Rheumatoid arthritis and the role of the General Practitioner in pain relief

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I would be lost without my GP (or primary care doctor).  He is the guy that prescribes my pain relief.  My rheumatologist does not.  That seems to be a pretty normal state of affairs.

Yesterday I was desperate, and couldn’t get in to see my usual GP.  But I saw a different one, whom I have seen a few times before.  He’s got a special interest in muscular skeletal issues and sports medicine, so he is a good choice, and has been very attentive and interested on previous visits.

But I was worried. He has also expressed concerns about the dosages of Endone and Targin (oxycodone)  I have been taking. So I was afraid he would not want to fill my script for Endone.

He was wonderful though.  He asked where I was at ‘with everything’. The last time I saw him I was begging him for cortisone injections into my SI joint and lumbar spine.  He sent me for those and wanted to know if they helped.  They did indeed!  He offered to send me again, but the truth is I can’t afford any more cortisone shots right now.  I would love to get my SI joint injected again, because it also causes a lot of referred hip pain.  But I can manage it right now.  If I get to the point where I can’t walk again, I will find the money then.

I explained it to him this way.  Cortisone shot = out of pocket expenses at $70 per joint. I need at least 8 injected.  Total $560.

Box of 120 endone tablets  = out of pocket expenses $6.

Yes the cortisone injection is treating the problem and the oxycodone is just masking it. But you can’t argue with the math when you live on a Disability Support Pension and have two kids.

So he agreed to fill my script.  I asked him for a higher dose.  I know that Oxynorm is 10mg of oxycodone, and I always take two 5mg tablets, because one doesn’t touch the pain.  So why not prescribe the 10mg tablets.

He refused.  He gave me my one month’s supply.  Six boxes of endone.  Twenty tablets per box.  That’s 120 tablets.  He told me I could take up to 8 tablets per day.  So let’s do the math again.

Assume a 30 day month.  8 tablets per day.  That would mean I need two hundred and forty 5mg tablets to make it through the month.  Or one hundred and twenty 10mg tablets.  Lucky math was my best subject, because this doesn’t add up.

He is telling me I can take 8 tablets per day, but my prescription authority is only for enough to take 4 per day.

Clearly he doesn’t believe I should need 8 tablets per day, every day.

He asked me to only take them when I really need to. I told him I do. He told me I was addicted now.

I paused. I was going to correct him, and say ‘No, I have developed a tolerance and so need a higher dose now.’  But that’s semantics, really.  Instead I said, yes, so some extent I am, and I do understand that’s why I need higher doses.  Then I asked him if he had a solution to that.

He actually looked very sad and said ‘No.  I’m sorry.’

I told him I didn’t really expect any treatment to work (because that’s exactly how I felt at that moment), and that oxycodone at least gave me some quality of life.

He asked me how long I had been suffering from rheumatoid.  I said 8 years.

He quietly agreed, and handed me the script.

I gratefully accepted the script and thanked him.  But that conversation finalised my decision on prednisone.  I asked for a script for prednisone as well, because I am going to need something to control the inflammation, not just pain relief, just for a little while.  Because I need a break.  Otherwise I will be back in two weeks asking for more Endone.

He agreed.

And then he stopped.  He asked me if I knew why my disease had gotten worse lately. Had anything changed. Was I under too much stress?  Was I depressed?

He was being caring, trying to help.

I told him my disease hasn’t gotten worse. This is normal for me.

He said I looked considerably worse today than the last time I’d seen him.

I told him this was because I have just spent nearly 4 days without Endone.  Without proper pain relief.  That every other time he has seen me I have had enough Endone in my body to allow me to function and to even smile. I have a habit of smiling. It’s a good habit. Except when you are trying to explain to people that you are in pain.  People seem to think you can’t do both.

Yesterday I couldn’t smile.  Three nights with no sleep because of severe pain will dampen a smile.  Plus I was still in severe pain.  No smile meant he took me more seriously.

But I still smiled when he handed me the script for Endone.

5 COMMENTS

  1. You are not addicted to endone. You are dependant on them. Meaning you need them to live a simple life! I hate the word “addicted”. It makes me feel like we are “junkies” looking for a score and that is not true. We are looking for anything to make our pain go away so we can simply enjoy our life! Heck I think some days I’d eat dog poop if it took my pain away! Have a peaceful night.

    • I have heard the rheumy I pay top dollar like you has 2 systems – the one at his practice & the other at the hospital that is called the clinic that ppl go to & get injections but don’t pay – check with your hospital to see if they run a free clinic

  2. What a horrid illness and when is the medical profession and pharmaceutical companies going to get it together to help you to be as pain free as possible I wish that for you cheers you are brave

  3. I’m so happy he listened to you and gave you the meds. It truly does make a difference when you aren’t being dismissed by your doctor. The medication should help you get back on your feet. Soon I hope 🙂

    ~Marti

  4. Will they increase your dose of long acting with the hope that you might need less endone? Short acting pain medicine gets you so stuck in a roller coaster of severe pain and …. Less pain. ( I was going to say relief, but all RA people know you will never have no pain).

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