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Here is the problem, I have psychosis and sever back and hip pain and have to use a walker or wheelchair except for goining very short distances like to the bathroom. To be able to even rest I am on a strong dose of Lortab - an opiod pain medication. I cant do without it and I am dependant on it. However my psych doc wants me off it because he seems to think that it is causing more problems with my psychosis and depression yet the pain without meds makes me very suicidal - its just that bad. It doesnt help that I also have fibromyalgia and painfully enlaged cystic kidnies. On a good day without pain medications my pain level is about 8 or 9 - and I am comparing that to pnumonia with 2 broken ribs. I've heard tell that the broken ribs alone is one of the worst pains there is.

I've done some reading and know that pain medications can cause hallucinations. I think I have experienced this but its nothing at all like the hallucinations that I have had as a result of my Paranoid Schizophrenia. I had the PS long before the pain issues or the medications and the quality of them is very different - for one the PS hallucinations seem very real where the pain med stuff is rather obvious to my mind that it is not real and usually nice or enjoyable where the PS ones scare the living crap outta me.

How can I get my psych doc to understand that the pain meds are necessary and that I dont need to be treated for addictions or go to AA? He also says that the pain meds will kill me - that I will just stop breathing one day. Is he just using a scare tactic on me? I know this can happen if you dont be careful on things like the pain patches because it can lead to an overdose. However if you follow the directions and have the right dose my medical dr says there are little risk - most of that happens when people decide to abuse them. Whats going on here? The psych doc even told me I needed to stop using the walker while I was in the hospital and I felt like - wtf?

Any input here?

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Are you being treated my a pain clininc? A pain specialist? Your psychiatrist could benefit from speaking with your other providers, especially if they are pain specialists.

Pain is often undertreated. There are non opiate pain meds such as Ultram. You have probably tried it. A patch would be good, and I hope your insurance company approves that. Has PT helped you? I am sorry you are dealing with so many health challenges at once.

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I think you need to get the docs talking to each other if your pain is that severe to come up with a workable option for you. different specialty docs are often not knowledgeable/versed in other specialities, maybe they can educate each other and come up with some compromises.

a pain specialist would be a good idea if your pain is that severe.

anna

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I am on coumadine so I cant take any thing like Celebrex because I had 2 tummy bleeds that were really bad. Ultram made me have some really bad 'trips' that I was told at first could not happen and then I looked it up and right there in the potential side effects it lists hallucinations as one of them. We tried it 3 different times. I do take Lamictal which helps with some of the nerve pain such as the sciatica. Right now I am on pain meds and using a walker. Its pretty bad. I hate being on opiates with a passion and I tell this to the Dr every time I talk to him but we seem to be out of options.

I am not working with a pain specialist yer. I have a referal to the spine pain center at the hospital and I hope I get in there soon - the things that happened recently got in the way - I was pretty psychotic. I'm looking forward to this because hopefully he will know of some options that my Dr doesn't know about or doesn't have experience with. Pain really sucks and some of it is extreemly annoying - I have started having restless leg syndrome because of the damage in my back now and the only thing that seems to control that is the opiods/opiates, too.

My Dr and my psych Dr both work on the psych floor together so they know each other. My psych Dr doesn't belive in pain medication and has this rule of not allowing them for his patients. They had a back and forth over this because I couldnt really walk - I actually was not able to make it to the groups down the hall because of the pain issues even though I wanted to participate in them untill my medical Dr finally got me my medication - even then it was at a lower dose than usual - a compromise that they made. The whole thing pisses me off because how are you supposed to work on mental issues when you are taken over by physical pain to the point you can't deal with anything - think about anything but the pain? I'd switch psych Drs but other than this one thing he is really good and one of the few that has ever really got my medications right or seems to belive that you can have a situation where you have both Schizophrenia and Bipolar disorder at the same time rather than switching my Dx based on whatever my most recent hospitalization centered around and then majorly messing up my medications.

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My psych Dr doesn't belive in pain medication and has this rule of not allowing them for his patients.

Most strange: my Pdoc encouraged me to get adequate pain control as part and parcel of treating my various and sundry MI issues. I am so thankful that my pain docs work so well with my other physicians. I simple could not survive, either physically or mentally, without adequate pain control. Currently I have four meds for pain and need every one of them.

I hear your rationale for not finding a new Pdoc, but...

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I am with indigo on this one and whilst HUGE OUTRAGEOUS doses of opiates can cause psychosis-LIKE sx, I guess, adequate pain control does sound like a must for you.

I'd say, personally, the biggest issue I'd see with long term opiate usage would be rebound depression, but you know, I'm neither of your docs. If I were, I'd give you decent pain control and keep tweaking the other meds until a regimen was found that WORKED.

Unfortunately, it's a shame that you like your doc for all other issues than this...

Anna

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what ya'll are saying makes sense. I might have to look into it. There is another Dr that works in the same office that I heard from other patients at the hospital that is cool with pain medications but maybe a little too cool with it. he gave one pt morphine - started her on it. I just dont know if I want a psych Doc prescribing pain medication like that because I would take it.

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I just dont know if I want a psych Doc prescribing pain medication like that because I would take it.

Morphine is one of my available medications, but it is prescribed by, and monitored by, my pain doc. My pain docs deals with physical pain, my pdoc with my emotional and mental quirks: they consult and find solutions to overlapping problems.

I would not only be reluctant to be medicated for chronic physical pain by my pdoc, I would be suspicious of him/her wanting to do so. But then, I would be reluctant and suspicious of a pdoc who does not "believe" in pain control.

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Rosarx,

it is really outrageous that your psychiatrist does not believe in pain medication and pain management. While chronic pain meds certainly complicate psychiatric care it is a necessity to treat severe pain. Healthy, neurotypical people committ suicide over pain. My sister, who does not have a MI, came close to that. Finally she found a surgeon/spine specialist who listened to her. Severe pain causes anxiety and depression.

Treating your schizophrenia and moods is important. Treating your chronic pain is also important. I would want doctors who respected both. Not some arbitrary philosophy that a psychiatric patient should never take an opiate. And if one condition is treated successfully it might help the other.

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  • 2 weeks later...

I have been pretty close to suicide over it before and my pdoc said "the pain meds are going to kill you anyway." The more I think about it - its probably not a good idea to keep the guy I just hate that every other pdoc I have had has over medicated me quite a bit - to the point that I could not really function. On the other end this one has under medicated me a few times, too. I'm feeling really confused about things today.

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perhaps your pdoc is worried about the potential for using the pain meds in a suicide attempt, or that the pain stems from a psych issue? Or maybe theyre irritated at the prospect of pain meds having psych side effects that upset your current balance. Have you asked them directly?

I have had pain from psych issues before but it wasnt major enough to consider real pain medication. I just wonder what your doc is thinking, it seems pretty odd.

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Here's to hoping two doctors actually talk with one another. That's a hard thing to ask especially since most psychiatrists are busy as hell, as are most doctors. So if you ever get two doctors to talk with one another, consider yourself lucky. I just thought that stuff happened only for Oprah.

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The psych Dr thinks part of the reason we have had a hard time getting the psychosis and depression under control is my pain medication. He doesn't understand that the depression is related to the pain and loss of physical ability and I think a lot of this bull is coming from the therapist that I am seeing.

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Your doctor obviously has a completely irrational bias. It makes no sense. People die on opiates when the abuse them, not because of some inherent flaw in that class of drug. Plus, you are not an addict, you are dependent, two separate things, which he has a p-doc should know. It is shocking that he would confuse the two.

I am sorry that you like him generally, but truly, this is a freakish thing for a p-doc to object to. I could certainly undertand his insisting on working with your pain docs, to try tweaking the opiates lower, but to dismiss it out of hand? He is not a very good doctor, imo. Pain is a critical component of your mental health. I really think you need a new doctor.

Does he not treat cancer patients with MI, because they are on pain medication? He sounds like a Puritan.

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I'm looking into trying someone new. My uncle said that I should approach it like an interview - I am interviewing the doc to see if I am going to want him taking my case. We have to figure out what kinds of questions to ask. I'm a bit scared that if I ask questions about pain medications that the new doc will just think that I am an adict looking for a place none will criticise me or sum me up that way. This type of thing gets to me because I would gladly give up the pain pills if it was not for the pain. I feel like I have to take too many pills with too many side effects as it is without the pain issues. I like to live my life - as weird as it might get at times.

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... if I ask questions about pain medications that the new doc will just think that I am an adict looking for a place none will criticise me or sum me up that way.

Have the MRI in hand as well as the written evaluation of the MRI. You have previously stated that once other physicians saw the MRI their attitude turned on the results.

Any physician that indicated they thought I was an addict would be dismissed out of hand and I would be on to the next. However, like you, I have both x-rays (I have too much metal in my body for an MRI) of my spine and joints that demonstrate the destruction of bone, ultrasounds of the synovitis that plagues me, and evaluations by more than one radilologist, ample evidence from laboratory results of blood sampling, and the evidence provided by the condition of my body.

I think your concerns about being criticized or judged may be something to discuss with your therapist.

Again, I urge you to obtain a referral to a respected pain clinic for evaluation and a treatment plan. However, if your diagnosis is degenerative disk disease, and/or osteoporosis the first step in treatment will be to quite smoking cigarettes, loose weight if you are overweight, and exercise each and every day: walking is the universal recommendation. Calcium supplements and increased vitamin D consumption will most like be encouraged. Many pain clinics do not use opoids for chronic back pain or sciatica, especially in the under 60 population.

Lingering back pain and/or sciatic is currently being treated with specialized physical therapy and exercises and injection therapy.

There is a trend towards behavioral therapy for osteoporosis incited back pain and accompanying sciatic that has proved to be very effective.

Not being sure of the cause of your chronic pain I am simple rambling.

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The only reason I am on opiods is that because I take blood thinners and have had two tummy bleeds I had to be taken off the celebrex. The celebrex was helping alot and it was a big blow to me.

I go to a warm water pool for my exercise since I can not really walk and do my physical therapy exercises there. I've tried everything to get my weight under control for 20 something years now - since medications started making me put it on and I've just been up and down, made myself throw up and ruined my teeth and all other sorts of things - including doing it slow and healthy and I'm still almost 300 pounds. I am not a candidate for the banding or anything like that because of the blood thinners. It seems every time I lose weight something happens and I gain it back - like getting pneumonia that almost killed me or my Dad dying and making me eat like crazy or whatever. I've given up on that one - honestly - because I don't want to end up 320 next time around. Seroquell put 70 pounds on me, BTW.

I do not want injections in my spine. That frightens me a lot. My mom got them in her knee once and never did again because it hurt so bad and it was not 'if it hurts bad enough' it hurt bad - she had her knees replaced.

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I do not want injections in my spine. That frightens me a lot. My mom got them in her knee once and never did again because it hurt so bad and it was not 'if it hurts bad enough' it hurt bad - she had her knees replaced.

I have joint degeneration from rheumatoid arthritis and count the days until I have have my knees, hips, wrists, and shoulders injected. I have also had my jaw joints injected more than once. Thus, I suppose I am a wuss...I would rather have injections than surgical replacement. Now, that frightens me!

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