How do I request stronger pain relief?

Discussion in 'Fibromyalgia Main Forum' started by nightngale, Mar 9, 2007.

  1. nightngale

    nightngale New Member

    Ok, I have been on ultram and it has always helped my overall body pain aches, legs especially. Now I have a new pain in top part of right thigh, and it does not help. Going back to old rheumy, after bad experience with new one, in couple weeks. I don't even know why I left. He was the one who originally dx the fibro and has always been good with meds for sleep and pain. Well, I never asked for anything stronger, cause I didn't need it. Can Rheumatologists prescribe stronger than ultram? I have seen other peoples' posts that say they get stronger stuff. Do you have to go to a pain clinic?
  2. nightngale

    nightngale New Member

  3. lastormer

    lastormer New Member

  4. FibroPainSufferer

    FibroPainSufferer New Member

    I don’t know about Rheumatologists but my new PCP is treating my fibro & prescribing my pain meds. He’s actually doing a better job then the pain specialist I was seeing.
  5. nightngale

    nightngale New Member

    I spent all eventing updating notes and am deathly exhausted I think I got it done though for the doc. I even attempted a form letter maybe he could play with for the SSDI people. I have no idea if he will even want to do that. But the times Ive seen him hes never taken notes so I dont know if he just scratches something down or dictates later. So he can scan my symptoms and have them all there. I hope that will be ok. I am so nervous. Today I had to get up early to have a mole removed and now another tomorrow. This is important for my allsup stuff. I guess I will see if he mentions something for pain and if not ask maybe Im alway scared.
  6. JLH

    JLH New Member

    Yes, Rheumatologists CAN prescribe stronger pain meds than Ultram -- it's juat a matter IF THEY WILL, or not!!

    Don't ask for stronger pain meds right off the bat, talk with him and explain how your pain is worse and that the Ultram just doesn't seem to be working. He SHOULD pick up on that and either ask you if you think you need to try a stronger pain med, or he'll tell you that he doesn't prescribe stronger stuff and tell you to take some Advil or Motrin along with your Ultram to give it a boost!

    Due to so much mis-use of prescription drugs in the country today, a lot of docs won't prescribe the stronger stuff and they will make you go to a pain specialist or clinic.


  7. shywolf4

    shywolf4 New Member

    I saw a fibro specialist and told him that the ultram was just not doing for me, but I was hesitant to go on stronger meds and he agreed because he felt that the stonger meds were worse for FMS patients in the long run because we build up tolerances so easy. What he did instead was add 600MG of a medication called Neurontin and that has helped me. There are still times it is not enought but between the tramadol and the neurontin I am in a tolerable level of pain on most days without the spacey feeling that a lot of stronger meds can give you.
  8. PVLady

    PVLady New Member

    I never ask for pain meds. I usually describe the pain and how I am doing with the current drug, which is not good sometimes. My doctor listens and puts note in his laptop computer. At the end, he turns and asks what meds I need. I then tell him I'm not sure, just something stronger for th pain. I am lucky because he has not pboblem letting me try different meds or to add one if needed.

    I see Dr. Rick Chavex in REdondo Beach. He is a great pain specialist. and does not hesitate to runs tests if needed. He sent for a MRI last week of lumbar sprine.
  9. obrnlc

    obrnlc New Member

    hi nightinggale!
    I never had luck w/rheumy's presc. pain meds myself. Many rheum. and even certain "pain specialists" will either want to give you toxic doses of OTC meds or try injections that you know won't work (anti inflammatory, epidural, etc.
    I do agree with others when they say "don't ask for specific meds" or doc will think you are drug seeking. If you have a good, and hopefully long, relationship with a doc. (pcp or rheum), tell them what type of pain and frequency by keeping a pain diary for a week or so. Since your appt. is tomorrow, you will need to try & remember it for the past couple of days, but keep very detailed doc. of :
    1) type and severity of pain, according to their useless pain scale used in office (i don't think it applies to CHRONIC pain, but it is the best they have)
    2) activity throughout day and what, if anything, precipitates your pain
    3) measures you take to help yourself (hot bath every 2 hours, thermacare, etc.
    4) pain scale before and 1-2 hours after your current med, and how long you get relief, if any

    If doc decides you need stronger meds, will very likely refer you to a pain management spec. , that is why its good to have a good, long relat. w/ your present doc--so he can show the Pain spec. that you truly have a problem and aren't just drug seeking.
    Ask doc to formally consult and recommend one, if you just call around and ask pain docs, they think you just want drugs.
    I personally don't have a problem w/ pain clinics--they will have you sign a contract prior to prescribing narcotics that you won't :sell, give away, take other peoples, go to any other pain docs, notify them if you need ER and get meds there, and consent to random drug testing at their discretion to make sure you take what they prescribe and nothing more.

    As long as you are legit.& follow their protocol, no problem, and they will be very helpful and a very strong ally in a quest for disab.
    Make sure you get the thigh problem checked out, to make sure its "just a fibro thing" and not a circulatory, etc. problem.
    Good luck with this--L

  10. suzetal

    suzetal New Member

    Patients’ Bill of Rights

    I. Information Disclosure
    You have the right to receive accurate and easily understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, assistance will be provided so you can make informed health care decisions.

    II. Choice of Providers and Plans
    You have the right to a choice of health care providers that is sufficient to provide you with access to appropriate high-quality health care.

    III. Access to Emergency Services
    If you have sever pain, an injury, or sudden illness that convinces you that your health is in serious jeopardy, you have the right to receive screening and stabilization emergency services whenever and wherever needed, without prior authorization or financial penalty.

    IV. Participation in Treatment Decisions
    You have the right to know all your treatment options and to participate in decisions about your care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.

    V. Respect and Nondiscrimination
    You have a right to considerate, respectful and nondiscriminatory care from your doctors, health plan representatives, and other health care providers.

    VI. Confidentiality of Health Information
    You have the right to talk in confidence with health care providers and to have your health care information protected. You also have the right to review and copy your own medical record and request that your physician amend your record if it is not accurate, relevant, or complete.

    VII. Complaints and Appeals
    You have the right to a fair, fast, and objective review of any compliant you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the conduct of health care personnel, and the adequacy of health care facilities.

    For more information on patients rights and responsibilities:

    Prescription Medicines and You, presents information on what you need to do to take your medicines safely, and how to get help when you need it.

    Agency for Health care Research and Quality (AHRQ), a part of the U.S.


  11. pj13

    pj13 New Member

    This is probably one of the hardest things to endure- not only the pain, but the constant fight to get adequate pain relief.
    Rheumys definitely can prescribe pain meds, and those who work with CFS/FM usually help more. However, whatever kind of doc you see, you either need to be assertive, or find a doc who doesn't believe that taking one narcotic a day makes you an addict. Usually my rheumy doesn't prescribe the pain meds, but my Family Practice doc does. Before I went to her I had an Internal Med doc who did. The most important thing is to find a doc who understands CHRONIC pain. I have tried everything, non-medical and Rx. Just know if you are asked to see a pain management group, make sure they actually give meds. Some are fronts for Rehab units, and others are only going to give you trigger point injections, other pain blocks. These are fine if they help,but it was usually temporary. As an inactive nurse,due to this DD and disability, I can tell you that many docs and nurse sare not up to date in the current thinking of pain relief-especially
    chronic pain. However the JCAHO (accreditation of hospitals)
    has made pain relief a priority, since it is the symptom most go to ER for and yet is often still a problem at dismissal. Your rights as a patient are to be BELIEVED when you complain of pain and treated for it until you perceive relief. Sorry this is wordy, but 2 other suggestions: if you know of a FM CFS group in your area find out who those people go to, and secondly take someone with you to reinforce how much pain you have! Good Luck, and don't give up HOPE! There are lots of docs and nurses etc who are compassionate and up on this DD AND chronic pain. BTW, I am taking Oxycontin CR every 12 hours and if needed Norco for breakthru pain,with much better relief. It was a long battle to get there, and obviously started on lesser drugs first. Know if you go to a doc who is afraid to give you a narcotic because "it's addictive", or after trying it without relief, she /he won't go up in strength or change the med to a stronger one RUN don't walk out of his office. The latest research and statistics show that only 1% of people prescribed pain meds become addicted. And if you are using it as prescribed, you are not addicted. However, it may help at first, but if your pain becomes worse, you can become tolerant to the stength or med and if so let your doctor know so he can increse the strenth or change your meds.
    Hang in there!

    [This Message was Edited on 03/14/2007]
  12. mujuer

    mujuer New Member

    he is going to refer me on to a pain clinic. He says he won't give anything for pain and he hasn't. I have had to see my primary care physician just to get anything at all. Over all of the past 2 1/2 years that I have had fibro, the thing that helps the most is my muscle relaxer. I have been to a pain clinic before and they gave me some strong stuff that only made it worst so I quit going.

    Suzetal, please post as a seperate article on the patient bill of rights. There are alot of people that need to see that. Thanks

    Good luck Nightngale.
  13. dc1980

    dc1980 New Member

    During the past two years since dx of Fibro & CFS I have subscribed to newsletters that is sent out once a are a few of the news letters I receive:

    Anytime I find an article with pain meds or other treatments that other people have tried and it seems to be helping them, I make a copy, highlight the info and give to my PCP and ask him if he is willing to try this treatment with me. He has never said no to any request yet. It lets him know that I care about my treatments and I am willing to share with him which gives him knowledge for treating others patients with Fibro & CFS. We will then dicuss the next visit (I go every 4 weeks) how the new meds are working or not working. I have tried numerous pain meds and currently because of an article I took in, I am taking methadone 10 mg 3 times a day. There is a stima associated with this drug but that was something I had to get over real quick. I have been taking methadone for the past 8 months and it is the only drug I get any sort of relief from the pain without the high of a drug such as Lortab, Soma, Vicodin, Oxycontin etc... I have to always take meds as prescribed because I signed a pain management form that I could be called anytime for a nurse to count my meds, which is a good thing.
    Every single newsletter is in my medical folder so we can always go back and refer to something if need be.

    Hope this helps,
    [This Message was Edited on 03/14/2007]
    [This Message was Edited on 03/14/2007]
  14. nightngale

    nightngale New Member

    for all the really good info. I was so tired and nervous as it was an a.m. appointment, I was in real bad shakes. He
    did let me read my list of new sx, and moved my legs around checking the thigh pain. Thought it was some kind of bursitis? Offered some sleep med or muscle relaxer, but I did not like flexeril from years ago. I didn't ask for new pain meds as I hadn't seen him for 1.5 years and wanted to reestablish the relationship. He did say I was taking a real low dose of tramadol. Oh, did update my rx for that right away. Said to try physical therapy and if that didn't work I may get corisone injections. in my thigh. When he stood up to end the appt. I stammared out that I was applying for SSDI thru allsup and handed him a letter detailing my symptoms. I asked if he wanted to copy it for future reference he agreed. I had seen on another thread that someone had done that for their doctor. He is so calm Its hard to tell what he is thinking, but he went and copied all my papers. And said when they send him something he will look at it and go from there. He also offered different sleep meds, actually offered serequel or trazadone, but I had been working with my pysch doc on that, just tried Ambien CR with no luck. So we agreed together to let her deal wiht that. All in all it was a good appt. I still don't know if he does stronger meds. As I was going out a lady who could barely hobble on her crutches stumbled in and it made me feel like my problems were fake or something! Its so hard when no one can "see" the pain. Sorry this is such a long a rambly post. It problyl belongs on my other thread. Anyway, I was happy he didn't freak out about the SSDI stuff. I had just seen a new rheumy someone else mentioned who was all spastic and the first thing he asked was was I employed and he did not do disability? That sent me running back to my first guy. Shouldn't have left him. Then I called my pysch doc from car in near hysterics saying I thought I was having a nervous breakdown cause of all the stress in my family and couln't sleep. I really think I am having some kind of menopausal freak out. She called back within hours (I LOVE HER) and called in 25 mgs Seroquel to see if that will help. She said it would help sleep, depression, and anxiety. I haven't tried it yet. I do feel better now that all the paperwork and appts. for the week are over. Sorry again for such a vent. I don't even have the energy or time for PT! Oh well, I made it thru another appt. I always get nervous if I haven't seen someone for long time.
    [This Message was Edited on 03/14/2007]
    [This Message was Edited on 03/14/2007]
  15. Ginner

    Ginner New Member

    I go through my primary physicin for any medications.
    If a specialist adds an rx to my meds., I ask them to please send a copy of my visit to my primary dr.
  16. galileo

    galileo New Member

    My experience has been that if you go in demanding this or that, then you automatically put him on the defensive. I like the approach of the laid back example, just describe it, but don't ask for it by name, that is a dead giveaway, then they think you are trying to get it or are a druggie. Its crazy, but have never had a problem with the laid back approach. But taking and waving a bill of rights will get you nowhere. Best to be friendly, and honest about your pain. My doc did make me sign something that i wouldn't get it from somewhere else, multiple different doctors, stuff like that. But never really had any problem. He gives me oxycontin, but I just take it when I am really bad off, like I way overdid something-- like the last time I painted the garage, oh ow. Boy, does that stuff ever work, but don't think i would want to be on in long term like somebody else said. Alternatives like epsom salt bath, the magnesium, massage, stretching...all these help. Then it depends if you have something specificly wrong to, besides FM pain-- like degenerative hip or bad knee etc. Just my take on it all.

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