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How to approach PM Dr about a change in medication?

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  • How to approach PM Dr about a change in medication?

    I am in agony and have been treated by a pain management Dr for about a year and a half. I was given Norco 4X as needed and Ultram 2X.Also Klonopin at night or half in the Am and half in the PM which ever works better. Well the Norco is not very effective and the Ultram does nothing but give me a migraine.The Klonopin allows me to sleep well but it is hard getting up in the morning because I feel hung over and have a headache from it.I was given Ultram at last appt because I told the PM Dr that the Norco did not last long enough.That is also when she gave me the Klonopin. I am dragging myself in pain ,cannot function that well, house is a mess, and I cannot work. I am gaining so much weight from lack of movement but it hurts to move. I am 32 but feel like I am 80. I have noticed grey hairs lately and my eyes look shot with black circles around them. I am sure that this is from the stress and pain. My pain is not managed, maybe only a little part of the time. I am so afraid to ask for a change in medication. I guess because I was treated in the past like a drugseeker by a urologist.So now I feel like if I tell my PM Dr the truth about the severity of this pain she will not believe me or cut me off my pain meds that I have now and I would die. I am barely functioning and my quality of life is terrible. After reading past posts about others being cut off thier meds it scares the heck out of me! What should I do? How do I approach my pain management Dr about a change in meds to something that works better? I am tired of being like this! At least if I had meds that killed the pain for a little while I could actually leave my house, work again and be somewhat normal. Help!

    Pain meds and other meds I have tried but did not work out: Vicoprofen(used to work but gave me stomach problems so I switched to Norco),Norco worked for about a year before I became tolerant to it I think? Neurontin(could not tolerate) Ultracet did nothing.Ultram not that effective. Elavil(could not tolerate)Lexapro and Cymbalta could not tolerate
    Last edited by Jessica12974; 03-10-2007, 05:53 AM.

  • #2
    I know this can be a delicate situation and it is hard for me to advise you because everyone has a different relationship with their pain doc. I can go in and ask straight out for a medication by name and my doctor is more than happy to let me try it. But some other docs would freak about that.
    I would keep a pain diary and when you go in to see her, I would just gently bring up that you are still in really severe pain and wondered if there were any other options for you? Dont come straight out and ask for anything, just tell her what you have tried and that you are still in severe pain.
    Honestly, she can't fix it if you don't give her a chance. Track your pain very, very carefully. Write down what it is before you take your medication, and what it is an hour after you take your medication. Try to stand your ground and tell her you are not living the life you need to. I think that is what got through to my pain doc. I told him all the things I was kept from doing in my life because of my pain. Not cleaning, cooking, getting together with family and friends, walking my dogs, having sex with my husband, etc. Things I should be able to do!
    I would call and make an appt ASAP. You shouldn't have to suffer like this, it isnt fair. We are here if you need to vent!
    love sarah
    Current meds; , effexor 37.5 mg 2 times a day, and lyrica 100 mg 3 times a day, lots of reading and snuggling with the pets!


    • #3
      I agree with Sarah about starting a pain diary and charting your pain in conjunction with when you take which pain meds..

      Ideally, your PMD will be willing work with you and find something that controls the pain. I know I would be afraid too, but I think we have to really speak up for ourselves when we are in pain. If your doctor won't help, you can always seek out another doctor.

      Good luck and big hugs! My thoughts and prayers will be with you.

      Hugs and Wishes for Pain FREE days!!,
      Kara ~reducing plastic waste one bag at a time~

      Facebook: Kara Kaiser
      Twitter: Love4Earth

      Me and my Guccigirl... she helps me through those painful hours!


      • #4
        I totally understand your fears. I am currently having the same problem you are. I have been on my pain meds for a year. I take 30 mg Kadian (24 hour, time released morphine) at bedtime and Lortab 10mg 2 x a day for breakthru pain. This combo worked well for me for a while, but like you, I think I have grown tolerant. It just isnt working like it used to work and I am in alot of pain still.

        I rarely ever see my Pain Dr. I have only seen him at 3 office visits in the last year, (at the initial visit, and twice when he tried to drop me.) I spoke to the nurse practicioner at all my other monthly visits.

        I have told her that it worked for a long time, but that I think I have either gotten used to it or my condition has gotten worse, because my pain level has been inching back up over the past several months. I told her I am not asking for something stronger, but that I wanted to make a lateral move by switching to something equivilant for a few months, and then possibly switching back, in case my body was just used to this.

        The Nurse Practicioner agreed that tolerance was definately a possiblity and agreed that my request was reasonable and thought it wouldnt be a problem. But, when she left the room and spoke to the Dr, she came back and said that since I was having no side effects on my current meds, he didnt want to switch me to anything different. She was as shocked as I was!

        Instead, she said since I was on such a low dose of Neurontin, that he wanted to titrate it up and see if that would help. I was on 300 mg 3 x a day. So, for the past 3 months they have increased it by 200 mg each time. My pain has still not responded, but my frustration level is increasing dramatically! She told me last month that when we get to the max dose for it, if I still show no response, then they will try switching the Neurontin to another neuropathic med, such as Lyrica. I am just not entirely sure that the pain I am having is neuropathic, but we shall see.

        I am tired of driving 5 hours round trip and paying out the wazoo for a Dr I never see, to treat my pain when I am still in alot of pain. I mean, I know that I will never be pain free. I realize that I will always have some pain, but I do not think it is unreasonable for me to expect to be able to do the dishes without laying down b/c I am hurting too bad! Nor should it be unreasonable for me to be able to sit on the couch and talk to my husband for 30 minutes without having to say, "I am sorry, but sitting here hurts too much, I gotta go lay down." These are not high expectations!

        I go back to the pain clinic next week. I wish I could go somewhere else, but like you, I have had some horrific experiances with Drs. not believing in IC or the pain it causes. I am just too tired and in too much pain to have to go thru that part again. But, if they cant get this under control soon, I guess I will have to drive another hour or so until I can find another Dr. that will treat the pain of IC. I am going to give it another month or so. (Just cause it would take me that long to get into another Dr. anyway.) But, in the meantime, I am going to go ahead and be looking for a new one and get an appt set, just in case I end up needing one.

        I wish you luck with yours. Since you havent had "the talk" with yours yet, you may be borrowing trouble. From what I have read on here, most pain clinics do understand tolerance and realize that adjustments will need to be made from time to time. Certainly most ICers dont have any problems getting their Drs. to make a lateral move. (Mine seems to be the only one with this particular problem! GRRR!!) The main problems most have is if they ask for a particular med or something, that sends up the drug seeker flags to alot of Drs. But, since you are an established patient and arent doing that, you probobly wont have any trouble.

        Anyway, I just want to wish you luck and let you know that you arent the only one who hates and fears talking to your Dr. about med changes. As you can see, I am right there with ya!

        I hope that everything goes well for you at your next visit and they switch you to something that will be effective for your pain and have minimal side effects.



        • #5
          Providing a surprisingly human shopping experience. Trusted and secure. Millions of domains to choose from.

          This is a very cool online pain diary. It's a little complicated to get it started, but once you do it graphs your pain, symptoms, etc. It's really a nice tool to help you and your doctor see what aggravates your pain, and what helps to control it.
          *IC-- Summer 2004; PFD--October 2005
          *Fibro--Fall 2000; CFS-- Fall 2000
          *MPS--Fall 2000; Crohn's disease-- 1997*IBS,GERD, *Migraines, hypothyroidism, GYN problems *Degenerative Disc Disease/scoliosis

          Total Abdominal Hysterectomy--adenomyosis--9\08

          04/17/09 Crohn's disease almost killed me with a combo of extreme constipation from pain medications. My bowel ruptured, I almost died from peritonitis and spent several days in the ICU then more in a private room on the floor. If you have any questions about severe constipation from pain meds please don't hesitate to send me a message.


          • #6
            pain management

            Thanks for all your replies and advice. I will start a pain diary. I called today to schedule an earlier appt, my original appt was not until April 18th. I go every 3 months usually. And the receptionist put me in for this Fri at 11:00. She kind of gave me a hard time and questioned why it was too long to wait until my next appt. So after mentioning the new med my Dr gave me to try(ultram 2X day along w/ the Norco 4X I was already taking) and that it was not working out she gave me an appt for Friday. It kind of ****** me off that I was questioned about needing to get in sooner because most go every month. Normally I like that idea but I am in pain! I am sooo nervous about telling my Dr about the meds not working for me. Every time I go and mention that the meds do not last long enough she asks have we tried ultracet or neurontin. And my answer is always yes, it did not agree with me(it says it in my chart). To me it seems that she is not willing to give me anything else but I guess I will have to wait and see.I do not know what to do at this point. I have to go back to work starting this Sat and if I do not have effective pain management I will not be able to. I cannot apply for disability because my urologist is a jerk. Long story I mentioned it in my post under cystoscopy-Chronic Hypertrophic Cystitis. My life is being ruined. I cannot take it anymore. I am so tired of having to explain myself to Drs. But I guess it is the same for alot of IC patients. I hope this goes well on friday. My stomach is in knots thinking about it. My life, job, finances depends on me having pain relief. I am so stressed! I got a bladder installation this morning by my urologist and instead of it helping it made things worse! I could not hold it in for more than 30 minutes. My Dr said to wait an hour and a half before urinating! It burned so bad! I do not think I will get another one! Well I hope everybody`s day is going better than mine!Thanks for letting me vent and thank god for this website! I do not know what I would do without all of you! Before I found this site I thought I was the only one with this crazy disease and felt so alone! Well I gotta go take my 12 year old to the ER now to get an X-ray. He hurt his foot skateboarding! It is always something going on in my house, never a dull moment! Wishing everyone a happy and pain-free day!



            • #7
              I hate to even put this in your mind but you might start calling around right now for another pain doc. Just in case your pain doc isnt receptive to your feelings on Friday. I am really hoping she will be, I just dont want you to get stuck in a bad position and sometimes it takes a really long time to get in to see other pain docs.
              Please let us know what happens! I am very anxious for you.
              Love Sarah
              Current meds; , effexor 37.5 mg 2 times a day, and lyrica 100 mg 3 times a day, lots of reading and snuggling with the pets!