dosage increase- how to talk to doc...

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mtgman
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Date Joined Mar 2005
Total Posts : 1289
   Posted 2/5/2011 11:23 PM (GMT -6)   
hi there.  i have had crohn's disease for 21 years...the past 2 have been the roughest and for about 6-7 months i have been seeing a pain doc due to severe pain associated with the disease- so bad it makes me puke.  i was prescribed percocets- 5/325-- 4 a day...the pain has progressed and the 5 mg tabs don't cut it.  i have been taking 1.5 or 2 of them at times and as a result am running out before the script can be refilled.  i want to talk to my doc about increasing the dose but don't want to appear that i'm a "druggie" or anything...i have absolutely no dependency feelings and don't take the pills for "fun"- just to try and keep my life as normal as possible at work and with my family...i'm nervous to talk to the doc about increasing the dosage- any tips or am i being silly about being nervous about talking about this with him?  thanks for any insight you can offer!

Jim1969
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Date Joined Jul 2009
Total Posts : 2042
   Posted 2/5/2011 11:34 PM (GMT -6)   
The best way to go about it is the simplest. Just tell your doctor that you are still in a lot of pain and ask what can be done about it.

One thing to keep in mind is that combo drugs like percocet, vicodin, etc that have both a narcotic and non narcotic med in them you have to be careful of the total dose taken of both medicines, so don't be shocked if your doctor ends up suggesting trying a different med instead of increasing your current one.

Chutz
Veteran Member


Date Joined Jan 2005
Total Posts : 9090
   Posted 2/6/2011 1:21 AM (GMT -6)   
I agree with Jim...but do it fast! Sooner is better because if you run out then you're really in a bind. Honesty is most often met with compassion. You have well documents that you are in need of the help so get on the phone and let them know what's going on and ask what alternatives might be available for you. Something that can give you back some quality to your life.

Keep us posted!
Chutz
Moderator on the Fibromyalgia and Chronic Pain forums
~*~*~*~*~*~*~
Daily Donnybrook: Fibromyalgia, Insulin Dependent Diabetes. Ulcerative Colitis, Rare form of Dermatitis, Collapsed Disk, Osteoarthritis (especially in right hand and neck) and a couple of other adjunct agitations.

"Gravitation is not responsible for people falling in love." Albert Einstein

flower123
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Date Joined Apr 2009
Total Posts : 856
   Posted 2/6/2011 7:23 AM (GMT -6)   
I'm sorry that you're having so much pain!

I think that it's better to make an appointment with your doctor before you take extra medication if you know you're going to run out. If your script allows you to take more than four a day because of the way that it's written, and you know that you will be able to make it to the appointment by taking less later, then it's fine.

But, if you are taking more every single day and won't have enough to last, then make an appointment right away because (my opinion) the doctor would rather you tell him that you need an increase instead of increasing it on your own.

You don't want to be without medication because then it could be hard to get your pain levels stable!

Be totally honest with your doctor. Tell him that the medication helps, but is not covering your pain. Keep a pain journal if you can, documenting pain levels, what you did to help the pain, and medications taken.

Also, can you bring a family member to the appointment with you? Sometimes it helps. It helps me just because I end up getting so nervous that I don't hear everything the doctor is saying. So, it's always good to have another set of ears there. Also, the family member can talk to your doctor about how you're doing--especially if you have an increase in pain.

Please keep us updated!

Hugs,

Flower

mtgman
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Date Joined Mar 2005
Total Posts : 1289
   Posted 2/7/2011 12:02 PM (GMT -6)   
Thanks all! I have an appt tomorrow so well see what he says. Unfortunately I'm just about out. I've been splitting pills and taking 1/2 does when I absolutely have to. Sucks! Oh well hopefully we can address tomorrow and either increase dosage or maybe number of pills. I'll let you know

Rhaevin
Regular Member


Date Joined Jan 2011
Total Posts : 230
   Posted 2/8/2011 12:31 AM (GMT -6)   
I'm so sorry to hear about the perdiciment you're in! I have been there myself before; both out of meds before my script could be refilled (I was facing 4 days without any of my loritab!) and trying not to sound like I was addicted while I asked for more. Oh I started to feel like I was fighting with my doctor.  cry
 
I came here though and talked to folks, and their advice was so helpful!
 
For starters yes, you do have to watch your doseage to make sure you're not taking to much of some things so as to cause issues with other major organs. I know for the longest time they had me on Loritab, and then Percoset, but always with the "anti-inflamatory" stuff cut in. It's good, but at the same time, you do have to worry about taking excess of it.
 
So while none of us want to be a pill counter (I still am, just out of habbit) the best thing to do is talk to your doctor. Explain it from the stand point that your quality of life has decreased dramatically because of your pain. I'm not sure if you're on extended release stuff or not; my doc won't put me on it currently but that's because I recently started the trial period for a SCS unit, so he doesn't want to get me on something when hopefully some day they'll get my doseage decreased. Currently I'm on 15mg of strait Percoset. My doc upped me from 10mg to 15mg, dropped the anti-inflamatory, and took me from 4 pills a day to 3, but gave me a generous enough script to allow for "bad days", knowing that in a few weeks I was to be scheduled for surgery.
 
Everyone is different, our pain, our pain levels, and our pain tolerance. Talk with your doctor about your quality of life and see what you can't work out. Maybe, if the anti-inflamatory part isn't doing any good, they can put you on a strait pill killer, or better, an extended release pain killer.
 
My best wishes to you... none of us should have to live with the pain we have. But it's brought us all together, made us who we are though it does not define us. We're all strong individuals, especially when you remember one important thing.
 
You're not alone. *hug*
 
Originally injured 10/26/2007 - Initial diagnosis; Tendonitis
Spent next year seeing specialist after specialist; Bone, Muscle, Hand, Chriopractor, Physical Therapist...
Went through a battery of tests, multiple MRI's
11/16/09 I was finally diagnosed CRPS - Stage 2
Permanently disabled and on Percoset for pain.
Hoping 2011 will see my spinal cord stimulator unit finally implanted.

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1234
   Posted 2/8/2011 12:49 AM (GMT -6)   
Hopefully, you have seen your PM doctor and were able to be honest with him about the tolerance issue. Most PM doctors are very understanding about that issue but, if you are under contract, or for that matter, even if you aren't, you can be dismissed and black balled from further pain medications and treatments by taking more of your medication than you are supposed to. It can also show up in the complaince urine testing if you happen to be selected to be tested that day.
Most PM contracts have a clause in them that states that the patient will not decrease or increase the dosage on their own and that they are subject to random drug screens and pill counts. If that should happen to you, and you don't have the number of pills you are supposed to have or your urine test comes back not within the testing limits for the medication dosage you are supposed to be taking, you can find yourself not only without a doctor but in withdrawal with no where to get more pain medication.
If you find that you are not getting the pain relief that you need or are having a flare, the best thing to do is to call your PM doctors office and ask him what you should do to get the pain levels under control. That way, you aren't jeapordizing your ability to be treated for your pain.
Best of luck to you,
Sandi

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 2/8/2011 10:23 AM (GMT -6)   

 

 

 Dear MMan,

    Good morning. I wanted to stop by and welcome you to the Healing Well Community. I am sorry I didn't stop by sooner. Things have been rather busy here.

    How did you appointment go yesterday? Where you able to get your doctor to help you with your pain increases? Stop by when you get a chance and let us know how things went.

*hugg*
  dani


TWO roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood

Chronic Pain Moderator
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mtgman
Veteran Member


Date Joined Mar 2005
Total Posts : 1289
   Posted 2/8/2011 8:51 PM (GMT -6)   
so thanks for all of the support. my appt went really well- doc gave me extra pills and also let me refill today so i didn't run out! phew!! couldn't have gone better. you were right- honesty is the best policy...hope you all have a great evening! i'm off to continue my prep for my colonoscopy tomorrow...woohoo! fun stuff.
36 year old male living in AZ.  Diagnosed with Crohns at age of 15.
Currently on 30 mg prednisone.  still taking Asacol.  Just had 3rd Remicade infusion 3 weeks ago
In the middle of a bad flare now for over a year...lost almost 30 lbs. -- gained most of it back now.

uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 2/9/2011 11:22 PM (GMT -6)   
I can understand being "afraid" to ask your Dr. about more pain meds...most people wait until the pain is unbearable before they ask...and that's too late. You should be keeping your pain under control so asking for an increase or a different pain med is normal...They usually won't think anything about it...they expect it...Good Luck...

mtgman
Veteran Member


Date Joined Mar 2005
Total Posts : 1289
   Posted 2/11/2011 11:22 AM (GMT -6)   
Yeah it worked out ok this time. Doc was really cool. He said I wasn't asking for much at all. I didn't want to press it. He gave me extra pills I can use or chop in half to take 1.5 or whatever I need. Pain sucks. Im glad I found a compassionate practice. Both doc and pa have family with crohn's so they totally get it.
36 year old male living in AZ.  Diagnosed with Crohns at age of 15.
Currently on 30 mg prednisone.  still taking Asacol.  Just had 3rd Remicade infusion 3 weeks ago
In the middle of a bad flare now for over a year...lost almost 30 lbs. -- gained most of it back now.
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