Did I set myself up for a false negative?

[Chronic_worrier]

For more than two years I have been on oxycodone and fentany for Chronic Regional Pain Syndrome in my foot/anklel.  My doctors insisted I needn't drug testing because of my age of 61.  Recently they joined a medical conglomerate.  Three days ago, I stopped taking the oxycodone, which I periodically do for severe constipation and drank 1/2 gallon of prune juice and bottles of water to help relieve my intestines. Today I went to pick up new prescriptions for next month and was informed it is now standard to do random testing, which they made me sign a paper and took a urine specimen today.  My question is: am I going to show a false negative?  I'm terrified this will be misinterpreted.

[Tuckamore]

Thanks for your input. It's appreciated.

PEG  or "Polyethylene Glycol" may be better known to our members by it's brand names, Miralax and Glycolax. It is effective for some ppl - and as you said, it's safe.

SIDE EFFECTS: Side effects of polyethylene glycol are diarrhea, nausea, stomach cramps, and flatulence. Patients with have kidney disease should consult with their doctor before using this product.

It's also important to drink plenty of fluid - but that's true in any good bowel regime.

~Tuck

[Durzo]

Hi Chronic_worrier,

I just wanted to offer one quick bit of advice that's been incredibly helpful to me, and I hope any/all chronic pain sufferers will become aware of this too.
I was a little unclear as to weather you're now taking *any* opioid analgesics now (honestly I'm incredibly exhausted and may have just missed it), but this will be VERY good to know down the line if/when you go back on them.

Constipation with opioid analgesics can be not just awful, but EPIC. Stimulant laxatives - as I know you're aware - have limited-effectiveness and you build up a tolerance to them; eventually killing your own body's ability to move things along itself. As I only just found out a few months ago myself, there's a VASTLY-superior alternative.

PEG - or "Polyethylene Glycol". You can buy it right off the store shelves in powder form and just stir it into any kind of drink; it's basically tasteless. It's both a mild-laxative and a stool-softener, yet more effective than other drugs from either class.
Unlike all the other conventional types, it's not actually a drug that acts on any receptors. There's no development of tolerance, and it doesn't give you extreme diarrhoea if you take too much. It just absorbs into the stool inside your intestines and makes it soft, moves it alone, and mildly-stimulates the bowels. You can take anything else with it if you like, but personally I just 100% stick to it.

When I speak of this, by the way, I'm talking from a perspective of someone who's suffered the most severe constipation in the world. I tried EVERYTHING else to no avail. I only discovered PEG upon doing research after one incredibly-horrible night where it literally took me 7 HOURS of agonizing hell trying to pass it. Ever since PEG, I've had no more troubles.

[Tuckamore]

Thanks for the update. It's truly appreciated when members keep in touch and remain active. :0)

I'm so sorry to read about what has happened to you since your Physician has passed. I am some what is your shoes. My Physician left her practice after 11 year of treating me. She was a God sent - literally saved my life. Now I'm left with Physicians that don't know or trust me. I have horrid pain too. I've consulted three PMPs. Currently with a so-so one that I am working hard to build a trusting relationship. He has a heart, I've seen it. He's also intelligent - so I'm staying with him.

I encourage you to search for another physician - actually two. You need and deserve compassion and caring PCP and PMP. I have to believe that they still exist.

You deserve so much better. Life is short - and grandchildren are a gift and reward for being a good mother.  You should be able to enjoy your time with them and not suffer in pain for days following their visit with you.

Be assertive my dear. That has always been true that we must be assertive in our medical care - now especially so in today's opiate-phobic climate. So begin your search and please let us know how you are doing.

Warm Wishes,
~Tuck  

[Chronic_worrier]

Tuck, I'm certain I was a more than a bit scattered through my first writings.  Yes, the nurse did reassure *before* results were known.  I have my results via the medical conglomerate I use(d); I see my results before the doctor.  I came to this doctor, not of my choosing.  My original doctor of twenty-five years died and I was handed off to this one.  She initially said she'd maintain treatment, but at the same time let me know that she wasn't happy dirtying her hands with pain meds.  Was this her chance to get me out of her hair?  I have no answer.  My pain is rough.  I had the two youngest grandkids for twenty-four hours and it took its toll.  

[Chronic_worrier]

Thanks, Sherry.  I received a letter ten days after posting my original question.  I offered to take them in and was informed I'd be contacted after they conferred.  I don't want a doctor like this.  I inherited this doctor when mine, of twenty-five years, died.  She told me she would continue to treat me, but she made it known to me many times she doesn't want anything to do with pain medicine; this may have been her way out; I'm not sure.  I'm not missing the medicine as much as I am minding the pain.  

[Tuckamore]

I'm also wondering how your pain is these days?

I saw your question, "....Who would take me?"  I think this thread is missing what was said to you about terminating your PM? I thought the nurse had reassured you. So I'm missing something. Sorry.

Certainly a PMP would see that you are not a 20 year old that has 60 or more years to worry about how opiate therapy will be managed. You are a mature person that has a very real reason for pain - that requires and deserves compassion and proper pain management. At least that's my take on things.

I'd like to believe that there are still medical providers that care about ppl - and their quality of life.

I'd request a copy of your medical records, all of them. Read what your practitioner has to say about your UDS (Urinary Drug Screen) and compliance. You'll be armed with information. I'd then begin the search for a PMP. Don't limit yourself to the immediate area. I drive 45-50 mins to my PMP. I would drive further if I necessary.

I'll look forward to hearing more from you.

~Tuck

[philnoir]

How's the pain?

[namnam46]

I'm glad you were able to come off your meds with relative ease, but I'm sorry you had to go thru all of this in the first place.  

I looked back thru your post and didn't see where your Dr. terminated you.  Did they call you or send you a letter?   I feel so sad that they did this to you.  As the others have said, this is becoming more and more the norm when it comes to pain management here in the United States.  :(    

Did you ever try to take your meds in so they could see that you still had all that you were supposed to have?   When you asked about it what did your Dr. say?  

The only thing I know that you can do is to call around all the different PM (Pain Management) Doctor's offices and ask for an appointment.   PLEASE let us know how you are doing and how you do finding a new Dr.  

I'm thinking of you and will be looking for your updates!    ............     Sherry   :)

[Chronic_worrier]

Thank you for the advice.  I've successfully gotten off fentanyl patches with barely a ripple.  I've had no oxycodone for a few weeks and I'm being medically reduced from Xanax.  As time goes on, I'm feeling more pain than I remember before meds.  I don't know how to go about getting another doctor since I've been terminated.  Who would take me?

[luvdolphins58]

Hi there. I too want to welcome you to an awesome forum. All here is very compassionate and understanding.  What I use for constipated is acidophilus chewable and magnesium nightly only brand I buy is nature bounty. I have tried all expensive health food store stuff. This is best I have found that works for me.

[Chronic_worrier]

Thanks for the information and the smile.

[philnoir]

Dear Chronic,

CRPS is a nasty condition with which to go through life. I can empathize with your troubles.

Today's pain management world is difficult to negotiate, even for people like us -- experienced in living with the pain and difficulties of pain treatment.

That world has become increasingly harsher to people who benefit from chronic opioid therapy since the Center for Disease Control (CDC) first released alarming statistics on opioid-related mortality in 2008. Those figures show that opioid related mortality has risen by 400% in the ten-year period of 1999 - 2008.

All kinds of medical reports by addictionologists have claimed increases in opiate abuse and addiction during this period.

And to add insult to injury, some now claim that opioid-based pain medication is not an effective treatment for chronic pain, and may actually increase the experience of pain in some -- a condition called opioid-induced hyperalgesia (OIH).

These mortality figures climb proportionally with the rise in opioid prescriptions written during this period, which is known as the "decade of pain," signifying an enlightened stance by the medical community to relieve pain and suffering.

Many medical professionals believe these numbers, and because it is difficult to prove a negative, especially when that negative is sensationalized by the news media, and self-interested news makers.

As a result, we have today's "chilling effect" on a physician's tendency to treat pain with the most effective medication in our arsenal -- opioid analgesics.

I won't launch into a discussion of why the CDC mortality data bears reexamination because it may very well be hugely inaccurate, or how the field of addiction medicine is in no way qualified to provide an unbiased judgment of the rise or fall in the people who suffer from opioid addiction, or even why the data on OIH is inappropriate for measuring the effect of opioids on people with chronic pain and long-standing opioid tolerance.

The facts are there for those who wish to read them -- all available on the internet, without once having to resort to WebMD or Dr. Phil.

Instead, I'm going to refer you back to our friends here who have shown you compassionate and experienced support, while I remind you of one of my favorite songs... it goes like this:


"Here's a little song I wrote
You might want to sing it note for note
Don't worry, be happy
In every life we have some trouble
When you worry you make it double
Don't worry, be happy
Don't worry, be happy now....


Now there, is this song I wrote
I hope you learned it note for note
Like good little children
Don't worry, be happy
Listen to what I say
In your life expect some trouble
When you worry you make it double
Don't worry, be happy, be happy now"

-- The wit and wisdom of Bobby McFerrin

[Tuckamore]

I read all your responses. I am so sorry for the death in your family. I've lost so many close relative, friends including my dad in mom in the last few years, my heart goes out to you!

I'm so glad the nurse was kind and understanding. It sounds like you won't have an issue.

Most of us worry every time we have an appointment with our prescribing physician. It doesn't matter that we know we have done nothing wrong - it's the fact that the climate has changed (for the worse) in PM. We're never certain what might come up; will the doctor leave the practice, will our drug screen return correct, etc? Some times I make myself physically sick with worry. Most of us get it - and I'm sorry I didn't take more time to explain that fact.

My former PMP,'s NP (female) brought up the subject of constipation with me. She was so kind and suggested several things. I was fortunate that one worked and continues to be effective. I hope you'll find a better way of handling constipation. You must be miserable during those times.

[Chronic_worrier]

You're very understanding about pain and worrying.  My life has changed since this injury.  I have to think every event through to evaluate if I can manage it.  It's embarrassing to have to pick up the prescriptions each month, embarrassing to go to the pharmacy, and so on.  I'm so private that only the doctor's office, the pharmacy, and my husband knows I am on medicine.  Thank you for your concern.

[Chronic_worrier]

No, I've never discussed the constipation issue with the doctor.  I'm a rather private person and this issue is an embarrassment for me; it was even hard for me to post my problem.  The doctor wasn't in yesterday, but I talked to a nurse I trust and explained everything to her.  She told me not to worry.  Now, we've had a death in the family yesterday and I will be with them every minute through Thursday.  I can go there after the wake to show I have the correct amount and be retested if needed.  Thank you for your time.

[Chronic_worrier]

No, I hadn't signed a contract all this time.  I got the results for the fentanyl (yes, patches) via email yesterday and that was fine, although low because I was on day 3.  Why I didn't get a full report, I do not know.  I had become addicted to stimulant laxatives and needed to change that aspect.  Stool softeners simply do not work in my system, nor does one glass of prune juice a day.  Yes, the 1/2 gallon of juice is miserable, but so are my alternatives.  I've tried every method I could think of over these couple years.  Thank you for your reply.

[remar]

You received very good advice from the above members. That's a great idea about going right to your Dr with your pill bottle so they can do a count.
Another thing that works well for the constipation is aloe vera juice. You can buy it almost any where.
Please keep us up to date on how things turned out with your Dr. I'm sorry that you have to worry. Most of us chronic pain patients worry so much and that's not good for our mental or physical health.

[Weathergirl21]

Did you let the nurse/Dr. know about you stopping the Oxycodone? If this is something you do on a regular basis then I would think you have discussed this with your Dr. The other thing is did you bring in your bottle of medication to show the extra that you have since you didn't take them those days? If not, your best bet is to drive to the Dr. on Monday and let them know immediately have them do a quick count to show that you are not selling your medications as that is what the conclusion can be if there is nothing in your system.

As Tuck mentioned, the best thing you can do is to speak with your Dr. about the constipation issue. I take Miralax a few times a week and is fantastic as it works with the water you drink daily to keep things from getting too hard. With any daily medications and especially opiates, we must drink a LOT of water daily. I drink 12-14 glasses daily just to stay hydrated.

The other thing that may happen is that if you can go days without pain meds each month then the Dr. may lower your quantity because you are not "needing" them for pain those days.....If you truly can get by with less pain meds then this is the best way to go...They should only be taken after every other method of pain control has been tried.

To sum up, I would speak to your Dr. Monday to clear this up immediately and as mentioned, the easiest way to prove that you didn't sell any meds to them is to show them the pills you have left.

Good luck!

[Tuckamore]

Hello and Welcomes to our Pain Management Community. I'm glad you found us and took the time to post.

Oh dear, I'm afraid you may be in for some explaining at best. Had you not signed a pain contract prior to yesterday? If not it may not be as bad as you anticipate.

Unfortunately many small Clinics are being gobbled up by conglomerates which insist on tightening the rules and have stricter guidelines. This war against Chronic Pain patients has extended into even the tiny bergs. None of us want opiates in our children's hands or the hands of addicts or those that divert them - but sadly we suffer.    

Three days without an opiate would be more than difficult for most of us. However I assume that when you say Fentanyl you mean the Fentanyl Patch. Your Drug Screen will reveal that the Patch was in place. I assume the oxycodone is PRN? After three days without Oxycodone in your system I doubt there will be any significant residual to show on the Drug Screen.  

You should be taking a daily stool softener or something similar like a bulking agent to avoid the kind of constipation you describe. Be sure and discuss this with your Physician. The two of you can determine what will work best. There are much better ways to manage constipation than going without an opiate for three days and drinking a half gallon of prune juice. That doesn't sound like much fun!  Your pharmacist can also offer several suggestions.

Please let us know how this turns out for you. I'll be very interested in your updates. Feel free to add additional comments or respond to other post. We welcome you into our community.

Peace,
~Tuck