Hello All,

I wanted to get some thoughts over an issue I am having with using an anti inflammatory as part of my pain control regime.

I have TOS, RSD, fibro, Occipital Neuralgia, Bulging discs and DDD, Osteoarthritis of the back and knees, bursitis in both hips and one elbow,

My pain meds include MS Contin, Norco, Piroxicam, and Neurontin. My neurologist has been writing for the narcotics, and my primary writes for the other meds.....scripts she 'inherited' from my previous primary.

I also have high blood pressure, type 2 diabetes, and high chol.....so I do have some cardiac risks.

My primary has been on a crusade to get me off the anti inflammatory med (Piroxicam) since I started seeing her 1.5 years ago. She is concerned about the cardiac risks. I TOTALLY understand that concern and the risks. My concern is that tampering with the pain management regime will increase my pain (I admit, this is my main concern) and end up making my blood pressure/cardiac risk worse because of the severe stress on my body.

She had been suggesting that only take the anti inflammatory when the pain is really bad or take it for a month and then skip a month, and repeat that cycle.

I have been putting off doing that. I consider it, but then I think "I'd rather not be in worse pain today, so I'll just take it today and re evaluate tomorrow"

We discused it again at my visit this week. I explained that I have a hard 'picking' which month is going to stink because of more pain.

She said she'd make the choice for me...and just stop prescribing it (which she did) Then she berated me for not being more proactive in my own health care and chosing to limit it myself.

I look at it is I am proactive. I'm saying I would rather croak from a heart attack while I was TRYING to lead a life as normal as possible, managing the pain as best I can and be able to leave the house on occassion and enjoy life. I truly feel like I will be at risk for the same heart attack due to increased pain than will also curtail my efforts to try to enjoy life.

I do understand that docs have to feel comfortable with the plan of care. I'm angry because I feel like she wasn't listening to my concerns.....like it would be one thing if she said "I just think the risks of the anti inflammatory are too great, let's try not using it and if the pain is worse we will see what we can do with other meds, and we'll keep an eye on your bp to see if it does go up with increased pain." but the whole belittling thing wasn't very professional, in my opinion.

Am I griping because I'm not getting my way ? Or should I be in the market for a new primary ?

Thoughts ?

I'm planning on seeing how it goes. Trying to remember where I put my bp cuff so I can monitor it on my own, or wondering if I should even bother.

My neuro WOULD write for it, I'm sure, but I wouldn't play that game.

Another option is asking again for a referral to see the orthopedist (by the end of my visit, both she and I forgot about it) about my knees. The pain/stiffness/inflammation has come and gone for years, but it has been BAD since March/April. I can't stand up from a chair or the toilet unless I have something to push off of or pull myself up with. And of course, doing that just flares my neck issues

I fought for several years with PCP's who a) apparently misinterpreted my blood pressure as a primary issue, as opposed to a result of pain, inflammation, or raging disease and b) worried more about a consequence of that blood pressure than immediately threatening symptoms like blood in my stools or worsening neurological issues. Turns out I don't really suffer HBP, but rather elevated readings when I am flaring. I have had to work hard to convince them that quality of life is of greater importance to me, so finz, you are not alone!

Hi ~ I completely understand where you're coming from. I've had chronic, intractable pain for over 25 years, and i think I'd feel the same as you. And I agree that your doc's approach was NOT very professional.

Instead of using the anti-inflammatory, why doesn't she prescribe some breakthru medications, i.e. MSIR (immediate release)?? That would help ease your pain, and you take it between doses of your long-acting MS Contin. I'm surprised you aren't on a breakthru med as it is. Or is that what the Norco is for?? I would think that MSIR would be more effective.

Could your doc put you on a low-dose aspirin regimen? Aspirin is an anti-inflammatory med too, and it CAN be beneficial to the heart if you don't take too much. Just a thought.

I wish you the very best -- I hope your doc was just having a bad day. NO, i don't think you're griping cause you didn't get your way. LOL It WOULD be difficult to "pick" which month you want to feel like crap. LOL Obviously your doc has never had any PAIN.

Take care & God bless. Hugs, Lee

I just have one comment. Of all the NSAIDs out there piroxicam is the most toxic and for that reason is not used much anymore.

Of all the NSAIDs...naproxen has the least negative effect on the heart. (but it still has an effect, it just shows up as the least toxic of the bunch).

So I agree with your doctor, to make some kind of change. Do some research and try to decide.

This link may be useful...it shows the FDA reports on various drugs:
www.drugcite.com
Keep in mind the reports for piroxicam look less numerous, and that is because it is rarely used anymore. The ratios of toxicity are accurate however.

There are other nonRX alternatives. For example SAMe has shown equal performance when compared to NSAIDs in reducing arthritis type pain. But it is not covered by insurance, and would run you about 40-50 dollars a month. (at 600mg a day). SAMe however, actually helps repair damage, which NSAIDs do not.

Thanks for the support All !

Mrs D.....I'm also on Zoloft, so SamE is a no no. For anyone reading not as into researching meds.....mixing some OTC mood stabilizers (which samE includes/does) with certain antidepressants (SSRI's) can be a fatal mix.

I'm not tied to the idea of Piroxicam....I'm open to ANY of the others. She has not suggested switching, but I also didn't specifically ask, so I may try that approach.

Hi finz,

FWIW, here's a list of anti-inflammatory foods. Of course rule out any that may exacerbate any of your current conditions/allergies/sensitivities:
http://www.metabolismadvice.com/anti_inflammatory_food/

Doc

I'm very sorry this is happening to you. I believe some doctors think that pain is something we should just cope with. My PCP is taking ALL my pain meds except for 3 Percocet a day. I'm terrified that if I ***** too much she'll take that away. I'm at my wits end. I believe since I take the risks it should be my decision on what I'm willing to do or not do.

I have been reading alot of threads, where doctors are removing people from pain medications. Today I received one, where some blessed soul is contemplating suiside.. Nobody wants to be in pain wreathing on the floor. My father had throat cancer and seizured in my arms more than once because of pain. I will not do that to myself, nor watch a family member suffer like that again. If I should be in such a position, I joined final exit. Regardless of what the moderators think of this choice, it is my personalchoice.I will not go out in terrible pain. I've been there and suffered that. They are crazy if they think humans were meant to suffer like that. Every time I hear of a physican who takes away meds because they themselves are afraid of Gov. intervention, are not the kind of doctor I would seek. so far I have been lucky in my own physicians. I am now facing the kind of cancer my father had. that is why i have been off line. I will not have my gov. dictate to me what I may and may not ingest into my body to help me. I am angry and discusted that in this day and age, we expect people to just "live " with it. Let the doctors feel that kind of pain and maybe they will change their mind. I hope you all read on the news on how many people where denied benefits and therefor saving the broke government money. All because they smoked something the gov. says is bad. who the hell is the gov. that should treat people so badly. I am sorry for all of us who suffer and have to endure because some doctor is now afraid of reprecussions. This state is the absolute worse, because there are people who abuse these drugs. However, there are alot of people who do NOT abuse, yet we are paying the price for the few. I hope doctors do read this. I read others posts and feel their pain and fright. This is no way to treat humans. ginnie