My GI refuses to give me pain meds for pouchitis!

My Internist prescribes my pain medication. Before I had the surgeries my GI would only prescribe an antispasmodic and when I asked his nurse what I should do if the pain got unbearable she said go to the hospital. I told my Internist, who got p o'd and she wrote a prescription for Tramadol. After take down surgery the surgeon would only give me 20-40 vicodin and I had a huge crater, abscess, cut out of my abdomen etc. Long story short I have had ongoing pain issues and she has been in charge of my pain management. My surgeon asked me at my year check-up, when he saw cuffitis, what I was taking for pain and I told him. He said that sounded good.

It is my opinion that they, surgeons & GIs, don't want to be involved on a month to month basis to keep track and see us enough to prescribe pain medications and our regular doctors that take care of everything are the best ones to do so. I'm still taking Norco but not as much as I use to. It depends on if I'm having cuffitis and/or c-diff with my adhesions.

I'm a critical care nurse, and the committee I'm on in my hospital is a pain committee.

Hydrocodone, which is in meds like Vicodin and Norco, is widely abused in the US (I live in WV, and Appalachia is hit hard by people abusing these meds/selling them, etc.) Think about how bad it was with oxycodone/Oxycontin, and then they moved it to a stricter category. Hydrocodone is heading that way, and doctors are getting skittish because of all of the attention these drugs and their addictions/misuse is causing. The FDA is making them be more strict with their prescriptions for these meds, too.

I swear, I've taken care of so many people who have real medical issues, but they're still abusing the meds (physical dependence is NOT addiction; addiction fuels things like stealing meds, taking them in inappropriate ways or amounts to get a "high," etc. - not everyone *gets* that). I can't tell you how many people I've had who had implantable ports for their IV meds, and they go home, crush their Vicodin, and inject it into their infusaport. Of course, they end up in my ICU septic because of it... but it's kind of rampantly awful here, the way people are abusing these meds.

Which ends up hurting the people who take them correctly. The bad always ruin it for the good.

Our pain committee is there to look at the person's pain and give recommendations for therapy that might help them use less opioid meds... such things like giving IV Tylenol before surgery, especially in orthopedic surgery, decreases the use of opioids postoperatively, and also looking at meds that work in conjunction with others to potentiate the pain med. Sometimes it's actually true that an opioid is NOT the best pain choice to start with. Chronic and long term pain is trickier, but they're there to make sure the docs aren't doing the patient a disservice by not treating pain adequately... it's a double edged sword. We're being forced to do better with treating patient's pain (by JCAHO), but the physicians are being driven to limit their prescriptions to things like hydrocodone due to the FDA issues, which is at times impacting to the patient's comfort.

But this is why it's getting harder to have access to opioids, previously oxycodone, and especially now hydrocodone found in Vicodin and Norco. They especially want you to have monthly visits with the doctor who is prescribing the meds (which I think is ALSO why specialists want the PCP to follow the pain, so *they* don't have the prescription under their name). This may be hard for every patient to do, especially if they don't have good insurance.

Here's a NY Times article from earlier this year:
http://www.nytimes.com/2013/01...roducts-vicodin.html

It's a complicated issue.

Yea, what rachelraven said I bet I see my Internist at least 6 times a year, and she prescribes most of my medications.

It's getting that way here as well, but thankfully, my GP and my GI doctor trust me enough to give me Percocet. Given my medical history, I've never had someone refuse me pain meds, but I can completely understand why so many places try to limit it. That being said, given your very real pain, you shouldn't have to go to emerg just to get pain meds, that's absurd! Hope you can find a doctor with a little more common sense. That's why they monitor every pill given here. All narcotics are listed on a government web site, before any pharmacy despenses any pain meds, they must, by law, enter all information into this site, which will tell any pharmacy in the entire province who has been give what medications and when. When picking up your meds, even if the pharmacy knows you by name, you must, by law, show a photo ID (like a drivers licence, which they record the number of), and sign for it. They keep exact count of how many pills you are suppose to take, if you request a refill sooner then you're suppose to, you need approval from your doctor to renew it early. It's a total pain in the ass, they give zero leaniency, so if you take more then the doctor has instructed in one day, you have to go without until the time expires, even if you have a repeat. We have the same problem here in Canada, with people getting addicted to percs, and/or selling them, but ever since they started this stricter control, that problem has all but vanished. Not one pill goes unaccounted for, making it damn near impossible to abuse the system, so as annoying as it is, I suppose it worth it, good luck!

Cheers,
Eric

I see PM at Cleveland Clinic. One of the top guys and he explained why in general they don't like to give out pain meds for these types of issues. It can make the pain worse in the end. I get blocks done that reduced pain in the pouch all together and my stupid bladder.I have Norco for now until they get it all under control with the blocks.

My primary in Dallas was not allowed to hand out Oxy scripts after I ran out 2 months post op. He got fined 10k once.

In general there's a big crackdown on pain meds, in particular oxycodone/oxyneo, and many walk-in clinics and even some ERs will no longer prescribe any form of narcotic. Unfortunately, we are just coming out of a period where oxycodone was highly overprescribed (I work in insurance claims and it was even being given to people in minor fender benders, without even considering milder forms of pain meds first). It was getting to the point that it was being widely abused and referred to as "poor main's heroin." As Eric said, in Canada these meds are now extremely controlled, rationed out, and every pill is accounted for. It's a lot harder to get unless you're an inpatient or have basically exhausted all other forms of pain management. It's the new normal; different pain management strategies are now being employed far more frequently.

Back to the original question.. wondering what is being done to get the pouchitis under control? I was not aware people took pain meds for pouchitis. I know everyone is different, but I had severe pouchitis and cuffitis and it never occurred to me to take pain pills for them.

Seems like it would be extremely important to be working with a GI doctor who was focused on figuring out why there is pouchitis and getting a plan to get it under control. If the pain is so bad to require going to the ER for narcotics, then I think it would require immediate quality GI care to get the jpouch sorted out.

Thank you to everyone for your supportive posts. Apparently our state imposed new laws in January that puts a doctor's license at risk for prescribing more than a very limited amount of opiate scripts.
I have a stricture that goes across the top of my j-pouch. Anytime it becomes inflamed from pouchitis the stricture cuts into the j-pouch. The pain can go up to an 8. I have asked two surgeons about removing the stricture but both said it was too dangerous.
The pain is bad tonight. I'll let you know if I find a solution.

WTH, we know you are in pain and why you are in pain. We can not fix the reason why you are in pain so you just need to learn to live with it.

Can you get to a better surgeon like a Mayo or CC one? I know we keep suggesting them to everybody but it appears that there are a lot of good surgeons out there that can do a great job with the initial surgeries but don't know diddly about corrective ones. It's probably because they just don't have the experience. I wouldn't want them experimenting on me.

I wish you could get your pouchitis under control as that wounds like the best way to solve the whole problem without surgery.

They still could have given you a prescription, they have the reason documented in your file.

thinking it might be in your best long term interests to save up and go see the jpouch experts at CC. Get the problem solved, rather than relying on pain meds.

http://www.ncbi.nlm.nih.gov/pubmed/15571580

In the same boat here. My GI doctor of years retired, and his replacement badmouthed him about prescribing oxycodone. I don't like oxy (it makes me itch), but it works to repress intense pain, spasms, and cramps. He put me on amitriptyline, which works OK as an anticolonergenic, but does nothing for pain and leaves me insomniac and with wrestless leg syndrome. Without pain meds, the pain is so intense, I cannot sit up for any length of time, and frequently spend hours writhing in level 10 pain. Old doc said removing pain meds would be inhumane - new doc says pain is not his problem, it's my problem and he doesn't want to hear about it.
I'd rather not take oxy or any opiates. They make me itch, but addiction has not been an issue. WHen I am not in pain, I will go days without giving it a thought. Once, I went a month without taking pain meds. That was a rare good period. Anyway..... addiction is not a problem. WHta is a problem is wishing I was dead and actively thinking about suidice because the pain is so unrelenting. But if I tell the doctor that, he will take me off of all medications and say I'm suicidal. I just want the pain to end. If it works, I will try anything. I wish there was something other than oxycodone, but I haven't seen it yet.

After a few bowel movements, the pain is intense and unrelenting, and ramps up steadily to spasms, cramps, and pain so bad I am completely incapacitated, unable even to communicate, walk, or do anything by rollback and forth yelling, biting things, and beating my face and head with my fists, which helps distract the rectal pain temprorarily.

I have no fear of addiction, but even if I was to become addicted, I would not care, so long as the medication WORKED! I seriously wonder if amitriptyline is used as a placebo pill. None of several GI doctors I have had over the years have even mentioned it, yet this doctor claims it is the one and only currently accepted drug for frequency and pouch pain, and insinuates my previous doctors were quacks for even acknowledging pain issues,let alone giivng me pain meds.

I don't know what to do. I don't want to become a pill addict, though I seriously doubt I would, but no one is immune. However, the pain leaves me contemplating euthenasia daily.

My Internist and PCP is the one that prescribes my pain medication. Neither my C/R Surgeon or GI want to prescribe pain medications. My Surgeon told me to take 3-4 ibruprofen. I guess he didn't make it to class the day they said we shouldn't take NSAIDs.

I take Norco 10/325 Hydrocodone/tylenol. I suggest you go to your primary care doctor or a pain management doctor for your pain. I have days when I only take 1 or 2 pills and days I need 4. It was explained to me that as long as we use the medication only for pain we will not get hooked. It's when people take more than than they need for pain that they get addicted. This was explained to my by my former doctor, who retired. I've been on the same dosage for over 2 years and am not taking more than I was then. I wish it helped my fibromyalgia too.

Good Luck!

Thank GOD! My new doctor just stopped the amitriptyline , which was causing insomnia and wrestles legs to the point it was making me crazy.

I thought prednisone was horrible..... it's a walk in the park compared to the Satanic concoction amitriptyline. Gawd what an awful, horrible, drug!!!!!

Well, one man's meat is another man's poison, I guess!

Amitriptyline (Elavil) is commonly prescribed for those with IBS and IPS, and has been effective for abdominal pain related to those disorders.

My husband was put on a different tricyclic antidepressant, nortriptyline, for treatment of migraines. He was supposed to gradually increase the dose until the desired effect occurred. It made his mouth so dry he could not speak! He preferred the migraines...I guess it helps some people.

Side effects are something we always need to be alert for, since we don't know how each medication will affect us. Plus, when we are given one on top of another, on top of another, on and on, the interactions between them can amplify side effects or create new ones.

I am glad you were taken off a drug that bothered you so much.

Jan