October 29, 2008 - 2:16am
In the past I have had compression fractures to the T-7-T-8 vertebrae and bulging lumbar discs. After going to a pain mgmt clinic and being on narcotics (oxycontin 40mg tid with roxicodone 15mg for b/t pain), I successfully tapered off after several epidural steroid injections and the us of ultram ER and regular ultram and diaeam as a muscle relaxant. Defore I went to the pain mgmt clinic, I was seen in th E.R. for the tird time due to this injury. The first time I was given endocet 5-325 1-2 q 4 hrs. The second time I was given dilaudid 4mg, 20 tablets in bo cases. On the third visit (while waiting to be sen y my new PCP and then the pain mgmt cinic) the ER doc said I needed something to control my pain round the clock and wnted to put me on MS contin with IR morphine for b/t pain. I once had a reaction to IV morphine where I started sizing and immediately was given IV ativan to stop the sizure so I told her I felt uncomfortable taking morpine again in an form. She then rx'd oxycontin 40 mg bid with oxy IR 5mg for b/t pain, in the ER! Two weeks worth till I could get in with my new PCP. 42 tablets of 40mg oxycontin and 40 oxy IR 5mg. Well, now its a year anda half later and I had an accident fallin down some slick stairs in the dark and aggravated my original injry long after I had stopped the use of narcotics. Since the first opening with my PCP was 5 ays away, I went back to the same ER and saw another doc there wo assesed my symptoms. After telling him what happened and what it felt like, he did not orer an further imaging studies but went straight to my med list from the past visits. He lookedit over and just said pain meds nd time sould help as he thought it an aggravation of my original injury almost two years ago. I told him I took ultram and that it was not helping at the moment. e than said he'd ordered me some meds and to get dressed and the nurse would be in with my discharge instructions. To my disbelief, when thenurse came in with my instructions, I was again rx'd 40mg oxycontin to take PRN as well as endocet 5-325 1-2q 4 hrs for b/t pain. I was shocked that he would write for such a high dose of a strong narcotic plus a b/t med with no imaging studies and jst a chat. I asked to speak with him nd is respons was "well, if it worked before, why re-invent the wheel?" I know it is not commonplae to have oxycontin 40mg rx'd PRN, especialy in the E.R.! So, he gave me a 10 day supply of 40mg oxycontin bid PRN along with endocet 5-325mg 1-2 q 4h PRN, 20 tablets each. Has anyone else ever heard of oxycontin being rx'd to a patient with a complaint of back pain with no imaging studies done to confirm anything? I'm not complaining, I am just shocked that on two separate occasions in the E.R. I was rx'd oxycontin plus a b/t med in both cases and this time to be taken PRN which confused the pharmacist to say the least. I just can't beleive that I was in and out within an hour with two highly addictive strong narcotics rx'd to me. I know other ER's I have ben to (not as a patient, but with a fiend or relative, there were signs in the waiting room saying tht they do not prescribe long acting pain meds in the E.R. specifically oxycontin and methadone. Sorry to ramble but has anyone else been rx'd oxycontin or any other long acting narcotic in the E.R. before? I look forward to any responses.
JPDX
P.S. Sorry about the typing, its late, I'm sitting in bed with my laptop and I'm on he oxycontin he prescribed today as well as the 10mg od dizepam I normally take at bedtime.
October 29, 2008 - 11:05am
#2
I got to say I'm in awe that
I got to say I'm in awe that an ER Dr. would be so loose in his prescribing of OxyContin. You definetly don't live by me! After I broke my back, I was left to wait in the ER for 6-7 hrs before the x-rays came back showing the extent of my injuries. Then they practically od'd me probably out of guilt for leaving me so long w/ absolutely no meds for pain. It wad probably the worst medical experience I've ever had. Now my neighboor is going thru the same thing. Every Dr. he goes to thinks he's a drug seeker. This is so sad when most legit patients can't get proper treatment. Count yourself lucky you found a compassionate ER. Take care and I hope you feel better soon, lil red 0005
October 29, 2008 - 12:01pm
#3
I live in Portland, Oregon
I live in Portland, Oregon and after some of the stories I've read about how hard it is for legit pain patients to receive narcotic meds is beyond my belief. On my first visit to a new PCP today, just this morning, he gave me #120 roxicodone 15mg tabs to be taken every 6 hrs. (4 x daily) and #120 2mg xanax bars to be taken on the same schedule. I told him I was just in the ER yesterday and they put me on oxycontin 40mg BID along with percocet 5/325mg for b/t pain. I told him that in the past when I was on the same dose of oxycontin be it TID, I didbt like feeling "doped up" constantly and thought it was good for a person to actually feel when they are in pain but not to let it get out of control and to take IR oxycodone at the first signs of pain. This I could not do with the oxycontin hence being put back on IR meds. I also prefer xanax to valium as a muscle relaxant/anxiolytic. Valium seems to take forever to kick in when xanax I can feel working and loosening my muscles within 20 min. although its a trade off cause the valium lasts much longer. I have to take the xanax every 6 hours. It just suprises me how unfairly some people are treated when it comes to prescribing narcotics, especially when they are written so freely and without question to me. I don't know if its my appearance, attitude, what I say, etc. but have basically never been turned down point blank for narcotics. I've even asked for a particular med before and the doctor didnt even know the strength existed until he looked it up on his palm pilot like device that has all drugs currently approved by the FDA listed and just said "score, Patient: 1, Doctor: 0. How many of these do you think you will need to last you a month?" This was for 15mg roxicodone about a year ago and I just randomly said "#150,"and then he pulled out his script pad wrote for #150 15mg roxicodone and said "Is there any other medicines you need written or refilled today?"To which I replied "yes, valium for my muscle spasms and to help me sleep at night since oxycodone tends to give me energy and wake me up as opposed to making me drowsy." He wrote for both and sent me on my way also giving me some free samples of celebrex to see if they helped the pain. This was about 6 months ago, not my visit this morning. Unfortunately, his wife wanted to be closer to her sick mother so they moved out of state forcing me to find a new PCP who I met with for the first time this morning with good results and hopefully the start of another good doc-patient relationship. Best of luck to those who cannot find a sympatheic doc. They are out there, keep looking until you find a practitioner who meets your needs and who you feel you can establish a good relationship with. !Buenos suerte!
JPDX
October 29, 2008 - 12:26pm
#4
Consider yourself very
Consider yourself very lucky. Not only for getting prescribed the Oxycontin in the ER but also for findind a doc who is willing to prescribe what you need.
October 29, 2008 - 1:17pm
#5
Just a Question
Glad you found a good doc, I have one and I know they are hard to come by. I was just wondering if there was a reason he did not give you a long lasting med.Was it because of the ER as they did RX you time released meds or because you did not want them. Just a question because I am RX'd duragesic 100 and oxycodone for BT as well a Xanax PRN for sudden panic attacks and klonopin for anxiety and muscle tightness.She also gave me ambien 10mg for sleep so I guess we are lucky to have found compassionate doc's who really care about their patients and their level of pain and anxiety instead of docs who just write and send you on your merry way.I love the fact that my doc takes all the time we need to talk and discuss the current meds I take and how they are working for me as well as how i am feeling.Thats why I try to tell people that there are good MD's out there it just takes time and footwork to find the right one for you.Again, Glad you made out well. All The Best, Nancie
October 29, 2008 - 2:53pm
#6
I prefer not to take long
I prefer not to take long lasting meds as I never truly know when I am in severe pain because there is a narcotic pain reliever in my system at all times. I did tell my doc this morning about the medications prescribed to me in the ER and told him that I would prefer to take a higher dose of IR meds than a long lasting med with a b/t dose for b/t pain. I believe that it is good for a person to feel some pain so they know where their pain level is at so that way they don't take the meds when they are not needed. This way, at least for me, my tolerance does not grow as rapidly and I can keep a journal of what my pain level is and when I need to take the meds and how much. The ER doc prescribed the oxycontin PRN as it only seems to last for 6-8 hours in my system and gave me the percocet to take if my pain is not fully relieved by the oxycontin during that time period. I have an extremely fast metabolism and IR oxycodone lasts only 2-4 hours in my system. So my doc this morning prescribed the roxicodone 15mg with the option to take 1-2 tablets 4 times daily PRN. He gave me #120 15mg which is technically a months supply but some days I will take 2 tablets and other days 8. He also added the xanax to my valium dose kind of like your doctor did since it is quick acting and the longer you are in pain, the harder it is to control, so I take 10mg valium 3 times a day and now I have 2mg xanax bars that I can take 1/2 to 1 tablet for muscle spasms and the anxiety that comes with dealing with chronic pain. This way it kicks in much quicker than the hour and a half it takes for the valium to work. He said I can still use the oxycontin if I have bad days where the pain is more severe and I don't feel like taking a roxicodone 15mg every 3 hours. Sot now I have the option of taking a longer lasting med with b/t meds or just sticking to the roxicodone PRN. Like you said, it can take time to find a compassionate doc and I certainly from what I hear lucked out in the ER. It took me six months and several attempts at finding a new doctor before I found one who is compassionate and understands my wishes and how I feel about my pain level and the management of pain with narcotics and other therapies. Don't let one doctor be the dictator of your pain because all doctors differ in their prescribing practices and how they deal with chronic pain patients, especially back pain. During my search for a new PCP after my old doc moved away, I had several docs who refused to see new patients with back pain and several times when calling offices and inquiring about being a new patient with chronic back pain, many times I was told that no narcotics would be prescirbed so I might want to look elsewhere. Don't get the wrong idea, I'm not seeking out narcotics and would prefer not to have to take them at all but due to compression fractures and bulged/herniating discs, my back will never be the same again. I'm just happy to have found a new PCP who will listen to my thoughts and suggestions for medications and not just say well this is your only option. I have also found that many group practices, especially those affiliated with hospital systems have certain prescribing practices that all the doctors in that clinic must follow. I would suggest finding a single doctor, or two or three that work together in a private practice. Had I not aggravated my condition by falling down stairs with a box in my hands, I would probably still just be taking ultram/ultram ER and valium with the occasional roxicodone for the really bad days when the ultram does not control the pain. Best wishes for those out there who are struggling to find a compassionate doctor to control their chronic pain. Keep searching and eventually you will find a doc who meets your needs. I am lucky to live in a larger city with multiple options and I feel for those who live in rural areas with not as many options. It might be worth the drive into a larger city to find a doc who is willing to not be a dictator but work together with you in managing your pain. I am still wondering if anyone else has heard of an ER doc prescribing oxycontin? Especially with no imaging studies. He did have a CT scan and x-rays from my original injury a year and a half ago but it still shocked me that I was in and out in an hour and a half leaving with oxycontin and percocet considering how hard it is for some people to obtain these meds from a doctor they have known their entire life like some stories I have heard on this site. Pain management is aptient right and how the doctor chooses to approach it is their decision but don't give up if one doc says no dice. Keep searching until your pain is under control and you are able to go about your life in a somewhat normal way.
JPDX
October 29, 2008 - 3:32pm
#7
Its possible that the
Its possible that the female ER doctor that originally Rx'd you Oxy is some kind of role model, mentor or just known to be a really good doctor to the new ER doctor that wrote the Oxy so he really trusts her opinion and assumed it was the best way to go. Its also possible that he is studying to be a PM doctor and is just doing his time in the ER now and thought that you were an ideal patient for round the clock medications. Im more shocked at the doctor writting it for PRN. Oxy is what is called biphasic. It releases half its med about 45 minutes after ingestion and the other half at around 6 1/2 hours. So if you took your second dose 5 1/2 hours or so after ur first dose you could potentially be double dosing,since the second half of the first dose and the first half of the second dose would be kickin in around the same time....get that? Thats why it specifically says in the Prescribing Info from the manufacturer not Rx it PRN.
October 29, 2008 - 7:31pm
#8
oxycontin PRN
The pharmacist who filled the prescriptions from the ER visit was equally as shocked to see oxycontin written for use PRN. Had it not been an electronic script, (the ER faxes over a copy as well as the hard copy given to the patient) I'm guessing he would have thought it was a forgery. He said it was the first time in his 20+ years as a pharmacist that he has seen oxycontin written for use PRN. I didn't know oxycontin was biphasic. I wonder why it wears off 6-8 hours after taking it if the second half of the medication is released 6 1/2 hours after ingestion? Is it possible that in my body, the second half is released sooner due to having a fast metabolism? I'm curious about how the time release mechanism of oxycontin works. What you have told me so far is intrigueing and I'd like to learn more about it. How and why it seems to work and act differntly in different people interests me. Especially why some people get sufficient pain relief with BID dosing, (which the manufacturer reccomends)and others require TID dosing or in some rare cases I've heard, QID dosing. Thank you all for commenting, keep the comments coming! I'm veryinterested in what others have to say about my experience andchronic pain mgmt using narcotics in general. Especially how things seem to differ depending on where you live, demographics of the doctor/facility, etc. Best of luck to all in finding pain relief and controlling chronic pain, specifically back pain.
JPDX
October 30, 2008 - 4:24pm
#9
new pcp?
Hello, i live in the pdx area and im looking for a new a pcp, my doctor is retiring and im afraid that unless i find the same compasinate pcp that i have had for many years ill lose my ongoing med therapy of #150 norco10/325 per month w/2 refills that i have been rx,d for 8 years for 4 back surgerys since 1988, but i have permanate nerve damage do to the ins. companys delayed decisions. so im physicaly dependant on these meds. So if you could and wouldnt mind passing on his name if you feel he can help me. Now please note; If you dont feel comfertable doing so that thats fine also!! I have read all your postings, and no i have never seen or heard the type of meds they rx,d you from that er DR. and how comfertable he did so without even blinking!! Usually its like#20 vicodin and 30 flexiril! thanks
I worked for five years as a paramedic in a busy ER, and that certainly isn't common here.
Typically, the doctor's will prescribe enough for one or two days...long enough to get in to see a specialist in their office. The type of drug really depends on the complaint, and (unfortuantely) the doctor's mood at the time.