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If you are too young then i don't want to know what he would say to me, i am 24 and i am in pain management for chronic pain in the back and head, i have chronic migraines compounding all of this as well. I also have a herniated disk that arose at 22, i seem to be the exception to every rule in the book for age and degenerative disorders/pain. i take narcotics just to function normally, I have oxycontins 40 mg and oxycodone 15mg for pain (which im in the process of changing). i am not ADDICTED, I am DEPENDENT. there is a difference and you should explain that to your doctor. addicts use for the high's and to masque their problems and pain, dependents use to function normally and to live a daily life that is as normal as possible.

 A doctor who tells you all of that is just trying to keep you around and i feel doesn't really care about you, you need to see a specialist as well as a Pain Management doctor.

no matter what you need to take care of yourself so you can live a normal life by whatever means necessary. Normal is something that we don't have the luxury of living, but we can get assistance to feel normal. I have had chronic migraines since i was 13, debilitating ones, and i recently had a surgery last year that caused unexplainable chronic pain in my head/neck. i didn't take heavy narcotics till recently, and did the natural and non narcotic route prior for many many years, but i always had my 15mg oxycodone for the emergencies, either that or i am in the hospital, at least once a month.

more people with much more experience will be posting giving you great advice, dont stress, this site has some of the most knowledgable, kind and understanding people i have ever met, they have amazing insight. How long have you seen this doc of yours, and how long has he Rx'd the hydrocodone??

Yea you are right I guess I am dependant because I do not take for the high. I asked him about a year ago to switch me to percs because my tolerance but he absolutely refused and got mad. My question is do I have to be referred to a pain management?

And I know what you mean about the doctors being a little "too" cautious about writing scripts for people.. I have gone through the same thing for horrible pain in my right foot that just doesnt go away. If I go any time without pain medicine it just flares up so bad I cant even wear a sock..I was just discharged from my previous doctors care and now am going to a rural health care doctor.. My first appointment is tomorrow.. Im a bit nervous about it because of all those who choose to abuse their meds and those who just straight up rob pharmacies. Im wondering if he will just cut me off, when in actuality I need something a little stronger than the 7.5 lortabs Im on now..I only get minimal relief from them and they dont last long...The best thing I can tell you to do is just be honest with him..They can run pharmaceutical boards to make sure you arent filling multiple scripts from different doctors..Id just invite him to do that and just ask if he could even put you on a hydro that doesnt contain as much acetimenophen(sp?) if youre worried about liver issues, etc...But Id just be very candid with him and maybe even tell him that youre afraid to talk to him because of various reactions youve gotten in the past... Good Luck

I would def. consider switching docs...I know it is very hard to find a doctor that you like...I too live in KY, and there are ALOT of prescription pain med seekers/addicts that do ruin it for those of us who actually need and use the medicine legally. The best thing i think you can do is just sit down with your doctor and have a frank discussion about your narcotic usage. Explain to him/her that if he/she is not comfortable prescribing narc pain meds on a consistent basis for you, then maybe you should consider finding another doc or just asking him for a referral to a PM doc...Also go online, maybe you can find one without a referal...Best of luck to you...Also, what part of ky do you live in...Maybe i could help... you can email me on here if u like.....

I'm not a doctor, but would LOVE to play one on tv....

Ray

Hi

I am 36 years old and I live in Massachusetts.  I also suffer from DDD, Sciatica, 3 Herniated disks, bone spur /arthritis on the vertbra and fluid in the marrow.  I have seen several Dr's and Neurosurgeon's over the past two/three years.  My neuro symptoms have since left me, and I am suffering wtih the pain from the DDD and fluid in marrow.  I CAN NOT function unless I am taking my percocet (1 -5/325) 3 times a day and 2 Soma twice day.  I have been on those for over a year now, and I have to be honest, they are definitly not getting me through the day anymore.  I tried a "SQUARE in the eye" converstaon with my doctor (Which I signed a narcotic agreement with, so she KNOWS I am not getting meds anywhere else from anyone else) and frankly, she does not care "Make them work, I dont want you getting addicted"  What I am suprised to see is that she is unaware that people get DEPENDANT on them after prolonged use, how can we all know that and my doctor does NOT?  I asked her to leave me on the 5mg twice a day and just give me ONE 7.5 at night so I can get to sleep (that is when it is the worst).. But I was met with skeptisim and looks of distrust.  Thanks to drug addicts, people like us, like me, who NEED this medication to function until surgury can be done are left out in the cold.  I was even told "I know you need more, but the law really watches the practice so we have to stay under the radar"  What the hell is that?????  It is VERY frustrating and causes me alot of stress.  I take them as I need them throughout the month, then I am always left with a week or more until my next refill with NOTHING.  I am down to cutting 5's in half and trying to streach them out, but that usually results in missed days from work and just not being able to function on a normal basis.  I TRULY wish I could find a doctor in my state who was NOT AFRAID to prescribe this medication and CHANGE it as needed as the years go by and make OBVIOUS adjustments that need to be made to the dosage.  My doctor thinks I should be thankful enough that she is willing to give me what I have.  My sympoms are real, they have been proven and being truthful, looking them in the eye and being honest gets you NO WHERE.  But you cant go look for a new doctor either, that is called DOCTOR shopping, so be careful, it only makes you look MORE like an addict and not a regular patient exercising her rights to explore treatment.  I tried a pain center in boston and they will only presctibe ANTI-DEPRESSANTS with WAY more side affects than percocet. I tried it, I have to admit.. I was physcially unable to do ANYTHING until I went back on the percocet.  I have given up trying and will just stay this course until I can have the surgury WHICH I have been told probably wont even work.  I am sad to say I have lost faith in doctors and until I hear of one that is actually strong enough to do the right thing.  I wish you all better luck than me.  :)

_We all know by now that all doctors are different, some are cool and are your friends, and some are stiff and rigid. Its hard to say that doctors don't care about their patients, and don't understand dependency, or that they don't understand pain. I would never say that because they deal with more than just 1 person in pain, especially those at a PAIN center. They deal with it everyday, and here different stories of the same diseases, and they understand that everyone reacts differently to different meds. Looking them in the eyes is not going to magically get you pills and better scripts, its to show your honesty and respect for them, why don't you comply with it and continually tell her the same thing, because you're doing that anyway, but maybe this time painbgone you don't get upset, be understanding of where she is coming from. i don't know you, and you seem to be mad at the world of doctors because you don't get what you want/may need. she knows people become dependent and tolerant, just because they don't give you stronger meds doesn't mean they don't care, it means they do care about what happens to you. she wants to see if you can manage it, not get stressed out, which raises blood pressure and actually can cause you to be in more pain. Now you take them as you need, not as Rx'd and you build a tolerance quicker then are left out in the cold because you ran out early due to your over medicating yourself. by the time you get back in to see the doctor your ticked off, and demand more drugs. i don't know about anyone else but that IS PILL SEEKING. Take as prescribed, if you go above and beyond that then you are falling in the category of abusing your meds. I bet the week and a half without ANY meds is worse than taking as prescribed. never go against what your doctor Rx's and dictates. otherwise she's going to stop your prescriptions in a heartbeat because that is technically now making you addicted, overuse and not following directed therapy. think about your irational behavior. its not healthy.

__________________________________________

I can't help you if you're not willing to help yourself...

~ Enigmuh

A non-medical professional

 Get a TENS unit....Mine has been a godsend, best thing since sliced bread and Lortab :-)

I'm not a doctor, but would LOVE to play one on tv....

Ray

Neurologic findings are things like decreased sensation, abornomal reflexes, decreased strength, and impaired balance.  Then the neurologic findings have to correspond with the anatomic abnormalities on the MRI.  Weakness in your right arm does not correspond to a disc herniation at L2-L3 for example.  Other causes of the neurologic symptoms have to be ruled out such as carpel tunnel syndrome or multiple sclerosis.  I sent a guy to the neruosurgeon for profound weakness and numbness in his left leg and pain in his low back and and abnormal lumbar MRI.  Turns out, he ended up having multiple sclerosis!  

I've been with my doc for 7 years and have a great relationship with him-I can talk to him about anything and he listens. It just seems that when I try to tell him that the meds don't work as well as before he's not willing to change them. I learned a long time ago-for other reasons-to always look someone straight in the eye & do so every time we talk. It's not that I feel like he doesn't believe how much pain I'm in-I know he does, it's just that he'll repeat an MRI or send me to the surgeon, etc & never discuss my meds except to say "you're on the max dose". I've never asked him to change them to a specific drug. I'm not sure if he's afraid to prescribe (law enforcement really comes down on docs around here) or if he's concerned about the long term health effects from taking pain meds (my husband passed away 2 years ago & I'm on my own to raise my 12 y.o. daughter). I lost the "high" from pain meds a long time ago & have been getting sick-nausea primarily-very frequently for approximately the last 6 months. I've told him about it & he's tried to figure out why but nothing is wrong. Well, after reading these postings, I'm willing to bet it's because of my body's physical dependence on the Vicodin. I never even put it together until now. With all of the insight I've gotten here, I will definitely be telling him my concerns about that. Right now not only am I in pain, but sick on top of it. I already have a "narcotic contract" with him, have done so for a long time, & he is the only doc I get pain meds from.

I have seen 3 different neurosurgeons, including the top one in the state, and all have concurred that because of the extent of the surgery that will have to be done it is better to wait as long as possible to do any surgery. The physiatrist that I see also concurs. All of the docs agree there is a good possibility that surgery won't even get rid of the pain anyway. I know I'm no spring chicken, but because I'm still relatively young they want to delay surgery as long as possible.

You've helped again & have given me insight about what to do at my next appointment. Keep the info coming!

1redhotnascarrn

- i mean red hot, are you on long acting vicodin or short acting? and have you thought of switching to even say, percocet. Rawoody, in his comparison table, states that percocet is 1.5-2.5x as potent as hydrocodone, right there you should get some extra relief and if you are on the 10mg vic's you are on the max strength, but i don't know if its really the max dose. basically one 10mg percocet/oxycodone we could say is ~equal to 20mg of Vicodin/hydrocodone. bring that up to him, more of  temporary switch in therapy to see if it helps over a 3_5 day period (i usually go for that, sometimes a week) and re-assess at the next appointment. When you speak to him about the meds as you look him in the eye(did you learn by speaking to a cop? thats how i learned, hee hee) and speak confidently and clearly, not shy or, um..you know..my meds arent well...really working that well...

Instead, I am getting some relief from my meds but not enough, is there another avenue we could attempt for a short term period to see if i could get better relief with something else, because if im on the max dose then we need to perhaps try something else. If that doesn't work, and he says no blah blah blah, say this exact phrase..."Will you please help me understand ______(whatever he said to you that meant no)" he cannot get upset at this statement, you are  polite and asking him to explain himself in an non-threatening way.

give it a shot, i am in psychology so if you have any q's for me in that area too let me know

I'm no doctor, i'm just a man with intelligent opinions.

-Enigmuh

Enigmuh, there are no long-acting vicodin, only immediate-release. You are right in that percocet is usually determined to be 1.5x the strength of hydrocodone, meaning it would take 15mg of hydrocodone to equal the strength of 10mg of percocet. Also, if someone is on 10mg of vics (hydrocodone), it does not automatically mean they are on the max dose. The "max" dose is determined by the amount of of acetaminophen that is taken. If one is taking 10/650's, then the total one could take in a day will be different than if one is taking 10/325's.

the maximum recommended dose of tylenol per day is no more than 4000mg. If one is taking the 10/650 (usually called Lortabs), then the max a day would be 6. However if one is taking the 10/325 (usually called Norco), then the max a day would be 12.

One thing to be sure to do at the doc when you are trying to ask to raise your meds is not to say "I need more" or "We need to raise it", instead say "It is not helping as much anymore", or "I am not getting as much relief as I used to". This will let the doctor know you are becoming tolerant to your meds. Most docs who know anything know that most people build a tolerance in about 6 months. I would not suggest when talking to your doc about your meds to suggest going to "something else" if you are at your max of your pain meds. This would of course be up to the doc.

Also, don't just concentrate of discussing the pain meds. Ask about other alternatives even if you don't really want it, such as anti-inflamatories, nerve pain meds like Gabapetin or Lyrica, anti-depressants with pain-relieving qualities such as Cymbalta, and other means like Lidoderm patches, Capsasin cream, etc. Even remind the doc that you are using more ice/heating pads than you used to, or whatever other remedies you used to use. Let the doc know what activities you are being limited from doing because of this extra pain. The point of being on a constant pain regime is to be functional in life, and this should be every doc's goal with pain meds, not matter what the regime has to be. Don't be afraid to also let the doc know that you do research about everything you take or are going through so they know why you know so much about things. I just recently was prescribed a new pain med and had to educate my doc on new practices with that med that almost excluded it as a good choice for me. 

I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.

Sorry Enigmuh, I must not have read the max dose/strength thing the right way. Of course, you are right that 10mg is the max strength of hydrocodone. You are also so right in that the doc is not going to be able to magically tell what is going on with you and whether or not you're getting the relief you should be. Alot of people say "the doc should be able to tell" and "I don't want to say anything cause he might think something", but as long as you don't demand it or say it ALL the time, then the only thing the doc will think is that your med isn't working anymore and you are  still in pain. Pain can't often be detected by tests like other medical problems can so the only thing docs can go on is what you tell them.

Thank you Enigmuh for all your kind comments. I try to help when I can without sounding too opinionated. Most of what I know is either from my experience or from what I have learned on here. I get into spurts of when I have a lot going on at home, and when I spend a lot of time on here. I have just been busy with starting a new job, school, home, and going through multiple med switches to try to find the right thing. Actually, you sound so much like me b/c we both have been going through many switches with our meds, told our docs about doing research and being on here, and the fact that I love for people to correct me as well! I think constructive criticism is a great way to learn, and extremely helpful. 

 Thank you again for everything, it's nice to hear someone say they like what I say, and that I am helping. I'm not always sure sometimes, lol. I know come with a different perspective than most of the other top posters on this site, so I am not always sure if I am appreciated or wanted because of what I say. They are more about just IDing the meds and the technical stuff whereas I am more about actually helping through discussions, offering support, advice, and opinions, and talking about things after you take the meds.  I'm going to try to be on here a little more often though, so hopefully you will be seeing more of me. Let me know if you need anything, or any advice, lol!

I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.

I catch him in the wrong mood I am afraid he will cut me down

- Ah yes, fear, the mind killer. You cannot be afraid, first, call your insurance company and see if you actually do need a referral to see a pain management doctor, then see if you need to stress about him not giving you a referral. The age thing is bs. I am 24 and got help no problem, age is not a factor, something just seems amiss with this guy and the way you describe his moody behavior, it's like this guy is Bipolar or something haha. You cant be afraid, seriously, that is the worst thing! Especially when you are trying to help yourself! come on now, i don't want to hear that self-defeating thought process that makes you quit before you start. Have you called around to the pain management clinics/ specialists? i found mine through a referral list at the hospital, they give them out for free, So call the hospital and ask a nurse if she can give you the names of the centers for pain relief in your area, they can't say no to someone trying to help themselves, that is completely contradictory to their job and duties. Same goes for your doctor, If he knows you and your mother, than thats all the more reason for him to trust you, i'm sure your mom knows of this and can verify your story, is this guy your family doctor/physician? you need someone who knows about pain, stop worrying about it and stressing about it and just do it, you wont know until you try. :P

I'm glad you are searching for a new job, your ailments and current job will land you in unemployment if you're not careful. please, call the hospital tomorrow, speak to a nurse and get the list, they can probably email it to you... also tomorrow call your insurance company and find out if you actually need the referral. talk to you soon, and you better have some progress made by then :)

I'm no doctor, i'm just a man with good intentions.

-Enigmuh

great way of complimenting, offering suggestions, and supporting, while at the same time trying to push them in a positive way.  Sometimes that is exactly what people need- just to be pushed. Good job, I knew you'd make a good addition to this website!

I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.