concern for some members

[Guest guest]

I have been reading many new posts and I must say I'm pretty perturbed at some

of your

doctors regarding pain relief. First I'm a new member so I don't want to start

off on the

wrong foot here--but I simply can't sit by and not get involved in this issue.

Second off, I

am an RN specializing in ER. I understand doctors not wanting to create addicts

but that

would be an extreme. Also, ER docs are notorious for thinking every patient is

a drug

seeker so I understand the mentality( don't agree but understand.) When I read a

post the

other day that a patient was going to be weaned off meds before sugery so that

post op

the pain meds will work better, that just angers me. How can this doctor let

the patient sit

in that much pain until then. Other doctors prescibe the bare minimum fearing

that there

patients will become addicted. Well ladies and gents, the condition that we

have requires

pain medication and strong pain medication at that! I Have a pain specialist

who is an

anesthesiologist and we have this conversation all the time. First of all the

worst kind of

med to put somebody on for more than two months of steady dosing would be a

combination pill--for example hydrocodone/APAP or percocet--these meds contain

tylenol along with the narcotic pain releiver and for long term at high doses

they could

damage your liver. Second, there is no ceiling for pain releif--doses can go as

high as

you need them. Patients including myself feel as if pain meds hold a stygma

(bad bad

bad), and can't wait to get off the meds. My anesthesiologist has helped me get

over that

feeling of being a failure. Of course the body becomes tolerant of the medicine

and

dosage increase over time will be necessary but, the meds have certainly

improved my

quality of life in every way. I just want everybody to not be ashamed if meds

are required.

Also a surgeon may need a consult with a pharmicist or a pain med doc to keep

from

undermedicating their patients. Be your own advocate when it comes to your

body.

Fortunatley pain releif is finally being taken seriously in the field of

medicine--not only

for cancer patients. There are fantastic meds out there and nobody should live

with

unbearable pain. I have been on the same dose of medication for two years now,

I take a

little somthing for breaktrough pain which I don't need very often. For dental

procedures

or airplane flights (which kill me) I use a fentanyl buccal pop for immediate

pain release.

You can never come to the point where pain meds will not work--there is no

ceiling!

Please don't live in pain. If need be have a pain specialist prescribe the meds

and your

surgeon do the surgery of course! Anyway, I'll get off my high horse now

haha--I guess

I'm just a little passionate when it comes to relieving pain!

[Guest guest]

Kerry,

You are right....pain management is a " hot button " issue for this

group as well as the population at large.

Ironic isn't it...a woman steals prescription narcotics from someone

she is supposedly " caring " for and our member gets a " ho, hum "

response from the authorities? Let a doctor prescribe needed

medications to one of our members and both come under severe scrutiny

as drug pushers and addicts. Infuriating.

Thankfully it seems that there is small headway being made on Capitol

Hill and chronic pain is slowly getting some of the recognition it

needs. It does scare me that the medical community generally seems to

have bowed to the pressure of the political/enforcement world for

years for fear of losing their licenses or funding, I guess.

You have written a clear and passionate piece on the absolute

necessity of finding a good pain management doctor. Unfortunately I

think it is a somewhat evolving specialty. Still...members who have

finally found their way to one have had near miraculous improvements

in their function and quality of life. Since many members find that

after revision their old friend pain either revisits from time to

time, or never really packs his bags and goes...it is an important

fact to keep in mind: you do not have to live in pain!

I won't pretend that I have the foggiest idea of what appropriate pre-

surgery medications might be, or their impact on post-surgical pain

management. I do know that when I pressed my surgeon after being told

by the pre-surgical consult team that I needed to be off Celebrex (I

could not use narcotic pain medication because of my employment and

so I suffered quite a bit of pain...the Celebrex just took the edge

off) he okayed me staying on it until 24 hours before surgery. I

don't know what effect it might have of blood loss but perhaps he

just decided he would manage that. Point was, when I made clear that

being glued to my couch the week leading up to surgery was not an

option we found a resolution. As you say...there is nothing like a

patient advocating for themselves. If we do nothing here as a group

other than help members learn enough to adequately do this well for

themselves then I will feel that we have all made a huge contibution.

I am so glad you are here in this group (not glad you have this

condition!)and am happy that we have a growing number of people with

medical backgrounds to help us sort through some of this. Knowing

there are understanding and compassionate medical professionals

everywhere helps. Many thanks. And by all means please continue to

make sure that you remain our " Jimminy Cricket " on this topic.

In the " Links " section there is a link to the American Chronic Pain

Foundation's medication guide, and you can also get their web address

there. They are working very hard to bring changes that effect all of

us. I hope you have, or will, visit their site.

Take Care, Cam

[Guest guest]

Hi Kerry,

I am 10 years post revision surgery and take methadone daily for pain relief, given to me by my wonderful pain doc (he's a physiatrist). In February, I will be having wrist surgery. My pain doc and surgeon have already told me they will confer before my surgery date. The surgeon has already told me he, and the anesthesiologist, would consider the methadone dose I take now as my base and go up from there to take care of the surgical pain. Yes! A surgeon who understands! When I mentioned this to my pain doc, he said, "Sure, that's how it's done. Whew! (The surgeon also said they will inject a long acting pain med into the surgical site while I'm under anesthesia, to take care of the worst of the immediate surgical pain, about two days worth.

Bonnie