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?
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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.