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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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This will be a little so please bear with me but I think you

Customer Question

This will be a little long so please bear with me but I think you need to know history of question. I am a 58 year old female. 30 years ago I was misdiagnosed as having MS instead of the real diagnosis of Lyme disease, even though I had shown MD the tick bite, he was sure he was right. I sustained permanent nerve and muscle damage due to it being untreated, When I got right diagnosis I was put on antibiotics for almost 5 years, switching to different ones often. Fibromyalgia set in due to the nerve damage. I have been on pain medication for over 25 years, with the strength increased and medication changed as needed. About 15 years ago, my medication was changed to 60mg MS Contin q6hr. I have not allowed it to be changed since then even though it is not always enough to help the pain. I have also had RX for Flexeril 10mg tid prn and Ibuprofen 800mg prn. I will only take the latter 2 when absolutely necessary and even then it does not always work. I lived in Chico, Ca until moving to Oklahoma 11yrs ago. I have seen the same MD here for all but 3 months ago when she was told she could no longer prescribe narcotics. I have seen a new pain clinic 3 times now. First visit was a PA who said I was taking too high of a dosage and he changed it to 60mg tid. My pain level increased with the lower dose. I saw the actual MD on the next visit and he gave 111 pills instead of the 90 so I had some to take prn on the days I needed more than the 3 per day. Last visit was on 9/15. PA was rude. He inferred that I was a drug addict and that Oklahoma wouldn't allow me to abuse the medication like that. I was insulted and told him so. I reminded him that I had taken the same dosage for over 15 years and never asked for an increase or a med change as my body got used to the med and it was not as effective. I never went to ER or another MD drug seeking. He rudely and sarcastically apologized and sent me to waiting room to wait for his nurse to call me back for script and to set next appt. He took me off my medication and prescribed Embeda 80mg q12hr. I took script to my pharmacy. They had never heard of it. When they looked it up they told me that it came out in 2009 and was recalled 4 times in the first year and that it wasn't being prescribed. They told me it would be 5 to 9 days before they could get it in and to try other pharmacies. I did and got same response. The MD had known I was leaving the next day for a 5 day vacation to Las Vegas. Pharmacies said to take script wit me and maybe it could be filled there. I called MD office a few times and got no answer back. While in Las Vegas, I tried to fill it and all pharmacies gave me a pick up date for after I would leave. I called the manufacturer and their locator service tried to find a place for me to get it sooner to no avail. The best they could do is talk to a pharmacy where I live in Oklahoma and ask them to order from them and I would bring in script when I got back. Needless to say I went into withdrawl without my medication. At one point I finally gave in and went to ER. The MD and nurses there hadn't heard of it either and had to look it up. They felt the MD who wrote it was being malicious and unethical because he had to of known I would not be able to fill it for many days and would go into withdrawl. He said the most he could do was give me a shot of Dilaudid and script for Tylenol 3. I am allergic to codeine so could only do shot. I was finally able to get RX when I got home on the 24th. My vacation I had planned for a full year had been ruined as I was too sick with the withdrawl to enjoy. Also the medication he prescribed was a 80mg capsule with MS crystals surrounding a medication that would counteract the morphine if someone tried to cut it up to snort it. Another slap in the face from the MD as it was an off handed accusation that I would try to do that. I have been on the medication for 3 days and it does not do well for the pain and has not completely rectified the withdrawl symptoms. So, all that said here are my questions. Are narcotic medications being dropped down to the point that my normal dosage of 60mg q6hr is considered too much and unequivicably to be refused? Will my withdrawl symptoms at sometime stop? Is this medication of Embeda safe to take since all of the recalls? I will be searching to get a new pain management MD as soon as possible and should I expect to be treated the same way by all pain med clinics or is his treatment to be the norm?
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Hello. Welcome to JA. Let me read this and i will be back. Dr frank

Expert:  Dr. Frank replied 1 year ago.

There is a new trend in pain management clinics to steer away from long term use of opiates for chronic pain as their effacacy has come into question due to tolerance a desensitization at the opiate receptor over time. Divergence of opiates has not helped creating tamper proof medications that in my experience are not as effective orally. But you will find pain management clinics using opiate contracts to lomit use to no longer than a few months. To do random urine checks and insist the patient come into the office for pill checks. There is pressure to try the synthetics like nucynta or tramadol. Or more neutral opiate agonist meds like bupremorphine.

Expert:  Dr. Frank replied 1 year ago.

Embeda is a new med in this catagory of more neutral agonists or a balanced approach of using two opiates together to reduce the positive reinforcing properties of opiates that many feel leads to addiction. Embeda is morpjine mixed with naltrexone. The naltrexone effects the opiate receptor hopefully to prevent desensitization by antagonizing it.

Expert:  Dr. Frank replied 1 year ago.

So i would say your pain management md has concerns that taking 60 mg q 6 hrs is from tolerance and he is trying to wean you back. Hopefully maintaining pain control. I hope that answers your question. Please remember to rate my srrvice if satisfied. Dr frank

Customer: replied 1 year ago.
Why would he force me into withdrawl to accomplish that? he knew I could not get this medication within a reasonable time frame. And it does not work for me. I am still having withdrawl symptoms. It makes more sense to slowly titrate a patient down than to cause withdrawl. Every single medical professional I saw or talked to over that 9 days said the exact same thing. There is no possible way that he could have believed I could get this medication any sooner than at least a week and that it had to have been deliberate. So would that then be considered a normal way to transition a patient to a different means of controlling the pain?
Customer: replied 1 year ago.
Even Phizser said it was not carried routinely in a pharmacy due to the recalls and it is ordered due to no current prescription due to the recalls
Customer: replied 1 year ago.
I have to leave for work. It seems as though you have decided not to answer my questions so I will have to ask for a refund
Expert:  Dr. Frank replied 1 year ago.

Hi. This is an answer service. I can send you useful information but cannot tell you why others do what they do. If you wish to discuss this further i can send you an option for me to discuss with you over the phone. Dr frank