When to bring up the Tolerance word wit the Doc

[juice421]

It's been about 2 years since I started the 40mg Oxy with my doc, then bout 7 or so months later he upped me with another scipt of 20mgz. So ever since Ive been taking 60mg of Oxy ever since. I havn't upped the does since then, about 1 year and half. My new doc (old doc retired) Ive had about 6 months. Hes cool and all with the Oxy, he just seems a little more tight with them. Im not sure if I should bring it up or not that I am not getting the same relief. Should I ask for just roxi, since I used to have that before for BT? How should I bring it up and all with the new doc? He seems OK, just I havnt REALLY gotten to know him. THanks yall.

[nick]

You could try the truth.ie,you hurt.

[reddragon3668]

Tolerance is a very reasonable issue given the amount of time you've been at that dose. I don't know if I would mention the word itself, but I definitely would make it clear that your current dose is leaving you hurting allot more than it used too. Your doctor should be able to draw that conclusion on his own. I hope everything works out!

[samsong]

I use the word "resistance" with my doctors, as if I am so fucking dumb about drugs, that I am making the comparison to how your body gets resistance to antibitiotics

[Narkotikon]

I wouldn't worry about it, but I wouldn't get too technical about it either. Are you looking for an increase because it's not as effective anymore in terms of pain relief, or are you looking for a better buzz, or both? I've never been to a PM clinic, and I don't know much about them, but aren't they supposed to change the meds around every so often to prevent cross tolerance or something. Perhaps you could get them to change you to Kadian. For some reason people on here don't seem to like them as much as OC, but I love Kadian. They're so easy to shoot, and I really really prefer IV morphine to IV oxy. It's more of a euphoric nod to me, whereas is more of a speedy high. I just love morphine though. Good luck.

[reddragon3668]

I wouldn't worry about it, but I wouldn't get too technical about it either. Are you looking for an increase because it's not as effective anymore in terms of pain relief, or are you looking for a better buzz, or both? I've never been to a PM clinic, and I don't know much about them, but aren't they supposed to change the meds around every so often to prevent cross tolerance or something. Perhaps you could get them to change you to Kadian. For some reason people on here don't seem to like them as much as OC, but I love Kadian. They're so easy to shoot, and I really really prefer IV morphine to IV oxy. It's more of a euphoric nod to me, whereas is more of a speedy high. I just love morphine though. Good luck.

Kadian may be cool, IV, I dunno. But orally, it sucks a big one, IMO.

[Slippin|Fallen]

dont say anything about tolerance. just tell the truth, that way your story stays the same, and your really arent lieing, and wont throw up red flags.

when i take the meds in the morning with my pain being a 8 it reduces to 4 for like 6 hours, then its a 7 again.

or something. just tell him/her its not the same relief. and if he asks you what you think, tell him you dont know but the last doctor gave you roxi's for BT or something along them lines.

keep it simple.

[Boudica]

After approx. 10 yrs. of requiring Pain Management Specialists to prevent myself from completing a suicide, I can give you a few hard-learned lessons, and I only do this for people that appear to me to actually NEED pain management. You most likely would not have been given OC for the past few years, with a dosage increase, if you didn't have any real pain issues. So...

First, NEVER, EVER ask for a drug by name. This is considered a list-topper of "drug-seeking" behavior.

Second, NEVER, EVER use the word "Tolerence", another term that applies to "drug-seeking" behavior.

Third, be as open and honest w/ your PM Dr. as you possibly can, as this is the foundation of developing a trusted relationship with your doc. Let he/she know you are hurting, period. Do not go in for your appt all happy and perky. If you are really in escalating pain, you are most likely also quite depressed, and your doc needs to know this, and also other ways in which your pain is negatively affecting your life. What have you stopped or reduced doing, that you used to enjoy? How is your sleep, job performance, relationships, etc. being affected? Ask and answer these questions for yourself, then bring them in to your next appt.

If the dose you've been on for a year and a half, which is certainly an appropriate length of time to make adjustments in your dosage requirements, is not doing the job for you, then say so. Don't be afraid to speak up. As long as you are being as honest as possible, the doc will sense this, and note it in your behavior, making you a ready candidate for upping your dose, and asking for help to deal with your BT attacks.

[bronyraur]

Boudica gave the best advice in the entire thread, and personally, that's what I'd do.

[betmylife]

My doc trusts me, I have been there a year, and he WON'T up my dose....he says their is no need, I say "but doc, Im in pain a lot, and my meds only ast like 2 hours(I get 2 15mg oxyIR a day)"...he says"well you need to put yourself in a situation that lessens your pain." I say ok, as I do actually want the right amount of relief, even though I like the euphoria as well.....I start swimming, I loose 50 pounds, I change my diet, I change my posture, I spend like 700 bucks on a new bed that is supposed to be good for my back......this all helps some, but my spine is in the wrong place, so there is only so much that can help, 6 months go by, the doc sees the changes in me, I say "listen I am doing all the things you suggested, but Im still in pain a lot of the day", he gives me 4 extra pills.....says take one on the really bad days.....so next visit I say, listen witht eh 4 extra pills you gave me I figured out what need for adequate relief for the day, I need 45mg instead of 30....I know I will always have some pain, but this helps me function, and be happy, and basically not fell like someone is pulling my spine through my stomach....he still won't budge, I ask....don't different doses work for different people? he gives me a look....I ask, what about a different med, a long acting med? He says, I could give you 5 Lortab 10s a day, maybe they would work better....(asshole)...knowing I can't take the tylenol cause it makes me sick...some doctors just won't up you, even when you need it....''


BML


doctor isnt ALL bad tho, he gave me new scripts when I lost mine last week.....

[Boudica]

My doc trusts me, I have been there a year, and he WON'T up my dose....he says their is no need, I say "but doc, Im in pain a lot, and my meds only ast like 2 hours(I get 2 15mg oxyIR a day)"...he says"well you need to put yourself in a situation that lessens your pain." I say ok, as I do actually want the right amount of relief, even though I like the euphoria as well.....I start swimming, I loose 50 pounds, I change my diet, I change my posture, I spend like 700 bucks on a new bed that is supposed to be good for my back......this all helps some, but my spine is in the wrong place, so there is only so much that can help, 6 months go by, the doc sees the changes in me, I say "listen I am doing all the things you suggested, but Im still in pain a lot of the day", he gives me 4 extra pills.....says take one on the really bad days.....so next visit I say, listen witht eh 4 extra pills you gave me I figured out what need for adequate relief for the day, I need 45mg instead of 30....I know I will always have some pain, but this helps me function, and be happy, and basically not fell like someone is pulling my spine through my stomach....he still won't budge, I ask....don't different doses work for different people? he gives me a look....I ask, what about a different med, a long acting med? He says, I could give you 5 Lortab 10s a day, maybe they would work better....(asshole)...knowing I can't take the tylenol cause it makes me sick...some doctors just won't up you, even when you need it....''


BML


doctor isnt ALL bad tho, he gave me new scripts when I lost mine last week.....


OK. With this said^^^^I will tell you to find another goddamn dr. When your dr (who YOU are paying to take care of you) is not doing his job proper, you need to fire his ass and hire one who will. Take your records with you to how ever many new drs you have to see before you find one who WILL prescribe for you effeciently enough to keep your pain managed, and even better, send them along a week or two before your appt, along with having the new office send you the shitload of paperwork you will have to fill out for your intake info, AND, top that pile of paperwork with a COVER LETTER, describing your pain issues, how they are affecting your life, your level of depression because of your pain, how underprescribed you feel you were by your soon-to-be former physician, because you TOLD him that your meds were not effective, and he still ignored this, which puts the blame/issue right where it belongs: ON the fucking dr. who wont give you the relief you obviously really do need, even tho he has the ability to do so. The new dr.s will most likely get the idea that your former doc has "prescribing paranoia", or you wouldn't be coming to them for help. In that cover letter, which DOES have an impact, as its written from your PAIN, and sense of utter defeat b/c of your former dr.'s inaction re: properly treating you for your PAIN, also tell the new doc(s) everything you have done to address your pain (showing that you are a very compliant patient, who has been willing to do whatever it takes to get your pain under control), and that you have NOT just been asking for more meds. And last, but certainly not least, tell the dr(s) what your goal(s) are, and what outcome you want/need from your visit with him/her.

I wrote my present, wonderful, compassionate, fearless doc a letter the day of my appt in the a.m., which was just about a suicide note. I was desperate for relief and I told her so. I said, "Please, get me out of this hell TODAY, as I refuse to continue living with this pain that has destroyed my life."

She had read the letter before I got there, took one look at me and started writing scripts. I am not going to list what I left with because I am so tired of people hittin on me for my meds all the fuckin time, but I will say that she fucking got on top of it and has stayed there ever since, not letting me suffer any more than I already have to.

The other point of doing all of this "workup" prior to you appt, is that it gives the Dr. time to assess you before you even get inside his exam room, saving him time (which he/she will greatly appreciate) and having a good idea of what he will be dealing with, with you as a patient. And cut to the chase, don't whine, but be frank and fearless about how you state your pain issues, and say "I simply cannot handle this anymore. I am ready to blow my goddamn brains out." If you've landed at a compassionate doc's office, you WILL finally get help. If not, keep looking until you do, and you WILL eventually get the treatment you need and deserve. Never forget, that YOU are hiring THEM, to do you an important service. You have the power to fire any ass who can't or won't preform their job effectively, and to hire one who can and will. Take back your own power in this situation. You will be glad you did.

[Black_Pony]

Ya, just say your pain is getting worse. Let him decide for himself that its not your pain thats getting worse, its your dose thats becoming less effective.

Just act dumb like you cant figure out why your pain would be getting worse. You've noticed it for a while but now its really obvious and you absolutely have to say something.

[Inspektahdek]

I would and this is me talking here, mention that your current dose isn't working for your particular problem anymore than when it used to be completely sufficient enouigh. I wouldn't use the word "tolerance" at all but more talking about pain control not being as adequate as before.

[oxydose]

How about this guys. Tell your doc the medicine isn't helping your pain as well as it used to and ask him if it would be safe to take some Tylenol or Aspirin when your pain flares up, tell him you was gonna try this but your SO reminded you that it may be a bad idea because of your current meds and that you listened and thought you'd ask him advice first. This seems like a very good story to tell, and then your not asking for more drugs in specific, just asking if OTC for breakthrough pain would be safe. Then I betcha he'll either give you some sort of opiates for breakthrough pain along with your Oxy, or tell you to try the OTC stuff. Then next month you can tell him you gave the OTC pills a shot but that they didn't work, then ask him wether you should increase the OTC dose to above what the box recommends or if he can help you with something else.

That story sounds good to be, it gets the point across that at this point your no longer getting enough pain relief while also making it sound like your a very responsible patient and not some drug seeking 'addict'.

Anyways I think thats what I'd do in your situation, what does everyone else think, especally the PM patients here who regularly have to deal with pain doctors. peace...

-ocd

[Boudica]

I'm most likely gonna piss some people off in this thread, and Oxy, I do not in any way have bitchy intentions towards your post. I just dissagree with it. I've been in pain mgmnt. for many years, but it doesn't make me an expert or mean that I know everything by a longshot. However, this lil scheme sounds exactly like what it is: manipulation by a drug-seeker. This is precisely the kind of shite that seekers make up in hopes of gettin' to the goodies, and savvy pain docs can and do spot it in a heartbeat. These is such a thing as "over-stating" in regards to showing the doc how you are SO NOT a drug-seeker.

Throwing in a lot of honesty, with bitching your arse off about how sick you are of having to live with pain that can and should be managed, will go a lot further than some obviously contrived story about how you have no interest in trying a higher dose or a change in your opiate meds. Really. Just me 2 pence, mates.

[Inspektahdek]

Always try to ask about alternative methods to medication, ask about if or can u do physical therapy, steroidal/cortisone injections, epidurals, ask for NSAIDS, like ibuprofen, etc. actually request these by name, theres a ton of anti-inflammatories out there and showing interest in them as well or actually asking for anti-inflammatories helps because it shows that you don't want "just" the narcotics. And make sure you always fill your anti-inflammatories too and down the road try asking about other anti-inflammatories instead of saying, and this is just an example: "Can I try another med instead of norco/oxy/etc. that's just as good?" Ask about the anti-inflammatories in this manner, also say u did some research and ask about steroidal pain killers as well. These two classes of medications are non-regulated or scheduled so it shouldn't be a problem or wouldn't raise any flags asking about these and showing or feigning interest in them shows your doctor you're looking for adequate pain relief, and not just drugs.

Show your doctor interest in all methods of pain relief in a broad spectrum and you will get your opiates. This will show the doctor you are trying everything possible to relieve pain and draw attention away from opiates. I do this with my main doctor who is also a surgeon and she gives me pretty much whatever I want and is very flexible because I've always done this and we have a long doctor/patient relationship.



capische'? and good luck!

[oxydose]

How do you figure? The guy is a CP suffer, whois tolerence has risen, and I suggested that ask his doctor if he should try OTC meds. What the hell kind of 'scheme' do you think that is, because from reading his post it sounds like the truth to me.

So if it does help him get more meds, then I'm happy for the guy, cause he claims he isn't getting a big enough dose anymore. Tolerance is real, and he said his is up, so that isn't scheming man, its telling the doctor the TRUTH.

I think you need to reread both the OP post and mine.

I'm most likely gonna piss some people off in this thread, and Oxy, I do not in any way have bitchy intentions towards your post. I just dissagree with it. I've been in pain mgmnt. for many years, but it doesn't make me an expert or mean that I know everything by a longshot. However, this lil scheme sounds exactly like what it is: manipulation by a drug-seeker. This is precisely the kind of shite that seekers make up in hopes of gettin' to the goodies, and savvy pain docs can and do spot it in a heartbeat. These is such a thing as "over-stating" in regards to showing the doc how you are SO NOT a drug-seeker.

Throwing in a lot of honesty, with bitching your arse off about how sick you are of having to live with pain that can and should be managed, will go a lot further than some obviously contrived story about how you have no interest in trying a higher dose or a change in your opiate meds. Really. Just me 2 pence, mates.

[CIIORNOTHING]

I think the key factor that determines what meds a patient gets and how easy they get them, increased, etc is what the pateints diagnosis is. Ive known a lot of people who call themselves CP patients, but their diagnosis doesnt really jive with that. The doctors have prescribing guidelines for every condition and diagnosis, and if they go outside those guidelines they open themselves up to legal troubles. You cant be a CP patient just because you say you are...the underlying Dx has to be there. Also, if there is a surgical solution or some other treatment that the patient doesnt wish to pursue and prefers to just stay on opiates instead, that can lead to a stingy or skeptical doctor . As someone said above, if the meds are all you are after and you truly arent really suffering, these docs figure it out pretty quickly. For me, when Im truly hurting and need relief, my conversation with the doctor focuses on ME and my pain level, not on drugs or doseages. If you are scheming, you arent likely to walk away with much.

I myself have a L5-S1 and L4-L5 herniations. Hard to fake that. Ive already had one surgery and dont really want to have another one, not yet anyway, so I get pretty much whatever I want, and I get the doseages upped every now and then because he understands that over time, tolernace builds and more is needed. If my doc didnt do those things, I would definately find another one pretty quickly. But again, if you are angling for drugs, expect problems and drama and having to work hard to get what you want because they are pretty hip to it these days.

[Boudica]

How do you figure? The guy is a CP suffer, whois tolerence has risen, and I suggested that ask his doctor if he should try OTC meds. What the hell kind of 'scheme' do you think that is, because from reading his post it sounds like the truth to me.

So if it does help him get more meds, then I'm happy for the guy, cause he claims he isn't getting a big enough dose anymore. Tolerance is real, and he said his is up, so that isn't scheming man, its telling the doctor the TRUTH.

I think you need to reread both the OP post and mine.


Gee, I am surprised that you found my post so offensive, oxydose. Perhaps you should reread mine, as well. The first couple of sentences I clearly stated that I simply dissagreed with what you posted, that's all, and that I had no "bitchy" intentions towards you whatsoever. I just disagreed. People don't always agree on one another's points of view. It's human nature/experience, whatever. Just people being people. Especially with no harm nor intention of inciting you to get angry over it. I just said my opinion on his situation, that is all. And if you look at earlier posts in this thread, I did take the time to post information that was clearly intended to be of help to him. I do care about people in pain here, very much, and I am one of them. And when I see that someone is reaching out for some sort of guidance on their situation, and I've got something to offer them that might be of help, I will put it out there for them.

And like me Momma used to say, "Take what you like, and leave the rest." He has a nice, big thread now, to search through, and hopefull can put together a plan for himself, that will serve him well, from the information that many people kindly gave here. Isn't that what we are kind of supposed to try and do here? Help one another?

My apologies, for whatever I said that made you so angry. I had no intentions of doing that in any way at all.I just made the mistake of disagreeing on a couple of things, that is all. I always have had a difficult time understanding why folks can't simply "agree to disagree", and allow one another their opinions, even though they may differ, at times. No biggie. My only intent, was to try to help another human being, that's all.

CII, I so understand where you are coming from, and am sorry you have had to go through what you have. Serious pain just completely dessimates peoples lives. It did mine. And a good pain specialist is golden, to people like us. I am glad you were able to find yours. And I thank the Universe everyday for mine. Without her, I would not be sittin up here typing this right now. I wish you well, and hope that at some point along the way, you get this at least managed enough for you to reclaim some of your life, and do some of the things that you find enjoyment in. That alone, can make life so much better it's astounding. So I can't surf anymore. But I can sit up at me pc, to reach out to others, and to learn, and a myriad of fulfilling things. I can sit and sew, do some artwork or some writing. I have come to place high value, on life's "little pleasures", that have become "food for the soul", for me. Wasn't that long ago that I was having to live out of my wheelchair, and could not sit upright for over a few minutes, and could not stand nor walk. Would not wish that on anyone, ever, and truely hope for you that you can start putting things back together, as best you can, and find some peace.

Bhiodh sin math. Slainte'.

[AGV10]

It's been about 2 years since I started the 40mg Oxy with my doc, then bout 7 or so months later he upped me with another scipt of 20mgz. So ever since Ive been taking 60mg of Oxy ever since. I havn't upped the does since then, about 1 year and half. My new doc (old doc retired) Ive had about 6 months. Hes cool and all with the Oxy, he just seems a little more tight with them. Im not sure if I should bring it up or not that I am not getting the same relief. Should I ask for just roxi, since I used to have that before for BT? How should I bring it up and all with the new doc? He seems OK, just I havnt REALLY gotten to know him. THanks yall.


First things first: are you using instant release or extended release?

You say you started 2 years back on 40mg Oxy, and that 7 months back it was increased by another 20mg – that would suggest to me you are using extended release (i.e. no doctor in his right mind would start a non-tolerant patient on 40mg IR).

If this is correct, it is not likely he will give you another increase in extended release, but will now start you (in addition to the current extended release) a prescription for IR (instant release) Oxy – which, because you have being using the stuff for so long, should be around one third to one half the current ER dose.

Good chance you will be treated now for breakthrough pain.

But beware – discipline yourself: this is also gives the doc an opportunity to test you, if he has any doubts (make sure the pain symptoms you now describe are consistent with the medical condition/status):

It is easy (very easy) to go overboard with IR Oxy, and you could very quickly find yourself using it all up before a replacement script is due.

If prescribed for breakthrough pain, the doc would expect most patients to back the next time (if within the prescription period) and still have some left – at least the first couple of times. At the very least, make sure you do not use them all up in a shorter time than that which you told the doc at the last appointment was how often you said felt the ER tabs were not working. Doc’s make a very careful note of this and look for the discrepancy in usage versus how often the patient said the last time they suffered pain the existing dose didn’t relieve. A change in story here, is an indication that the med’s are serving a recreational purpose.

Because you are asking the forum I assume also that you are feeling this all out because you are enjoying your pain meds i.e. not using them strictly for pain control (?) – else you wouldn’t be asking. But, if I am wrong, then what is said above is not applicable. Your normal response/behaviour, as well as whatever the condition is and the doc’s experience, should be sufficient to get the dosage upped.

In summary, it’s not so much what you say to get an increase. It is important you do not contradict yourself in how you use the increase in med’s in the time till the next appointment – especially the first few times. Anything that suggests recreational usage could put you back in square one.

Good luck

AGV