I am in total mental shock.

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Date Joined Jul 2009
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   Posted 6/30/2011 10:24 AM (GMT -6)   
I just got back from my monthly visit to my PCP in order to get my scripts for me pain meds.

4 or 5 months ago during a visit, which was a few months after she took me from 4mg to 6mg of my pain meds, I mentioned that I was satisfied with the amount of relief I got at that level but was not with the duration. I told her that it was working really well for 4 hours, and then I had 2 hours of diminishing effects and then 2 hours of nothing before I could take another dose and had asked for her to Rx it as 4 doses per day (every 6 hours) instead of every 8.

Well she told me that she was a her limit of what she was comfortable prescribing and referred me to a pain doctor. She said she would continue whatever doses the pain doc would Rx but she just wasn't comfortable upping the dose in any way on her own. Ok, I may not be happy with that answer but I can respect it and I had the appointment made with the pain quack for the 1st available which is not until September.

So for the last several months I have been saying the same thing, good quality, not real good duration, of pain relief at every appointment. I wasn't saying this trying to get anything more out of her, just being honest. She would hand me my scripts and say something to the effect that hopefully the pain doc would be able to help more when I seen him in Sept.

Fast forward to today. Same routine as usual, only this time she says, as if it was this brilliant idea that just occurred to her, that we should add a 4th dose in order to level out my pain control better and proceeds to rip up my already written scripts and starts preparing new ones.

Color me shocked. I almost said "I thought you were uncomfortable upping my dose any" but at the last second my brain started working again and I just said "Thanks" instead.

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Date Joined Aug 2008
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   Posted 6/30/2011 10:37 AM (GMT -6)   
Amazing.  It's a "good" thing..... and I hope it helps keep your pain better controlled.
But what the heck was w/ the change?  And, if she was going to end up doing it anyway - why did it take her months to do it???
I just don't get doctors sometimes.  Especially ones that can't think for themselves and let all the bureacracy crud get in the way of proper care.  Like I said - I really wonder what the change of heart was from....?
Above all - I'm glad you got that 4th dose - and I hope it helps you.

Post Edited (Momto8kids) : 6/30/2011 11:07:28 AM (GMT-6)

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Date Joined Jul 2009
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   Posted 6/30/2011 10:41 AM (GMT -6)   
I wonder the same thing.

Sometimes I think this doctor suffers from multiple personalities.

This is not the first time she has done a 180 on me, especially in regards to pain control.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

Screaming Eagle
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Date Joined Sep 2009
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   Posted 6/30/2011 11:03 AM (GMT -6)   
    ...glad it worked out for you Jim!...I'm in the same boat...but have been holding off visiting with my Dr about it...as we just upped mine a few months ago. At the moment, I have reverted back to my homeopathic treatment, and have had some success with it...but not a cure all, thats for sure!
           I see the trend getting worse for patients as Dr's opt out of responsibility or pass the buck so to speak onto PM's that are really under the gun.
Moderator Chronic Pain Forum

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Date Joined Jan 2010
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   Posted 6/30/2011 12:13 PM (GMT -6)   
That was like a page turning novel and I thought it was going to have a bad ending! LOL...

So, I'm very happy that she is helping you out right now...I guess you will see if she continues this, or it changes after you meet with a PM in Sept. Not sure how long you have been seeing her...but maybe she just had to get to know you better and feels comfortable trusting you..

I just wanted to say that my PM has said that non PM Dr.s are now under great pressure when/if they prescribe any narcotics. And by next year..(can't remember the exact dates) the DEA is requiring all non PM Dr.s to take certain courses and pass certain regulations if they want to be able to prescribe narcotics. Even PM Dr.s are having to tighten up their own prescribing and state by state are passing new laws in regards to contracts including urine tests, pill counts, etc. As well as having the State Monitoring system for medications...focused on controlled substances. So a Dr. or Pharmacist can track any place that one gets their prescription to prevent Dr. shopping.

So, I'm not trying to necessarily 'defend' your Dr. per say...I'm just saying that GP's, PCP's, or Internists, Surgeons, etc...all non PM's, are not all trying to be cruel, mean, or pass the buck...but they are going to have to make decisions on whether to pass more regulations to prescribe opiates or not...They have their licenses on the line...just like PM's, when prescribing narcotics so that is why they are so careful and need to monitor the why and how much for each patient and that the patient is actively seeking care for their PM and not just opiates.

PM's are usually Anesthesiologists, and spend their entire schooling, residency, and board certifications studying pain medicine. That is their speciality...As well as using all other modalities to help people manage pain...

Again...not trying to defend...but explain to everyone what I have learned from my PM and what is coming down the road..

I wish people could live near me and see my PM:)...He was just voted one of the top 70 PM's in the US!! Proud of him:)

Jim...I am so glad that you are going to get some better pain control!! That is wonderful news...especially with the holiday weekend coming up:)
SB and "the pup who snores loudly" 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006

Veteran Member

Date Joined Mar 2011
Total Posts : 816
   Posted 6/30/2011 5:39 PM (GMT -6)   
Hey Jim1969, makes you wonder doesnt it?  I mean sometimes I think the thing to do is work it so they think its there idea and then it makes it alright.
You know its funny, not ha ha funny, but the kind where you say to yourself, ok if this is the way its going to work, then we can pretend its your (the doctor) idea.
I guess the main issue is, you at least got what you need to make it as painless as possible all day.  I am having trouble getting to make my meds last the 30 days they are supposed to.  Some days I feel great and dont have any trouble staying on the routine of meds I have been given.  Then there are the days when I can barely move, where everything hurts so much, it hurts to breath.
The trouble is there are more days that are days I can hardly move unless I increase my medication on my own.  Then by the last 5-6 days before I am due back at my pm doc, the struggle becomes  an awful battle within.  If I try to take enough not to hurt so much, I will run out totally and begin withdrawal.  I will not go thru that nightmare again in life if at all possible.
Enough, I will be hoping you will have low pain days, and more and more and more low pain days.
Take care,
degenerative disc disease, fibromyalgia, osteoarthritis, neuropathy, lumbar laminectomy july 1998 no help, rechargeable neurostimulator unit low right back w/lead wires to left side and right leg unit not working just sitting there.i am 57 years young in may will turn 58. i have 2 grown daughters, 25 and 29. i have 2 grandchildren, 9 year old grandaughter and 5 yr. old grandson

Regular Member

Date Joined May 2011
Total Posts : 164
   Posted 6/30/2011 11:09 PM (GMT -6)   
Hi, I totally understand what SB is saying and had my PM even tell me that. I guess the bottom line is that your getting what you need at this time...better late then never.

I'm happy for you about that atleast.

Dx: Herniated disk in my neck C6-C7, Degenerative disc disease and arthritis in my neck, sciatica, RLS, migraines and post-op RNY gastric by pass and depression.

Meds: Oxy, Nucynta, percocet, norco, xanax(as needed), sinement, topamax, imitrex, and paxil

Personal: Single mom 43yrs old to three children- two girls 6 and 13 and my son 16yrs old. I work fulltime.

Regular Member

Date Joined May 2011
Total Posts : 28
   Posted 7/1/2011 9:08 AM (GMT -6)   
Sometimes I think it's not only the pressure the primary care doctor is under for prescribing the meds, it's also they don't really understand the meds in the first place. even though my primary care doctor has continued to prescribe for me..there have been many uncomfortable situations this has caused between her and I. It makes me very sad because she's been my doctor for the last 15 years or so..and I actually was beginning to consider her a friend.

I have been accused by her twice now of upping my medication doses without her consent. The last visit, I even took out my pill bottle and showed her how she herself had written it. I was taking less than what she prescribed, yet getting told I was taking too much. This makes no sense whatsoever. Then she told me that one of her other patient's was smoking their drugs and had to go to rehab.

I understand how upsetting this must have been to her..but I felt like she was taking it out on me. At the end of the visit she told me I needed to sign a drug contract. I told her that was fine since I felt it would protect me as well (from the accusations, etc.)

I signed it and got a copy of it. Then whenever I see another specialist, I make sure they see it right up front and add it to my chart. I'm not trying to get more meds out of anyone...just trying alternate therapies.

But I guess I kinda feel like I've outgrown her. I feel like I know more about the meds than she does..mostly because I do lots of research on my own. I see a pain doctor in my immediate future...I just need to find the "right one" I've been to two pain centers so far and just didn't feel comfortable in either of them. If you are going to go to a Pain Center...it just has to be one in which the doctors show you some compassion and treat with you respect...and sometimes this is really hard to find!!

Veteran Member

Date Joined Aug 2006
Total Posts : 9661
   Posted 7/1/2011 11:21 AM (GMT -6)   
Sure does make you wonder...at least yo finally got some help...
yeah for that...
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...

Forum Moderator

Date Joined Feb 2003
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   Posted 7/1/2011 12:00 PM (GMT -6)   
Jim glad she finally heard you, but hasn't this dr sort of flip flopped back & forth with you before? If not her maybe it was the one before this one, but the sad part is it took how many months for her to get it, but at least she heard you this time.

Hope the meds help you out.
Moderator Chronic Pain Forum

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Date Joined Jul 2009
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   Posted 7/1/2011 1:04 PM (GMT -6)   
Yep, this is the one. Like I said this isn't the first 180 she has done with me in regards to pain meds. In fact it is over this same med.

The first 180 was when I was first tried on it. She put me on 2mg every 8 and after a month I told her that it really wasn't working. I was only getting about 20-30 min of minimal pain relief from that dose and that we either needed to try adjusting the dose of try something else so she pulled me off of it saying something to the effect that dilaudid is a very strong medication.....yadda, yadda, yadda.

A few months later after trying several different NSAIDS, Lyrica and a few others she asks what the problem was with the dilaudid, so I told her again that the 2mg dose didn't work. So she then comes up with the idea of going to 4 mg. 3 months later she asked me how it was working and I told her OK, just wished it lasted longer as I was only getting 4 hours of pain relief out of every 8. Without blinking an eye she ups the script to 6mg every 8 and that has been it for quite some time now.

What is ironic, pathetic, makes no sense in all of this is that I have actually been pushing for a script of every 6 hours since shortly after being put on the 4mg which provided enough pain control I could manage the rest. Several times she has made the comment of not wanting me to take "too much" and not being comfortable prescribing "large amounts" etc but if you do the math....4mg, 4x day is 16mg per day. 6mg 3x day is 18 mg a day. So when she took me from 4 to 6 mg she actually started giving me 2 mg more per day that she would have if she had went with the every 6 hours as I had been asking for.

I guess they don't teach basic math in medical school.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

Forum Moderator

Date Joined Feb 2003
Total Posts : 15858
   Posted 7/1/2011 1:28 PM (GMT -6)   
Its crazy isn't it how her mind thinks, a little scarey. I was pretty certain this was the one that really has flip flopped a lot with you.

When my pain pump was put in all my dr would give me for BT pain was 2mg of Dilaudid and after the first script I refused it. Why spend money on something that did not work and I insisted my chart be documented that the reason I refused the BT meds was because they did not work. I got more benefit out of Tylenol than I did 2mg of Dilaudid, no joke.

So, when I got referred to my current PM dr, she did not know it came in 2mg, she could not understand why he rx'd it, she said that is getting nothing. She bumped me to 4mg every 4-6 hours depending on the pain, now I am at 8mg every 6 hrs.Believe it or not the difference of going to 4mg back then was incredible for me. lol. My neighbor is an RN and he laughed at the 2mg, he asked why the dr even bothered with it when you get 10mg in a shot in ER, lol. Makes no sense. For sure math was not her strong point. Have a good weekend.
Moderator Chronic Pain Forum

Veteran Member

Date Joined Jul 2009
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   Posted 7/1/2011 11:03 PM (GMT -6)   
Today my pain control has been pretty good. I took a 6mg dose when I first got up and then I was able to get by pretty good on 2 4mg doses during the day today and I just took another 6mg getting ready for bed time.

One thing I love about this med is that is doesn't come in a 6mg tablet so I get my script in a 4 and a 2, so on my good days I can just take a 4 mg dose if that is all I really need.

Now my next big concern is my appointment with the pain doc in September. I really hope he doesn't pull one of these idiot bits and decide I am on "too much" meds or that my pain is caused by being on the meds or some such crap and want to take me off of them.

The one good thing is that he really can't suggest any more injections as and make them "stick" as I have it in my file from a spine specialist that injections are not effective and a strong recommendation that I not receive any more.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

Veteran Member

Date Joined Jan 2005
Total Posts : 9090
   Posted 7/1/2011 11:53 PM (GMT -6)   
You are a wise man, Jim! Good thing the brain kicked in before the mouth did...<whew> Good work!

Chutz smilewinkgrin
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.
Use the talents you possess, for the woods would be very silent if no birds sang except the best.

Veteran Member

Date Joined Oct 2009
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   Posted 7/2/2011 11:28 AM (GMT -6)   
I wish I could get even decent pain control when I land in the hospital. Last Monday I should have taken my dose when I went in, at 8PM, but never got them to give me anything until 3AM, although I asked 4 times, and only one of the 2 pills I take. Then my 7-8 AM dose came at 10AM, after I nagged.
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