Getting better pain meds?

[Meow]

I have a very low tolerance for pain and it seems I am always hurting myself by accident, slipping a disc, back problems, knee probs, etc. I recently had general surgery and I get tension headaches now

I hate Tylenol 3 and codeine made me nauseated and I started telling docs that because it does nothing for me and they look towards other options.

I've been prescribed Everything from tram to (great) to Percs to hydros and I have preferences obviously. But doctors are so stingy they want to give you as little as possible.

So my q is: what do I tell them to get the better meds?

On the one hand I don't want to sound like an expert because it raises a flag when you specifically ask for something. On the other hand I want to get what I need.

Stating a GI upset from codeine does tend to lead them more towards hydros which im ok with, but I'm wondering if anyone has other tips for getting the more effective pain meds?

Specifically in relation to a PCP or specialist like a back / sports injury type doc.

[funkh]

In my experience it's all about patience and building up a rapport with the doctor you're seeing. If you're willing to try the stuff they offer you first, then return at a later date with a specific complaint regarding the medication they've prescribed then they're more open to suggestions from you and more willing to prescribe the meds you really want. It's unfortunate but doctors are dealing with 'drug-seeking behaviour' every day and none of them want to be the one that gives they guy who's just turned up the high he wants regardless of whether you need the meds or not.

[waterlogged]

@Meow the advice that @funkh just gave you is the only way I know to do this. First establish a relationship with your doc. Try what they want you to try and after a reasonable period of tome if the medication isn't helping then tell them. Ask the doc what they think would be better. Don't tell them what you want. all this takes time which really sux for folks who are really suffering but It's the only way I have been successful and im still not where I need to be but I will be going back to my PCP this week and I plan on trying to get my pain meds changed so good luck to the both of us!

[billyboy1965]

@funkh @waterlogged An element of honesty needs to be thrown into the mix. True relationships of any kind require honesty.

[IGoeOn]

I am so happy I saw this thread. I actually have the opposite problem but it's still (kind of) on topic.

I had my 2nd f2f with PM - I see a CRNP via a national service. She writes Soma and Vicodin for me. I spoke with her last week about my pain levels and how the Vicodin wasn't really helping my pain - more distracting me from my pain. I left with my two scripts + 1 for Vitamin B 12 injections. I came home and filled my scripts - went to pt - got my pills. Came home and saw that she prescribed the same amount of Oxycodone (10-325). I want to stress that the word OXY was never mentioned in our conversation. I cut the pills in quarters and have been taking them. Carefully.

I called my "doc" and left her a message on Friday. I have not heard back.

Weird, right? I am hoping to hear from her tomorrow.

[alumni]

In my experience it's all about patience and building up a rapport with the doctor you're seeing. If you're willing to try the stuff they offer you first, then return at a later date with a specific complaint regarding the medication they've prescribed then they're more open to suggestions from you and more willing to prescribe the meds you really want.

If you are being treated by a pain management doctor, rather than specific complaints about the medication you are prescribed, I've seen more success achieved by describing the physical symptoms you are experiencing.
Times of the day when the condition is worse, tasks that you cannot do now because of increased pain symptoms, specific comparisons about how your life is being more negatively affected currently versus in the recent past.
I work with these physicians' practices often. Recognizing, diagnosing and treating symptoms is inherent in their training. Typically, however, when a patient instead starts making specific med suggestions or concerns about tolerance, etc. the treatment dynamic can change from the doctor's perspective.
You might consider this unfair or hard to understand but I've seen it happen frequently. I believe the more a patient knows about how a physician practices medical care, the better the potential that they will receive appropriate pain treatment.
I would be very careful with the idea of working a doctor to somehow prescribe "the meds you really want."
That can be a slippery slope.

[Meow]

Alumni - that's exactly what I'm afraid of. I feel like I need to give as little info as possible to avoid setting off alarms. I often say that tylenol 3 gives me an upset tummy (because it's weak) so they will give me something stronger. They are always asking how great on a scale of 1-10 the pain is, and obviously saying anything above a 7 or 8 is going to give better script, but it might lead to tests or additional treatment I don't want.

[Lynx4]

My doctor finally gave up on asking that stupid question. How can I answer on a scale of 1-10 when I don't know for sure what each number should feel like? Should a 3 be painful but tolerable like a sprained ankle, or should 3 be like a bee sting or should 3 be like the pain a week after surgery? I hated that stupid question and I heard it every month for 4 years. With my PM doctor now I haven't heard that question since my third visit when I got frustrated and said I didn't know how to rate the pain. I can describe it, I can tell you what it stops me from doing, I can you how many hours a day I'm focused on how bad the pain is ....but I can't give it a number!!

And @alumni is right, tell your doctor what you are feeling. You don't need to discuss the medicine you are currently taking unless it's causing unwelcome side effects. Tell the doctor if you are in more pain, or can't do certain things, or if you feel like you are isolating yourself, etc. I never really think about my medicines when I see my doctor every month. I talk about how I'm doing, my fears, what I can do now that I couldn't do before, or what I'm having problems with now that I didn't have problems with.

Discussing your medicine on every visit is something that makes a doctor uncomfortable and I can understand why. To them it's merely part of the whole process; it's not the WHOLE process. We usually talk for a little while and discuss how things are going and then he hugs me and says the nurse will be in with my prescriptions in a minute. When my prescriptions weren't right he knew it because I couldn't sit still or stand still, my color was bad, I couldn't do any physical activities without acute pain. The first thing he says now is "you look good, your color's good,...". He's checking to see if physically I look okay before we start talking.

To @Meow - I can't take Codeine because it makes me unable to drive (I just stare off into space), it upsets my stomach and it makes me cry. I told my doctor on the first visit what medicines I was allergic to but he wanted to know not just what I'm allergic to but what I have an intolerance for. I don't do well on morphine either. When he asked me what extended release medicine I would take if I had a choice I said Methadone or Opana ER, because I've been on all of them and those two are the only ones that take the pain away without making me stupid. Don't aim for a specific medicine because you might not know yet which is the best for you. Aim for a better life, a better day and the ability to do a few things each day without causing too much pain. You are aiming for a stronger medicine when actually you might need one that isn't so strong, but with another med added in. They could up my pain meds every month and it wouldn't have helped me until they added klonopin to the mix. I was absolutely miserable and a hermit and I felt like I was in unbearable pain all the time when what I needed was an anti-anxiety medicine. It takes a while to figure out the best mixture but once we did I've been fine since, with only an increase in my roxicodones once (although it was a large jump and surprising but since then I haven't had to increase it).

You will get there. Just be honest with him, express your frustrations and if you have one of those doctors that say um hum, yeah, okay, see ya next month then you might need to change doctors. Good luck and sorry this is so long!

[chell55]

I hate those pain scales too. I once told a neuro that I couldn't answer that because when I think of 9 or 10 I think of that guy that had to cut his own arm off. He started laughing and said we are asking about your pain. What is your scale according to the worse pain you have felt. That helped some but I still have a hard time with them.

I do know that my doctor wants to see some improvement with his treatment. If nothing is working he will send you somewhere else.

I've been on the same dose for years and I think getting pain medication is going to get harder. I've watched it get more and more difficult as time goes on.

If you have a good doctor keep him, (her), and be patient. Try other things to help your pain as well. I've ordered books my doc suggested bought a treadmill and get shots. I was against shots at first but they have helped me so much.

It isn't easy anymore to get the care that pain patients need. Do what you have to do and stay where you are if your doctor is trying to treat you.

[Jeremy Fisher]

I am so happy I saw this thread. I actually have the opposite problem but it's still (kind of) on topic.

I had my 2nd f2f with PM - I see a CRNP via a national service. She writes Soma and Vicodin for me. I spoke with her last week about my pain levels and how the Vicodin wasn't really helping my pain - more distracting me from my pain. I left with my two scripts + 1 for Vitamin B 12 injections. I came home and filled my scripts - went to pt - got my pills. Came home and saw that she prescribed the same amount of Oxycodone (10-325). I want to stress that the word OXY was never mentioned in our conversation. I cut the pills in quarters and have been taking them. Carefully.

I called my "doc" and left her a message on Friday. I have not heard back.

Weird, right? I am hoping to hear from her tomorrow.

I personally find Oxy to only be slightly stronger than Hydro, so no need to be so careful. In my mind, it's just a different med so for some it works better. Odd though that she didn't mention it. Is it working better for your pain than the hydro?

Water

[IGoeOn]

Hi @Waterfall -

Thanks for commenting on this. I was actually freaked out when I got the script. I spoke with the PM clinic yesterday and the PHARMACY actually filled the prescription incorrectly. They gave me the right medication last night and asked me to flush the other pills down the toilet.

I don't know if the Oxy helps more than the Vicodin - I was cautious with it and I have built up a tolerance to the Vicodin. Mind you, I don't take that much and rarely get any euphoria anymore. I find that the pills more distract me from the pain more than anything else. I do think my pain was different on Oxy - I don't know. I have difficulty articulating how my pain feels - I've learned on this board that I need to pay more attention to it and work on that. I try not to think about the pain because I find it incredibly depressing. I don't want to be depressed.

I appreciate your input - your thoughts on the two medicines. I am going to be going back on my regular dose of Vicodin and see how I feel.

What type cp do you have? What do you do for it? (If you are comfortable.)

[Jeremy Fisher]

@IGogh, I had a cervical fusion in 1995 (apx) of c5-c6, no hardware, used bone from my hip. Had a couple of good years, but then the disc below c7 started bulging. Apparently that is a known side effect of neck fusions, as the disc below must bear the weight of 2 vertebrae not one. Also, my ruptured disc was not diagnosed for over a year so I think some of the nerves were bruised.

These discs are where one's arms hook in, so I am limited in what I can do w/my arms or it sets off my neck. Recently, I messed up a shoulder (have painful trigger points) by dusting overhead too much.

I see a chiro, a neuromassuese (sp?), and now an accupuncturist on a regular basis. Couple years ago I did PT 2x a week for 8 months. I use TENS, anti-inflammatory creams, numbing patches. You name it; I've done it.

The good news is that I have a loving family (one dd) and determination. I have a PCP who scripts 5/500s and has for 6 years. I have this board. But like everyone, I get tired of the daily grind. I am also very careful w/my med use as I know that I am not going to get better. There is no cure. So I must carefully prepare for a life of PKs, so that I can still have pain relief from them decades from now. Tolerance is unavoidable and an unforgiving witch.

Here's a link to a good thread where many members have listed their source of pain What's Your Damage?

[lucyloo]

They gave me the right medication last night and asked me to flush the other pills down the toilet.

Tell the truth---who else cringed upon reading that?

[IGoeOn]

@lucyloo - I know. They only asked. I didn't tell.

I thought it was crazy that they let me keep them at all.

[alumni]

They are always asking how great on a scale of 1-10 the pain is, and obviously saying anything above a 7 or 8 is going to give better script

I think that is a misconception regarding pain management doctors I know "giving better script."
If there has been an adequate explanation discussed about what the levels on this type of scale mean and the patient was able to walk into the office unaided, then any feedback describing the pain as above a 7 or 8 is very likely going to be met with skepticism by the physician or nurse conducting the examination.
A patient typically cannot simply walk into a pain management practice, report 7-8 level pain symptoms and expect to be prescribed "better script."
The same is true for an existing patient attempting to just move up the med ladder.
I believe it's always better to make an effort to understand your doctor's use of any pain measurement charts and then truthfully report your levels rather than trying to overstate them to get different drugs.

[Meow]

Many of the drs I see are specialists who don't know me, don't care, and who I may never see again. When I had my 2 herniated spinal discs, I saw at least 4 specialists, was tossed about at PT and never really got any help. Time, script, and some bed rest made it better a bit, but I still have that among my top pains.

I finally have a good PCP (I swear to god th last set of ladies got their degrees on teh interwebs) but the specialists are an entirely different ball game. They do not take the time to get to know you or help you beyond the acute initial symptoms. I walked out of the last one because she kept me waiting for an hour. I HATE when they do not value your time. So lame. Like my job or life is somehow lesser than theirs.

I don't have a pain mgmt dr, I just have my new internist and various specialists. I get one shot, maybe two f2f with them to get what I need, and I feel like I need to be direct, but not scare them or whatever.

I'm my metro area, there are probably as many docs as people and it is hard to find a good one who cares.

[Lynx4]

@alumni, I agree that saying your pain is a 7 or 8 is ridiculous and basically means you are in the ER with a broken bone, a collapsed lung or some other serious problem. The trouble comes in when patients have no idea how to rate their pain and the only chart we have is one with smiley faces that slowly go from big smiles to a sad face to a crying face. They actually had those when I was in the hospital - ridiculous. So my current pain doctor told me to remove the last 3 digits and act like the pain scale went from 1-7, with 7 being in the ER. We only did that for a couple of visits but even then it was hard.

Many doctors (including a few my Pain doctor has sent me to) think that my medicines are too much for my condition but they make that judgment in 3 minutes or so, so I understand exactly where @Meow is coming from. Yeah, I look and act normal now, BECAUSE of the medicines I'm on. You can't judge the pain level of a person who is adequately dosed. My doctor has a new sign in his office and I can't quote word for word but it basically says that no one has the right to say just how much medicine each patient needs to be productive. It shouldn't come down to the number of pills, but the number of days lived better. But it's written very poignantly.

I believe if they want to use a pain scale that perhaps it should go to 20, or maybe go by halves, like 1, 1-1/2, 2, 2-1/2 and on. Or at least give us an idea of what that particular doctor feels is a 1, 2, 3.

I didn't understand the scales at all when I started pain management and I always said 7 or 8. I wasn't trying to mislead; I was in a ton of pain and to me a 5 is what I felt was probably my day when I'm sitting and watching tv (I'm in pain and trying not to move) and a 7 is what I felt when I had to do any work at all. I'm sure that's why my dr. looked at me like I was crazy but I was naive. Get rid of the scales and ask us how we feel and what the pain feels like and what it prevents us from doing.

[alumni]

There's no question the 1-10 scale with the smilies/frownies (usually referred to as Wong-Baker FACES) is a generally unscientific way to measure pain conditions.
There are other, more complicated tools used like the Triage Pain Score (TPS), or the Brief Pain Inventory (BPI).
Recently, I have seen a number of pain management specialists using the McGill Pain Questionnaire which seems to be an improvement in communication between the doctor and patient especially at the beginning of treatment.

[Meow]

The scalex remind me of the scene in "Idiocracy" where "Not Sure" ends up in the hospital and the clerk is looking for the graphical button to categorize him at intake - like it's a McDonald's cash register.

[sambob]

First be careful what you wish for, sometimes there's not turning back. On that note, keep a pain log and what you are doing to help ease the pain and whether or not it is working. If you've taken a certain medication in the past that worked maybe mention this to the Dr., but it is all about finding the right Dr. that is able to listen and discuss different options if what he is prescribing is not working. When I see my Dr. we talk for at least 30 minutes or so. I recently told him I wanted to stop taking hydro and we sat and talked about all my different options and at the end of the conversation he asked me if I was sure and sent my script to the pharmacy....