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Message
Question for OT Docs
Posted on 2/11/15 at 10:29 am
Posted on 2/11/15 at 10:29 am
My mother is in her seventies and has a bulging disk. She sufferers from rheumatoid arthritis as well.Even though she is in tremendous pain the orthopedic doctor will not prescribe her narcotic pain medication. She was told by the nurse unless she is a candidate for surgery they will not prescribe. She may or may not be a candidate for surgery depending on how the next set of procedures go but not prescribing her pain medication seems really odd.
I was diagnosed with Degenerative Disk Disease last year and have painful flair ups a couple times per year. I've never had a problem getting a small prescription of hydrocodone when I was in pain.A bulging disc certainly seems to be something that would qualify as needing more than ibuprofen to help manage the pain. Has the rescheduling of drugs like hydrocodone caused doctors to not be able to prescribe these drugs as easily anymore?
I was diagnosed with Degenerative Disk Disease last year and have painful flair ups a couple times per year. I've never had a problem getting a small prescription of hydrocodone when I was in pain.A bulging disc certainly seems to be something that would qualify as needing more than ibuprofen to help manage the pain. Has the rescheduling of drugs like hydrocodone caused doctors to not be able to prescribe these drugs as easily anymore?
9
Posted on 2/11/15 at 10:32 am to ThuperThumpin
quote:
and has a bulging disk
as does about 60% of the population, so the diagnosis alone does not say much
has she thought about asking for a referral to pain management?
Posted on 2/11/15 at 10:32 am to ThuperThumpin
she can go see a pain management doc
surgeons will only prescribes those meds for their post-op patients.
surgeons will only prescribes those meds for their post-op patients.
Posted on 2/11/15 at 10:35 am to ThuperThumpin
quote:
bulging disc
almost every human above 40 has multiple of these, so this in itself really doesnt mean much
even if she has real symptoms that are specifically attributable to a disc herniation, opiates are not a viable long term solution and will just lead to tolerance and bigger problems down the road
Posted on 2/11/15 at 10:41 am to Tigerpaw123
quote:
has she thought about asking for a referral to pain management?
They are going to give her an epidural steroid injection and see if that works. We will inquire about the pain management referral if epidural injection does not work. I just hate to see her like this while she waits to get the procedure.
Posted on 2/11/15 at 10:47 am to TigerRad
quote:
even if she has real symptoms
She was embarrassed to mention this but she has been having bladder control issues as well. Can disc herniation cause this?
Posted on 2/11/15 at 10:55 am to ThuperThumpin
quote:
Can disc herniation cause this?
its possible....she needs an MRI for sure if she hasnt had one recently
Posted on 2/11/15 at 11:21 am to TigerRad
Get the epidural...The swelling is the problem, and causing the pain. Narcotics, just make you ignore the pain signal, and don't really help the problem, just the coping...Not saying it won't give her relief, but sometimes it isn't the ideal option, and has increased side effects/reduced pain threshold.
Posted on 2/11/15 at 11:32 am to ThuperThumpin
Same thing happened to my mom. She had shots in her back every few months... didn't help. Her ortho put her on Lodine, then Mobic. No go. Then he basically said... sorry. He did one months of Ultram and told her to go to a pain doc. She does that. Once every three months.... gets ultram and ultram ER scripts. Doesn't help all that much, but she refuses to see about surgery, and the pain doc asks her every time if she knows there are much strong meds and does she want them. She says no. Dummy. 
If you didn't look at her face at times, you wouldn't know she's in pain. But she is. She's just alot tougher than me. My wife says I have absolutely zero tolerance for discomfort, not to mention actual pain. I'd be like... gimme the oxy.
If you didn't look at her face at times, you wouldn't know she's in pain. But she is. She's just alot tougher than me. My wife says I have absolutely zero tolerance for discomfort, not to mention actual pain. I'd be like... gimme the oxy.
Posted on 2/11/15 at 11:44 am to TigerRad
quote:
will just lead to tolerance and bigger problems down the road
Possibly. But for someone that's lived past life expectancy and it comes down to surgery vs pain meds, I'm not so sure narcotics is the worst choice. If I'm nearing 80, I'll be damned if I'm going through a back surgery.
This post was edited on 2/11/15 at 11:45 am
Posted on 2/11/15 at 11:51 am to ThuperThumpin
It seems somewhat callous to me that the ortho doc won't prescribe pain medication until she is able to see a pain management physician, especially if he/she initiated the referral.
My advice is to contact her primary care doctor, bring in evidence of a pain management appointment, and ask them for medication to bridge the gap until she is able to go to the pain clinic. Also I would advise you to seek conservative management for her (i.e. epidural steroid injections, medication, physical therapy) prior to undergoing surgery. Depending on the severity of the disease, back surgery may be minimally helpful and only provide temporary relief after months of recovery.
ETA: the above is not to be construed as competent medical advice - this is the OT after all
My advice is to contact her primary care doctor, bring in evidence of a pain management appointment, and ask them for medication to bridge the gap until she is able to go to the pain clinic. Also I would advise you to seek conservative management for her (i.e. epidural steroid injections, medication, physical therapy) prior to undergoing surgery. Depending on the severity of the disease, back surgery may be minimally helpful and only provide temporary relief after months of recovery.
ETA: the above is not to be construed as competent medical advice - this is the OT after all
This post was edited on 2/11/15 at 11:53 am
Posted on 2/11/15 at 12:00 pm to pleading the fifth
quote:
It seems somewhat callous to me that the ortho doc won't prescribe pain medication until she is able to see a pain management physician,
Thats what I'm saying. Like I said in my post I was prescribed pain medication by another ortho doc in the same clinic for back pain that was imo less severe than what she is going through. Now maybe my doc should NOT have prescribed it to me but it certainly relieved my pain(or at least made me not care about it as much) for the week that I took it. I had a car accident this past year that caused another flare up and I just made a phone call and was able to get a refill. I know that is not allowed anymore.
Posted on 2/11/15 at 12:08 pm to TigerRad
Dr needs to know about any bowel or bladder issues. Can be related.
Posted on 2/11/15 at 12:11 pm to ThuperThumpin
My dad has severe back problems-bulging discs as well as other issues. The Dr prescribed hydrocodone and tramadol. He uses the tramadol once in a while. He's never filled the hydrocodone script. Maybe it depends on the dr?
Posted on 2/11/15 at 12:12 pm to ThuperThumpin
She may be a fall risk. You should send her to a chiropractor.
Posted on 2/11/15 at 12:12 pm to ThuperThumpin
if she is having incontinence issues then she needs to tell the doc.
sounds like s1 is pretty hot. often times a surgical issue when incontinence is involved.
if she hasn't told the doc, she needs to. that completely changes things.
sounds like s1 is pretty hot. often times a surgical issue when incontinence is involved.
if she hasn't told the doc, she needs to. that completely changes things.
Posted on 2/11/15 at 12:13 pm to mtcheral
A lot of MDs dont like giving narcs to old people. It's even in the warning label. Main problem Ive found is constipation in older patients with in. I tell them to take a stool softener with it and put them on a low dose.
Posted on 2/11/15 at 12:13 pm to ThuperThumpin
quote:
I know that is not allowed anymore.
New schedule has definitely made a lot of docs hesitate to write them. I know a lot of local PCPs around here won't write for the chronic pain pts that have been taking them for several years. But it shouldn't be that big of a deal to write a few unless you're thinking it's a seeker.
This post was edited on 2/11/15 at 12:16 pm
Posted on 2/11/15 at 12:13 pm to ThuperThumpin
Weed.
Posted on 2/11/15 at 12:17 pm to ThuperThumpin
quote:
She was embarrassed to mention this but she has been having bladder control issues as well. Can disc herniation cause this?
Just saw this. If she hasn't had recent imaging she should have an mri now if this is temporally related to her low back problem.
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