Pain Management

Hello, I'm writing today because I'm unsure what to do. I've had pain in my neck, back, and shoulders for some time now and last year I was in a pretty bad auto accident. I decided I was tired of being in pain every day and asked my PCP for help. She started me on Tylenol 3 but was not comfortable prescribing for a long period of time. She reffered me to pain management and I've been going for the last 14 months or so. Initially I was on tramadol 50mg 3 times a day and it was increased to 4 times a day. The tramadol was giving me headaches and they switched me to Norco 5mg 3 times a day. It was helpful and I was able to exercise and function much better. Over the last year they have cut me back from 90 to 75 to 60 and now to 45 with plans to go-to 30. I'm not able to exercise anymore without pain in my neck and back and now I've ruptured my bicep tendon. I told my orthopedic Dr. I'm in pain management and called my pain management and told them what happened. They refused to give me any extra pain meds. They told me that if the orthopedic Dr. wrote me a prescription to call them and let them know before I filled it. The orthopedic Dr. won't write me a script for anything because I'm in pain management. The script for 45 was insufficient for my pain before this most recent injury. I have a week left before I go back to pain management and I have 2 norcos left. My script is for 1-2 a day so 45 if I take 2 a day like I have been since I tore the tendon does not last a full month. I've been completely honest with them every step of the way. Today they called me back after I dropped off a letter from my orthopedic Dr. yesterday telling them that I had ruptured my bicep tendon. The guy says well we are not giving you any more pain meds, really rude and then says when you come in you better have the appropriate amount in your urine. Well, I told them I've been taking 2 a day and my prescription allows for 1-2 a day. This rupture hurts like heck and 1-2 a day before this rupture was not enough for the pain I was already in. They are making me feel like I'm a drug addict and I'm just trying to deal with the pain. I want to take a pain pill so I might be able to get comfortable and go-to sleep. It's 4 am and I've been laying in bed since 11. I don't know what to do. I'm taking ibuprofen 3 times a day but it is very little relief. Any advice?



  • dmoddmo Posts: 471
    edited 07/31/2019 - 11:10 AM

    Hi Tim,

    I am sorry for your pain.  As a matter of fact there are many of us here that say that exact same thing over and over.  I have said it a million times since the war on opioids started.  Unless you find a sympathetic dr chances are you will not get an increase.  I know you are new to the forum and might not have read much about the war so its best to start reading and learning the new system on pain management. 

    Our government has decided what is best for everybody.  You need extra meds, no can do sir.  Maybe if you have cancer you might get in increase.  I am all for a complete and thorough study of the effects of pain meds on the general population.  Chronic pain patients need to be certified by a pain management dr and therefore not subject to all this unnecessary interrogation that we now endure. 

     It is said, "The government is best which governs the least"

    Please know I am not bashing drs though I believe some do not have the best interest of the patient at heart.  I am however criticizing the DEA and the CDC for their overzealous crackdown on pain medications for the chronic pain patient.  I am not sure of the reason but there definitely seems to be a hidden agenda behind this war.  Perhaps someone smarter than I could enlighten us all.


  • Thanks for the feedback. I haven't been taking more than I was allowed. My prescription is for 1-2 a day as needed. So if I take 2 a day it would only last 22 days. What I don't understand is how they can demand I have an appropriate amount in my urine when I go back in a week. If I take my last 2 the day before I hope that will be sufficient. I don't know how that works. I don't want to call them again because every time I do they seem very aggravated that I am bothering them. Despite the fact they demand to be kept in the loop. I've done therapy twice in 14 months here. Literally nothing as changed since my initial visit yet I've been cut in half from what was already a low dose. I think I'm going to try and find another Dr. before I start rehab on my arm. Thanks again.

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  • Tim I'm so sorry your being treated this way. I assure you others here on this board are hitting the same road blocks and are now being under prescribed too instead of over prescribed ..Yes I see your saying your allotted up to 2 a he should be giving you 60 not 45..and what worse is here you have a new issue and your being treated so harsh..You most definitely need a new pm... I would discuss this with your primary doctor asap since they were the ones that referred you for PM in the first place. Plus it would help with getting in faster.

      I am also concerned about the fact your about out with a week to go before your seen..the body get dependent on this medication and you will also be suffering with withdrawal symptoms which is going to make this a even ruffer week for you.

      Wish I had better  answers for you but I dont..but please notify your primary care doctor . He also needs to be in this loop .

  • The whole purpose of pain management is to treat pain and reduce pain (not totally eliminate it).

    With that said you should be able to expect reasonable pain relief. Going from 90 to 60 to 30 doesn’t sound reasonable IMO.

    In fact, I bet no one on the forum who is prescribed an IR opioid has a script to take just one pill daily (unless it’s an ER med). 

    From a realistic standpoint pain management on one 5mg of Norco daily sounds unreasonable.

    Even a dentist, following oral surgery, will prescribe maybe 12 to 16 pills, to be taken every 4-6 hours for pain, as needed.

    When you’re getting less of an allowance than a dentist would allocate to you, something seems wrong.

    I have no idea why they’re mean when you talk to them. Is there anything that’s happened in your 14 month history with them that would cause them pause when prescribing? 

  • Tim,

      You need to speak to your doctor and make sure you are both on the same page when it comes to your meds.

    normally if they write 1-2 per day and anything less than 60 pills, it means you are not meant to take 2 everyday.

    your pharmacy and insurance is always going to look at that as a 30 day script and may not let you refill at 22 days.  

    And I would bet that's what he is thinking since he made a remark about having the proper amount of meds in your system.

    I would just clarify that with him and maybe he will increase the script to 60.

    Especially if your pain isn't well managed.

    you deserve to have your pain treated properly.


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  • Thank you all again, I've passed every urinalysis (generally every other month on average) never had any problems, they have in the past reffered to me as a perfect patient. I got a new pm np. And since this happened she has been very rude at each encounter. She told me that I needed to stop taking my Klonopin and my ssri that I've been on for years through my psychiatric Dr. And when I told her that my psych Dr. Told me to tell her no, that's when she started treating me different and cutting my pain meds. She got very rude with me and told me that I was on a huge dose of Klonopin I've been on them for 6 years for anxiety that was causing very high blood pressure. I'm on 1mg twice a day. I honestly feel like she just doesn't like me but I have no idea why. I've always been honest and polite, follow all the rules. I just don't understand.

  • She got very rude with me and told me that I was on a huge dose of Klonopin I've been on them for 6 years for anxiety that was causing very high blood pressure. I'm on 1mg twice a day.
    I used to take 2mg Klonopin four times a day and work full time. 1mg twice daily is not a “huge” dose.  :(
  • Tim, 

    Like others have said, you are sitting in the same boat as many of us. Since the government put the opioid scare out there doctors are afraid to prescribe them. It's a shame and it's not fair to those of us that actually get pain relief from the opioids and use them correctly. It also really sucks that the statistics that they throw out there aren't fair or correct. They need to mention that it's the drug addicts that are the ones that are overdosing. The street version of most of the opioids is even more deadly than the real deal and people just don't understand (some don't care) what the consequences are. Yes, occasionally someone that uses them as directed accidentally does it but that's not the issue. The issue isn't even that the doctors were over prescribing like they say. It's really the people that use them incorrectly that is the problem. 

    I've been on fentanyl patches since 2005 and now my PCP is tapering them down and getting rid of them. I'm actually scared to death of the pain that I know is coming. I have no idea what I'm going to do. The fentanyl patches are the most constant pain relief that I've had and they provide the best pain relief out of all the medications I've tried. I feel for you and know exactly what you're going through. There are a lot of doctors that just refuse to prescribe pain medications all together and it's nearly impossible to find a new doctor if you have to take them. I had to look for a new doctor because mine left the clinic I was going to. I was treated like a drug addict, a couple looked at me like I was lying about my pain, etc. It's really sad that people who so desperately need the medications are treated like that!

    I have learned a lot over the years about how the healthcare system works. You need to advocate for yourself. If you don't those doctors walk all over you, take all your money, and send you packing. I would suggest calling and asking who you would talk to regarding an issue you're having with your doctor's nurse. I recently called billing and explained my situation. I thought she would just transfer me to someone that could help but she actually took all the information down and took care of it for me. You need to explain that there is an issue with the doctor's nurse/assistant and that you would like to resolve it. Explain that you have had nothing but a positive experience there until she came a long. Tell them about the way she treats you, that she refuses to even give you enough medication to cover the directions on the bottle, and that you are considering looking for a new doctor because of her, etc. You have to tell them everything. In the meantime begin looking for a new pain management doctor just in case they are not willing to resolve it. Check out the doctor's ratings & credentials before just picking one. You may need to make a few appts. so you can basically interview the doctors and pick the one you think will be best for you. That's what I did and I told them that when I went in. I explained what was wrong with me, brought a list of my medications, told them that I'm not looking for medications, I'm looking for pain relief, and asked what their plan of care would be. 

    I'm afraid for you as far as your drug screen goes just because of what she said to you about having the right amount in your system. My previous doctor used a urine drug screen to get rid of me. I didn't fail the test and my physical therapist, my pharmacist, and a few other doctors confirmed it. I'll elaborate if you want but I think I've rambled enough. Sorry for that. I've been in terrible pain for 15 years and I've learned a lot about how the healthcare system really works - the hard way. It's really sad and unfortunately, many times has nothing to do with helping the patient get better. It's all about the money and making a profit. I wish you the best!



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