat,they like that).NEVER ask for a specific med or a specific dose.If the Dr. ABSOLUTELY refuses to help SWIY out then it's time for a new Dr.
SWIM knows it is hard to find a GOOD Dr. that is willing to help as most of them feel that a certin amount of a med should be good enough but that isn't always the case.
On another note telling your Dr. that you have a "High Tolerance" is NOT a good idea.That would automaticly get them thinking SWIY has an addiction.For future conversations with a Dr. just simply state that SWIY is NOT getting relief,leave out the "High Tolerance" part.
Good Luck,and keep us posted!!!

[Vitamin Airplane]

SWIM only told him about his tolerance because of his last surgery experience. He went into shock because they refused to give him enough medication in the hospital. Only then did they give the PCA Dilaudid button thing...and that was still too low of a dosage. Even SWIM's doc admits that not everyone reacts the same to meds, so I don't believe informing him of SWIM's tolerance is necessarily a bad thing. SWIM has been seeing this doc for a long time now. SWIM has indeed let the doc have the driver seat. I believe SWIM's doc is just getting paranoid. He mentioned something about his license being on the line, and how people sell these drugs on the street. This pissed SWIM off...it's almost an accusation, and implies that doc does not trust SWIM. Perhaps SWIM does need a new doc.

[pinksox]

No, SWIM should probably stay with his longterm doc and ask for a referral to a pain specialist. Most surgeons or PCP's, don't have the same expertise in pain control that a pain specialist does. Many end up either under-prescribing and having patients suffering and in pain, or over prescribing and having patients OD, become addicted, or divert for money. They don't really have the knowledge or the resources to monitor for adequate control while remaining vigilant for signs of addiction or diversion.

And SWIY's doc is correct. His livlihood and license IS on the line. But if he doesn't feel comfortable prescribing a larger dose...and SWIM feels his pain isn't being adequately controlled, then he really ought refer SWIY to a pain specialist.

It may not be a matter of his not trusting SWIY, he may just have a general policy of never prescribing over "X" amount to any patient. But, if he's going to do that, then he has a duty, yes, duty, to refer patients who need better control to a specialist. Since he hasn't, SWIY should call and ask for a referral.

In the meantime, there are many, many alternative methods for pain control. Has SWIY tried or looked into any of those?

[Vitamin Airplane]

He actually has referred SWIM to PT and a pain management center, but SWIM lives kind of far away from everything and finds it difficult to get to any of these places, which are about a min of an hour away, in any direction. SWIM's local doc is a sports med doc who specializes in spinal injuries.

SWIM has already been to pain specialists before the surgery, and they seemed even less open to meds than SWIM's doc. All they wanted to do was PT and epidural, which did not work at all.

Should SWIM ask his doc if this policy is the case? SWIM really doesn't want to start from square one again, trying to earn the trust of a new doc who wants to start at the min dosages again, as they always seem to. Around here, it's hard to find a clinic that will even prescribe narcotics at all. SWIM has been frustrated by this for years, as all docs can indeed prescribe anything they want, if they feel it beneficial.

[beentheredonethatagain]

Originally Posted by Vitamin Airplane

SWIM suffers from severe back pain, and has had his 3rd surgery. SWIM's doc has prescribed a lot of low doses of different things. Currently, SWIM is getting irritated because doc does not think SWIM should be taking more than 2mg of hydromorphone per day, which does absolutely nothing for SWIM. SWIM likes to inject at least 6mg, so his prescriptions go fast.

SWIM's question is, how can one get a doctor to prescribe something better or at least give a reasonable dosage? SWIM has been very careful not to ask his doc for pain meds, since they tend to get weird about it, but he's getting frustrated with the low doses. SWIM has told his doc that he just seems to have a high tolerance to most pain medications. (which is completely true, whether SWIM has been on them or not)

SWIM would appreciate any advice or experiences from others. SWIM couldn't even get his doc to prescribe more than 5mg oxycodone, before and after surgery. He did prescribe Oxycontin, but only the cheap ones that turn to gel. SWIM is wondering how anyone can get any doc to prescribe such high doses as 80mg! How is this done?

it doesnt make the doctor bad because he is giving you pain meds , shooting them in one or two days is your idea, yeah your tolerance is high.

we cant advice you on what to tell the doctor , it would be against the rules to help someone gain medications under false pretences.

Reputation Comments on this post:

Nobody was breaking any rules. leave the Judgement outside of the forum

[Vitamin Airplane]

When you're in serious pain, you will sometimes do anything to ease that pain...especially if you're not being prescribed an adequate dosage or medication. Anyone who has been in very serious pain should understand that. There are no false pretenses here.

Vitamin Airplane added 3 Minutes and 24 Seconds later...

Originally Posted by beentheredonethatagain

it doesnt make the doctor bad because he is giving you pain meds , shooting them in one or two days is your idea, yeah your tolerance is high.

we cant advice you on what to tell the doctor , it would be against the rules to help someone gain medications under false pretences.

Easy for you to say, since you're not the one in pain. If SWIM is given an adequate dose or adequate medication, he wouldn't need to resort to such tactics.

[nick23]

It's sad,but true to say that being honest with doctors is a crap shoot.

Either way,finding a doc who'll write requires persistence.

Oh and always be polite-it goes a long way.

[Vitamin Airplane]

SWIM is very polite and allows doc to determine meds. Although, SWIM has told him that the Dilaudid works the best, so far, but only at higher dosage. Doc still insists SWIM take only 2mg at night. SWIM is thinking of talking to doc as honestly as possible and telling him that he really feels under medicated for his level of pain, and maybe show him the pain documentation he has started. SWIM thinks that was an excellent idea. SWIM is trying to avoid switching docs, since that tends to bring up red flags in the medical communities.
SWIM's vehicle has been in the shop for over a month, which makes getting to these distant pain management and/or rehab clinics even more difficult. It's been on hold for that reason.

[trannyboy]

I just saw that you mentioned PT or what I assume means physical therapy. The fact that you don't follow through with physical therapy is a bad sign to the doctor. In almost every case I have seen where patients rely on pain medication instead of using pain medication as one component of their overall treatment; the patient suffers needlessly. Now I am not saying physical therapy or any adjuctive treatment will cure your problems but a) neither will drugs and b) they each can offer a bit of relief. I understand that is difficult to get there but so is being in pain and being addicted to drugs. Adjunctive treatment is just that adjunctive, it is meant to minimize the overall problem and each little bit helps. So maybe physical therapy only helps 5% of your pain that is still 5% less then before and if you combine that with say acupressure or acupuncture maybe that number can be up to 10% (btw I am using hypothetical amounts), then maybe you add some biofeedback in the mix and things are a little better still. You can learn what physical therapy exercises helps and do them at home. In my experience patients who follow through with all elements of their treatment do much better then those who don't. It is extremely rare for injuries to exist in isolation, usually things we do effect our pain levels. If your goal is to be stoned on drugs all the time sure then just seek out a doctor who writes scripts blindly but if your goal is to be in the least pain possible and to be as functional as possible you need to fighting for every little bit of treatment even if it means travelling from here to timbuktu. Do you see what I mean? Nobody else but you can take the steps you need to take and nobody but you should be fighting as hard as you to get feel better. All too often I see patients who treat drugs like a panacea but it isn't it is an adjunctive treatment like physiotherapy, massage, strength training etc. Yes it has the power to temporarily relieve your pain but at a much higher cost then many other treatments or travelling to get them.

trannyboy

Reputation Comments on this post:

Good points. Pts who dont follow-thru on non-narcotic therapies are the ones docs are less likely to write for AND are ...

[Vitamin Airplane]

But SWIM has never been addicted to drugs. He's not one of those people who have that problem. SWIM has been on some serious pain killers after each surgery, and SWIM has always managed to ween himself off of them just fine, after the pain is tolerable.
Physical therapy causes more pain. Sometimes, you have to wait until you're stable enough to do things before it's helpful. SWIM has been through this 3 times now. PT does not really help. SWIM is a pretty active person anyway, and probably does a lot more than he should, most of the time.
The first time SWIM had surgery, he went through all the PT they wanted him to go through. After every session, SWIM just hurt more and ended up spending large amounts of money going to a Chiropractor after every session. The Chiro was much more effective than PT. SWIM has also tried alternatives...such as acupuncture. That was definitely not for SWIM. He hated it, and thought he'd run out of that room screaming if that Chinese guy didn't remove the needles very soon. LOL

SWIM has learned the exercises and does do them at home. SWIM does not believe these exercises are helping at all. In fact, they only cause more pain. What does seem to help SWIM most is walking and riding a bike, which he has started doing, now that it's warming up. This is SWIM's 3rd identical surgery, so he has a pretty damn good idea how the program works. But, back when SWIM had his last surgery, he had no problem getting powerful enough meds from the doc. Now days, the surgeon claims they are not responsible for post care at all and told SWIM to go back to his reg doc. SWIM's surgeon does not believe in medication at all. He was given one or two bottles of 5mg oxycodones and that's it. Then he was left to suffer, pretty much. This is not the way it used to be.

SWIM's goal is to be able to waterski again someday (and carry things, like his guitar amps), so he's not just sitting around. Before his disk blew out again, he was working out and relatively pain free. For some reason, he just has a reoccurring disk problem. It's always the same disk, and SWIM will not even go see a doc until he can't stand it anymore. (Sometimes, it passes and everything is ok.) He tried everything to avoid surgery again, as he did the last two times.

SWIM has gone up against doctors/experts in disability court who claimed that SWIM was not entitled to benefits because the surgery generally fixes the problem. SWIM pointed out that the surgery usually doesn't have to be done multiple times if you're cured, and won his case with no problem.
Back then, SWIM was not in pain and he was working and living a normal, relatively drug free life, except for occasional weekend partying.

After SWIM's first surgery, it just took time to heal. Unfortunately, it took about a year to heal...in which time SWIM experienced a lot of daily pain, as he does now. SWIM does not want to rely on drugs, but when pain is severe, SWIM feels like there is no other choice. Nobody wants to live in pain.

SWIM's regular doc told him to go back and see his surgeon again, which he did. They took X-rays and said everything looked fine. He offered no further help, but told him that he did not think it was a good idea to be on 24/7 slow release drugs, such as Oxycontin. SWIM agrees entirely. SWIM only wants short acting meds around for those times when he really needs them, and he told this to his regular doc.

Vitamin Airplane added 13 Minutes and 47 Seconds later...

In short, SWIM believes he can overcome this, as he already has twice before (at least for a few years at a time), but he does want to have something to kill the pain when it's more severe. SWIM has had recent pain so bad that he would've gone to the ER, if his insurance covered ambulance rides. But then again, the many trips he made to the ER were not very helpful before the surgery. They too do not seem to want to give SWIM enough pain medication. Last time this happened, they just gave SWIM meds until the pain was relieved. Things have changed. They'd rather just let someone go into shock these days, so it seems. There is way too much stigmata around drugs these days. Even if you really need them, it's hard to find anyone that will prescribe much.

[beentheredonethatagain]

You know I do know about chronic pain, alot. look at all the freakin pills that I have gotten from doctors, there here .

http://www.drugs-forum.com/forum/album.php?albumid=170

ask your doctor to allow you something for the breakthrough pain, this is a term that they use and understand. it is the starting point , if he won't then I will advise you on what I had to do to get the proper medicines.

[Vitamin Airplane]

Thanks. I'll mention that at my next appt.

[beentheredonethatagain]

Originally Posted by Vitamin Airplane

Thanks. I'll mention that at my next appt.

you are welcome. I want to be helpful, it does suck when the treatment is not working, I do feel your situation.

and I didnt get the whole scope of your plight early on in your posts, it just sounded like you were seeking a method to score a script, I do apologise.

[hamsterdam]

swim cannot believe that doctors recommend garbage like acupuncture.

Where's the SCIENTIFIC evidence that it's helpful?

If anything it's more harm then good. Punching holes in your skin lets bacteria in, you might as well sit at home and slit your wrists, it's a much cheaper way of getting yourself an infection.

if swim's doctor recommended acupuncture.. he'd flat out say he's not going to try something that's not backed by medical science, and that's a valid point. you're not going to some "holistic healer", you're going to an MD who spent many years learning about medical science.

Same goes for any quack who recommends an herbal treatment that isn't backed by clinical trials.

No clinical trial, no way!

[Vitamin Airplane]

Originally Posted by hamsterdam

swim cannot believe that doctors recommend garbage like acupuncture.

No doctor has ever suggested that SWIM try acupuncture. It was just a last (really last) resort to surgery.

[hamsterdam]

Originally Posted by Vitamin Airplane

No doctor has ever suggested that SWIM try acupuncture. It was just a last (really last) resort to surgery.

Ah.. ok.

There are "doctors" who actually will suggest things like that. They should have their licenses revoked and be thrown in jail.

[trannyboy]

I have seen people get better with acupressure and acupuncture. Personally I prefer the idea of acupressure because I see no point in making holes in the body if not absolutely needed. I see no reason to pull someone license because they suggest alternate therapies that do work for some. You are well within your rights to refuse said suggestion without it affecting further treatment options or seek another practioner but it seems excessive to pull someones license for suggesting something that people have used for 1000s of years with sucess. I personally don't believe acupressure/ acupuncture theory of chi is correct but that doesn't mean I haven't personally seen it work for some or that there might not be another reason it works. For instance studies show people who pray/ meditate get better faster then those who don't pray/ meditate. Do I believe that prayer cures people? No, I don't but I do believe that the mind is capable of doing amazing things that none of us really understand. Heck doctors don't even fully understand why codeine works but people use it and feel better. At the end of the day getting better is all that really matters to me and many I know. I don't really care what I have to do to feel better if it works great, otherwise on to the next thing.

trannyboy

[MEKONE]

I'm not quite sure how long SWIY has been dealing with this but it does seem like a long time.SWIY needs to realize that the "Sports Medicine" Dr can only go so far and will only prescribe certine meds that they feel comfortable with.Like mentioned before SWIY NEEDS to start seeing a pain mannagement Dr.Even if SWIY starts off with low doses I'm sure they will adjust the meds accordingly after time.
SWIM started off with his Ortho Dr,who scripted Vicoden ES, provided PT,and cortizone injections which caused more PN than good.He was then refered to a Neuro Dr for further tests.Once the tests came back positive for permanant nerve dammage the Ortho Dr then refered SWIM to a PN management Dr.(about a year later,because the Ortho Dr. couldn't/didn't want to keep scripting SWIM with Vics) who started SWIM off on Tramadol(Which really did NOTHING).SWIM went along with the program and told the PN Dr. how he felt,still in PN.From there the PN Dr felt comfortable and started adjusting the meds to fit SWIM's needs.As for epidurals,SWIM's PN Dr. felt that they MIGHT help him and after some time SWIM did have a series done which actually aggrivated his PN(See where SWIM's going here?At least SWIY makes any and all efforts).SWIM's Dr has advised SWIM that PN meds have to be a part of his life unless he wants to deal with PN.

Basicly what I'm trying to say is that SWIY REALLY needs to start PN Management.Even if in the beginning the meds are NOT the greatest it will at least give SWIY the chance to start a relationship with a PN Dr.
Even though SWIY had mentioned before none of these Dr's are near SWIY,SWIY still needs to make an effort on their part as it seems SWIY is going to get nowheres with their Ortho Dr.

Reputation Comments on this post:

Excellent Advice and right on the money!!!