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Insufficient medication

Discussion in 'Knee Replacement Recovery Area' started by Enna, Feb 25, 2011.

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  1. Enna

    Enna Junior Member

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    Hi everyone! I am very grateful to have discovered this invaluable forum and SO appreciate the useful information and caring advice given here.

    My question is an old one but I need advice on how to handle it. I am three weeks three days out of surgery and mostly doing very well. I do have a suture abcess but it is slowly responding to antibiotics.


    My issue is PAIN MANAGEMENT.

    My GP has me on 2 tablets of 30mg codeine plus 500mg paracetamol (Panadeine Forte) four times a day (i.e. six hourly). (The reason for 6 hourly dosage is due to the maximum allowed paracetamol = 4000mgs a day)

    It is simply NOT enough!

    I cannot manage the last couple of hours without feeling a great deal of pain.

    I was discharged with Endone (Oxycodone hydrochloride) but have limited my usage for this to a pill prior to physical therapy. I have also taken a pill a couple of times when the pain was excessive.

    I cannot get my GP to renew my Endone prescription, presumably because of the "addiction fear".

    Ideally I think I could manage if I could have one (or possibly two) Endone a day instead of Panadeine Forte - as this would allow me to take the Panadeine Forte four hourly. And the Endone could be taken prior to PT.

    Currently I am having difficulty with PT because the additional pain is very restrictive on movement.

    However, I am VERY open to ANY suggestions on ways to get around this pain meds issue PLUS any advice on convincing the GP I really NEED the higher dosage at present.

    Thank you in anticipation of your responses.
     
  2. referee54

    referee54 Moderator

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    Welcome to the forum! I am sorry to hear about your troubles with managing your pain. Staying pain-free during recovery rehab is of tremendous importance. I will tag this for three of our most knowledgeable people, Josephine, Jaycey, and Jamie: they will be able to help you out and give you advice.

    I have a difficult time understanding why somebody would be worried about addiction--i was, initially, but my ortho was not---he said that "You will know when it is time to stop taking the meds." Have you given any thought to a pain management clinic? What does your ortho say about this?

    Please keep us posted as to how you are doing and how you are progressing---this is a great forum to have questions answered or just to vent or to rant!
     
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    • Josephine

      Josephine NURSE DIRECTOR, BONESMART Administrator

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      Hi Enna. Well, it shows how ignorant GPs can be of the need for adequate pain management in knee replacement. And this is the time when you need it most! I cannot for the life of me think your doctor is in the addiction fear because no-one would be at risk in only a few weeks. In fact, no-one is really at risk anyway as data has shown there to be no risk when there is genuine pain to require the pain pills.

      I would suggest you go back to your GP and ask him if he can't suggest an alternative to what he is giving you. I know codeine was insufficient for me when I had mine done and the nurses in the hospital changed me over to Tramadol (also with the paracetamol) which was perfect. My prescription was 100mg Tram with 1,000mg paracetamol 4 times a day but I was allowed to take 150 of Tram when the pain got really bad which I took advantage of quite often! I also took this combo for three full months.
       
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      • darncat

        darncat Junior Member

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        Enna, oh my goodness...I'm in my third week of recoup and am going through just what you're going through. Read the other pain management threads, and remember that your doc is responsible for keeping you pain-free. Funny, but all the UK people seem to get Oxycontin and here in the US docs don't want to prescribe squat. My OS started to try to wean me off of pain meds the MORNING after my surgery!:rolf:
        I'm in the medical field, and from what I've heard is that surgeons are just that, surgeons. I felt like just a # at their office, especially when I ran out of meds last weekend...

        Get yourself a trusted primary care physician, or go to a pain specialist. I went to my PCP of 20+ years today, who has been through MANY surgeries with me...she gave me a BIG hug, an RX for MORE than 2 1/2 days, and I have another appt. in 2 weeks...
        NO reason for all of us to have to be in pain and be counting pills!!
         
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        • carousel66

          carousel66 Graduate

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          I have had a overally GOOD experience w/ pain meds and management
          OTHER than them not listening to me in the Hospital that I can NOT tollerate morophine.... once that was corrected I was on the right track. My OS was very much on my side for pain management, it was about 1/2 the nurses at the hosptial that seemed not to "get it" and seemed to delay my meds on purpose. I was quickly on Oxycontin 12 hour 20mg cr (controlled released) and oxycodone 5mg then Vocodin 5/500 for break through pain. At each of my appts w/ my OS I was asked how I was on pain meds. My OS wants me to be active and work hard on PT and knows pain meds are part of this.
          since about 2 weeks post op, I stopped taking the oxycontin during the day but continued to take the Oxycontin at night and the vocodin during the day. A few days a week extra vicodin at night.
          (I have also on anti inflams - naproxen, and I'm on asprin routine to help prevent blood clots)
           
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          • Jamie

            Jamie Administrator

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            Hi, Enna....welcome to BoneSmart! I'm glad you found our forum. You are definitely in need of help! Proper pain management, especially in these early weeks, is soooo critical.

            You need to be assertive with either your GP or your surgeon (whichever you think will work best) and tell them the pain meds you have been prescribed are NOT CUTTING IT!!! Be firm....some of these folks have the "addiction fear" and they don't want to prescribe adequate amounts to get you thorough the roughest recovery in all surgery-dom. Knee replacements can be really tough!

            Don't feel guilty or that you are being a wimp. You NEED meds to help you through recovery. If neither of these options works...do you have access to pain management clinics in Australia? That can be a third option if available.
             
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            • Gardengirl

              Gardengirl Member

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              Welcome Enna, You sound just like me in reference to the med mgmt. I'm on Oxycodone 5mg up to 6 a day but they prefer I take less. I don't even have to look at my watch to know when it's been 3.5 hours, that last 30 minutes can turn me into a not so happy camper. I just kept calling them & saying, please, I can't go six hours, ever.

              Your knee probably stiffens up & feels like a big old chunk of wood I'd guess. My other way of describing the pain to them was like someone wrapping a roll of duct tape around my knee to tight. They finally got it, they need our help to understand.

              Good luck with expressing ourself & I hope painfree days are around the corner for you!:THUMB:
               
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              • parla

                parla Member

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                I agree with everyone, your request for adequate pain control is 100% appropriate. With the residue pain from a big surgery and with physical therapy you need your pain controlled to help you progress. I had problems getting pain meds from my OS after about 6 weeks, he said Aleve should be ok. But it was not ok. I went to my pc and he gave me vicodan 500, which I can break in half also or sometimes I need to take 2. Just depends on the day my knee is having. They made me feel like what we used to call "drug seeking behavior" but it was for real pain and I was in agony at times ... Just be assertive. I wish you the best Ennna, and let us know what happens.
                Parla
                 
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                • Jaycey

                  Jaycey Moderator

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                  Hi Enna, glad you joined us here! I do hope you take the good advice you have already received and go back to your GP. You will simply not progress without proper pain management. I know it's sometimes hard to be assertive but I hope you can be firm and get what you need.

                  Please let us know how you get on. All the best!
                   
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                  • PhoenixS

                    PhoenixS Post-Grad

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                    This is so interesting in that I had the same problem with my OS, and then the Pain Mgmt Doc (who works for my now EX-OS). It was my GP who came to my salvation!!
                    As long as you take the meds for pain, you simply will NOT become addicted.
                    I still have a supply of oxycodone and I make use of it after over-doing it at the gym, standing all day, or a day of ice climbing.
                    When my leg doesn't hurt, I don't use it.
                    Find someone who will attend to YOUR needs.
                    Sandy
                     
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                    • Enna

                      Enna Junior Member

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                      Thank you so much to all of you for your responses. Armed with your excellent advice, I have finally managed to get the pain relief I need. I have now been prescribed 2 of Oxycontin (controlled release) per day - 12 hourly. Each tablet is 15mg.

                      I also have a script fpr Endone (oxycodone hydrochloride) 5mg. tablets for break through pain (p.r.n.).

                      Today is the first day since post hospital that I have felt my pain is managed and I can tolerate it, rather than just survive it!! I told my partner today that I am no longer in pain, just in discomfort - since starting the higher level meds.

                      My problem is that I live in a rural town where doctors are scarce. A number of doctors in the practice I attend are overseas trained doctors who are undergoing their Australian certification. These doctors are very concerned that they do NOTHING to draw the attention (unfavourably) of Medicare (our Australian medical system). I think it is this that has caused them to be over cautious - I understand their position and sympathise, but it hasn't been helpful for me.

                      By the time I saw the (fourth!) doctor, I was quite emotional due to the pain. I told him I resented being forced to "beg" for appropriate pain management. He was quite condescending but he DID prescribe the meds, so I am now in a much better place!

                      I feel so much less isolated because I can "talk" to others here who know what I'm going through. My sincerest thanks to all of you for your support and advice.
                       
                    • referee54

                      referee54 Moderator

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                      That certainly is great news! Having the proper pain meds helps to ensure that you recover in the best possible state of mind. I am also sorry to hear about the attitude of the doctor himself.

                      We will be here for you--this forum was a great, big help to me and many others, and Jo, Jamie, and Jaycey are wonderful with their wisdom. Please keep in touch and let us know how things are going.

                      Hang in there!
                       
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                      • Gardengirl

                        Gardengirl Member

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                        Enna, I'm sooo happy for you. Way to articulate your needs & feel better because now your on the road to recovery. I can see why it was so difficult to get your doctors to hear you because of certification.
                        Yeah ENNA!:yahoo:
                         
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                        • Kneesup

                          Kneesup Junior Member

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                          Hi, reading this thread with great interest as Im only 19 days in after op and I'm on oxycontin. I happen to be a recovering alcoholic ( not drunk now for 10 years ) and I'M the one worried about addiction not my
                          GP. I cannot wait to get off this drug, I don't like how it makes me feel and its addictive reputation. It is defo making me very emotional. Having said that, its catch 22 because I simply need the pain relief and cannot manage without. I'm just wary of it though and will be very glad to step it down. Glad to hear you are in less discomfort now.
                           
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                          • Jaycey

                            Jaycey Moderator

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                            Well done Enna, so glad you are back on the right track now. Full speed ahead as they say!

                            Kneesup - I know you are worried but as long as you are taking your meds for their specific purpose you are not addicted. You are right on - you need pain control now. It is literally the only way you will get mobile and be able to get on with your life.

                            Please don't worry yourself now!
                             
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                            • PhoenixS

                              PhoenixS Post-Grad

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                              Enna:
                              I am very happy you are finally comfortable.
                              It is too bad that the Docs are more concerned with their status than your pain, but I guess they must have good reason. Who knows what pressures are on them from the government.

                              Kneesup:
                              Congratulations on your sobriety. I understand your concerns, but pain relief is absolutely necessary for recovery to occur. You say you don't like how they make you feel. Does it remind you of the way you felt with alcohol, or does it make you feel poorly?
                              Yes, these drugs are addicting and you must stay on top of your use of them,because you are at higher risk, however, you seem to have a good handle on it, and I doubt you will become dependant.
                              As all those above said, if you take these meds for REAL PAIN, you will wean off naturally as your need for them decreases.
                              Best to both of you.
                              Sandy
                               
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                              • Kneesup

                                Kneesup Junior Member

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                                thankyou for your kind words of support. I am taking these for my recovery, and yes they do make me feel a bit like I did when drinking all thoses years ago. My GP is fully aware of my situation though and we are watching my reacation to the medication carefully. I know I couldn't manage without them at the moment.
                                 
                              • Josephine

                                Josephine NURSE DIRECTOR, BONESMART Administrator

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                                Kneesup, I left links to some threads in your other thread. One of them is regarding pain meds. Your history notwithstanding, it will still apply to you.
                                 
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                                • Jamie

                                  Jamie Administrator

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                                  Enna, I'm so glad you have some relief now. I hope you are able to continue to obtain the medication as long as you need it. You may have to continue to be assertive to make that happen, but don't hesitate to do that! Your well-being is at stake!!!
                                   
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                                  • Enna

                                    Enna Junior Member

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                                    I have made the mistake of overdoing things because my pain level was so much better! Just goes to show how easy it is to underestimate the effect of pain on recovery! I hope I've now learnt my lesson and will be more moderate in the future!

                                    I am so very grateful to all of you for your warmth, advice and encouragement. THANK YOU!!
                                     
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