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    Pain Management doctor?

    My 68 yr old mother had a massive stroke 4 yrs ago, is completely paralyzed on left side & has been trying to deal with central pain & lower back pain since then. She lives with me & though she's not sci, I've received tons of info from this site which helps me with her care. So thank you all!!

    Here's our current issue: Mom had been taking Percocet 5/325- prescribed for every 8 hrs as needed. Mom would try to "tough it out" and not take it unless she was in very severe pain, usually taking 1 or 2 per day. She complains that it doesn't work and my theory is that she's not getting enough pain meds & waits too late to take them. Her doctor put her on MS Contin 15mg twice a day. After a few days, she became completely nuts- beligerant, angry, extreme paranoia, extreme confusion.. so I stopped it. Then doc puts her on Fentanyl patch 25mcg/hr. After about a week & half, it totally zonked her out.. when she would awake, she could not do the most basic functions and was just totally a confused, non-functioning mess. I read up on Fentanyl and it said it is only for those who are already opiod tolerant & it gave amounts of meds that would qualify- and I believe it said Percocet 30mg/day. She obviously wasn't anywhere near that amount. I finally gave up & stopped the patches & started giving her Percocet 5/325 every 6 hrs (=3x/day). This worked fine- she was pain-free & mentally ok. Next doctor's appt I explained what we were doing, doc said ok, we'll continue with that since it works but only gave me 35 tablets! We were going back in 1 week, though, for a checkup on another problem, so I didn't press the issue, thinking maybe he just prescribed a few to see if they would work since we would be back in a week. When we went back & explained need more percocets & asked for enough to last 1 month when she due for another followup check. Doctor refused to prescribe that many... but said he would prescribe Lortab 7.5 every 6 hrs but only gave us 60, which is enough for twice a day. What's up with this? I was given the spiel that Percocet being highly monitored by the DEA, very addictive, etc, etc. Mom is 68 yrs old with intractible pain & it is not going to get better. She is almost completely bed-bound as it is and has no life. She has to have round the clock care, is miserable with her life and should not have to deal with not being properly treated for her pain.

    It was mentioned that if this didn't work, we may need to go to a Pain Mgmt doctor. So- here's my question- should we just skip this BS and go straight to the pain mgmt doctor? I don't know what's involved. I'm just extremely frustrated because I'm just trying my damndest to make my mother's life as comfortable as possible. It makes me furious that this doctor (who we really like and who seemed so on-board about treating Mom's pain) is so concerned with the DEA. I think I'm going to tell him to send the DEA to my house & see what we deal with on a daily basis. And why is Fentanyl, which is obviously entirely TOO MUCH for Mom ok when 5 mg Percocet 3x/day not ok? Makes absolutely NO sense to me.

    Any thoughts/suggestions would be appreciated.

    See the pain specialist. Will this doc give you a referral? Having meds prescribed by the specialist will make the present doc feel less uneasy.
    - Richard


      lamissgirl - that is quite a story. Your mother is lucky to have you with your dedication to her comfort. I want to commend you on your instincts, especially your conclusion that what you went through is bullsh*t.
      This doctor that you have won't help your mom, get her to a pain management doctor. Don't waste your time getting angry at him/her. Move on to the pain management doc.
      The explanation for her reaction to MScontin is that she is 68 years old and elderly people can "sundown" (become disoriented, paranoid, kind of crazy) very easily with narcs. It happens all the time in hospitals with very small amounts sometimes. So you walk a very fine line between her comfort and the side effects. Totally different for a 45 year old....
      The good news is that it seems like 3 to 4 percocets per day may make her life comfortable but not wig her out. Maybe the pain doctor will prescribe Oxy-IR which is just the oxycodone without the tylenol so she doesn't get too much tylenol per day. The fentanyl patch may not just zone her out , but it could be downright dangerous...
      It is hard to manage chronic pain, but the throw in geriatric pain management and it becomes even tougher.
      You are obviously dedicated to your mother, and I think that is wonderful that you are doing the right thing, get to a good pain management doctor. No one should have to suffer like that.
      Last edited by arndog; 12 Jan 2009, 5:07 PM. Reason: spelling


        Arndog is spot on! My daughter works at a nursing home. Unforturnately, drugs do not work the same way on the elderly. Many can't take the neurotin and lyrica for neuropathic pain, sleeping aids can work the opposite, etc.

        See the pain specialist and hopefully he can make her comfortable.

        (The way that all doctor's are being monitored, thanks to a nasty few, makes us all pay for it. I think that every time I have to sign my life away for a lousy claritin D tablet.)

        You are a blessing to your mother, she's lucky to have you.


          Thank you all very much for your responses. My hunch was to go to the pain mgmt doctor... but I just hate "doctor shopping." I live in a small town and there is only 1 pain mgmt doctor here, but I will see how that works out. For the last couple of days, she's done ok on the Lortab... so I'll just continue until I see that's not working & the minute I think she needs something further, I'll get a referral to the pain mgmt doctor.


            I think you should make the appointment now. If and when you decide it is needed, they probably won;t be able to see you right away. You can explain the ordeal to him, with the bad side effects, and that the percocet seem to do the job, and that the lortabs are also working at this time, and see what his advise is.

            That way, should something need to be chnaged, she will already be a patient, you don;t have a long wait.

            I am actually surprised, that considering that he was willing to try the fentenyl patch, you regular doc wasn;t willing to go 3x a day on the percocet, with enough for a month, it is a lower dose that the fentenyl.

            Glad she is feeling better at the moment. Hope it stays that way.

            Oh an you are right about "toughing it out". It is a lot harder to bring down the pain level, that to keep it from getting high. And takes more medication in the long run.
            T7-8 since Feb 2005


              arndog is great......bullseye w/ that answer. i also commend you for your efforts. the only thing is the original doc you liked and seemed on board may have prescribed the longer acting mscontin since she said in the beginning she wasnt getting enough w/ 2 percocets. then prescribed the patch hoping for relief w/ less side effects. finally gave the 35 percocets to see how she was doing as a trial, then switched to less addictive lortab thinking 5mg percocets 3times =15 and 7.5 lortab 2times=15 might be better. after asking for the percocets back he probably thought the specialists should be involved since it did get confusing. the only reason i add this comment is you might not want to give up on the doc for other things if he is primary/family/etc. i can totally see your frustration. this happened to me one and i flipped the same way.
              good luck n great job
              Many Blessings,

              So we can say with confidence, The Lord is my helper, so I will have no fear. What can mere people do to me?" Hebrew13:6


                Josh - what makes you think that lortab (hydrocodone) is less addictive than percocet (oxycodone)? I don't know the answer.
                Your point about not totally giving up on the general doc is good, just get him out of the loop of pain management.....


                  Although it's probably not something your general doc is going to believe, the DEA does not break down the doors of doctors who keep good documentation, see their patients getting narcotic refills on a regular basis, don't self prescribe and don't write hundreds of Rx for the same drugs each day. They're after the "pill mill" doctors. In many states its against the standard of care to undertreat pain. But your doctor is looking for an excuse not to refill her meds so, a pain specialist is needed at this point.