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  #1  
Old 07-30-2012, 09:35 AM
kittenblue kittenblue is offline
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How do I convince my doctor to renew the Vicodin?

I have very little cartilage left in either knee. It's bone on bone, and it hurts. Add in the arthritis in my ankles, the bone spurs on my insteps, and the fact that I work retail and stand 8-10 hours a day, and I am in constant pain. I had a gastric bypass and can't take NSAIDS anymore, so Tylenol and its friends are my only relief from the pain so I can do my job. I take a lot of Tylenol, though I keep under the daily limit. And I don't take it if I'm planning to have some wine with dinner. The cortisone shots for my knees have stopped being effective, and I am waiting to be approved for Synvisc injections. Knee replacement is on the bucket list.

I January I broke a toe, they gave me Vicodin, and it really helped my knee pain for the three days the pills lasted. March I fell and badly bruised my knee and leg, same thing...three days of Vicodin which I made last a month by only taking one when it was really unbearable. Last month I cracked a tooth just before leaving town...Vicodin from dentist. When I had the tooth pulled a week later...more Vicodin. My sister, who has worse knee pain than me, just got prescribed Vicodin to be taken three times a day (slightly lower dose than what I was getting) for as long as she needs it until she gets her knees replaced. And she CAN take NSAIDS as well.

So why can't I get my Family practice doctor to do the same for me? Why is requesting a better pain killer considered a bad thing when it works for the extreme pain I'm dealing with? How do other people get prescribed all these marvelous painkillers willy-nilly and I can't get simple Vicodin? What can I say to him to convince him? Last time I asked him, he flat-out said no. He's been my doctor for almost 20 years now, he's seen me through a lot of crap and he knows I am taking more Tylenol than I'm comfortable with. Because of the gastric bypass I have malabsorption issues, so I'm probably not even getting the full effect of the Vicodin anyhow since it is in pill form. What do I have to say to convince him? I just want to be able to continue to do my job so I still have insurance so I can get that knee replacement and not have to take anything! And I don't want to change doctors. So what should I do?
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  #2  
Old 07-30-2012, 09:40 AM
elbows elbows is offline
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Ask him why he won't prescribe more, when you were very impressed with the pain relief it provided.

Maybe he has a valid reason. You'll only know if you straight out ask. It's okay, he's a doctor, he's used to answering questions!

(Isn't it highly addictive? And over prescribed? Am I thinking of something else?)
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Old 07-30-2012, 09:47 AM
Omar Little Omar Little is offline
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Because it's an addictive narcotic.

If you have the insurance, why don't you just get the knee replacement surgery? Sure you've most likely got the deductible and or the copay, but you should be able to work out a payment plan with the doctor and hospital to make it work.
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  #4  
Old 07-30-2012, 09:53 AM
Broomstick Broomstick is offline
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Some doctors really, really, really hate to prescribe anything for pain. If you specifically ask for something it's "drug seeking behavior" and you're screwed. If you're in agony and leave one doctor unwilling to help you to ask another for help then you're "doctor shopping" and even more screwed.

I think in some cases these guys have never, themselves, actually experienced severe pain.

Yes, there are addicts out there, and yes opiates do carry a risk of addiction. On the other hand, pain also really exists.
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Old 07-30-2012, 09:56 AM
Vinyl Turnip Vinyl Turnip is offline
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My WAG is that if he already said no, he's not going to change his mind and pursuing it further will just be seen by him as drug-seeking behavior.

As to why, who knows. Some docs are loath to prescribe any narcotics, some will do so only in extreme cases, and some are relatively liberal with them. It's possible he fears the wrath of the DEA and just doesn't want to take a risk, or he might feel that Vicodin isn't a good long-term solution for you.
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Old 07-30-2012, 10:04 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Knee replacement surgery is not for everyone. Get it too young, and there's a world of hurt waiting when the joint wears out. 2nd replacement operations are much more problematic than 1st ones.

Opioids are great for moderate and severe acute pain. They are more problematic for chronic non-malignant pain, and orthopedists and other physicians are now recommending avoiding them for chronic joint pains in most situations. A lot of people are dying of overdoses, a lot of drugs are getting diverted, and as a whole, they don't seem to work better than other pain management strategies. Individual results may differ.
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  #7  
Old 07-30-2012, 10:04 AM
guizot guizot is offline
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Originally Posted by Vinyl Turnip View Post
It's possible he fears the wrath of the DEA and just doesn't want to take a risk....
That could very well be. So one way NOT to convince your doctor is by showing him a dog x-ray in order to get your pain killers. They've figured that one out--don't try it.
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  #8  
Old 07-30-2012, 10:12 AM
kayaker kayaker is offline
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When my doctor suggested Tylenol for my post-op pain I woulda laughed, only it hurt too much. I told him that if he refused to script me for effective pain meds I would buy it off the street. He could see I was serious and he gave in. As he was writing he mentioned the DEA watched over his shoulder; I told him I didn't give a damn.

ETA: second opinion?

Last edited by kayaker; 07-30-2012 at 10:12 AM..
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  #9  
Old 07-30-2012, 11:07 AM
Teaira Teaira is offline
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Well, one of the problems (as others have mentioned) is that your pain is chronic. A lot of doctors feel that they are actually doing you a disservice to prescribe something so addictive for chronic pain, seeing as once you get used to Vicodin (or any other opiate) it is literally hell to get off of. Then you will not only have terrible knee pain, you'll also have terrible withdrawal. I personally wish I'd never, ever seen or heard of any kind of opiate.

But if no other painkillers work, I think you should just talk to another doctor, possibly one at a pain clinic. Just seeing another doctor doesn't necessarily mean you need to completely give up your regular doc of 20+ years.. it just means maybe you can find one more amenable to prescribing opiates.
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Old 07-30-2012, 12:05 PM
Broomstick Broomstick is offline
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You know, if it was just as simple as "go to a chronic pain specialist" but when my spouse looked into it (he, too, suffers chronic pain) every single one required signed contracts, random drug testing (as in, they can call you any time and demand you come in within 4 hours no matter how inconvenient), you had to tell them any time you left town for a vacation, etc. - basically, treating anyone coming in the door as a criminal and an addict based on nothing more than having chronic pain and wanting to seek some form of relief.

I used to think the chronic pain clinics were a good idea, too, until my spouse actually tried to go them. Do we seriously have to treat every single person with chronic pain as a criminal?
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  #11  
Old 07-30-2012, 01:01 PM
Vinyl Turnip Vinyl Turnip is offline
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Originally Posted by Broomstick View Post
I used to think the chronic pain clinics were a good idea, too, until my spouse actually tried to go them. Do we seriously have to treat every single person with chronic pain as a criminal?
My mother, who actually hates opiates or taking pills in general if she can at all avoid it, was directed to a pain clinic by her doctor after suffering a long period of pain in her extremities that they couldn't find a cause for. They were complete assholes from the get-go and she never went back for a second visit.
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  #12  
Old 07-30-2012, 01:08 PM
Farmer Jane Farmer Jane is offline
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There's no reason why you should be in pain. Find a different doc...or take up smoking pot. Or both. (Not that pot gets you through the day.)

I feel really sorry for you. I managed a back spasm for a month because I just so happened to have a full bottle of Vicodin from a dentist visit.

There's no reason why anyone should be in chronic pain. Doctors like that piss me off.
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  #13  
Old 07-30-2012, 01:11 PM
Loach Loach is offline
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Originally Posted by Farmer Jane View Post
There's no reason why you should be in pain. Find a different doc...or take up smoking pot. Or both. (Not that pot gets you through the day.)

I feel really sorry for you. I managed a back spasm for a month because I just so happened to have a full bottle of Vicodin from a dentist visit.

There's no reason why anyone should be in chronic pain. Doctors like that piss me off.
Other than the horrible effects of narcotic addiction.
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Old 07-30-2012, 02:08 PM
Broomstick Broomstick is offline
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Not everyone who uses opiates becomes an addict. You do know that, don't you?

My mom was on morphine for over a year after complications arose from her second heart surgery. Once they got the wounds to close up and heal they tapered her down over a month and she was off it. No withdrawal. No "agony". No horrible symptoms. No cravings.

I've known a half dozen other people in the same position - took an opiate long term for pain, when the problem was cured/healed they tapered off and no problems. No agony. No horrible withdrawal. No cravings. No addiction.

Yes, some people have problems. Not all do. It's a myth that opiate use leads automatically to addiction. Appropriate pain management and dosing can minimize the chances of addiction occurring. Opiates are a tool. Like any tool they can be mis-used. The solution isn't to ban the tool, it's to use it responsibly.
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Old 07-30-2012, 02:20 PM
drachillix drachillix is offline
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Originally Posted by Broomstick View Post
I used to think the chronic pain clinics were a good idea, too, until my spouse actually tried to go them. Do we seriously have to treat every single person with chronic pain as a criminal?
Because such a place is a tailor made solution for shady narcotics distribution. One of my customers is such a clinic. They are apparently subject to additional scrutiny from law enforcement on a regular basis because of it, kinda like at least here locally all massage places have a permit from police department and get checked by undercover officers for prostitution regularly.
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  #16  
Old 07-30-2012, 02:20 PM
Chimera Chimera is offline
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But some doctors are total dicks about it. When I ripped up my right arm a couple of years ago and went to urgent care, they prescribed Vicodin. Since it isn't very effective with me, I asked for something else instead. The doctor exploded, screaming at me about hunting for drugs. I tried to explain that I did NOT want something stronger, I just wanted different, but she cut me off, refused to listen and said I could have the Vicodin or nothing.
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  #17  
Old 07-30-2012, 02:24 PM
Farmer Jane Farmer Jane is offline
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Originally Posted by Broomstick View Post
Not everyone who uses opiates becomes an addict. You do know that, don't you?

My mom was on morphine for over a year after complications arose from her second heart surgery. Once they got the wounds to close up and heal they tapered her down over a month and she was off it. No withdrawal. No "agony". No horrible symptoms. No cravings.

I've known a half dozen other people in the same position - took an opiate long term for pain, when the problem was cured/healed they tapered off and no problems. No agony. No horrible withdrawal. No cravings. No addiction.

Yes, some people have problems. Not all do. It's a myth that opiate use leads automatically to addiction. Appropriate pain management and dosing can minimize the chances of addiction occurring. Opiates are a tool. Like any tool they can be mis-used. The solution isn't to ban the tool, it's to use it responsibly.
I second this. Likewise, people who drink socially aren't alcoholics.
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Old 07-30-2012, 02:29 PM
Rachellelogram Rachellelogram is offline
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Originally Posted by Loach View Post
Other than the horrible effects of narcotic addiction.
So the only pain remedies other than tylenol and NSAIDS are opiates now? Some others I know of (not all of which may be appropriate for her situation-IANAD) are elavil, celebrex, lyrica, neurontin, cymbalta, etc. Her doctor does not appear to be taking her pain seriously. Perhaps that's because she went in asking for a vicodin scrip, but if that's the only rx pain med she's ever received, that's not necessarily an indicator of drug-seeking behavior. Her doctor ought to be providing her with appropriate pain medication when OTC meds aren't doing the trick.

Not to mention that taking tylenol long-term can cause liver damage, and it's also less effective for joint pain because it doesn't reduce inflammation like NSAIDS. Maybe she doesn't need an opiate, but there are still more options than tylenol.
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Old 07-30-2012, 02:33 PM
Loach Loach is offline
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Originally Posted by Broomstick View Post
Not everyone who uses opiates becomes an addict. You do know that, don't you?

My mom was on morphine for over a year after complications arose from her second heart surgery. Once they got the wounds to close up and heal they tapered her down over a month and she was off it. No withdrawal. No "agony". No horrible symptoms. No cravings.

I've known a half dozen other people in the same position - took an opiate long term for pain, when the problem was cured/healed they tapered off and no problems. No agony. No horrible withdrawal. No cravings. No addiction.

Yes, some people have problems. Not all do. It's a myth that opiate use leads automatically to addiction. Appropriate pain management and dosing can minimize the chances of addiction occurring. Opiates are a tool. Like any tool they can be mis-used. The solution isn't to ban the tool, it's to use it responsibly.
Prescription pain killers are now the most pervasive addiction problem in most if not all of the country. You do know that don't you? A lot of doctors hand out addictive pain medication like its candy. You do know that don't you? The effects of addiction to such medication is horrendous. You do know that don't you?

I'm not saying that there is no place for pain killers and opiates. There obviously is a place. But they are tremendously over perscribed. I would trust a doctor who was reluctant to perscribe pain killers to one who writes out a script whenever anyone asks for it.
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Old 07-30-2012, 02:39 PM
Loach Loach is offline
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Originally Posted by Rachellelogram View Post
So the only pain remedies other than tylenol and NSAIDS are opiates now? Some others I know of (not all of which may be appropriate for her situation-IANAD) are elavil, celebrex, lyrica, neurontin, cymbalta, etc. Her doctor does not appear to be taking her pain seriously. Perhaps that's because she went in asking for a vicodin scrip, but if that's the only rx pain med she's ever received, that's not necessarily an indicator of drug-seeking behavior. Her doctor ought to be providing her with appropriate pain medication when OTC meds aren't doing the trick.

Not to mention that taking tylenol long-term can cause liver damage, and it's also less effective for joint pain because it doesn't reduce inflammation like NSAIDS. Maybe she doesn't need an opiate, but there are still more options than tylenol.
I have no idea where you got that from. She said Vicodin. You are now making up a long conversation about other pain medication.
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Old 07-30-2012, 03:02 PM
ladyfoxfyre ladyfoxfyre is offline
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Unfortunately you are going to be seen as a drug-seeking patient if you go in there asking for one of the most commonly abused opioid medications on the market. You won't likely be able to convince him to renew the vicodin unless he is planning on discharging you as a patient shortly after. I would ask him for a referral to a pain or orthopedic specialist and discuss your pain treatment options with them. Do not mention any medication specifically when you discuss it with them. There may be better medications out there that work on your issue more effectively. Do not poison the well with the information that you have had good results with one specific medication, it will raise red flags.
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Old 07-30-2012, 03:15 PM
Fuzzy Dunlop Fuzzy Dunlop is offline
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Originally Posted by Rachellelogram View Post
Not to mention that taking tylenol long-term can cause liver damage, and it's also less effective for joint pain because it doesn't reduce inflammation like NSAIDS. Maybe she doesn't need an opiate, but there are still more options than tylenol.
You can't take vicodin long term for pain without taking tylenol for pain. Vicodin is tylenol and hydrocodone. They're packaged together to inhibit hydrocodone abuse and because they're potentiators - they enhance each other's pain fighting powers.
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Old 07-30-2012, 03:27 PM
Rachellelogram Rachellelogram is offline
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Originally Posted by Loach View Post
I have no idea where you got that from. She said Vicodin. You are now making up a long conversation about other pain medication.
When Farmer Jane said, "There's no reason why anyone should be in chronic pain," you responded with, "Other than the horrible effects of narcotic addiction." But the addiction potential of opiates is not a good excuse to let a patient suffer from chronic pain. That's why I suggested non-opioid pain medications in response to your post. I'm not making up a long conversation that's irrelevant to your post... I'm providing a response to your claim that it's okay for people to be in chronic pain, due to the horrible effects of narcotic addiction.

Her doctor should have taken her request for vicodin seriously, provided her with the reasons he felt vicodin was a bad idea for chronic pain, and offered to prescribe something stronger than tylenol. The reason she said vicodin was likely because it's the only strong pain med she's ever taken--if he'd taken 2 minutes to discuss the request with her, he'd have found that out. If he gave a good god damn, she'd be on something else rather than having her pain downplayed. That's not right.

Last edited by Rachellelogram; 07-30-2012 at 03:28 PM..
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Old 07-30-2012, 03:30 PM
Farmer Jane Farmer Jane is offline
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Originally Posted by Loach View Post
Prescription pain killers are now the most pervasive addiction problem in most if not all of the country. You do know that don't you? A lot of doctors hand out addictive pain medication like its candy. You do know that don't you? The effects of addiction to such medication is horrendous. You do know that don't you?

I'm not saying that there is no place for pain killers and opiates. There obviously is a place. But they are tremendously over perscribed. I would trust a doctor who was reluctant to perscribe pain killers to one who writes out a script whenever anyone asks for it.
I don't respect a doctor who won't prescribe it to someone with two bad knees, several injuries, and has been their patient for 20 years.
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Old 07-30-2012, 03:33 PM
Loach Loach is offline
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Originally Posted by Rachellelogram View Post
When Farmer Jane said, "There's no reason why anyone should be in chronic pain," you responded with, "Other than the horrible effects of narcotic addiction." But the addiction potential of opiates is not a good excuse to let a patient suffer from chronic pain. That's why I suggested non-opioid pain medications in response to your post. I'm not making up a long conversation that's irrelevant to your post... I'm providing a response to your claim that it's okay for people to be in chronic pain, due to the horrible effects of narcotic addiction.

Her doctor should have taken her request for vicodin seriously, provided her with the reasons he felt vicodin was a bad idea for chronic pain, and offered to prescribe something stronger than tylenol. The reason she said vicodin was likely because it's the only strong pain med she's ever taken--if he'd taken 2 minutes to discuss the request with her, he'd have found that out. If he gave a good god damn, she'd be on something else rather than having her pain downplayed. That's not right.
I don't disagree with any of that. There are more options.
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Old 07-30-2012, 03:34 PM
Vinyl Turnip Vinyl Turnip is offline
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Originally Posted by ladyfoxfyre View Post
Unfortunately you are going to be seen as a drug-seeking patient if you go in there asking for one of the most commonly abused opioid medications on the market. You won't likely be able to convince him to renew the vicodin unless he is planning on discharging you as a patient shortly after. I would ask him for a referral to a pain or orthopedic specialist and discuss your pain treatment options with them. Do not mention any medication specifically when you discuss it with them. There may be better medications out there that work on your issue more effectively. Do not poison the well with the information that you have had good results with one specific medication, it will raise red flags.
A friend of mine whose sister worked as an ER nurse told him they had a policy (perhaps unofficial) of never giving patients a specific narcotic medication that they requested by name. They'd always try to prescribe something else instead, and not necessarily something less strong, just not the one they asked for.

I guess I understand the rationale for this. It does feel odd and a bit demeaning, though, when I have surgery or an injury that requires medication and have to play dumb about what I'm being prescribed (when in fact I try to read up and be reasonably well informed) lest I sound like a drug seeker.
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Old 07-30-2012, 03:41 PM
Loach Loach is offline
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I don't respect a doctor who won't prescribe it to someone with two bad knees, several injuries, and has been their patient for 20 years.
I have 2 bad knees. I took oxy for about 5 days after my last knee surgery. That's it. Going straight to the addictive option is not very smart. In some cases it is the best option. It is not the only option.

My ex-sister in law was very possessive of her pain. Told everyone about it any chance she got. Went to the doctors that would give her the most pills. She didn't die because of her back pain. She died at 35 because of her opiate addiction. All of it obtained legally from doctors.
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Old 07-30-2012, 03:45 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally Posted by Rachellelogram View Post
elavil, celebrex, lyrica, neurontin, cymbalta, Maybe she doesn't need an opiate, but there are still more options than tylenol.
The alternatives you list are pretty useless for bone on bone pain.

Tylenol is safe in folks with normal livers in doses of up to 3.5 grams a day, if not used with chronic alcohol consumption.

Another problem with opioids is that the dose required to relieve the sort of chronic, non-malignant pain described by the OP generally rises with time until the person is taking enough to kill an elephant, is laxative dependent for each bowel movement, is groggy and not participating in their life due to sedation effects, and is finally in just as much pain as before they started on the opioid. Not a good place to be.

"There's no reason for anyone to be in chronic pain"? Sadly, there are all too many reasons. Lots of chronic, irreversible, untreatable diseases cause chronic pain, and our best tools rarely provide safe, effective, long-term relief.

And if opioids were to be used for a person with a specific source of pain, such as one very, very bad joint, vicodin is still a lousy choice. Better to use long-acting opioids (MS contin, methadone, oxycodone long-acting) in the lowest dose that improves function acceptably. And if functional improvement is not seen on opioids, stop using them for chronic pain, because once the doses go up to try to overcome the tolerance that will inevitably develop, bad outcome rates skyrocket.

I've been struggling with managing chronic pain in my patients for decades, taken the latest seminars to learn the latest theories and approaches, seen new meds and procedures become popular, then disappear as they fail to work as promised, see people's lives dwindle not just due to pain, but due to side-effects of the treatments, and seen my patients die of opioid overdoses, and seen their family members and associates die when they get their hands on Grandpa's pills. And this is not just anecdotal, evidence demonstrates more and more folks are dying from use of legitimate opioid prescriptions.

What works best? Lifestyle changes. Stop smoking, lose the weight, do the appropriate exercises, meditate, biofeedback for stress reduction, distraction with other activities, occasional nerve blocks for particular types of pain, TENS units, sex, rock and roll. Judicious use of proper medication is also useful but frankly is only a small part of the picture.

So I sympathize with the OP, but the answers to such problems are seldom simple.

Last edited by Qadgop the Mercotan; 07-30-2012 at 03:48 PM..
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Old 07-30-2012, 03:48 PM
Loach Loach is offline
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Thank you QtM. Very concise and informative.
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Old 07-30-2012, 03:52 PM
Farmer Jane Farmer Jane is offline
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I have 2 bad knees. I took oxy for about 5 days after my last knee surgery. That's it. Going straight to the addictive option is not very smart. In some cases it is the best option. It is not the only option.

My ex-sister in law was very possessive of her pain. Told everyone about it any chance she got. Went to the doctors that would give her the most pills. She didn't die because of her back pain. She died at 35 because of her opiate addiction. All of it obtained legally from doctors.
Not everyone is like you or your SIL. Every person I can think of has probably had Vicodin one time or another. Only one person I know ever had issue with it, and he had a pretty reckless personality in his 20s, anyway.

If I take a Vicodin, I'm not buzzed. My pain just goes away. (A joint would make me buzzed and unable to drive. Same with a shot. But a Vicodin? I just go back to normal.)

If I take a regular Tylenol OTC, I'm still limping. I could never understand people who 'got off' on opiate drugs, so maybe this is part of my reasoning.

Quote:
Originally Posted by Qadgop the Mercotan View Post
"There's no reason for anyone to be in chronic pain"? Sadly, there are all too many reasons. Lots of chronic, irreversible, untreatable diseases cause chronic pain, and our best tools rarely provide safe, effective, long-term relief.
With the availability of modern medicine, there's really no reason why a doctor shouldn't be concerned with someone's chronic pain. People shouldn't have poor quality of life.
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Old 07-30-2012, 03:58 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally Posted by Farmer Jane View Post
With the availability of modern medicine, there's really no reason why a doctor shouldn't be concerned with someone's chronic pain.
A doctor certainly should be concerned with addressing chronic pain problems. I spend a lot of my time working on improving the function of my patients with chronic pain, educating them about their situation, trying to motivate them to do their part.
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People shouldn't have poor quality of life.
Maybe they shouldn't, but they do. Modern medicine is not so advanced as to be able to end all suffering (short of euthanasia). To think otherwise is unrealistic.

And I've not said there is no role for opioid use in chronic pain. It is but one tool in the toolbox, but it is one that should not be reached for first, and in many cases should be avoided completely.
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Old 07-30-2012, 04:02 PM
Farmer Jane Farmer Jane is offline
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Originally Posted by Qadgop the Mercotan View Post
And I've not said there is no role for opioid use in chronic pain. It is but one tool in the toolbox, but it is one that should not be reached for first, and in many cases should be avoided completely.
Fair enough. Do you think the OP should live in chronic pain and poor quality of life in the meantime while looking at other options?

Also curious how you feel about chronic pain and the elderly. Now that one pisses me off quite a bit.
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Old 07-30-2012, 04:14 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally Posted by Farmer Jane View Post
Fair enough. Do you think the OP should live in chronic pain and poor quality of life in the meantime while looking at other options?
I don't know where should enters into it. It may just be the way things are. I wouldn't prescribe vicodin to someone just because they felt they needed it while they were looking at over options. I would try to effect some sort of pain-reduction plan in the meantime which might or might not include opioids.

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Also curious how you feel about chronic pain and the elderly. Now that one pisses me off quite a bit.
Be as pissed off as you like, it won't alter the unrelenting reality of that particular combination. Old age and chronic pain frequently go together, that's the way the human body works. And I've seen all too many old folks suffer from the complications of their chronic pain treatment plans. That includes old folks who died from stomach bleeding due to normal doses of ibuprofen or naproxen, old folks sedated so much by muscle relaxers that they fell and broke a hip and saw their overall chronic pain level and disability level go up by orders of magnitude, and old folks whose cognition was so impaired by their opioid meds that they caused an auto wreck, killing themselves and others.

So I'm intimately involved in the problem of chronic pain and the elderly. It's a lot like the problem of chronic pain with younger people, only more common, more complicated, and with fewer good outcomes.

Last edited by Qadgop the Mercotan; 07-30-2012 at 04:17 PM..
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  #34  
Old 07-30-2012, 04:22 PM
Broomstick Broomstick is offline
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Originally Posted by drachillix View Post
Because such a place is a tailor made solution for shady narcotics distribution. One of my customers is such a clinic. They are apparently subject to additional scrutiny from law enforcement on a regular basis because of it, kinda like at least here locally all massage places have a permit from police department and get checked by undercover officers for prostitution regularly.
Uh-huh.

So... people who suffer from genuine chronic pain in this country basically have two choices:

1) Go to a regular doctor who won't prescribe what you need and simply suck it up and suffer

2) Go to a place that supposedly exists to treat chronic pain and be treated as an addict and a criminal from the moment you step in the door.

Really, both choices completely suck.
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Old 07-30-2012, 04:23 PM
astro astro is offline
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I'm currently on the county grand jury for a few more months. Without getting into specifics, based on what I have seen come before us for indictment doctors are looked at VERY closely these days by law enforcement, and their licensing boards re the quantity of pain meds they are prescribing. Mainly because of concern that they are acting as de facto conduits for street sellers.

I understand their caution, they are under a microscope these days re prescribing pain meds.
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Old 07-30-2012, 04:26 PM
Broomstick Broomstick is offline
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Originally Posted by Loach View Post
Prescription pain killers are now the most pervasive addiction problem in most if not all of the country. You do know that don't you? A lot of doctors hand out addictive pain medication like its candy. You do know that don't you? The effects of addiction to such medication is horrendous. You do know that don't you?
Yes, I am aware of all that. I worked for four years in the administration of a methadone clinic, please do not lecture me on the horrors of opiates, I've seen them first hand.

I am also aware that there are people in this country suffering genuine pain every single goddamn day of their life, which is ALSO horrendous, horrible, hellish, and a bunch of other things.

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I'm not saying that there is no place for pain killers and opiates. There obviously is a place. But they are tremendously over perscribed. I would trust a doctor who was reluctant to perscribe pain killers to one who writes out a script whenever anyone asks for it.
Antiobiotics are also tremendously overprescribed, but when you have a medical need for one you can get it without being treated as a criminal.
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Old 07-30-2012, 04:41 PM
Loach Loach is offline
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Originally Posted by Broomstick View Post
Yes, I am aware of all that. I worked for four years in the administration of a methadone clinic, please do not lecture me on the horrors of opiates, I've seen them first hand.

I am also aware that there are people in this country suffering genuine pain every single goddamn day of their life, which is ALSO horrendous, horrible, hellish, and a bunch of other things.


Antiobiotics are also tremendously overprescribed, but when you have a medical need for one you can get it without being treated as a criminal.
I took that tone with you because of how you replied. Do not presume to think you are the only one here with experience with the subject.

Unfortunately those with medical need are treated like criminals because of the actions of an overwhelmingly large number of criminals who are also trying to get those drugs. Not the same as antibiotics.
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Old 07-30-2012, 04:44 PM
Vinyl Turnip Vinyl Turnip is offline
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Originally Posted by Qadgop the Mercotan View Post
I've been struggling with managing chronic pain in my patients for decades, taken the latest seminars to learn the latest theories and approaches, seen new meds and procedures become popular, then disappear as they fail to work as promised, see people's lives dwindle not just due to pain, but due to side-effects of the treatments, and seen my patients die of opioid overdoses, and seen their family members and associates die when they get their hands on Grandpa's pills. And this is not just anecdotal, evidence demonstrates more and more folks are dying from use of legitimate opioid prescriptions.
Disproportionately from methadone, as I read recently, because of its particularly long half-life which makes it both beneficial and potentially dangerous for treating chronic pain.

(Not meant as a "gotcha" because you mentioned methadone; it just reminded me that I read that article recently.)
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Old 07-30-2012, 04:50 PM
Broomstick Broomstick is offline
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Originally Posted by Loach View Post
I took that tone with you because of how you replied. Do not presume to think you are the only one here with experience with the subject.
You assumed that because I do not come to the same conclusions as you do I must be ignorant. I am not.

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Unfortunately those with medical need are treated like criminals because of the actions of an overwhelmingly large number of criminals who are also trying to get those drugs. Not the same as antibiotics.
I don't think it is right to treat people with a medical condition as criminals when they have done nothing wrong. It's like assuming everyone with HIV is a promiscuous pervert and "deserves" their disease.

The bottom line is that the puritanical approach to drug addiction in this country increases pain and suffering among the injured and ill, who are expected to suffer because someone else is misbehaving. I find this loathsome and unethical. Those with medical needs should have them treated without being humiliated or subjected to restrictions normally reserved for hardened criminals.
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Old 07-30-2012, 04:57 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally Posted by Vinyl Turnip View Post
Disproportionately from methadone, as I read recently, because of its particularly long half-life which makes it both beneficial and potentially dangerous for treating chronic pain.
Methadone's both a great, and very scary chronic pain drug.

Great because it produces a relatively minimal "high" while delivering a big wallop of pain relief.

Scary because it lasts so damn long, is slow to kick in, and as a result, one must understand the dosing very, very well when taking it. And that applies to doctors and patients.

I used to think I had a pretty good handle on prescribing it. Now, while I don't think I've made any big errors in doing so, I'm a lot more leery of it than I was before that mortality report came out. Long-acting morphine or delayed-release oxycodone both have better safety profiles, and with the new oxys harder to crush and get an instant super-high out of, I'm starting to consider their role in chronic pain again. Mostly for malignant pain, however. Especially with the problems of morphine and methadone being exacerbated in end-stage liver disease....
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Old 07-30-2012, 05:03 PM
Loach Loach is offline
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Originally Posted by Broomstick View Post
You assumed that because I do not come to the same conclusions as you do I must be ignorant. I am not.


I don't think it is right to treat people with a medical condition as criminals when they have done nothing wrong. It's like assuming everyone with HIV is a promiscuous pervert and "deserves" their disease.

The bottom line is that the puritanical approach to drug addiction in this country increases pain and suffering among the injured and ill, who are expected to suffer because someone else is misbehaving. I find this loathsome and unethical. Those with medical needs should have them treated without being humiliated or subjected to restrictions normally reserved for hardened criminals.
No I assumed you were being condescending because you were being condescending. Lots of smart people have different opinions than me I have no problem with that.
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Old 07-30-2012, 05:05 PM
Broomstick Broomstick is offline
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Disagreeing with you isn't the same as being condescending.
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Old 07-30-2012, 05:11 PM
Loach Loach is offline
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Originally Posted by Broomstick View Post
Disagreeing with you isn't the same as being condescending.
Right. It was the way you did it.
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  #44  
Old 07-30-2012, 05:54 PM
Broomstick Broomstick is offline
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Oh, and your repeated "you do know that, don't you?" couldn't possibly be arrogant or condescending? You've been rather snarky in your replies to everyone here, going on and on about how horrible opiate addiction is as if that wasn't common knowledge. I still think your problem is that you weren't instantly hailed as an authority and correct the moment you set food in this thread.
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Old 07-30-2012, 05:58 PM
lavenderviolet lavenderviolet is offline
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Originally Posted by kittenblue View Post
Why is requesting a better pain killer considered a bad thing when it works for the extreme pain I'm dealing with?
I am a doctor. I very quickly became cynical about drug seekers after working in a state where we had a computer database to show how many opiate prescriptions someone had had filled (that made it very easy to bust the drug seekers no matter what sob story they told us).
Opiate abuse is a huge, huge problem in medicine right now - bigger than most people who haven't worked in primary care or an emergency dept probably realize.
Some of my colleagues in family medicine have experienced that if they prescribe opiates for one drug seeker then word will quickly spread through the grapevine to all the other druggies and then you have to deal with the headaches of a bunch of druggies trying to scam you out of opiates. This is one reason why some doctors take a hard stance and simply refuse to give opiates to anyone.

My suggested approach to discussing this with your doc would be this:
First, tell the doctor that your pain is out of control and ask him what else he can offer you. Don't tell him what to do. Be willing to consider whatever he does offer you. If someone has excuses for why nothing except opiates will do then that does make me suspicious compared to someone who's willing to at least give other options a chance.
If you feel like the doc has nothing left to offer you, then you might want to ask him if he would be comfortable with having you agree to sign a pain contract (which usually says things like that you agree not to get your opiates anywhere else but that doc and that if you are found to be double dipping that the doc can terminate you from the practice) and agreeing to do urine drug screens. Yes, I know that such things are a hassle, but it does show that you have legitimate intentions.
If he's still not comfortable with that idea, then I would ask for a referral to whoever the doc thought might be able to offer some help.

That would be my suggested approach. Going there and demanding Vicodin probably will backfire, but if you can show that you're serious about wanting to consider the options he can offer you and willing to play by the rules if he does write for an opiate then he might be more open to it.

Last edited by lavenderviolet; 07-30-2012 at 05:59 PM..
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Old 07-30-2012, 07:52 PM
Saintly Loser Saintly Loser is offline
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My two cents, FWIW.

I've been there. Bone on bone knee pain, loss of mobility, inability to walk more than a block or two, and complete disruption of my life.

I got that way because of an accident. Unfortunately that accident happened during a really brief (like a couple of weeks) period of time when I didn't have health insurance.

You show up in an ambulance not looking exactly like, say, Mitt Romney, combined with a lack of health insurance, and you're apparently branded as a biker dope-fiend. You're categorized immediately, without anyone so much as talking to you.

They stuck me in a room with about six other guys, all of whom were handcuffed to their beds. Turns out they were sent to the hospital from Riker's Island (the local jail).

No insurance? Screw you, you'll wait three days for surgery. Painkillers? Even though you had a spike driven all the way through your knee joint (literally), you'll have to get by on Tylenol. After the surgery? You can have a couple more Tylenols. By the way, when you get the bill, you find out that they charge uninsured patients about twenty times what they charge insurance companies for everything, and those tylenols cost you about $15 a pill. No physical therapy for you afterwards, either.

And then, some years down the road, when you do have health insurance, and your knee has deteriorated to the point where, as I said above, my world had shrunk to about a one-block radius (I had to take a cab every day to work, 'cause I couldn't even make it to the subway station, so I was well on my way to being broke, but at least I had insurance), doctors still won't give you any kind of painkillers. I remember after knee replacement surgery asking the doctor for something, just so I could sleep. I could tough it out during the day, but I really wasn't getting any sleep. A Vicodin, or even a Tylenol 3, would have at least gotten me to sleep.

But no. Seems like no doctor will write presciptions for pain relief any more. And I wasn't asking for any drug by name. I wasn't asking for morphine, or Oxycontin. Just something so I could get some sleep.

With all due respect to the physicians who have posted in this thread, who I don't know and who may be far more reasonable than the doctors I saw (although the guy who did my knee replacement is supposed to be the rock star of joint replacement in New York), it does seem to me like doctors have gotten so cautious about pain medication that you're just not getting any, no matter who you are. You're a grown man, with no history of addiction to anything (well, except cigarettes, but I kicked that one eventually), and you don't even like drugs, and you're treated like some drug-seeking junkie.

It sucks.

Oh, yeah. And signing some contract, where I agree not to see any other doctor for pain, and promise to come in for piss testing on demand? No way in hell. That's just degrading beyond belief. I'd rather have the pain.

Last edited by Saintly Loser; 07-30-2012 at 07:55 PM..
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Old 07-30-2012, 08:10 PM
Mama Zappa Mama Zappa is offline
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Originally Posted by Chimera View Post
But some doctors are total dicks about it. When I ripped up my right arm a couple of years ago and went to urgent care, they prescribed Vicodin. Since it isn't very effective with me, I asked for something else instead. The doctor exploded, screaming at me about hunting for drugs. I tried to explain that I did NOT want something stronger, I just wanted different, but she cut me off, refused to listen and said I could have the Vicodin or nothing.
Wow .

I went to the ER in a city 2,000 miles from home, after a fall in which I broke my elbow. I suspected it was broken (prior experience, other elbow), they X-rayed it and said nope, just a sprain.... and GAVE ME A SCRIP FOR VICODIN. I have to assume that I didn't meet any drug-seeking patterns: I sat quietly while they took more urgent cases (something a drug-seeker would, I assume, not do). Also I was (still am) a fat middle-aged woman, not that we FMAWs can't be seekers... (oh, and the elbow WAS broken, as confirmed by an orthopedist a couple weeks after I got home, but it was a break that can be tough to see on X-ray).

For the OP: Is the primary care doctor one of long-standing? It's boggling to think that a doctor would be soooo paranoid about being tagged for overprescribing, that he can't work with a known patient to figure *something* out. As in, take the time to really evaluate what you've tried, recognize that you've had a history of being *very* careful, etc. At the least, maybe a scrip for 20 tablets or something with the caution that there ain't no more of those for a few months.

Knee: a friend of mine (mid 40s) just had a procedure where they did some kind of resurfacing / artificial cartilage implant, might that be an option vs. a total knee replacement? Also push whomever you can for the synvisc injections to be approved: while they're by no means a cure-all, especially if your knees are that bad, they may give some relief and are rather less disruptive than knee replacement.
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Old 07-30-2012, 08:24 PM
Mama Zappa Mama Zappa is offline
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Rereading, I noted that the OP has been with this doctor for 20 years, which at least eliminates the concern that he's afraid of new patient / drug seeking behavior.

As another poster noted, there are alternative pain medications. Celebrex (mentioned) is pretty close to being an NSAID; it's a Cox-II inhibitor (I think) and may well have the same contraindications as NSAIDs. Ultram is not considered a narcotic, though they're lately finding that it does have some issues with dependence. Neurontin / Lyrica: not sure how helpful those are with joint pain like this, with a genuine mechanical trouble; I know they're useful for nerve-based pain.

Saintly Loser: how awful . Adequate pain relief is so critical in helping people recover from an injury or surgery. I'm not a medical pro, but from anecdotes (and my own experience), be appropriately aggressive early on and you stand a better chance of being off it sooner. I had better pain relief after my gallbladder surgery; a friend who had the same surgery a few days later had less-powerful help. I was off the narcotics within 72 hours. She was not.
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Old 07-30-2012, 08:38 PM
grude grude is online now
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For those who can't believe a doctor could be so stingy with pain killers, my father is in his 70s and has a history of kidney stones and in the ER he was lied to and told opiates were old fashioned, and this amazing new drug works best on kidney stones! They gave him a script for ibuprofen 800mg He came to me and I gave him a bottle of vicodin I had laying around.

Same deal with my mom who is the same age with no history of drug seeking, the doctor finally after sucking a office visit out of her just to tell he doesn't RX pain meds period and that she would have to go to a pain management clinic. All she asked for was some small amount of low dose pain killer because she couldn't sleep because of pain.

It has gotten REALLY bad in the USA, even normal patients basically have to go to the black market to get pain killers.
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Old 07-30-2012, 08:41 PM
aruvqan aruvqan is offline
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Originally Posted by Loach View Post
I have 2 bad knees. I took oxy for about 5 days after my last knee surgery. That's it. Going straight to the addictive option is not very smart. In some cases it is the best option. It is not the only option.

My ex-sister in law was very possessive of her pain. Told everyone about it any chance she got. Went to the doctors that would give her the most pills. She didn't die because of her back pain. She died at 35 because of her opiate addiction. All of it obtained legally from doctors.
Sorry for your loss, but chronic pain sucks ass, and anybody who wants me to live in chronic pain because their relative had issues needs to be pitted.

I refuse to live in chronic pain, and I have a doctor that listens to me. I am in no way going to die of an addiction I don't have, I already cold turkey'd morphine with no ill effects [I actually stopped accepting the morphine while still in hospital, I didn't need that level of pain med at that time.]
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