Pain Management/Pain medication


QUESTION: I go to a pain clinic for my medicine for lower back pain every 2 months. They have me taking 5/325 hydrocodone.  I have had 3 back surgeries 8 knee surgeries & arthritis. Today I was told they were not going to give me anymore pain pills because I always run out 2 or 3 days early. Every time I go I mark on the paper that I finish medicine early. I have never lied. 2 months ago I went and the nurse said I need to be on something stronger, but I work with kids and needed a low dose even if it did not work well. I need some advise on what to do? I have pain everyday. I thought it was best to tell them the truth about taking more than I should. I could have asked someone for medicine and never told them. How do they know what works if you don't tell the truth. Will another pain Clinic see me

ANSWER: Anne, don't think I've forgotten about you. I waited until I could log onto my computer because I had a lot of suggestions for you. However, I "forgot" my password. Anyway, right now we are under tornado warning and thunderstorms are beginning, so I have to log off the PC. I live in NC, so we've been under the threat most of the afternoon. I will get back to you. I have a lot to say to you. Have patience, please!
Thanks in advance.

---------- FOLLOW-UP ----------

QUESTION: Also I'm having surgery  Oct 16th . Having ovary took out & all the scar tissue that has gave me a lot of pain.

Hi Anne,
Sorry for the delay. I had a little crisis today with my teenager. Anyway, let it not be said that I don't keep my word!
You and I have a lot in common. While I have not had as many surgeries as you, I am unfortunately a patient at a Pain Clinic, too. I have been there for almost two years. I learned very quickly how it works. Ideally, of course, a patient should be completely honest and up front with them. Each pill count should be correct, etc. However, you and I both know that it doesn't always work that way. Some days we need less, some days more. That has been my experience.

First, I think you may need to be on something stronger. You are only on 5/325 hydrocodone which can be little more than an aspirin after a while, because the natural order of things is that our bodies get tolerant to it. This is not considered addiction, but in pain patients it is considered "tolerant". It is to be expected. Even the clinics realize that. I think that instead of telling the nurses or doctor that you had to take more than you should have. Well, they don't want to hear that, even if its true. It puts them and their special certification in jeopardy. I can remember when there weren't any pain clinics and people like us had to deal with what we got from regular physicians- sometimes nothing! I realize I am not speaking like you would expect a nurse to speak, but I told you I had a few suggestions for you, and I am trying to be candid with you.

I truly think you need to go in and tell them you really aren't getting proper pain control from the present dosage you are on. (You have to use the proper language, OK?) It is admirable that you want to keep your dose down since you work with children, but think about it-- pretty soon you may not be able to work with children if you aren't getting adequate pain control. If this particular clinic will not give you any more meds, or they "cut you off" then DO try to go to another clinic, OR you can simply speak to the doctor himself/herself. As I said, be candid about it and say that your pain is not well-controlled. I know you are being honest by marking your intake on the paper, but as I said, they don't want anything to "rock the boat". It may take a whole new medication for you to get comfortable. Last year, I had to "play the game" with my clinic while the PA tried Butrans, which didn't work, and then Fentanyl which worked, but gave me terrible migraines. This was all during the Thanksgiving holidays, so I was indeed miserable. So, instead of doing a lot of complaining, which I knew wouldn't get me anywhere, I started keeping a little journal. Each day of "AGONY" I simply entered how bad my migraine was on a scale of 1-10. (They love their pain scales, you know)! I really was in a lot of pain during the holiday, but I didn't make waves by calling constantly. I simply made an appt and used my journal to point out to my PA that the meds weren't helping, or either there were side effects of other types of problems, (migraines can be worse than body pain sometimes)! So, he went back to my regular meds, which is what I wanted all along. However, if I had asked or begged for the original meds it would have raised a 'red flag'. Are you getting my message?

I am putting a lot of trust in you, Anne. I am telling you a few trade secrets here, but I also understand from what you've shared with me that you have plenty of reason for chronic pain - all those orthopedic surgeries.

So, learn to play the game, if you want to call it that. Keep a journal. Be fairly honest. "Suggest" that you go on a slightly higher dose, if that's what you want, or if not, ask them what they think of using so and so med....etc. Just remember, they don't like people using too many pills even if there is a good reason for it. I learned that early on. They don't like urine screens to come back with anything other than what they've prescribed, but that's only right. I have learned that they will not, under any circumstance, give early refills. I had to be a guinea pig for a month or so, then I went back with all my information organized, but was very honest about my pain scale, and then I got put back on the med that worked well all along.

I really wanted the chance to communicate to you this way, because even though I'm a nurse, I am also a patient, and I've seen it from both sides. I felt I wanted to give you a little "inside information" because I could see you were trying to live by the rules.

Now, I hope you have not gotten my reply too late since you are having surgery tomorrow. I wish you a quick recovery. Think about what I've said. IF you have any further questions, etc. please feel free to email back to me. I will do all I can to help.
God bless you in your surgery and recovery, Anne. I would love to hear back from you after you've had a chance to see if you can meet with your doctor and get better pain control.

Pain Management

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Patricia M


I welcome questions from people who may want a "nurse's perspective" on the subject of chronic pain and pain management. I am a nurse, NOT a physician (MD).I can answer questions on medications, alternative approaches, and the various organs and body systems. There are many avenues to explore with chronic pain. I am against seeing patients suffer simply because healthcare professionals might suspect they are "drug seekers". There are methods of identifying true pain, and this makes patients feel as if they are taken seriously, which they should be.


Over 25 years working experience in Internal Medicine, Adult Cardiology, Post-Surgery care, Cancer, psychiatry and some experience as a lay-counselor in addictive medicine (dependence to alcohol and/or drugs, both legal and illegal drugs).

I am an Expert with AllExperts in several areas: Pharmacy, Internal Medicine, Medical Errors. Feel free to check my Q&A history as well as my ratings, which are very high.

Diploma from hospital-based nursing school. Additional courses in pharmacology. I keep current in continuing education. Am currently working as lay-counselor which can lead to my certification as Substance Abuse Counselor.

Awards and Honors
Dean's List while in college.

Past/Present Clients
Internal medicine patients, cardiology patients recovering from heart disease and/or open-heart surgery, cancer, as well as recently working as a lay-counselor to individuals dealing with addiction to drugs and/or alcohol. NOTE: Just because I attempt to help patients with addictive diseases, I have over 25 years in Internal Medicine, have nursed patients with great deal of pain, and I am compassionate. I never label anyone as a "drug seeker". I have seen that done for years, and am against it. All patients should be evaluated for pain in a fair and comprehensive manner. Am an Expert with AllExperts in three other medical categories; feel free to check my ratings, which are high.

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