June 12, 2007 - 6:22am
I will try to be brief, I have rheumatoid arthritis,triple cervical fusion,double lumbar fusion,and I'm 52 years old. I hurt all the time. I take hydrocodone 10/500, 4 times a day, and flexaril 10 3 times a day. My question is this, how do I make my Dr. understand that I am having breakthrough pain, and I need something stronger, or something needs to be added to what I take? Please help, I don't know how to handle this. Sometimes,(alot) I have to double up on the Lortab, and I know that can't be good...........Thank you
June 12, 2007 - 7:54am
#2
nice people
I have been visiting this site for quite awhile, and really have been impressed at the support every one gives. This is why I posted my question earlier, I knew someone here could help me figure out how to make my Dr understand how I feel. She is a wonderful Dr., but, I cannot get through to her when it comes to my pain level. She has told me that I will get worse, I know that, but will not discuss any other meds. What can I say to make her see?
Thanks in advance
June 12, 2007 - 8:01am
#3
Thank you!
Thank you gtrplayer, and I agree with you 100%. I have taken in the past, 60 mg extended relief morphine 3 times a day with lortab for in-between, but, that was prescribed by my back surgeon. Since I wasn't about to have more surgery, he referred me to this Dr. She cut me off the morphine.....said I didn't need it. I have been miserable for the last 2 years...................
June 12, 2007 - 8:24am
#4
You might just casually
You might just casually mention to her, in an asking way, "do you think that I would be a good candidate for an extended release medication?".
You could tell her that, even though you take the Lortab 4 X per day, you are still having problems controlling the baseline level. I'm sure you know this, but the long acting pain medicines are meant to lower your overall pain, and establish a desirable baseline comfort.
However, some doctors decide not to prescribe breakthrough medications when they switch to a long acting med. If I were in your shoes, and this is just my opinion, I would ask if there wasn't some way to lower the overall pain, and then just use the hydrocodone for when the pain flares get really bad, and the Flexaril only when the spasms start to get out of hand.
I just read your part about being on, and taken off of, morphine extended release. You might want to tell your doctor that, although you appreciate her willingness to take you on as a patient, you would prefer to try another long acting pain medication, even if it isn't morphine. That being said, I don't think I'd go into the appointment asking to try any certain medication. I'd leave that up to the doctors.
Gtrplayer
June 12, 2007 - 8:30am
#5
Bless your heart!
I have an appointment this Friday, and I will surely try your suggestions! You have been a Godsend!!
I'll let you know how it goes........
June 12, 2007 - 11:17am
#6
If she is unwilling to write
If she is unwilling to write for long acting, high dose narcotics, ask for referral to a pain management specialist.
Is your doctor concerned that you are at high risk for addiction? If so referral and comanagement with an addiction psychologist might be helpful.
You don't say what other treatments you have tried. If you are having pain from the rheumatoid arthritis, you should also be on an anti-inflammatory (Aspirin, prednisone, or motrin type medication). What about the older chemotherapy agents like methotrexate? What about the new disease modifying agents for rheumatoid? Intra-articular steroids can also give relief for specific joint pain. If the pain is primarily from your back, interventional pain management techniques may be helpful as may Lyrica or Neurontin, or Cymbalta or nortriptylline or amitriptylline (antidepressants), or topical anaesthetics like Lidoderm or Capscaisin. Have you tried a TENS unit?
I agree with gtrplayer on the issue of a long acting med with something for breakthrough, but round the clock Lortab or Norco or Percocet(oxycodone) at more frequent intervals may be another alternative depending on what your pain pattern is.
June 12, 2007 - 11:58am
#7
Thank you!
Thank you for your response. I can't take anti-inflammatories because of a hiatal hernia, before my husband died in '99, I took Plaquenil and Prednisone with some success, but, after he died I lost my insurance, just a few months ago got my disability started, and I can't afford the Plaquenil. My Dr. DOES want me in pain management, but, once again, I can't afford it. Pain management in my area won't take you if you don't have a medical card, insurance, or a red, white, and blue card, so, I'm out of luck there for a while. Please don't misunderstand me, my Dr. is a great Dr., I just don't know how to ask, or explain to her how I feel............
June 12, 2007 - 12:13pm
#8
That's funny dr. lois-
That's funny dr. lois- almost all the meds, all but about three of them, you suggested I have already tried for my arm!
I would go with what gtrplayer said about trying the extended release meds, that is your best option. if your doc doesn't feel ready to go that route, how about trying a different dose of hydrocodone? The daily max allowance of tylenol (apap) is 4000mg. right now you are taking 2000mg. What about taking 2 in the morning, 1 in the afternoon, 2 in the early evening, and 1 at night. you could of course switch this around to fit when your pain is the worst, but I am just suggesting some type of schedule. usually in the morning pain is pretty bad and it needs to be immediately controlled so it doesn't get worse during the day, so that's why I suggest 2/morning.
this is something you and your doc could figure out. Or another route would be to switch from 10/500 to 10/325 Norco. Then you could start taking 2/time 4x/day (=8 pills/day). This would be a total of only 2600mg, which is not much more tylenol than what you are taking already. again, this is something you could discuss with your doc.
there are many treatment options out there, it is just a matter of finding what is right for you. don't be afraid to talk to your doc, remember, the only way your doc knows there is a problem or that you are still in pain is if you speak up. she can't just guess that you need something. if you want, you can PM me, and I can give you more suggestions as to how to talk to your doc about what you actually need without sounding like you are drug-seeking. it sounds like are in real pain and something needs to be done. either way, good luck at the doc friday, and like I said, don't be afraid to tell your doc what is really going on with your body!
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
June 12, 2007 - 4:10pm
#9
A hiatal hernia would not
A hiatal hernia would not necessarily be a contraindication to anti-inflamatories, although they are all %@$$*## your stomach. Celebrex which is associated with less severe GI bleeding is pricey. Long acting pain meds tend to be more expensive, even the generics, so around the clock short acting, but cheap, narcotics may be the best way to go. My understanding is that Lortab and Norco are more expensive than Vicoden. Percocet is almost dirt cheap and contains oxycodone which is more potent than the hydrocodone in Lortab and only has 325mg of acetaminophen. So you could take up to 12 tablets a day. Also make sure you price shop for drugs at the discount pharmacies like Costco and Sam's club (you don't have to be a member to go to the pharmacy). Some of the Mom and Pop independants will give you a reduced price if you have no insurance.
Many of the pharmaceutical companies have prescription assistance programs. PPARx. org or 1-800-906-7279, or go to the manufacture's website for the medication you are interested in (like Plaquenil or one of the disease modifying agents) and see if they have a patient assistance program. Project Hope is another organization that provides low cost meds to the underinsured. If you live near a university with a medical school, you can sometimes find a clinical trial that you could enroll in for more effective treatment of your rheumatoid arthritis. If you find the program and get all the paper work filled out and put it in a stamped, addressed envelope, it makes it easy on your doctor and all they have to do is sign the papers.
June 12, 2007 - 6:56pm
#10
Dr. Lois, I know that
Dr. Lois,
I know that Ligand Pharmaceuticals also offers a $20 off discount card for their prescriptions on Avinza.
Gtrplayer
June 12, 2007 - 8:57pm
#11
try this one:
try this one: clinicaltrials.gov
you can search by the trial or by location. there are thousands.
I'm a social worker, not a medical professional. All comments and thoughts are simply my opinion and experience.
June 13, 2007 - 2:47pm
#12
Endo offers a coupon for
Endo offers a coupon for Opana ER also offers a coupon, I think it is for $40, and so does Perdue for Oxycontin. Doctors never get free samples of Scheduled drugs, so the drug companies use coupons for promotion instead. I had not heard about the Avinza coupon. In my state they just made it legal to apply these types of coupons to insurance deductables and copays.
June 13, 2007 - 2:47pm
#13
Dr. Lois, My panic
Dr. Lois,
My panic disorder doctor gets samples of Klonopin wafers, Ambien, and a couple other scheduled drugs. Nothing above CIV though.
Gtrplayer
June 13, 2007 - 2:55pm
#14
I dont know if this applies
I dont know if this applies to people without insurance, but BCBS Federal Employee program makes you sign a liability waiver once a year if you are Rx'd Celebrex because of the risks and lawsuits associated with the other COX-2 drugs.
June 13, 2007 - 5:26pm
#15
There are so many drugs that
There are so many drugs that are used routinely that have much higher known risks than Celebrex! (and the other Cox-2's for that matter.) I do think doctors prescribed them improperly to patients who were not at increased risk for GI bleeding. I also think patients asked for them because they mistakenly thought they worked better than the older NSAID.
June 14, 2007 - 6:30am
#16
Thanks!
I have never seen so many nice people!! Thank you for all of your suggestions, I'll probably try all of them. Here in the great state of Kentucky, if you find a good Dr. that understands the meaning of "Pain Management" you'd better stick with them. That's why I feel like I need to be really careful with what I say about my meds, I'm terrified I'll be cut off, and I just don't think I could deal with my pain without anything at all
Anyway PM me anytime, I'll let ya'll know how it went!
June 14, 2007 - 9:43am
#17
And here I always thought
And here I always thought they just didn't want to give doctors the really really good drugs! It may be a state regulation, it may be a company policy. I remeber getting Ambien samples in the past, but I believe at the time it was unscheduled.
June 27, 2007 - 1:40pm
#18
Annabelle...
Give us an update on your situation! Unforunately, Kentucky has been hit really hard by "opioiphoiba" after all the Oxycontin issuses and from what I here it is very difficult to get any help with pain problems there. Good luck!
June 27, 2007 - 1:43pm
#19
Dr. Lois, You seem like a
Dr. Lois, You seem like a very caring MD! You must still be young, as far as doctors go. 
The cynicism hasn't set in yet!
Has your doctor ever tried you on a long acting pain medication, instead of just the Lortab and Flexaril?
In my opinion, if Lortab 4 times per day is not cutting it, you might ask to try a long acting medication. I don't know how you could address the situation of "breakthrough" pain, when the only medication you are being given is meant to be used for "breakthrough" pain. In general, you have a chronic condition that is being treated with acute care medicines.
At 4 Lortabs per day, I doubt that a doctor is going to prescribe something else to take in between the Lortab. From what I have experienced, this is usually the point when a doctor initiates a long acting medicine.