Wondering how best to address increasing Pain Meds with my PCP

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Date Joined Aug 2005
Total Posts : 617
   Posted 6/9/2012 2:46 AM (GMT -6)   
Hey Gang,
The time has come when I really need to get the dosage of my pain meds increased, but I could use some advice on how to approach the subject with my doctor.  This is my situation...I have chronic pain issues, primarily bad back and knees, as well as chronic migraine headaches.  I go to a major university Pain Management Center for treatment for my back and knees, and to another one which specializes in the treatment of migraines.  However, both PM centers require that my regular Primary Care Physician take care of writing the scripts for my pain medication. 
I am on an incredibly low dosage of Lortab, 1- 5/500 tablet 3 times a day, which doesn't come close to making my daily pain manageable.  I only get 30 tablets at a time, so I have to manually pursue my PCP for a refill EVERY TEN DAYS.  Sometimes I can get him to write it seven days apart, but even that isn't adequate.  I also get #50-50mg. Tramadol every 30 days., which also isn't written with any refills.  I've been on this dosage for several years now, and it's not remotely satisfactory in making my pain levels manageable on a regular basis. 
At this point, in order for me to function, I need to take a minimum of four Lortab when I first receive my prescription.  Within a couple of hours, I am finally comfortable enough to perform the basics, start handling my daily chores, and dealing with the various aspects of normal living.  I have to take at least one or two more Lortab every four hours or so, in order to keep operating at this level, which is just tolerable.  I definitely don't feel completely normal, but at least at this rate, I can get by somewhat comfortably for a few days.  Needless to say, my Lortab script runs out far ahead of schedule, at which point I start augmenting it with 3 or 4 Tramadol at a time.  My level of functionality drops off significantly, but at least the Tramadol does temporarily postpone the withdrawal symptoms from lack of Lortab. 
When I get a migraine, which happens at least two or three times a week, it throws off the whole system.  In the past year, on average, I have had to get a Narcotic pain shot(15mg. Nubain) from my PCP or local walk-in clinic about once a week.  The addition of a narcotic shot does not do anything to improve my daily functionality, as the migraine headaches correspondingly decrease my activity level.  I just underwent BOTOX injection therapy to help deal with the migraines, which consisted of getting 31 shots of BOTOX in various points around my face, head, and neck.  Never let it be said that I'm not willing to try anything to mitigate my pain issues!
I guess the bottom line is that level of pain medication I am receiving does not adequately manage the amount of pain that I deal with on a daily basis, and being unable to maintain a steady quality of life has gone well past the point of acceptibility, especially when you consider how long I've been at the same low levels of medication.  It's not like I've got a major OXYCONTIN or Methadone habit, no Fentenyl patches, heck...I'm not even up to freaking Percocet. 
I don't think it's too much to ask to be given enough medication to be somewhat comfortable, so that I can have a fairly decent standard of living.  I guess I would just like to know what/how would be the best way to approach the subject with my PCP, so that I can reasonably represent my situation without coming off sounding like a dreaded "drug seeker".  Any suggestions or advice would be greatly appreciated.
Thanks for listening,
Leigh Ann  cool   

•On Disability for: Chronic Migraines, serious Back and Knee problems (will need surgery eventually), moderate Depression, Anxiety/Panic disorder, TMJ, stomach problems
•Divorced, 46, spawn-free


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Date Joined Aug 2008
Total Posts : 3193
   Posted 6/9/2012 4:30 AM (GMT -6)   
Leigh Ann,

I'm sorry that you are undermedicated.

I've shared this viewpoint before on here; for me, I would just encourage you to throw the whole "drug seeker" worry out the window. I think this "worry" holds some back from getting proper treatment for their pain issues. As long as you are open and honest about your situation... you are doing nothing wrong except trying to improve your quality of life. Yes, there are always going to be doctors that have a slant on prescribing narcotics. There is obviously a crackdown by the DEA on scripting certain medications.

But when you shift your mindset that you are simply trying to increase your quality of life, living w/ chronic pain... I think it puts you in a better position to advocate for yourself. Just as you would want appropriate treatment for diabetes or a heart condition, you are simply seeking this same treatment for your CP.

I would basically let your doctor know what you've shared. That your quality of life is compromised by your pain issues... that you really think you would fare well w/ an appropriate increase in medication... you feel you've done everything asked of you (you go the PM Center; you've done the Botox; and are willing to continue exploring other non-medication treatments).

In addition, just for me, there's no way that I would have the time/energy to go to the pharmacy every 10 days for meds. I would also discuss that your issues seem to be chronic in nature... and given the time it takes you to go to the efforts 3x a month to get your meds - plus the expense - can he script you 30 days at a time.

To me, these are very appropriate requests. If he has issues w/ any of that - at that point - it's going to be up to you to either seek a new PCP..... ask for a referral to a PM doctor that DOES script medications.... etc.

Take care... --Tina
Moderator - Chronic Pain Forum

My faith and family sustain me even on my worst days... as well as my wonderful friends here at HW.

Health/Pain Issues - too many to list; feel free to ask

Veteran Member

Date Joined Dec 2007
Total Posts : 2113
   Posted 6/9/2012 6:00 AM (GMT -6)   
You really do need to address this with you PM-if you are taking that much tramadol at a time you could be endangering yourself. It is much better for your body to take an appropriate dose of a stronger medication rather than taking too much of a weaker medication.

I would not tell your doctor you are not taking your meds as prescribed-rather I would concentrate on telling the doc that even on your current dose/schedule your pain level is still high and let the doc know how that is impacting your daily life.

Veteran Member

Date Joined Mar 2011
Total Posts : 1276
   Posted 6/9/2012 7:16 AM (GMT -6)   
I think we need a 'Like' button here as we have on Facebook ;-)

Leigh Ann, I too am sorry that your level of pain relief isn't enough to keep you comfortable and functional.

I couldn't have said it better than Tina has - be open and honest about your pain levels and your need to function. Make sure they are aware of what you've tried - and as Tina said, that you are open to other therapies as well. It might also help to keep a 'Pain 'Journal' to take when you next see your doctor - just recording your pain levels, the impact (or lack of) that you medications have on them, and how your normal daily activities impact on your pain.

Also record things like those visits to your PCP or walk-in clinics, and any other 'emergency' treatment or medication you've had to take - anything that will help emphasise your need for a change in pain management.

Best of luck.

Moderator - Chronic Pain Forum

Full body CRPS with spasms, dystonia & contractures, gastroparesis, orthostatic hypotension,bradycardia/tachycardia, bursitis, CTS, osteoporosis, multiple compression fx, disc bulges.

Oxycodone ER/IR, Topamax, Mobic, Somac, Cipramil, Midodrine, Vit D & C, SCS, baclofen/bupivacaine pump

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Date Joined Feb 2003
Total Posts : 16764
   Posted 6/9/2012 12:15 PM (GMT -6)   
Leigh Ann, Tina said it best on how to deal with your dr. But, I am assuming the PM drs you see only do injections and procedures and will not write a script for pain meds, this is common practice now. That is why its up to your PCP to rx the Lortab. Do not be surprised is the PCP refuses to go any higher. I say this because of all the hype about the new rules & guidelines set out by the DEA, PCP's limit what they will write and for how long. The PCP's do not want the DEA breathing down their necks or coming into their offices and doing an audit, the drs are scared to death of them. I hope you already know about all of this.

If you get turned down for an increase or not be given something different, then I would be looking for a new PM dr that does it all, rx's plus procedures. You do a lot of running around to various drs when you could get it all in one shot so to speak.

Recently, my husband went in to his PCP that he has been seeing for 20yrs, and he has been on the same pain medication for 20 yrs and it finally stopped working after all of this time. He did not take it every day this is why he was able to take it for so long. PCP says can't give you anything stronger the DEA is someone we do not want any business with.

Good luck with your appt.....Susie
Moderator, Chronic Pain Forum & Psoriasis Forum
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