I'm in pain and no one will listen (clinical questions)
Nov 21, 2024
2 min read
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A friend writes:
"I’m struggling really bad with pain. And nobody will write me anything stronger than Tylenol #4. So I don’t know what to do."
Whenever I get a question that involves dosing, it is always difficult to completely answer because no matter how long a "book" they write me, there are always more questions that will effect the answer. However, here are some assumptions I am going to make in this instance - I assume you are not able to take more than one at a time, and I assume it is not more than 4 times per day.
Each T#4 is only slightly stronger than a 5mg Hydrocodone/apap tablet, so if you were taking 4 per day (and it is probably less given the choice of this archaic formulation), you would be on fairly low dosing 20-24 MME per day, depending on the conversion scale you use. So, I can see how if you were a chronic pain patient, this level may be falling short of giving you quality of life.
But the conversation you need to have is about the plan, not the pill. Remember that a pill is not a plan, so you begin by describing vividly (but briefly) why the plan is not working. What do you need to do that the medication is BARELY allowing you to do. Are you able to work? at all? Would increasing the medication allow you to work at least part time? Remember that the ultimate goal of pain management is to allow you to live your life in a way that is productive and satisfying and there is no more satisfying a goal than to be able to successfully manage a job or a home.
So focus your reasons on why the plan is not working in this area. If you can't get anyone to listen to you so far, then quietly keep searching, staying on your current plan until you have a provider who seems inclined to increase it. Focus strongly on your adjunct therapies, cold, hot, bracing, accupuncture, cbd if they will allow it, NSAIDS if you are able, stretching and exercise.
Also - be sure all of this includes a healthy bit of grace to yourself. I do recognize you can only do so much, but the more you can do to feel less trapped, the more your pain plan will be effective even if zero things change.
But I do believe things need to and will change. If Kratom is not banned in your state, make sure you take the time ( a weekend is good) to try Kratom instead of T#4 to manage your pain, not to stay on kratom or stop traditional pain medicine but to see if you can have a back up plan if you need it - if you suddenly find yourself without a prescriber.
Hope some of that helps. Other ideas, comment below.
How do u convince Dr that being taken off cold turkey after 8 yrs of oxy that in 6 days you will still have metabolities? Dr insists I bought something on street and that in off pist test it's oxy. No way it's a metabolite, so in stead of getting meds back I keep detoxing and he continues to say I need to keep u safe. He said I peed cocaine in Jan, perfect urine in Feb, but punish me for Jan buy cold turkey for 1 month in March. But with oxy after 6 days I need to start over. If I was unsafe that of been in Feb .by the way cocaine level was a metabolite at152.1 can u get that from 3rd person I've never did cocaine but someone did in my car till I told them to get rid of it, crack. Can you give ne advice to suffer to get back is cruel. Same office diff Dr doesn't do that nure said he should of given me something for help with detox he said no. I swear I never did cocaine or buy off street. I have extra pills but if I take he'll know and will discharge.
Thank you so much for your book Dr. Mike, it is very informative and helped me to see some things from a different perspective perspective, I so appreciate your kindness and compassion and thank the lord your common sense