I've been seeing my current PM for about 2 years and has been very flexible thus far.
He seems to have no reservations about prescribing any opioid for me as well as benzodiazepines, etc..
I don't think he's just easy going with prescriptions in general, but he has said to me in the past that he has "no worries" about my needs -- implying that he sees at least some of his other patients differently.
But during this appointment, he seemed to not want to discuss options with me and said no to all that I proposed.
I currently take 300mg of Ultram ER and use Hydrocodone or Oxycodone for BT pain (I vary as the latter helps more with pain but hinders my work more than the former). about 6 months ago, because I no longer felt that the Ultram was helping adequately, he switched me to Kadian. The effects were quite bad. I informed him and I returned to Ultram.
After some discussion, he suggested that it was worth trying to augment the Ultram with an anti-depressant type medication. We tried Wellbutrin, which had no effect, then Savella, whose side effects caused me to stop taking it (and was advised to return to Ultram until my next appointment).
During my recent appointment, I figured we would talk about trying Cymbalta and I also wanted to bring up Provigil. The former is a common medication for pain, of course. My rationale for the latter is that rather than trying to bring a level 5 pain down to a level 3 with an opioid, perhaps I could improve my concentration and focus on work even with the pain.
He said that the Provigil wouldn't help in that way. Perhaps he's right. But oddly, he then said (sarcastically), that if I wanted something to help me ignore the pain, he could just write me a script for a massive dose of xanax. Bad analogy on his part -- my goal remains being active doing what I enjoy in life , not just knocking myself out.
I then brought up Cymbalta or something else to supplement the Ultram. He said no. I also brought up the idea of increasing the Ultram to 400mg. I understand the risks here. I also know that it is prescribed to that dose in other countries and told him that. Again, no.
He had his pad out to write another script for hydrocodone or oxycodone if I needed it, but was otherwise just done listening.
I can chalk this up to a bad day on his part -- he looked tired and disheveled. But I'm also now worried about his attitude towards me. My main pleasure in life is writing. But my hip hurts, my back hurts, my neck hurts, my arm burns, etc.. I can ignore pain at levels 1-3. At 4 or 5, I turn to hydrocodone and can work again. But, I am not willing to take BT meds every day. So, some days I just have to spend in bed. Some days, I'll just get a bit of writing done and end up filling my time with distractions from the pain. Maybe 30% of my time is lost to pain as it is. Taking more hydrocodone will help, but I can't take much without it too making it difficulty to focus. Thus, something other than an opioid seems appropriate -- to me.
But to my doctor? I now wonder how he sees me. By continuing to ask for alternatives to opioids, have I come across in some objectionable or suspicious way? Maybe he is now thinking that my pain can't be so bad, or maybe I just like to experiment, or maybe I'm looking for a nootropic and not really there about the pain. To be honest, a genuinely safe and effective nootropic would be great, but that interest stands right along with my need to work while in chronic pain.
So, from this meeting, no longer do I feel like a partner in my medical care but rather a patient -- patiently waiting for the doctor to tell me what he wants me to take.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray