Aa
Please help!
My husband has necrosis of the bone, the marrow dies and then the joint. Consequently, he has three prosthetics and his cervical spine is fused. He has not turned his head in over 6 years. He was prescribed Fentanyl Patches 75 mcg / 72 hours. He has been using the patch for over 6 years, faithfully. He does not abuse drugs, does not drink, the patch simply works at controlling the pain. The Doctor quit prescribing all schedule II drugs and getting another doctor to take over medication management has been a nightmare. Today is the first day. He does not have a new patch to put on and we are very concerned about what is goin to happen. I personally feel that it is irresponsible for the Dr. to not help - we were told that if he "gets sick" he should go to the ER. Not only will he experience the severe pain (condition related) but he will endure ???? withdrawl symptoms. I feel that it is not medically safe for him to do this cold turkey after 6+ years. Please advise.
Just wanted to touch base and see how things are...I've been thinking about how you all are doing, and hope you were able to get some medical help. If you have time, give us a quick update. I hope everything is ok:)
Love, Alison
Love, Alison
Jaybay, the ERs in my state do prescribe Class II narcotics. Maybe it's different state by state. I have never heard that they absolutely do not prescribe them. Where did you read that? Just curious.
Thanks,
Flower
Thanks,
Flower
Lord have mercy. I completely agree with everything Alison said. Your husband's withdrawal is going to be severe so get ready for the ER trip. Bring in all medication bottles including non-narcotic meds. If you still have the fentanyl box with the doctor's prescribing information, bring that too. It will help establish your husband as a legitimate pain patient.
ERs do not prescribe schedule II narcotics. Period. I can tell you with certainty that your husband is going to need medical help when the withdrawal really gets rolling. Vomiting and/or diarrhea will likely be a big part of it, and dehydration is a definite worry. Get some immodium if you don't already have it in the house. Muscle spasms similar to Restless Leg Syndrome are a huge complaint with withdrawal, as is the related insomnia. Soaking in a hot bath temporarily helps with the RLS-like symptoms. And yes, seizures have been reported with fentanyl withdrawal.
Definitely ask for detox assistance when you go to the ER. Unfortunately, your husband's pain will probably not be addressed there so don't get your hopes up. Clonidine is an old blood pressure medication that helps withdrawal symptoms. If nothing else, they might prescribe that for him. It's off-label usage, so it would probably have to be a detox doc who prescribes it.
You are both in my prayers. This is one reason I hate being dependent on opiate therapy. There are too many things outside our control that can interrupt it and this is what happens. Please post back and let us know how he's doing.
ERs do not prescribe schedule II narcotics. Period. I can tell you with certainty that your husband is going to need medical help when the withdrawal really gets rolling. Vomiting and/or diarrhea will likely be a big part of it, and dehydration is a definite worry. Get some immodium if you don't already have it in the house. Muscle spasms similar to Restless Leg Syndrome are a huge complaint with withdrawal, as is the related insomnia. Soaking in a hot bath temporarily helps with the RLS-like symptoms. And yes, seizures have been reported with fentanyl withdrawal.
Definitely ask for detox assistance when you go to the ER. Unfortunately, your husband's pain will probably not be addressed there so don't get your hopes up. Clonidine is an old blood pressure medication that helps withdrawal symptoms. If nothing else, they might prescribe that for him. It's off-label usage, so it would probably have to be a detox doc who prescribes it.
You are both in my prayers. This is one reason I hate being dependent on opiate therapy. There are too many things outside our control that can interrupt it and this is what happens. Please post back and let us know how he's doing.
Fentanyl is a VERY strong drug to come off of all at once....I would just plan to go to the ER...so that he can at least get some help detoxing off of it. Best case scenario would be that he could get a prescription or find another doctor right away, but if this does not happen, and he is wearing his LAST patch...and starting withdrawals....he NEEDS to be in a medically supervised setting. They can at the very least, give him fluids, and meds for his blood pressure, and something to help relax him....HOPEFULLY.
I know that my local hospitals have a department where you can go for help with detoxing...so if they refuse to give him pain meds at the ER, then ask for help with detox...I know he'll be in extreme pain...but I'm very worried about the withdrawals. If he can be safely detoxed until you find a good doctor for him, that may be the only answer....IF he runs out of meds completely. PLEASE do not do the detox at home....go to the ER....they can be very compassionate sometimes. If they refuse pain meds...ask for help with detox.
I hope I've made sense...I'll definitely be thinking of the 2 of you...and your family.
Love, Alison
I know that my local hospitals have a department where you can go for help with detoxing...so if they refuse to give him pain meds at the ER, then ask for help with detox...I know he'll be in extreme pain...but I'm very worried about the withdrawals. If he can be safely detoxed until you find a good doctor for him, that may be the only answer....IF he runs out of meds completely. PLEASE do not do the detox at home....go to the ER....they can be very compassionate sometimes. If they refuse pain meds...ask for help with detox.
I hope I've made sense...I'll definitely be thinking of the 2 of you...and your family.
Love, Alison
Wow. I would start at this point (if withdrawals are awful) by going to the emergency room because that is a large amount of medication to stop taking all at once. Even though I can't stand emergency rooms, it seems that it may be your only choice.
I would then try to find another pain management doctor. Will your PCP be willing to refer you to another one? I would think so, since the other one is not even returning your calls! Wow. You should not have been be treated that way.
I would try to find a physiatrist (PM&R) or an anesthesiologist. It's great that your husband is willing to try other treatments, but there are many Pain Management practices that don't prescribe narcotics at all and only do injections and similar procedures. I went to a PM doctor at a MAJOR hospital and found out when I met with the doctor that he would only give me epidural shots. If you have someone (a friend, a nurse) to ask, that would be great. If not, maybe you can call ahead to ask what types of medical treatments they give to treat chronic pain patients with your husband's disorder.
I'm so sorry that he is going through this. Many people have a lot of difficulty finding a doctor to treat their pain. I agree with RunningMom. It is very important to be careful with what you say because things can go into your chart...words can be twisted and inferences can be made. It's unfortunate, but true.
I found my doctor through a friend in the medical field. I think that (if possible), word of mouth is the way to go.
Also, the doctor should have never talked to you that way! You and your husband deserve to be treated with respect. I wouldn't go back to him!
Flower
I would then try to find another pain management doctor. Will your PCP be willing to refer you to another one? I would think so, since the other one is not even returning your calls! Wow. You should not have been be treated that way.
I would try to find a physiatrist (PM&R) or an anesthesiologist. It's great that your husband is willing to try other treatments, but there are many Pain Management practices that don't prescribe narcotics at all and only do injections and similar procedures. I went to a PM doctor at a MAJOR hospital and found out when I met with the doctor that he would only give me epidural shots. If you have someone (a friend, a nurse) to ask, that would be great. If not, maybe you can call ahead to ask what types of medical treatments they give to treat chronic pain patients with your husband's disorder.
I'm so sorry that he is going through this. Many people have a lot of difficulty finding a doctor to treat their pain. I agree with RunningMom. It is very important to be careful with what you say because things can go into your chart...words can be twisted and inferences can be made. It's unfortunate, but true.
I found my doctor through a friend in the medical field. I think that (if possible), word of mouth is the way to go.
Also, the doctor should have never talked to you that way! You and your husband deserve to be treated with respect. I wouldn't go back to him!
Flower
I would also explain to the next doctor you both see, that although his previous doctor gave him 2 months and a referral list, his previous doctor did not, but should have identified which of those doctors on the list prescribes medication. Now you have wasted your 2 months trying to get in to see 2 doctors who do not!
But, just as runningmon said in her post, I have also had to have multiple injections. Even after many, many with my last doctor, I kept saying 'ok' until he said we were done. I have also been told I have to medication that I know has never worked for me. If I had tried some medication 2 years ago and it did not work, I have to try it again... It really is unfair.
Gosh, I will be thinking of you both... please let us know how he is doing -maybe you sould go to the ER or the urgent care center if he gets too sick. I am the type of person who avoids those places like the plague - but it might just be necessary for him.
One last note, I think I would begin asking around - do you know ANYONE who is in pain managment? See if you can find the name of a compassionate pain doctor who is not adverse to prescribing meds- and then go there...
If the doctor you are calling everyday has not responded to you by now, he is really not going to be a good fit for you both. Staying with him right now is going to prolong him getting relief.
Who is your husbands ORIGINAL doctor? you mentioned that this doctor was on the list but that he had been the one who had referred your husband to the PCP (who is no longer prescribing meds)... Is he a PCP, too? or a specialist? or a pain doctor?
You know, as I write this - is it possible that none of the doctors on the list are pain management doctors?
I will be thinking and praying for your husband - and feel free to vent.. we all do!
But, just as runningmon said in her post, I have also had to have multiple injections. Even after many, many with my last doctor, I kept saying 'ok' until he said we were done. I have also been told I have to medication that I know has never worked for me. If I had tried some medication 2 years ago and it did not work, I have to try it again... It really is unfair.
Gosh, I will be thinking of you both... please let us know how he is doing -maybe you sould go to the ER or the urgent care center if he gets too sick. I am the type of person who avoids those places like the plague - but it might just be necessary for him.
One last note, I think I would begin asking around - do you know ANYONE who is in pain managment? See if you can find the name of a compassionate pain doctor who is not adverse to prescribing meds- and then go there...
If the doctor you are calling everyday has not responded to you by now, he is really not going to be a good fit for you both. Staying with him right now is going to prolong him getting relief.
Who is your husbands ORIGINAL doctor? you mentioned that this doctor was on the list but that he had been the one who had referred your husband to the PCP (who is no longer prescribing meds)... Is he a PCP, too? or a specialist? or a pain doctor?
You know, as I write this - is it possible that none of the doctors on the list are pain management doctors?
I will be thinking and praying for your husband - and feel free to vent.. we all do!
I'm so very sorry for your husband. I've been in his shoes and it's very frusterating and stressful. It has given me many anxiety attacks. Yes, he is going to have a very difficult time finding a good pain management clinic. I too, suffere with severe pain(neck pain).
Most pain management clinic are there to give injections. I have had 12 steroid injections in just over one year. None of them worked. In fact almost every single one has increased my pain to off the charts unbearable. I have a horrible reaction to steroids and the doctors did not listen and said I would be fine. I finally found a great pain management clinic and let them know what happened. They told me that most people do not have the reactions and that it is very uncommon. I have had to repeat every injection and some were done 3-4 times. I also have never refused an injection even though they are very risky and I knew they would not work. It's so unfair.
The pain management clinic I'm at now does not force any procedures. All I have to say is a gentle no and they leave it at that. The clinic I'm at now will take in my suggestions. I make up my treatement plan with in their rules. It's very nice and I'm very happy there. So, there are good pain management clinics. You will have to do some searching for them. You can not depend on your doctors to lead you to them.
In the mean time, you will most likely have to change PCP's too. Becareful what you say and what goes in your charts, even with the PCP. It's best to bite the bullet and be on your best behavior. It is not safe for your husband to come off of the patch cold turkey. I believe you can go into severe seziures with this one.
I do wish your husband the best of luck. I hope you find him a decent pain management clinic. They are out there, but very few. Please, vent all you want. We are here for your support.
Most pain management clinic are there to give injections. I have had 12 steroid injections in just over one year. None of them worked. In fact almost every single one has increased my pain to off the charts unbearable. I have a horrible reaction to steroids and the doctors did not listen and said I would be fine. I finally found a great pain management clinic and let them know what happened. They told me that most people do not have the reactions and that it is very uncommon. I have had to repeat every injection and some were done 3-4 times. I also have never refused an injection even though they are very risky and I knew they would not work. It's so unfair.
The pain management clinic I'm at now does not force any procedures. All I have to say is a gentle no and they leave it at that. The clinic I'm at now will take in my suggestions. I make up my treatement plan with in their rules. It's very nice and I'm very happy there. So, there are good pain management clinics. You will have to do some searching for them. You can not depend on your doctors to lead you to them.
In the mean time, you will most likely have to change PCP's too. Becareful what you say and what goes in your charts, even with the PCP. It's best to bite the bullet and be on your best behavior. It is not safe for your husband to come off of the patch cold turkey. I believe you can go into severe seziures with this one.
I do wish your husband the best of luck. I hope you find him a decent pain management clinic. They are out there, but very few. Please, vent all you want. We are here for your support.
Thank you for responding.
Our PCP told my husband 2 months ago that they were not going to do "pain management" (for anyone) anymore and gave him a referral list of providers. The original (prescribing) Dr. was on the list but the phone number was disconnected. He called another provider and it took a month for an appointment. When he went to see him, the Dr. said that he should go to back to the original Dr. since he knew his history and gave him the new number (which is not in the phone book).
My husband called and got an appointment. He went two weeks ago and I should have gone with him but we have a disabled child who had an appointment that day so he went alone. My husband is very quiet-laid back- never stands up for himself. Anyway, the Dr. told my husband that "I give shots and do therapy" ect. My husband responded- yes I know and we did all of that for several years, you even did a Rizotomy (cut the nerves to relieve pain) and then you prescribed the patch which is the only thing that worked. The Dr. said I can't do that, I want to start with injections. My husband said no, they don't work. The Dr. said then I can't help you.
When my husband came home and told me I was livid. How irresponsible and what should we do now? I phoned our PCP and told them that we needed another Rx until we could find another Dr.and explained what happened. They called back and said that the PCP gave us enough time to find a Dr. and that the Pain management Dr. informed them that "my husband refused the treatment plan"! I was dumb struck and stated that my husband would never refuse a Tx plan and that the Dr. was lying.
I phoned the the Dr. and asked to speak with him, he refused and we were told to make an appointment if we wanted to talk with him. I did and he saw us on Thursday. As soon as we got there, we were treated disrespectfully. We waited over an hour and when he finally came into the room, he was very defensive. He stated that he spoke with our PCP and did not appreciate being called a liar. That my husband did refuse the treatment plan and that he is the liar. I explained that there must have been a misunderstanding somewhere and what exactly was the Tx plan that he refused? He said my husband is not stupid and fully understood, that he was manipulating me and all he wanted was drugs! I argued that he was wrong- he looked at my husband and siad "did you refuse injections?" My husband said yes but you didn't say anything about a "treatment plan". The Dr. then said if you didn't understand that then you are not even "oriented" and I will not treat a non-responsive client.
Of course I was offended by his accusations and told him so. I told him that my husband would comply with a treatment plan and to please explain his plan to us. He replied that he likes my husband and would treat him but that he would need to start over with a complete exam and he didn't have time - to go home and discuss it - call back with our decision. We left- discussed it, and have been calling back to get an appointment. They keep telling my husband that he has to speak to the Dr.and that he is with a patient - keep trying. So here we are- no patches-no appointment- no regard for what is going to happen to my husband. We will go to the ER, but that will not solve the problem and I feel that it is unethical to put my husband through this. We really don't know what to do next.
Thanks for letting me vent-We appreciate your support.
Our PCP told my husband 2 months ago that they were not going to do "pain management" (for anyone) anymore and gave him a referral list of providers. The original (prescribing) Dr. was on the list but the phone number was disconnected. He called another provider and it took a month for an appointment. When he went to see him, the Dr. said that he should go to back to the original Dr. since he knew his history and gave him the new number (which is not in the phone book).
My husband called and got an appointment. He went two weeks ago and I should have gone with him but we have a disabled child who had an appointment that day so he went alone. My husband is very quiet-laid back- never stands up for himself. Anyway, the Dr. told my husband that "I give shots and do therapy" ect. My husband responded- yes I know and we did all of that for several years, you even did a Rizotomy (cut the nerves to relieve pain) and then you prescribed the patch which is the only thing that worked. The Dr. said I can't do that, I want to start with injections. My husband said no, they don't work. The Dr. said then I can't help you.
When my husband came home and told me I was livid. How irresponsible and what should we do now? I phoned our PCP and told them that we needed another Rx until we could find another Dr.and explained what happened. They called back and said that the PCP gave us enough time to find a Dr. and that the Pain management Dr. informed them that "my husband refused the treatment plan"! I was dumb struck and stated that my husband would never refuse a Tx plan and that the Dr. was lying.
I phoned the the Dr. and asked to speak with him, he refused and we were told to make an appointment if we wanted to talk with him. I did and he saw us on Thursday. As soon as we got there, we were treated disrespectfully. We waited over an hour and when he finally came into the room, he was very defensive. He stated that he spoke with our PCP and did not appreciate being called a liar. That my husband did refuse the treatment plan and that he is the liar. I explained that there must have been a misunderstanding somewhere and what exactly was the Tx plan that he refused? He said my husband is not stupid and fully understood, that he was manipulating me and all he wanted was drugs! I argued that he was wrong- he looked at my husband and siad "did you refuse injections?" My husband said yes but you didn't say anything about a "treatment plan". The Dr. then said if you didn't understand that then you are not even "oriented" and I will not treat a non-responsive client.
Of course I was offended by his accusations and told him so. I told him that my husband would comply with a treatment plan and to please explain his plan to us. He replied that he likes my husband and would treat him but that he would need to start over with a complete exam and he didn't have time - to go home and discuss it - call back with our decision. We left- discussed it, and have been calling back to get an appointment. They keep telling my husband that he has to speak to the Dr.and that he is with a patient - keep trying. So here we are- no patches-no appointment- no regard for what is going to happen to my husband. We will go to the ER, but that will not solve the problem and I feel that it is unethical to put my husband through this. We really don't know what to do next.
Thanks for letting me vent-We appreciate your support.
Welcome to the Pain Mangement Forum. How horrid for your husband...and you also.
Of course he will experience some serious withdrawal symptoms unless they provide him with some supportive medications. Did they give him anything? If they did may I ask what they gave him?
I totally agree that your husband should go to ER if he develops withdrawal symptoms. I am not sure how much help they will give him but be sure that you tell them exactly what happened and what your physician told you to do.
There must be some major reason that your current physician is no longer prescribing schedule II. Obviously that does not matter now however is there were issues the entire medical community is aware of it and may do more for you.
Please let us know how your husband is doing. If you can tell us what if any kind of medications your husband was prescribed if anything. We may be able to offer additional information or suggestions.
I cannot tell you how bad I feel for you and your husband. Please keep in touch and let us know how he does without the opiates.. My heart goes out to you. I will look forward to hearing from you.
Take Care,
~Tuck
Of course he will experience some serious withdrawal symptoms unless they provide him with some supportive medications. Did they give him anything? If they did may I ask what they gave him?
I totally agree that your husband should go to ER if he develops withdrawal symptoms. I am not sure how much help they will give him but be sure that you tell them exactly what happened and what your physician told you to do.
There must be some major reason that your current physician is no longer prescribing schedule II. Obviously that does not matter now however is there were issues the entire medical community is aware of it and may do more for you.
Please let us know how your husband is doing. If you can tell us what if any kind of medications your husband was prescribed if anything. We may be able to offer additional information or suggestions.
I cannot tell you how bad I feel for you and your husband. Please keep in touch and let us know how he does without the opiates.. My heart goes out to you. I will look forward to hearing from you.
Take Care,
~Tuck
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