October 18, 2009 - 12:44pm
I have been on this site many times and I am glad to know that you guys are here for people with chronic pain. I am trying to make some important decisions in my life. I will try to keep this short; just so you know I tend to get wordy! First I am a nurse. I have worked in the OR and ER for about 20 years. I had to stop the OR and ER due to my back problems. I still work as a nurse just had to find a job that was less demanding. I was diagnosed 2 years ago with Grade 1 anterolisthesis at L5-S1 with chronic bilateral spondylolysis. Severe left sided neural foraminal stenosis at L5-S1 with compression of exiting left L5 root and a mild compressin of the exiting right L5 root . Severe DDD. This was taken straight from the MRI. There are alot of big words and as a nurse, I can't even pronouce them! My neurosurgeon wants to do surgery... fusion with metal rods, plates and screws, and bone grafting. I have done much research on this procedure and not convinced this procedure is gonna work. The statistics are not that great. I am told by many people not to have surgery on your back!!!!
I currently see a PCP for pain control. She only prescribes me 10/500mg Lortab #60 a month. I am still in pain. I have been to a pain clinic and all he wanted to do was the ESI. I had 3 and they were unsuccessful. He would not prescribe any meds other than Ultram and Lyrica. Neither of which I could take due to unpleasant side effects. My neurosurgeon referred me to this PCP and she gives me the Lortab. In my area, they are very strict with pain meds even if you have documentation proving the need. At least that has been my experience. Seems as if the doctors want me to have surgery to "make my pain go away". I am not convinced that surgery will make my "pain go away". I have elected not to have surgery at this time for several reasons. Mainly financial reasons due to being out of work for 6-12 months recovering from this surgery. Another reason is that I am scared to death to have this done in fear of being worse off as far as pain goes. The fusion surgery is only gonna fix one of my problems. I will still have issues with the DDD and the stenosis after surgery.
I would like to find someone to help me with pain control. I have been on Lortab going on 2 years. I am finding it is not helping like it did at first. I have talked to my PCP and she refuses to change the med or up the # I get a month. She only allows 2 pills a day!! "I don't care how you take them but you only get 60 a month...make it last!" per PCP. I hurt all day, it is worse in the mornings and wakes me up in the middle of the night. I am a mother, wife, and a nurse. The 3 things I love about my life. Why won't anyone help me with pain control so that I can enjoy the 3 things I love the most??? I have gone to other doctors but they always turn me away or refer me back to my neurosurgeon. They don't want to deal with it. I am tired of being turned away and I don't want surgery!! Frustrated!
My questions to you guys are has anyone out there had this type of surgery done and how was your experience? Do any of you recommend having the surgery? What can I do about pain control for now? I don't understand that if I can control my pain with meds, why won't someone help me? I read all these posts about everyone else taking meds to control their pain and seem to have doctors willing to help... What can I do?? I am in the SC/NC area.(close to Charlotte NC) Any advise would be greatly appreciated!
Sorry for the long post. It felt good to finally get this off my chest! Thanks for listening! I hope I have followed the rules! I don't mean any harm if I said something wrong.
October 18, 2009 - 6:51pm
#2
Thanks Med Head!
I am trying my best to keep surgery as a last resort. As you can tell, I am a little frustrated as I have tried to look for a doc.... maybe I am not being firm enough. Just not my personality ,I guess?? After you have been turned down by 5 docs, it gets to the point of no return. I guess I don't know where to start or what to say. It is a big stigma around here with narcotics and docs don't want to treat CP patients. I really don't want to mess with pain clinics because of the hassles, but I guess I am going to have to look for one. You have to start with their regimen before they will prescribe narcotics. I just hate having to start over with the injections again. It actually made my pain worse for a while.
Charlotte only has one pain clinic. We are not as big as people think... :)
I have talked with my PCP. She's the one who denied my request for a change in meds to percocet and also denied my request to up the # of pills each month. She said you get 60 and that's it. She actually writes it for a half a tab twice daily. For a big total of 10mgs/day. I did ask her if I could take a whole pill and she says I don't care how you take it just make it last. So I feel I have to "obey"(for lack of a better word) her orders in fear of not being able to get what little relief I get.
Just wondering if there was anyone here that can give me insight on the surgery. My neurosurgeon told me that eventually I will need it. Or if there is anyone here from my area that can offer some advice on where to go, what to say?? something! Just glad to hear that I am not alone in this battle.
Thanks again for listening to me vent! You are very kind Med Head.
October 18, 2009 - 7:20pm
#3
your numbers not adding up
in 1st post you get 60 10mgs hydros twice daily
2nd post you get 2 halves daily for a total of 10mgs per day, are you taking the other 10 at nite
would ask Your Dr. to let you try 30mg morphine sulfate ER TWICE DAILY
if there s no give you may have to find another pain management clinic, I ll agree, there s only a 50/50 chance the surgery will aleve the pain, if there where spurs to be removed that be a different matter.
I always preach 800mgs of ibuprohen daily for imflammation.
hope You get better releif.
WOODSTOCK
October 18, 2009 - 9:45pm
#4
woodstock
Sorry for the confusion. When I first started going to my PCP, she would write the rx Lortab 10mg 1/2 tab two times/day == 10mg (1 tab)/day. After talking to her...long story short.... she writes the rx for 1 tab two times/day.== 20mg/day. # 60.
As far as Morphine, I gave it ALOT as an ER nurse for all kinda of pain. I do not have any personal experience with it. You don't think going from 2 Lortabs daily to Morphine is too much of a jump for me to ask for? I know that my PCP would not go for that. I need to find a pain clinic that will help me.
I took Motrin for years prior to my diagnosis. Hind sight, I was having trouble with my back for years. I wasn't until the Motrin wasn't working any more and it was irritating my stomach that I went to Urgent Care, had an xray, and it was all down hill from there. From time to time, I will take Motrin and it does help, but my stomach won't let me take it anymore.
Thank you Woodstock. You guys are great!
Still searching for some one to elborate on the Lower Lumbar Spinal Fusion?
October 18, 2009 - 10:35pm
#5
I M
not really sure if morphine sulfate ER is avaiable in a lower dose as 10 or 15mgs, if loritab gives you releif then this should fit in, You can ask for a sample for a week to see how they do, if the Dr agrees it is a better an long lasting med. it gave me my life back.
I m pretty sure Avinza is avaiable in several different strengths , its 24 hour release, verus Ms-contin or morphine sulfate ER GENERIC which is 12 hours the latter is the most reasonable priced, the Avinza is pretty high depending on the strength.
tell the Dr. like it is, I m no dopey, nor drug dealer , I need pain relief, please hear my pleas an help
Woodstock
October 19, 2009 - 9:37am
#6
I seriously doubt that...
Charlotte, NC has only one pain managment physician. You need to find another doctor who will treat your pain adequately. Do some more research, and good luck to you.
Let me explain something, the reason they're providing you with less than adequate pharmacologic analgesia is that there is MUCH more money to be made by doing procedures (i.e. injections). Another example of American greed in the healthcare system. Again, I wish you the best.
P.S. Woodster, MS Contin is avail. as a 15mg preparation, and is dosed either every 8 or 12 hours....Hope you're doing' alright.
FeliksD
October 19, 2009 - 8:55am
#7
Hi, h20s! Nice to meet a
Hi, h20s! Nice to meet a fellow health care worker. I'm not a nurse (I wish, I joined the army to become one, but ended up married and pregnant instead, ugh!). I'm a neurologic asst for 20 yrs and transcriptionist for the same doctor. I also have similar problems to yours but not as bad. Instead of the Motrin, have you ever tried Mobic? I can't take most NSAIDs because they either don't work, bother my intestines or raise my blood pressure. I can take 600 mg Motrin three times a day, but once I bump it up to 800 mg t.i.d. my blood pressure hits 190/100! I've taken the Mobic for years and it helps and doesn't have any side effects. I also take Neurontin 600mg in am., 600 in afternoon and 900 at h.s. It helps a little. And also Robaxin 750 mg 1/2 in the am, 1/2 in the afternoon and one at h.s.
Wish I could help about the surgery. Trying not to go that route myself. My biggest problem lately is compressive neuropathy in three nerves in my left arm, which is extremely painful with numbness, tingling,weakness, partial paralysis of my last two fingers. Makes doing transcription difficult to say the least. That, I will probably have surgery for. Have an appt for surgical eval next week.
Good luck and welcome.
October 21, 2009 - 10:42pm
#8
Hi h2o's! I do know several
Hi h2o's! I do know several people who have had the surgery you are speaking of, and they continue to have problems. Obviously, everyone is different, & perhaps surgery will help you when you decide you are ready. Until then, I doubt your PCP is going to up your meds, even to the long acting type. So I have a question. Are you in an HMO, where your PCP has to refer you to Pain Management? If so, I wouldn't wait any longer living in pain. I would tell your PCP that you feel like you need a referral to a Pain Management doc. If you don't need that referral, I would starting looking by calling your insurance and asking for a list of Pain Management docs in your area. You might have to go out of Charlotte. You can call the pain clinics and ask them straight out if they do med management. I am currently looking for another pain clinic here in East TN, The one I did find was actually found by my PCP's office. The clinic is new and was on NO ONE's list yet. When I began calling clinics, I found some that do injections only, and I marked them off of my list.
Also, there is the chance that if you ask your PCP for a referral to pain management (even if it is not required by your insurance), she may realize the seriousness of your pain and up your script. I kind of doubt it though, based on what she has said thus far, but it couldn't hurt!
Best of luck to you!
October 22, 2009 - 10:26pm
#9
EveryBody
I will post when I have more time. I do want to respond so keep watching for me.
Thanks again for all the wonderful advice!
October 23, 2009 - 11:26am
#10
h2os, I feel for you. I
h2os,
I feel for you. I cannot believe you cannot get a more effective perscription for your pain. That is BS. First of all, Hydrocodone/apap is not made for 12 hour relief. You might get 6 hours of relief at best. I cannot believe the Dr. expects you to get relief out of the current dose you are on. If you have been on them for 2 years, your tollerance coupled with such a low dose probably does you little if any good. Sometimes you have to be firm with the Dr's and tell them "I DO NOT WANT BACK SURGERY RIGHT NOW" You might find that 20mg Oxycontin every 12 hours will releave your pain and let you live a more normal life style. I know that Oxycontin is a dirty word to some Docs, but it is made for people just like you who have chronic pain. It is time released and is made for 12 hours of relief. It is a very effective pain killer indeed.
I have chronic back pain due Multiple Myeloma. I have 2 fractured vertibre and spine compression that cause me constant pain and muscle cramps. I have taken Oxy and hydros for almost 3 years now. The oxycontin coupled with flexaril has been a life saver for me. I lead a normal life even though I have a broken back and very poor bone density and terrible hips. I truly feel for folks with chronic back pain like we have. I guess I am "lucky" in a way. Having cancer seems to give the Dr's a justifiable reason to perscribe a powerful pain killer, even though I am in no more pain that anyone else with back problems.
Don't give up! I would go to a different doc over and over until I got some relief and got some sort of normallity out of life.
October 23, 2009 - 12:05pm
#11
There is another member on
There is another member on the board with cancer who feels the same way. He is dissapointed by the fact that he gets deluxe personal treatment and pain meds/increases/ what have you, and with a more than helping hand. Mean while many CPs have to do the circus act to get any kind of pain relief that usually is better than nothing, but definitely not optimal. He knows first hand, as his wife is a CP.
Unfortunately for us CPs, cancer is the ultimate CYA card that doctors have, and since we dont have it, things are not as easy for us in the pain management department. I dont get too angry over it, because the way I see it, having cancer is hard enough to deal with let alone have to fight for pain relief, especially in terminal cases.
October 23, 2009 - 1:56pm
#12
The Pain Game
The players are "you" an insensitive or frightened doc, and the DEA.
Makes for the good old american doctor/patient and law inforcement relationship.
1.The rules of the game will not be explained to you.
2.they will change without warning
3. You can not win
I am a bit shocked that as a nurse, you would not have been heard a lil better than the average ground pounder.
Come over to ratemds.com see the forum.
You may find something useful.
I wish you the best, another CP sheep.
October 23, 2009 - 3:37pm
#13
Helps on the way!
Man if your pain level is where you say its at these doctors need to be doing something better to help you with that. For one taking too much Lortab can cause severe liver problems because of all the acetaminophen(Tylenol) thats in it. If your going to be on long term pain management they definitely need to get you off that stuff immediatley and on to another painkiller thats not a combo of Hydrocodone and Tylenol. In my opinion they should probably put you on some form of Oxycodone (they make preperations of this stuff that doesnt have tylenol, asprin or ibuprofen to go with it) because for one its stronger and two you should not be having to put your body through any more abuse all that tylenol is doing to your liver. They have Oxycontin which is a continuous release form of Oxycodone with doses ranging from 10-80mg. They also have an Immediate release version of Oxycodone called Oxy IR and it comes in 5, 15, and 30 mg versions which is something I think your doctors should probably have you on. Now if there unwilling to bend and give you the pain meds that you desperatley need at this point then I would suggest findind another doctor that has more care and concern for their patients. Well I hope this helps you out-God bless and Amen
October 23, 2009 - 8:59pm
#14
H2O, I will pm you when my
H2O, I will pm you when my computers get out of the shop. I know you can find someone to treat your pain.Htmom
October 26, 2009 - 4:54pm
#15
Thanks to all that posted!
Here goes...
Saturated: There is one pain clinic in Charlotte that has about 10-15 docs in that one practice. There are others that claim to be pain clinics but do not treat with meds. I agree about the docs and the money making riot with the injections. That is why I haven't gone back to the pain clinic where I had injections because that is all he was about. When they didn't work... I decided that he was not getting any more money from me or my insurance. I have really good insurance, in fact I have double coverage... through my employer and my husbands employer. If you refuse the injection then he refused to treat you. That is when I went back to my Neuro surgeon and he referred me to my PCP.
BeavisMom62: Thank you for your support! I hear wonderful things about Neurotin and Lyrica. Personally I cannot tolerate the side effects and one of them broke me out in a rash. Allergic? My numbness is not a constant thing, only intermittent. So I don't think those meds are necessary for me at this point. If my numbness becomes constant then I think that would warrant surgery to prevent permanent nerve damage. Just my opinion.
TNlady777: My PCP will NOT change my meds in any way shape or form. I have tried. I wanted to be switched to oxycodone/percocet beacause it works better for my pain. She said "hydrocodone(currently taking) and oxycodone are the same thing, just one molecule is different. We will keep you on hydrocodone since it is the same as oxycodone" I would have argued the point, but figured it was useless since she is pretty firm on her decision not to change my med. I am not in a HMO. There is a pain clinic in Hickory NC that I have heard good things about, but you have to be referred. Thought I might try that. The only problem is I work full time and it might be difficult for me to get there before the clinic closes. My job won't allow me to get off work early every month. Gonna have to work out the details..... Thank you for your input! Wish i could avoid the pain clinics because of the hassles but looks like I might not have a choice.
drfinn2k2: Thank you for your concerns and everyone i talk to can't believe it either. I can't believe it myself! I see people all the time getting the meds they need or want and their issues aren't near what mine are. I don't understand!! Maybe because i am a nurse?? You are right about the hydro comment. I do not get much relief at all! and always run out early because I need more. I even started making my appointments earlier and earlier and my doc commented on it. i told her I have been having more pain. She gave me my script but wrote "do not fill until...." on the prescription so I couldn't get it filled before my 30 day mark!!! Did not even address the pain issue. I have repeated told her that I am not having surgery any time soon but every time I go in... she always asks " so have you decided to do surgery yet??" If I take your advice and go looking for other docs... would that not be considered doctor shoppin? I am desparate to have a normal life.. I can't get over how hard it is to find help. Like I said in previous posts, they think you are a seeker in this area. If anyone knows of a doc around this area, please pm me!! I think most PCP's in this area don't want to treat CP patients. By the way, hope your cancer is not terminal! Life is not fair!
mrbrandman: Not sure why I have to do the circus act to get relief?? It is well documented why I need the meds! So why are the docs worried about the CYA card! They are ignorant to the laws in prescribing meds. It would be different if they couldn't find anything wrong with me or if they were overprescribing me meds. They are allowed to treat pain as long as the documentation is there to prove it. I couldn't imagine having cancer and not having pain controlled, thank goodness they are taking care of those patients.
blake 2go: Sometimes I wonder if it is because I am a nurse that they don't want to listen to me. Some doctors have an ego and if a nurse suggests things to a doctor they get offended. Or maybe they think i know how to work the system? Who knows?? Again I have documentation to back it up. I'll check out the site you recommended.
Element420: AMEN! How many docs do I have to go to to find one that will help? I have been to 5(I think) and they all pass the buck or just plain out tell me that I need surgery! I even had one doc tell me that narcotics don't help pain! What???? I get so discouraged and I don't want to be labeled as a seeker. Just want a little sympathy and help.
htmom: PLEASE HELP! I look forward to your pm.
THANKS TO EVERYONE! I was beginning to think that I am suppose to live like this.. just be tough and deal with it. I have thus far and my quality of life and personality has changed due to my pain. I am just tired of fighting. Not that I am giving up, but definitely discouraged!
October 26, 2009 - 8:37pm
#16
Im not saying its right, its
Im not saying its right, its just the way it is. Sad really. Ignorant doctors paranoid by the actions of addicts shouldnt prevent innocent people in legitamit pain from obtaining proper relief, but it is what it is. It does help a little to put yourself in the hot seat. What precautions would you take to protect your license if you were a doctor? With the DEA treating some pain docs like columbian drug lords I know it would take a lot of trust for me to risk hundreds of thousands as well as years in education on a patient.
I know I would not dismiss someone all together, but I cant say that I would not require someone to work at it. I can understand all things on the way up, except failure to treat. Yes, start from the bottom, try alternative treatments, do PT, order tests, even do pill counts or drug tests on patients that may exhibit some addictive tendancies, but treat the pain.
October 26, 2009 - 9:34pm
#17
I understand not wanting to
I understand not wanting to lose their license. I know they have to be careful. I would too if I were in their shoes. I have a medical license as a nurse, so I do understand completely. I have already done the PT, anti-inflammatories, injections, and the low dose meds (Ultram, steroids, Lyrica, muscle relaxants, Limbral). I even inquired about chiropractic treatments. Have a Tens Unit. It is all documented in my chart. I have been compliant with everything I have been told to do. Except surgery. I am just not ready.
I am receiving treatment. Minimal at best. Haven't found the right doc yet. I am just discouraged with my pain management and not sure how to start over again. Fearful of having to start at the bottom again.
October 26, 2009 - 10:16pm
#18
Keep your chin up! The right
Keep your chin up! The right doctor is out there, you just have to find him/her. If you have a good relationship with your pharmacist, ask them if they could recommend a doctor for you. They handle all the controlled pain meds and will have an idea of which doctors are more likely to rx pain meds. They also have interactions with many doctors, even if only by phone, and they can point you in the right direction. When my godsend doctor got cancer and moved away unannounced, I had to find a new doc and fast. The doctor my pharmacist recommended was absolutely amazing, I didnt have to start at the bottom again, in fact the new doc increased my meds on the initial visit! Good luck.
October 27, 2009 - 11:50am
#19
Hello h2os
Your problem is exactly why they make Fentanyl 12.5mcg/hr patches, get the gneric Mylan brand, they work the best. Find another clinic or Dr. that will prescribe the appropriate drugs for chronic lower back pain. If all you're taking now is Lortab 10mg bid, then that doseage of Fentanyl (12.5mcg) is going to make so much difference in your quality of life. With less side effects, no ups and downs and you don't have to take pills all day or carry them with you. It is safer because it is a patch as opposed to a pill, more effective for the same reason. This is pretty standard treatment when it comes to chronic back pain management. Good luck
Ray
October 27, 2009 - 5:05pm
#20
I saw another post................................
recommend the website RateMD.com and there is another one called Vitals.com. You can search for doctors in your area and see comments from patients who have firsthand experience with the MD's in question. Good luck and prayers for you. Greg
October 27, 2009 - 5:40pm
#21
I totally agree Ray. Some
I totally agree Ray. Some people may disagree with you, as I experienced in another thread. Drs usually dont go from lortab to fentanyl, they usually try a couple others first like morphine or oxy, but that is not set in stone. Some people think that fentanyl is only used when every other med has failed, just because it is so strong. I pointed out that it can mean that it will take a lower dose of fentanyl to equal the higher dose of the other ER meds. There are also things like digestive issues, people not being able to take pills, that makes fentanyl ideal.
October 27, 2009 - 6:27pm
#22
I wish I had a good rapport
I wish I had a good rapport with the pharmacist. They are like the docs around here....DRUGGIE! It is unbelievable. I wish they could walk in my shoes for one day. They would want the *** out quick! Where are you guys from? It seems as if there are no problems for most here at this site to get help. I am so sick of these docs here. They truly don't understand what i endure everyday. I don't know how to get them to understand. Honestly, I have a very high pain tolerance. I had a c-section and didn't take anything for pain once they discharged me from the hospital. It wasn't until this back issue came along that I started taking meds.
I can't imagine that the docs around here will start me off with Fentanyl. They won't even give me percs!
I did check out the ratemd website. very nice. Not sure where some of the docs listed there come from, because they are not listed in Charlotte. I'll keep looking....
I wish I could find someone in my area with the same or similar diagnosis and talk to them about their docs, pain management, surgery, etc. Seems like the ones I pick to go see are not the ones for me. Obviously!
Thanks again for all the support. It keeps my hopes up that maybe one day I will find a doctor that truly understands.
You know they taught me in nursing school ,as matter of fact drilled it in my head, to not be judgmental about people requesting pain meds. Treat their pain regardless of what my opinion might be. When I worked in the ER, if we didn't document their pain level every hour or so and address it with the ER physician..we would get written up. Now why am I not getting the same care I gave my patients?
October 27, 2009 - 7:00pm
#23
actually
I think Dr.s would rather be inclined to write low doseage Duragesic patches, as they know that there is little chance of misuse or abuse, My Dr. had no trouble writing the Duragesic but they did not work well for me, I constantly was nodding off, believe She had Me on too strong of a dose.
Woodstock
October 27, 2009 - 7:16pm
#24
Definitely don't want to be nodding off...
I have to be able to function daily. As I have said, I do work full time and I am a mom to an 8 year old so I need my brain to be awake and working...
Thanks for the input. I am taking all of this in, in hopes that I find a doc soon.
October 27, 2009 - 10:59pm
#25
SEEMS
Like the Dr., placed me on 50mcg, or 75mcg, a 12.5 would be considerable low amount, belive You would be able to function.
Woodstock
October 28, 2009 - 12:19am
#26
You are exactly right Woody
You are exactly right Woody about the inclination to write for it due to its low abuse potential. My Dr had no problem writting for it either nor did he have a problem increasing the dose and frequency. I dont think many have looked at the conversion chart. I dont even think the "For use in opioid tolerant patients only" red banner on the box starts untill you get to the 75mcg patch.
h2os, you might have to broaden your search, I have heard of people driving 2+ hours to their doctors or pain management clinics. Im sorry for what you are going through, I hope you can resolve it soon.
October 28, 2009 - 10:14am
#27
The red banner that says for
The red banner that says for opoid tolerant patients only is on the 50 mcgs. If I had to guess, I would say it is on all FTD products. Htmom
October 28, 2009 - 5:01pm
#28
Psychiatry
I am wondering what a psychiatrist would do?? At least he/she would LISTEN! I heard that they do prescribe pain meds? Feeling the need to get all this frustration off my chest. Maybe he/she could refer me? Should I give it a try?
The thing about driving 2+ hours is that I can't get off work every month to do that. Most offices close at 5:00. i wouldn't get there in time.
I also looked up the pain clinic guy that did my injections on one of those websites that was suggested above. Low and behold.... he was on there with a bad review. He was giving too many injections. What is the standard for these ESI's. He was wanting to inject me every 2 weeks until it worked! I read that he was doing this to other patients also. I think he should be reported? I knew something wasn't right about him!
October 28, 2009 - 9:53pm
#29
Htmom, you are right, my
Htmom, you are right, my mistake, I use the 75mcg patch so I guess my fingers just filled in my dose and not the 50mcgs I was thinking of. Im not sure as far as the PI as Ive never had anything lower than 50mcgs, but as far as on the box, the Mylan generic 12.5mcg & 25mcg boxes do not have them. I assume that the same PI is used in each box since the PI's I have for the 50mcg & 75mcgs are the same Im pretty sure and am positive lists all the doses. Also to correct myself, its not red on every box. Mylan's generic uses a different color for each dose which I like and the banners match the color of the box and are located on the bottom right side.
https://www2.pharmacare.com/hcp/healthcare/rxadvisor/pictures/photo_us/053/fent025a.jpg
https://www2.pharmacare.com/hcp/healthcare/rxadvisor/pictures/photo_us/053/fent050a.jpg
October 29, 2009 - 12:48am
#30
Neurosurgeons
are in business to do surgery...my guess as to why he/she won't increase your meds is to attempt to steer you into surgery - if you hurt bad enough, and long enough, you will finally give in and have the surgery. You are wise to put off back surgery, as once you have it, you are not the "same". Speaking as one who has had a few back surgeries (5), you may or may not be better after surgery and there is always a high probability that one surgery will lead to another. The only time surgery is really imperative is when there is nerve damage, as this can be permanent.
My best suggestion is to find a good PCP - internist or such. Take your medical records as well as a list of the doctors you have seen and drugs you have tried. Explain that you have not decided to have surgery yet - you are a nurse (on your feet all day) and have a young child...i.e. just not the right time. It should speak volumes that you are continuing to see the same neuro and have been constant with the one med, more or less. Ask the new PCP if there are any suggestions for conservative treatment...there are some muscle relaxers such as Soma that are helpful.....as for Lyrica, this is an incredible drug...there are though, as you have experienced, some heavy side effects - I'm not sure where you started, but an initial dose that is too high, or increasing the dose too fast can create problems.....you might consider attempting it again with a clear head...it really can aid with the effects of pain meds.....
A referral to a good pain medicine doctor is really what you need and this only comes with a solid referral from a pcp (in most places). I think your previous experience is not indicitave of a good pmd. Yes, most of them like to try the blocks, trigger injections, RFL and such......these can be helpful in some patients - so they haven't worked for you in the past, they could in the future (provided the doctor is better at it, so to speak).....that said a good pmd is going to try these things with other modalities as an adjunct - and this could include pain meds, physical therapy, counselling - even acupuncture. Expecting pain meds, and only pain meds, is a true misconception of what a good pain management program should be. And yes, pain clinics can be a hassle - rules, contracts, drug test, pill counts and such..........it is though worth it if you find the right doctor....and there are some out there. As for your concern about monthly time off......many see patients quarterly........after the inital exams ans such. This may though, just be one of those things where you have to do what is necessary to improve your situation. I can only wish you the best
October 29, 2009 - 11:02am
#31
Hey h2os, Q here . . .
I'm the cancer dude from Mrbrandmans reply #11. I've been down for awhile, stuff happens, but I just read your thread this AM and felt that I should post you. I saw that you drew some of the best informed as well as most caring members of the board to your thread . . . there's certainly a lot of good advice on there!
I'd like to start with your last post, #28. You asked about a psychiatrist, I've been seeing a fantastic one for about 8 years now, he is definitely the Top 'o the Pops for me. However, unless your going for therapy, which I am not, most psychiatrists are really just Pill Docs. I don't mean this in a negative way, what their role is these days is to evaluate you for what category you fit into by the descriptions laid out in the DSM-IV. They then Rx you what they consider the proper drug and then they evaluate your reactions and fine tune your dosage.
For example, me: I was first diagnosed at age 47 for ADHD, real heavy on the Hyper part. He put me through several "paper and pencil' evaluation tests, interviewed me quite skillfully, and then Rx'ed me Ritalin. He made me an appt. for a month later for evaluation . . . at that time he adjusted my dose and made another appt. for every 3 or 6 months, whichever I preferred. After a year on Ritalin we decided to switch to AdderallXR 20 mg at one p/d and I've been happy with that ever since. I turn 55 in a couple of weeks.
Now you know what the typical psychiatrist will do for you. From my experiences (I also receiced a B.A. in Psychology in 1976) with Dr. M I'd say you'd be diagnosed with anxiety and be Rx'ed either Xanax or Valium (I take Xanax). You are probably also aflicted with Chronic Depression, if he/she knows their stuff they'll Rx you Cymbalta or another SSNRI (Selective Seratonin and Norepinephrine Reuptake Inhibitor). The action on Norepinephrine seems to help with the perception of pain, Cymbalta certainly made a significant improvement in my self-reported pain level as well as knocking my ultra severe Clinical Depression out cold. I mean to say, having terminal cancer is bad enough, but there's more. The hormone therapy that is extending my life has turned me into a sexually non-functioning hermaphrodite that is going through menopause. Yeah, I was so depressed that I was having suicidal ideations every 15 minutes. The Cymbalta took care of that 100% by the end of 6 weeks. My only warning on it is that I wouldn't advise it for people under 30-35, too many reported side effects.
On to the pain, OK? Str8updude, Ray, was right on in mentioning Fentanyl. The 72 hour Fentanyl 12.5 mcg p/h patch sounds right to me. If it isn't, you can always move up to the 25 mcg patch. The 12.5 mcg p/h is equivalent to 15-33.5 mgs of Oral Oxycodone p/d. The 25 mcg p/h is equivalent to 30-67 mgs of Oral Oxycodone p/d. For BTP, I would recommend the OxycodoneIR 5 mg tablet, there's no tylenol or Acetominophen in those. A proper dosage would be #120 OxycodoneIR 5 mg. 4 p/d prn. I am currently Rx'ed the Fentanyl 100 mcg p/h patch along with #120 OxycodoneIR 30 mg. one every 6 hrs. for the main pain and for BTP I'm using the effervescent Fentanyl tablet, Fentora, at 400 mcg. 4 p/d as needed.
Will this Q person EVER shut up? Patience my friend, I'm almost done. Psychiatrists almost never prescribe pain meds, some might write your scrips for you if they've known you for quite a while. Even after 7-8 years with Dr. M, I wouldn't ask him to even write me a scrip. As Mrbrand said, cancer dudes like me are allowed a lot of input into their pain med Rxs. I research the choices, discuss them with either my oncologist or one of the PRN Triage nurses at the Cancer Institute of NM, and then , upon approval, they write my scrip . . . easy-peasy. You, however, will probably have to go through the horrible and demeaning CP Pain Management mill. My wife is a CP, she has DDD, Fibro, foraminal stenosis, Osteoarthritis, and a few other painful bits as well as Chronic Depression that is documented over the last 25 years. She and I are both on SSDI as well. She almost has to beg her Dr. of 8 years to get her measly undermedicated #60 OxycodoneIR 30 mg, 2 p/d monthly Rx. I read your post about how you "shouldn't have to put up with a circus" because you have had all the relevant tests, etc. So does my darling 53 year old wife, in triplicate. I really HATE the way CPs are all treated like they're a bunch of potential drug addicts, and that's at best. Usually the health profession just skips the "Potential" part and goes straight to "You CPs are a bunch of slacker junkies!" and then proceed to treat you on that biased assumption. Believe me, I get to see it from both sides. Best Wishes and Good Luck h2os . . .
Q 
PS: To just talk and "get the frustration off your chest" and maybe even get some good advice, you should check out a pain counselor . . . look in the Yellow Pages under counseling. Telling your PMD that you are doing this might get her/him to lighten up a little, who knows, it couldn't hurt.
November 8, 2009 - 11:17am
#32
Q I will hear your advice any
Q I will hear your advice any time!I am glad you understand where I am coming from due to your wife. I am trying to be patient and trying to keep my chin up but it gets harder everyday. I haven't given up. I am working on getting in to a family practice in Hickory and if that don't work then I will try the pain clinic in Hickory NC. I have talked to a few people that have experience there. I also have family there.
Can anyone tell me if a family practice or internal medicine doc is better? I am 39 years young and fortunately haven't had any major medical issues until my back. I should know the difference between the two docs but haven't needed one until now.
Hope all is well! Take care!
November 8, 2009 - 3:03pm
#33
Can you get or have access to
Can you get or have access to a provider list or booklet? I know the hospital I worked for had them and we also had them from other hospitals. They have the name of every dr that has privileges to the hospital. I know you know what I'm talking about. That might be a better resource than the net or yellow pages. Have you looked for a pmd in the Lake Norman area? I know Charlotte has burbs like Mathews and Monroe just to name a few. Have to looked in the Concord area? I know there are a few hospitals in that area. Rock Hill isn't that far from Charlotte, it all depends what side you live on. I think that if you expand your search you will find that there are more than enough pmd that are willing to treat your back pain with meds. I think that if your current PCP refers you it will be to someone just like her. So you are going to have to get off the wheel. That might be your problem. Good luck, htmom
November 8, 2009 - 4:32pm
#34
You are right. I complain
You are right. I complain alot and don't do anything about it. I think it is partly because I don't want another door to shut behind me. I have been to 5 different places from Urgent care, neurox2, pcp x2. Oh and a pain clinic. I guess I want to make sure I pick the right one this time. I think some depression due to all of this has set in also. Hopefully once I get my pain under control I'll be some better. I know I will probably never be the same very active go getter I use to be.
I am not currently working at a hospital because I can't work the long hours being on my feet anymore. So I do not have access to a provider booklet. yes, there are tons of MDs in and around the area and I have stated before that I am sure there is one out there that will help. It's finding one.. and I know it won't happen until I get off my rump! I was hoping someone on here might be able to point me in the right direction. Thinking someone here might be from this area.
I have had some not so good experiences with doctors around here. They seem to downplay my back problems. ..
I have a few places in mind from people I have talked to. Guess I'll start my search again this week.
By the way, I came here to vent, to get things off my chest and to see if anyone else was having the same issues with docs, advice regarding surgery, etc... I know now from some posts that I am not alone. Alot of the people here do understand. I went back and read my first post and it felt good to share it.
Thanks for all the support! You guys are wonderful! I'll keep you posted if you like?
November 8, 2009 - 6:03pm
#35
I have been to 2 pmds, 3
I have been to 2 pmds, 3 neuros and 2 pcps. I knew there was something wrong with me. Finally, after thousands of dollars in tests and one pcp telling me and putting it in my chart that I was a drug seeker. This was after the neuro thought I had a neuromuscular disease, btw I do. So finding a dr is not always easy. Nothing in my post was meant to sound rude or mean spirited. Take care, htmom
November 8, 2009 - 10:30pm
#36
htmom
No no. No rudeness taken.
How did you finally get through to a doc?
November 8, 2009 - 11:20pm
#37
I seem to prefer DO's over
I seem to prefer DO's over MD's, that are in family practice, they seem to have a better approach to your health as a whole and not just medicating the dickens out of a person. They are also more open to alternative treatments like Chiropractic & Accupuncture.
November 9, 2009 - 8:32am
#38
My last pcp referred me to my
My last pcp referred me to my current pm. My medicals records were sent to my pm and after reviewing my MRs they decided to accept me into the practice. Like I said earlier, I'm not a candidate for any injections or PT. There are no treatments for my disease, it's just managing my symptoms. My pm has a dr that does injections and my dr sees patients that need to be managed by meds. My medical records spoke for me. My pm put me on Fentanyl the first.visit. I had been on Avinza for over 2 years. I been on just about every drug there is. I know my disease is unique but it shouldn't matter, pain is pain. Take care, htmom
November 9, 2009 - 11:05am
#39
Just checking in, h20s . . .
I wanted to see what progress you have made, and I'm sorry to see that you are still hurting. Isn't there something in the Declaration of Independence about "Pursuit of Happiness"? I've never seen a person in pain that says they are happy about it. Too bad the Founding Fathers didn't put that line in the Constitution. Best of wishes and luck to you . . . Q
I am sorry to hear about current situation, in the fact that its hard for you to find adaquate pain relief.. I've have not experienced back surgery before, but from what i've head from several people who have fusion sugeries, the results are very mixed to say the least..IMO I would leave the surgery for a last resort. . Im sure other members on this site can give you more informed input on this topic..
As far as your pain meds, two Loratabs 7.5mg for the pain your having is very minimal...I mean thats like giving a pregnant woman two tylenol instead of an epidural during child birth (my attempt at a not so funny analogy)...I understand you live in an area where doctors are reluctant to write scripts for narcotics, but Charlotte is a major city. You might have to do some research and find your self a doc that will take care of you, i mean they all can't be that bad. . . You have a very legitimate case and the documentation to back it up, its just up to you to take things in to your own hands...Your situation seems to happen all to often these days. . . Just remember doctors work for you, if the ones you have aren't doing their job very well then fire them and get a new one. . Maybe with your current PCP, just be firm, get to the point, all while not being rude and see what happens. . .Tell her the same things you said in this post (family, quality of life, work etc.)
Best of luck with whatever route you decide to take..
M.H.