After sufering fron chronic left knee pain, DJD, Cysts, Etc ( I beleive the 1 - 10 pain scale is not effective and a total waste except when used with the "same" doctor who has been treating and understands you, your activity levels and pain meds schedule), I was referred by Orthopedics to a PRM/Pain Clinic at a Major and well respected University Hospital (Not a Pill Mill!). in JUly 2009 (2 Years Ago). Prior to that, I had several surgeries that DID provide great pain relief, FOR ABOUT THREE YEARS after. In 2008 (last surgery in 2005), the pain returned with a vengence. Icing (to numb so I could fall asleep) became a nightly routine lile brushing my teeth. I had never ask for or received opiate pain meds prior except post op, dental etc. NSAIDs was all I was ever given. My primary care Doc (managed care - Im retired Military) changed frequently. When first sent to PRM/Pain Clinic saw 5 year Residents who without request prescribed 5/5 Hydrocodone. Third and all vist since then have been with My assigned Attending who is Certified in PRM and Pain. Without much discussion, she changed pain meds to 10/5 Hydrocodone 4 times per day. Given my Military & medical history, demeanor and whatever else, I wasnt not required to go thru extensive screening, pain med contracts, etc. I did ask about and express some concern about dependence/tolerance down the road. The Doctor assured me that the meds were just apart of the "plan" which included injections, including suprax, prolotherpy, cortisteriods etc, PT. A year later "I" inquired about alternatives like TENS, Accupucture, and found out their was "Pain Support Group" at the Hospital! I was accepted into group, run by a Phd. Psycologist. SORRY for long intro but Now's here the real STORY. In the 16 weeks I was in group, I met many fine people (I am sure there were some "malingering addicts", but what I learned from some the the credible folks SCARED ME. Several confirmed my ongoing concern for showing up for an appointment and finding out I had a "new PRM doctor" (cause old one move on) and new Doc has different view on Opiate Pain Releivers ( I have many other DOC's in last two years express concern if not total disdain for long term use of 10/5 Hydro (not time release) even other PRM Docs in Same Clinic. ) I also learned that many people are "CUT OFF" from pain meds merely for expressing concern, or saying the wrong thing, etc.
To make matters worse I was badly injured in a car wreck last year, broken ankle and foot on same "bad leg" and was on IV morphine in a different hospital with different docs and discharged with two weeks of stronger oxycodones. I weaned on them and back to normal dose of HydroCodone (first time in my life I ever felt the VERY VERY uncomfortable feeling of withdrawal!!! ) I dont want to ever fell that way again. Present: I have never taken the full four 10/5s prescribed for two years, before the car wreck and additional injuries and pain, I usually took 2 - 3 on a "as needed basis" (Although I "ALWAYS" filled scripts on time cause Doc lectured me once when they saw I had not and again explained pills were for "propolayctic" and not "As needed" use. I was oft told "Take the 4 pills aday on schedule to prevent pain not react to it" and "Dont worry this is not a stong or large dosage and when and if necessary you will be able to wean off", etc etc.
Honestly, I now take 3 - 4, am coming up on two years AND a prescription REnewal. I am feeling more physically functional, though now I am having back problems, bulges, probably from favoring leg so long and age in general.
I am very confused, a little afraid and tired of the medical opinions of friends, family, other DOC etc. that 2 years of 10/5 is not the standard of care? Yet, I know my PRM/Pain is a very qualified, experienced and well respected Practioner, Med School Professor, etc.
I am very sorry for long summary, I am looking for as many opinions as I can get. I have been very impressed with knowledge of people on this site. I want to be prepared to wean, detox, if necessary. I now have heard too many stories of patients left out to dry by DOCs even though they did everything they were told to! I do not and cannot (due to my job as a criminal investigator) be labled a "addict" someday. I understand the difference between "dependence/tolerance" and "abuse/addiction",. unfortuntely (in my state as many others), the media, law enforcement and even the medical establishment appear to be no longer drawing a distinction between the two. I live alone, kids are grown, a long way from family, am not in a relationship and am facing this alone!
Thanks in advance for your ideas, imput, stories, recommedations, etc