PDA

View Full Version : Pain Meds needed



mbeckoff
02-17-2011, 08:27 PM
I came home from the hospital on Oxcodone 10 mgs - up to 6 pills a day. My surgeon prescribed Tramadol which did nothing for me. He does not want me on Oxcodone. What are some other drugs?

Thanks

Melissa

jrnyc
02-17-2011, 09:08 PM
i am not sure whether oxycodone is the same as hydrocodone...which is like vicodin...
i take a 30 mg oxycontin on "bad" days, and 2 hydrocodone together, up to 3 times a day, on "regular" pain days...
my system is funny...i NEVER get constipated from those meds...
i stopped all pain meds for a week once, and nothing much happened...i mean, i was a little grumpy, but that was it...no other symptoms...

i also have nucynta...but i don't like it...it doesn't do anything for my pain...
i have opani, but i can't take it, as the morphine in it makes me throw up...as soon as it hits my stomach!

i do not know what a doctor should be giving you for pain...but i do believe you need a serious pain doctor or physiatrist or neurologist or anesthesiologist or other pain specialist to address your needs!

jess

mgs
02-17-2011, 09:28 PM
I just don't understand why some surgeons are so skimpy w/the pain meds in the early phase of recovery. My discharge pain med, after my hardware removal surgery, which is not as rough as the fusion surgery, was 20 mg oxycodone every 3 hours - the same as I took during my 2 day hospitalization. The spine fellow wrote that order, not my surgeon, and I very much appreciated it. My surgeon would never have written for that generous of a dose. But, I needed that much, for the first week or so. It made a huge difference - I wasn't zonked, I was just reasonably comfortable.
At my pre-op appt on Tues, the RN went over, among other things, pain meds. That office discharges you from the hosp with about a week's worth of oxycodone, then when you call them for a refill, they take you down to hydrocodone. I told the nurse that I've never found Vicodin any more effective than Tylenol. She paused and said she agreed, in some instances - that oxycodone is better for bone pain, and hydrocodone is more for soft tissue injury pain. I didn't know that.
Pain management seems to be an area where there are wide differences of opinion among surgeons, and a common area of patient dissatisfaction.

Cinch
02-18-2011, 10:31 PM
I agree with mgs. The pain meds are an issue. I'm 4.5 months post op and am told that my pain should be subsiding, but my upper thoracic is still very painful. I was all but told that my most recent refill will be my last after a 15" incision and a 12 vertebrae fusion. I don't know, should the pain just magically go away?

My primary care physician has gotten into a pissing match with my pain specialist as to who should write an rx and I feel kicked to the curb. I think you may want to consult with another provider; I know I am if my pain continues as it has.

I think these providers are too worried about liability and perhaps should undergo the scalpel themselves for perspective.

mbeckoff
02-19-2011, 07:17 AM
Yesterday, my surgeon's nurse called me back and is giving me some more Oxcodone . She says that I have to go to a Pain Mangement Doctor for future pain meds. Why? Is this an insurance issue?



Melissa

mbeckoff
02-19-2011, 01:42 PM
Yesterday, my surgeon's nurse called me back and is giving me some more Oxcodone . She says that I have to go to a Pain Mangement Doctor for future pain meds. Why? Is this an insurance issue?
Melissa


When I went to the drug store today, the drugs that had been prescribed were Hydrocodone. Where do they fit in in terms of getting rid of pain and additicion?

Thanks
Melissa

mgs
02-19-2011, 02:08 PM
Hydrocodone is not as strong as oxycodone. It's not a "nothing", though. A lot of doctors and oral surgeons use it for post-op pain. Also, it is common for surgeons to have patients go from oxycodone to hydrocodone after a while (in the case of my surgeon, at about 2 weeks post-op).

There is a difference in how easy the meds are for you to get them. For hydrocodone, the dr's office can call the prescription in to the pharmacy. For oxycodone, there is no calling it in. .. you (the patient) have to give the pharmacy the paper prescription in order for them to fill that prescription..

I hope that you can find a pain mgmt doc SOON.

Why do so many surgeons want to back off from pain mgmt fairly soon after surgery? I can only postulate.

jrnyc
02-19-2011, 03:24 PM
i do not think it is an insurance issue..
i think it is a doctor issue...

there are a lot of doctors who do not understand pain...
they are afraid of prescribing...they think they will either be responsible for creating a dependence or addiction problem....or will contribute to one that already exists...
my pain management doctor in Manhattan is the only one who is not worried about that...at least not with me...
he told me flat out that he does not believe i have the potential to abuse meds,
though i know from working in the field that dependence is a different thing from abuse...

i have met pain doctors...at least, that is what they call themselves...who are hesitant to prescribe large amounts of meds, even when they are clearly needed!

i think it is horrible that patients in severe pain often go without appropriate medication!

jess

mgs
02-19-2011, 03:51 PM
Jess, you are so blessed. . .your doctor is a friggin' saint.

Ditto everything Jess said, and I'll add that many docs are worried they'll be flagged by the DEA as heavy prescribers, then have to deal with a DEA audit.

Obviously, I have no idea how long I'll need opiates after my surgery on Tues. . .but, I'm sure it will be the same old story, me "hat in hand", a couple weeks post-op, begging for pills to get some relief.

jrnyc
02-19-2011, 04:22 PM
i know you may be put in that situation, mgs...and that is just so wrong!

i do not like having to make the 6 hour round trip in bad winter weather, but i am thankful to have a pain doc who really understands pain! i know from reading forum to be grateful for him!

the only thing i could recommend would be to try to find a pain doc before surgery...
i know that is a lot to ask, as patients have enough to do to get ready, and a lot to worry about...
i don't understand why surgeons can't just work in conjunction with pain doctors, if the surgeons are so skittish about doing the prescribing themselves...
it would make sense...and show compassion to their patients!!

i wish you the best, mgs...i hope your surgery goes smoothly, and recovery goes uneventfully!

Melissa...is there a way you can just start making appts with all the pain docs in your general area who take your insurance...? better to see too many than too few...even if traveling is involved...

jess

Doodles
02-19-2011, 05:37 PM
Jess--
You are just making too much sense--and that never works! Getting pain meds to handle it was always tough. I could not get more hydrocodone after 6 months from the surgeon. No way was I ready for that. I had to go to my general doctor. She was very skimpy with it. She was out of the country then and the "sub" doctor was much much, much more helpful. Maybe because he was actually retired. I still have a whole bottle after I was done at about a year plus. Janet

Elisa
02-19-2011, 06:13 PM
Was wondering if they prescribe the same pain meds post-op to teens that they do to adults and if so, how long do teens 'generally' stay on pain meds? I'm so focused right now on the countdown to my son's surgery, halo traction and second surgery that I haven't even begun to think about recovery but am very curious about it.

jrnyc
02-19-2011, 08:59 PM
hey Janet
you are right...
and there seems to be a lot in the medical field that doesn't make sense...
so the medication issue is just one of them...
i think doctors are not well trained in the field of pain treatment...if they were, perhaps they would not be so freaked out at writing prescriptions that are justified...
maybe it is the government watch dogs, too...

the patient is always the one to suffer from their screwed up policies!

jess

mbeckoff
02-20-2011, 04:41 AM
i know you may be put in that situation, mgs...and that is just so wrong!

i do not like having to make the 6 hour round trip in bad winter weather, but i am thankful to have a pain doc who really understands pain! i know from reading forum to be grateful for him!

the only thing i could recommend would be to try to find a pain doc before surgery...
i know that is a lot to ask, as patients have enough to do to get ready, and a lot to worry about...
i don't understand why surgeons can't just work in conjunction with pain doctors, if the surgeons are so skittish about doing the prescribing themselves...
it would make sense...and show compassion to their patients!!

i wish you the best, mgs...i hope your surgery goes smoothly, and recovery goes uneventfully!

Melissa...is there a way you can just start making appts with all the pain docs in your general area who take your insurance...? better to see too many than too few...even if traveling is involved...

jess

Jess, I actually have an appt with a pain doctor on Friday. I had totally forgotten about it until they sent paperwork in the mail.I do not even know when I had made the appt. I hope that this Doctor understands me and can help me
I took Hydrocodone last night for the first trime and keep waking up every hour. It seemed to have helped my pain somewhat , not as good as Oxcodone but OK

Melissa

trulyaries
02-20-2011, 08:09 AM
During my pre-op visit with Dr. Lenke, I asked him about his attitude toward pain meds because I have had the same experience, having to beg for refills. The docs were more worried about creating a drug addict than whether I was in pain. I also developed allergies to several pain meds so it's going to be a challenge for me. I appreciated Dr. Lenke's response: If you're in pain you won't move. And I want you to move, so you will have pain meds as long as you need them. And we will involve pain management docs to find what works for you. Let's hope he follows through with this refreshing attitude.

jrnyc
02-20-2011, 11:13 AM
that is so good to hear, Felicia!

Melissa...i am glad you had some kind of medication to take!...
i know...the pills never seem to help with sleep, at least not to my knowledge...but they can take the edge off the pain...so you can stop grinding your teeth from the pain!

jess

Karen Ocker
02-22-2011, 05:16 PM
How a person responds to pain meds is genetically modulated. What works for one doesn't help another. This is not a moral issue but a physiological process.

Pain is carried through different pathways in the body.
Different medications work on pain differently: gabapentin/lyrica help nerve pain which no opiate relieves.

Early abolishment of pain is better than letting it get out of hand. There is a "wind-up" phenomenum where insufficient relief of pain, at it's onset, can result in chronic pain later on.

Pain management docs are usually the best because they can fine-tune different medications which relieve pain via different pathways.

The problem with opiates is that higher and higher doses are needed because the body gets more efficient at metabolizing them in the meantime bowel problems can ensue.

Tranquilizers such as valium, xanax and ativan are not recommended as effective in the recent pain management course I took. Sudden stopping of such meds after regular use can result in seizures. They have also been implicated in suicidal depression in the elderly as well as memory problems.

Antidepressents help pain but science is not sure how.

Other non-pharma methods do help pain: ice, heat and alpha-stim(TENS).

I was very grateful to my pain doc who had me gradually tapered off opiates after 3 months and dealt with the expected withdrawal that did happen.

mbeckoff
02-22-2011, 08:06 PM
How a person responds to pain meds is genetically modulated. What works for one doesn't help another. This is not a moral issue but a physiological process.

Pain is carried through different pathways in the body.
Different medications work on pain differently: gabapentin/lyrica help nerve pain which no opiate relieves.

Early abolishment of pain is better than letting it get out of hand. There is a "wind-up" phenomenum where insufficient relief of pain, at it's onset, can result in chronic pain later on.

Pain management docs are usually the best because they can fine-tune different medications which relieve pain via different pathways.

The problem with opiates is that higher and higher doses are needed because the body gets more efficient at metabolizing them in the meantime bowel problems can ensue.

Tranquilizers such as valium, xanax and ativan are not recommended as effective in the recent pain management course I took. Sudden stopping of such meds after regular use can result in seizures. They have also been implicated in suicidal depression in the elderly as well as memory problems.

Antidepressents help pain but science is not sure how.

Other non-pharma methods do help pain: ice, heat and alpha-stim(TENS).

I was very grateful to my pain doc who had me gradually tapered off opiates after 3 months and dealt with the expected withdrawal that did happen.

This is very interesting.Thanks for explaining .
My docotor gave me Tylenol with codeine. Lets hope it works with the least amount of side effects

Melissa

LAL
02-26-2011, 11:25 PM
In response to Elise who asked about pain meds and teens. My daughter had surgery at the age of 16. They sent her home with a script for about a week of pain meds. She needed more, the told me to give her tylenol. (this was Shriners in Chicago) I ended up having to take her to our GP who gave her another script for vicodin, but was reluctant, due to her age and he told her at that time he would only give her one script, so what, she better be pain-free after that or else? I found during this experience that many doctors are very reluctant to prescribe teens pain medication in the amount they need becasue they are afraid of causing "addiction". Even a pain management center at a well known hospital here in Michigan would not give her any pain meds due to "her age". So someone her age are just supposed to be in pain? We finally found a great pain management doctor who works with her to try to give her what helps with her pain, but she is 20 now, so maybe its because she went over that 18 year old mark, I am not sure. My suggestion is to find someone prior to surgery, because the surgeon will only prescribe pain meds for a short period of time and if your son happens to need it longer, it may be difficutl to find someone to help you if you wait until you need it.

Pooka1
02-27-2011, 05:56 AM
Spiny mouse,

I didn't see your question about pain needs for kids until LAL responded.

You may want to search the archives for the many answers or re-post the question on your thread.

I can't answer for what most surgeons do but our surgeon sent us home with a script for about a week of percoset with each kid. It was dicey after it ran out with the first kid but she managed on Tylenol. The second kid was better but then had the hug injury and then it was dicey. But she managed on Tylenol.

Some kids need only a few days of meds and some need far more. This might be under genetic control plus some complexities... my identical twins react to drugs differently to the point that one is allergic to sulfa drugs and the other is not. Also, one had a much easier recovery seemingly due to handling the anesthesia better.

The bottom line is the main reason parents need to be with the kids to to make sure pain is controlled and to advocate for them when it isn't.

jrnyc
02-27-2011, 11:13 AM
how awful that doctors are so ridiculously hesitant...and how insensitive!! i wouldn't be surprised if children or teens were not in a hurry to see a doctor again, if they were made to suffer for lack of pain meds!!!

jess

mbeckoff
03-17-2011, 06:23 AM
Here I am back again.I saw my pain management doctor last week and my surgeon yesterday. I am back on Nycentia at 100 mgs . It has brought my pain down to a 5.Yea!!! Bad news is that it makes me dizzy at this dose. I called the pain management DR and she told me that the dizziness could go away in several weeks. I will stick it out and see what happens . My surgeon is pleased with my healing.He does not feel that it is too soon to be off pain meds.
Thanks for all of your prayers and concern

Melissa

asccbodypro
03-17-2011, 03:28 PM
Here I am back again.I saw my pain management doctor last week and my surgeon yesterday. I am back on Nycentia at 100 mgs . Melissa

Melissa,

I have never heard of Nycentia prior to your post. What type of pain were you having and did they prescribe it as an alternative to narcotics? I've had pain management issues and am now on just valium and Tramadol and the ever consistant Celebrex. Valium has been the only thing that has worked for my muscles spasms but I have been on it for 4 years now. I can back up Karen's statement as far as memory loss goes....good lord, I seem to forget so much latey I feel like I'm loosing my mind. Pehaps I have found my culprit! I hope you have good success!

jrnyc
03-17-2011, 03:36 PM
hey Melissa
glad the nuycenta is helping you...
it did nothing for me!

hope your pain stays manageable, if it doesn't diaappear!

jess

mbeckoff
03-18-2011, 06:52 AM
I am having as bad a pain before my surgery and yes they gave it to me as a alternative to narcotics.Memory loss is so bad for me

Melissa

jrnyc
03-18-2011, 01:06 PM
nucyenta is listed as a "mu opioid"....
anyone know how to explain it...???
i am pretty sure it is still in the opioid "family"
????

jess

Pooka1
03-18-2011, 02:01 PM
okay I looked it up because I don't know squat about this stuff.

The "mu" is the Greek letter and refers to morphine.

http://en.wikipedia.org/wiki/Mu_Opioid_receptor


The μ-opioid receptors (MOR) are a class of opioid receptors with high affinity for enkephalins and beta-endorphin but low affinity for dynorphins. They are also referred to as μ opioid peptide (MOP) receptors. The prototypical μ receptor agonist is the opium alkaloid morphine; μ (mu) refers to morphine.

So that drug is in the mu class which I take to mean works on the same receptors as morphine.

mbeckoff
03-18-2011, 03:44 PM
So which is stronger, oxcodone , oxcocontin or nycenta, The nycenta makes me feel dizzy and forgetful but it takes the pain away. The other two work great with no side effects but no one will prescribe them for me.

jrnyc
03-18-2011, 05:08 PM
wow! i had no idea...thanks, Sharon...

funny...the nucyenta does nothing for me...i think i have 50 mg dose...
but i cannot handle morphine...makes me vomit the moment i swallow it!
my mother was allergic to morphine...
strange that nucyenta has no effect on me! i asked the PA what it was for...i could not even tell it was a pain medication!

glad if it helps you, melissa....just shows how different people's bodies function!

jess

mbeckoff
03-20-2011, 07:35 PM
wow! i had no idea...thanks, Sharon...

funny...the nucyenta does nothing for me...i think i have 50 mg dose...
but i cannot handle morphine...makes me vomit the moment i swallow it!
my mother was allergic to morphine...
strange that nucyenta has no effect on me! i asked the PA what it was for...i could not even tell it was a pain medication!

glad if it helps you, melissa....just shows how different people's bodies function!

jess
I am on 100 mgs. The 75 did nothing for me. I hope that some day soon I will not need anything for pain but not happening now.

Melissa

jrnyc
03-20-2011, 08:18 PM
yes, i know...it would be like a whole new world, not needing pain meds!
it is amazing to me that it takes 100mg to get relief!
for now i just stay on my hydrocodone, and take the oxy on "bad" days...
i'm glad you found something that helps to some degree...
i wonder if anything really takes all the pain away...

jess

mbeckoff
03-21-2011, 06:39 AM
well, the oxcodone and the oxcocotin did. I cannot get any from any doctor. Glad that you are able to get what you need

Melissa

Lilysaidwhat
03-21-2011, 08:27 AM
oxycoDONE is short-term pain relief. It lasts about 3 hrs. OxyconTIN is long-term and lasts about 12 hrs. I take contin every 12 hrs and codone every 3-4, valium for spasms, and tramadol or tylenol to fill in for breakthrough pain so i can get off the codone faster.

Unless you have a history of addiction, I would really push to get the oxycontin with codone for breakthrough and if rejected, ask for a specific reason why. Be your own advocate and remember that the doctor is working for YOU.

mgs
03-21-2011, 10:57 AM
Ummmm. . .the docs are not "working for you", they are (most of them) trying to provide quality care that is within the scope of their specialty (says this wife of an MD and mother of an MD). They are not the waitstaff, even if someone likes to think they are. (I must be having an estrogen surge today.) Regarding pain management, different physicians have different approaches, which is well within their rights as practitioners. (Thanks to the "SUE HIM/HER!" mentality, many physicians now operate on the premise that "I can't get in trouble for pain meds I don't write for, I can only get in trouble for the pain meds I do write for", hence. . .) So, I could not obtain my pain meds from my surgeon (who, though it may be inconvenient for me, is within his rights to limit his writing for narcs to just a few weeks after surgery). How he chooses to practice medicine is his choice, not mine. I might have the opinion that he should handle this differently, but see how far that takes me. I might as well expect to "tell" the IRS that they should go to a flat tax, and expect them to do it because "they work for me".. .

I have seen pain management, post surgery, be a "hot button" issue in the MD world. Surgeons usually feel that their job is SURGERY. Read through many a thread in this forum: many of us have had the experience that our primary physicians pick up (out of kindness to us) where our surgeons chose to leave off. Pain mgmt is one of several issues that has caused a rift between primary care and surgeons (and other specialists). Don't think for a second that the internists and Family Practice guys haven't noted that the surgeons have just made a nice chunk of $, and they (answering our phone calls, and writing our scripts) made [relatively] little or zilch $ for their time and risk.

Lilysaidwhat
03-21-2011, 12:10 PM
Ummmm. . .the docs are not "working for you", they are (most of them) trying to provide quality care that is within the scope of their specialty (says this wife of an MD and mother of an MD). They are not the waitstaff, even if someone likes to think they are. (I must be having an estrogen surge today.) Regarding pain management, different physicians have different approaches, which is well within their rights as practitioners. (Thanks to the "SUE HIM/HER!" mentality, many physicians now operate on the premise that "I can't get in trouble for pain meds I don't write for, I can only get in trouble for the pain meds I do write for", hence. . .) So, I could not obtain my pain meds from my surgeon (who, though it may be inconvenient for me, is within his rights to limit his writing for narcs to just a few weeks after surgery). How he chooses to practice medicine is his choice, not mine. I might have the opinion that he should handle this differently, but see how far that takes me. I might as well expect to "tell" the IRS that they should go to a flat tax, and expect them to do it because "they work for me".. .

I have seen pain management, post surgery, be a "hot button" issue in the MD world. Surgeons usually feel that their job is SURGERY. Read through many a thread in this forum: many of us have had the experience that our primary physicians pick up (out of kindness to us) where our surgeons chose to leave off. Pain mgmt is one of several issues that has caused a rift between primary care and surgeons (and other specialists). Don't think for a second that the internists and Family Practice guys haven't noted that the surgeons have just made a nice chunk of $, and they (answering our phone calls, and writing our scripts) made [relatively] little or zilch $ for their time and risk.

I'm going to assume positive intent and that your tone is coming off differently than you anticipate. I too am a med spouse - year 12 of what's become a 14 yr program - and the reality is that they ARE working for the patient. You are paying for their expertise. At no point did I say to tell them HOW to do their jobs, but if I were still having pain management issues you can bet your bippy I'd like to know exactly WHY that was the case.

What I was trying to say is that a lot of people tend to be intimidated by their docs, and are afraid - or don't know how - to advocate for themselves. Docs are humans and far from mind readers. They can't help if you don't communicate clearly with them, and that is the biggest part of advocating. THAT was my point. Believe me, we've lost plenty a dinner to treatment of the Worried Well and Dr Google. It's critical though that her doc understand what is happening from a pain perspective. *That* was my point and I don't know if that is happening since apparently her only interaction is with a front-staff nurse who may or may not be conveying info to the doc.

I wasn't trying to get into a pissing match here. I was trying to help.

*steps off soapbox*

mgs
03-21-2011, 12:29 PM
Of course, positive intent. We can agree to disagree about the semantics of the doctor working for the patient. . .I do not consider Dr. Tribus as someone who works for me.

14 years?!?!?!?!! What specialty is your husband going into? My daughter's program is "only" 9 years, at the end of which she'll be a transplant surgeon (5 years clinical surgery residency, 2 years research and 2 years fellowship).

Anyway. . .hugs. I am so happy that you are doing well.

jrnyc
03-21-2011, 01:04 PM
hah! working for you...hah! not even close!

any "intimidation" factor will quickly disappear for any patient who has an illness not easily diagnosed...many doctors just plain bail....many seem to want the easy to diagnose and easy to treat cases...any respect will likely disappear with the "intimidation"

i don't really care if someone is a doctors' wife, husband, sister, brother, mother or father....plenty of folks in this world work hard...and don't make a whole lot of money...so i am not crying any tears for any doctors! the good ones are worth their weight in gold...the crappy ones should be drummed out of the business...because they can do a whole lot of harm...and delay treatment by a physician who actually cares!
i couldnt believe the complaints from a GP in Manhattan who shall be nameless, whom i knew for many years....no longer see him...he complained of not being able to retire because, between HMO's and Obama's plan, he just doesn't make a ton of money anymore...he said this to a former special ed teacher and current social worker...who never made a lot of money!

yes, this is just my opinion...not to insult anyone on this forum...just to express the experiences i have had with the medical community...
ask anyone who had problems getting a diagnosis...i suspect many had the same experiences!


Melissa...none of it takes all the pain away for me...it does stop me from grinding my teeth in pain...

jess

jrnyc
03-21-2011, 01:30 PM
thanks for your kind concern...

jess

mbeckoff
03-25-2011, 06:18 AM
Well I had to stop taking nycenta. I could not get past the dizziness. I have a call into the pain management doctor. I will let you know what happens

Melissa

jrnyc
03-27-2011, 12:17 AM
sorry to hear that, melissa...i hope that they can find something that will help with the pain....and not make you all wobbly!
i just got back from pain doc in Manhattan, and we discussed the same medication...he told me i was on 75mg of it...i told him i thought it was less, and it did nothing for me (he was right...it was 75 mg)

he is keeping me on oxycontin and hydrocodone, but wants me to take the oxy every day instead of just on "bad" days...i am not crazy about that idea...i also got another script for Nuvigil, for the exhaustion from pain meds...you know, they give you a medication to deal with the side effects of the other medications they are giving you!

i downloaded a wicked virus by mistake, and it destroyed our computer....so til we get it fixed, i am using an ancient one my husband had...
if anyone happens to write to me and i don't answer, it could mean i have no access to ANY computer if my brother in law(computer wizard) is working on fixing the computer that has the virus....hope he gets here soon! (watch out for the "UPS virus")

jess

mbeckoff
03-27-2011, 12:16 PM
I am so upset with the pain management DR. They never called me back on Friday and now I had use the nucentia all weekend. Tomorrow I am going to call the office manager and tell her exactly what I think .

Melissa