For the past 7 years (ish), I have taken tramadol for diabetic neuropathy. I have been at 400mg/day for most of that time. I also take lyrica, 200mg/day as an add-on / adjunct. I have tried tricyclic antidepressants in the past, but they gave me severe dry mouth, to the point I was wanting water every 5 minutes.

My journey to starting tramadol was NOT for neuropathy, which I am currently having a difficult time in getting my doctor to understand. He also happens to be the initial prescriber of tramadol for me, which makes this very, very frustrating. It was prescribed for back pain. For back pain, it does not provide any relief. It never did. He is currently talking about tolerance and etc., but originally I stopped taking tramadol as it was ineffective, and just took tylenol. That was 6-7 years ago. It was ineffective for non-nerve pain from the start.

I am on coumadin, so NSAIDs are dicey due to potential stomach complications.

So, I recently had an acute pain issue that I went to the emergency room to have checked out. There I was given an antibiotic and a narcotic. I was initially offered hydrocodone, but that too has tended not to work for me in the past. I was then offered oxycodone, which I accepted because that HAS worked in the past.

I was given 15 pills of percocet (oxycodone 5mg + 325mg tylenol). As it is a schedule 2 drug, no refills. I was able to get 1 new script from my regular doctor, but also for only 15 pills (2-3 day supply). When I was still in some pain after that, I could not get anything from my doctor. He pointed back to the tramadol as part of the justification for denying any further percocet. I tried to explain the tramadol only works for neuropathy for me, but was still denied.

Ultimately, the pain went away after another 3 days as it was apparently an infection, but I feel as though I had to tolerate some pain that could have easily been addressed if my doctor had either written the script for a 7-day supply OR had been more understanding / taken a more in-depth look at my history when I made the request for a few more days of percocet.

So, I am still trying to explain to my doctor the steps that got me started on tramadol in the first place. I am also trying to explain that not only does tramadol not work for non-nerve pain, neither does hydrocodone (vicodin, norco), and those both share a bioactivation phase by the same liver enzyme that does NOT bioactivate oxycodone to any great extent (cyp2d6 vs. cyp3a4).

I do not know how he is going to respond, so, other than the obvious "get a new doctor" what do I do here?