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What Causes Chronic Pain In Neck And Knees?
Question: Hello,
I have had severe chronic pain in my neck, back and knees for many years. It took some doing to find the best medication to handle the pain in my situation and so, I've been prescribed oxycodone since 2000 for chronic, severe pain due to arthritis. After waiting 7 years to be eligible for a knee replacement, the surgery was finally done in 2011. The condition of both my knees was such that I was supposed to have both knees replaced but the surgery on just the left knee left me with daily intense pain and swelling that has reduced my quality of life to that of a much older and frail person without the use of these meds for the pain.
My PCP referred me to a pain management program that I have been in compliance with since I began. They prescribed hydrocodone in addition to the oxycodone, (I never knew why, I did not request it), and though I have been taking the medication daily, I recently was told that I failed 2 urine tests for the presence of hydrocodone, not the oxycodone, and therefore was summarily and immediately dismissed from the program.
There is a strong probability that the urine tests produced false negatives. I say this because I have been taking the medication daily. My physiology and possibly my metabolism, (I had a gastric by-pass in 2009), could be the culprit as well as other possible factors but I am now being told that no one else will help me or even listen to me and I have until the completion of my last prescription for these drugs, less than 30 days, to withdraw from these medications because I will be unable to get any more prescribed.
Because I am an invalid without the aid of these drugs to control the pain in my body, the outlook for my immediate and ongoing future is very poor. How can I investigate the probability that my urine tests were false negatives? Also, I heard of some kind of test or procedure I could go through to show the pain management doctors that I am in compliance with the existing regulations, (my PCP said something very fast and would not repeat it when she mentioned this option about requalifying for the pain management program). Are you aware of what this might be?
Many doctors sympathize with me but will do nothing to help because of fear of losing their license. I question why the pain management doctor, not doctor actually but a P.A., did not seek to find out what was going on with me when they received the first negative test. That doesn't help me now. As I read the comments and questions on this site I see I am nowhere near alone in this predicament. I nhope I can find some help here, at least pointing me in the right direction...
Thank you so much
I have had severe chronic pain in my neck, back and knees for many years. It took some doing to find the best medication to handle the pain in my situation and so, I've been prescribed oxycodone since 2000 for chronic, severe pain due to arthritis. After waiting 7 years to be eligible for a knee replacement, the surgery was finally done in 2011. The condition of both my knees was such that I was supposed to have both knees replaced but the surgery on just the left knee left me with daily intense pain and swelling that has reduced my quality of life to that of a much older and frail person without the use of these meds for the pain.
My PCP referred me to a pain management program that I have been in compliance with since I began. They prescribed hydrocodone in addition to the oxycodone, (I never knew why, I did not request it), and though I have been taking the medication daily, I recently was told that I failed 2 urine tests for the presence of hydrocodone, not the oxycodone, and therefore was summarily and immediately dismissed from the program.
There is a strong probability that the urine tests produced false negatives. I say this because I have been taking the medication daily. My physiology and possibly my metabolism, (I had a gastric by-pass in 2009), could be the culprit as well as other possible factors but I am now being told that no one else will help me or even listen to me and I have until the completion of my last prescription for these drugs, less than 30 days, to withdraw from these medications because I will be unable to get any more prescribed.
Because I am an invalid without the aid of these drugs to control the pain in my body, the outlook for my immediate and ongoing future is very poor. How can I investigate the probability that my urine tests were false negatives? Also, I heard of some kind of test or procedure I could go through to show the pain management doctors that I am in compliance with the existing regulations, (my PCP said something very fast and would not repeat it when she mentioned this option about requalifying for the pain management program). Are you aware of what this might be?
Many doctors sympathize with me but will do nothing to help because of fear of losing their license. I question why the pain management doctor, not doctor actually but a P.A., did not seek to find out what was going on with me when they received the first negative test. That doesn't help me now. As I read the comments and questions on this site I see I am nowhere near alone in this predicament. I nhope I can find some help here, at least pointing me in the right direction...
Thank you so much
Brief Answer:
Several points.
Detailed Answer:
First, you should make sure that the urine test was SPECIFIC for oxycodone and hydrocodone... or .. it isn't. I'm a board eligible physician in addiction and a clnical pharmacologist. I can find references like:
http://www.ncbi.nlm.nih.gov/pubmed/0000
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
Simply, you get a mouse, immunize it to HEROIN, get it's HEROIN BINDING protein (antibody) and put it into a test.. XXXXXXX ! it detects HEROIn (but not saxophones nor oxycodone).
Just a repeat test specific for oxycodone.. test code 763997.
Several points.
Detailed Answer:
First, you should make sure that the urine test was SPECIFIC for oxycodone and hydrocodone... or .. it isn't. I'm a board eligible physician in addiction and a clnical pharmacologist. I can find references like:
http://www.ncbi.nlm.nih.gov/pubmed/0000
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
Simply, you get a mouse, immunize it to HEROIN, get it's HEROIN BINDING protein (antibody) and put it into a test.. XXXXXXX ! it detects HEROIn (but not saxophones nor oxycodone).
Just a repeat test specific for oxycodone.. test code 763997.
Above answer was peer-reviewed by :
Dr. Raju A.T
No one at the pain management clinic will talk to me so how can I find out anything about the tests they took? Also what measures are there that will allow me to apply somewhere else for a pain management program?
Do you mean to suggest that I immunize a mouse to any substance? I am not clear as to your suggestions and how they might help me.
Do you mean to suggest that I immunize a mouse to any substance? I am not clear as to your suggestions and how they might help me.
Brief Answer:
wow, can they even do that ?!?
Detailed Answer:
Hi,
First, the mouse immunization is how the test is manufactured. They get an immune binding protein and stick it on paper. Hopefully the drug sticks and the urine doesn't.
Second, more importantly.
http://www.hhs.gov/ocr/privacy/hipaa/faq/right_to_access_medical_records/
http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/eaccess.pdf
You Have Legal Access to Your Medical Records. I've stopped saying mean things about people in them!
So.. first get lab slip results for the test. Then call the lab and verify that it is NOT GC-MASS SPECT Verified. See if you can get it GC MASS SPECT verified.
Hurry. They won't keep the sample for a long time but they may have it. They may be able to get the verification done. It Will Be NEgative and there you go.
Alternatively, let us assume the very worst.....
There is SUBOXONE programs which have pain effect equivalent to 5 mg oxycodone 5x day. There is also methadone; do not go into a methadone program.
wow, can they even do that ?!?
Detailed Answer:
Hi,
First, the mouse immunization is how the test is manufactured. They get an immune binding protein and stick it on paper. Hopefully the drug sticks and the urine doesn't.
Second, more importantly.
http://www.hhs.gov/ocr/privacy/hipaa/faq/right_to_access_medical_records/
http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/eaccess.pdf
You Have Legal Access to Your Medical Records. I've stopped saying mean things about people in them!
So.. first get lab slip results for the test. Then call the lab and verify that it is NOT GC-MASS SPECT Verified. See if you can get it GC MASS SPECT verified.
Hurry. They won't keep the sample for a long time but they may have it. They may be able to get the verification done. It Will Be NEgative and there you go.
Alternatively, let us assume the very worst.....
There is SUBOXONE programs which have pain effect equivalent to 5 mg oxycodone 5x day. There is also methadone; do not go into a methadone program.
Above answer was peer-reviewed by :
Dr. Raju A.T
Does bariactric surgery and/or urgent incontinence, (urinating 12-15 times daily) have any negative impact on urine testing for hydrocodone, (causing false negatives because of fast rate of urine processing)?
Brief Answer:
Not a bit
Detailed Answer:
The drug is gotten rid of by the liver. The dilution of the urine will affect the concentration of the breakdown products in the urine after they get put there from liver metabolism of the drug. BUT:
1) Urge incontinence does noting to affect this; doesn't dilute the urine
2) Bariatric surgery isnt associated with any of these processes.
3) There's a real limit to how diluted you can get the urine...you can get the concentration of Whatever is in it down by 60-70% by diluting the urine 3x. BUT much more diluted than that and it won't be considered an except able urine.
Not a bit
Detailed Answer:
The drug is gotten rid of by the liver. The dilution of the urine will affect the concentration of the breakdown products in the urine after they get put there from liver metabolism of the drug. BUT:
1) Urge incontinence does noting to affect this; doesn't dilute the urine
2) Bariatric surgery isnt associated with any of these processes.
3) There's a real limit to how diluted you can get the urine...you can get the concentration of Whatever is in it down by 60-70% by diluting the urine 3x. BUT much more diluted than that and it won't be considered an except able urine.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
I have been told I have been removed from the pain management program I was in because two urine tests came back negative for hydrocodone in the combination drug with acetaminophen, (1 pill 3X daily @5-325 tb). I have been taking oxycodone as well and there is no problem there with the urine tests, (2 pills 3X daily @ 10 mg each) but they have refused to prescribe either of the meds for me. This raises several concerns for me:
1. Why not just discontinue the drug that didn't appear in the urine test? Why discontinue both?
2. Why not discuss with me alternate ways of managing the pain rather than just cut me off a drug as addicting as these? Is this standard operating procedure in these pain management programs?
3. hey sent an Rx to the pharmacy for 14 tab clonidine @ 0.1 mg 2 X daily, ( the grand equivalent of 1 week), to help me withdraw from the oxycodone that I have been taking for 14+ years, (for the last 3 years at the rate of 60 mg per day). Even the pharmacist asked if they knew what they were doing. What should they have done?
4. How do you withdraw from oxycodone / hydrocodone? How difficult is it to withdraw from these drugs? What is the usual course the withdrawal takes?
What can I expect? I've only been taking the hydrocodone for a few months but the oxycodone I have been prescribed for 14 years. How long do I need to successfully get off these drugs?
1. Why not just discontinue the drug that didn't appear in the urine test? Why discontinue both?
2. Why not discuss with me alternate ways of managing the pain rather than just cut me off a drug as addicting as these? Is this standard operating procedure in these pain management programs?
3. hey sent an Rx to the pharmacy for 14 tab clonidine @ 0.1 mg 2 X daily, ( the grand equivalent of 1 week), to help me withdraw from the oxycodone that I have been taking for 14+ years, (for the last 3 years at the rate of 60 mg per day). Even the pharmacist asked if they knew what they were doing. What should they have done?
4. How do you withdraw from oxycodone / hydrocodone? How difficult is it to withdraw from these drugs? What is the usual course the withdrawal takes?
What can I expect? I've only been taking the hydrocodone for a few months but the oxycodone I have been prescribed for 14 years. How long do I need to successfully get off these drugs?
Brief Answer:
look at your drug contract
Detailed Answer:
Murdering someone because they are black is a federal violation of civil rights; what does this have to do with you? Not one thing.
First I want to strongly state that similarly my mentioning of federal drug laws and policies implemented to comply with them is about the laws and not about you.
Second, we have outlined why you are not proven to be a drug dealer or drug addict; the tests have significant limitations. Do not take my outline of why you are being tossed out to my thinking that you are an addict or committing illegal acts. I am merely giving information about drug prescribing and drug laws that are in the US due to federal laws.
Me, and most primary care doctors have written agreements patients get outlining the rules. You certainly have received one. They can give you another or the one you already have (signed) on file.
It will say that not taking the drugs as prescribed will result in you not getting any controlled substances from the clinic. Here is why:
#1. They will be breaking the law if they do not do this and will be put in jail as drug dealers. The XXXXXXX Act of federal law states it is a FEDERAL CRIME to give drugs to people who are misusing them.
#2 Giving drugs to people who misuse them will harm people. Possibly the person getting the prescription, possibly the people they sell them to.
They have to NOT give ANY controlled substances, certainly not very very similar ones to people who have misused them.
Addicts frequently wheedle and manipulate and mis-hear simple things as part of the addiction process. Indeed, we've recently found that certain parts of the brain that determine how focussed people are on things are (temporarily) messed up from drugs of abuse making them focussed narrowly on drugs.
That would be the answer to question number one (they legally cannot give drugs to addicts).
Two and Three cannot be fully answered in your case. First, I am not answering ANY OF THIS IN YOUR CASE since I do not have you nor your records nor your criminal history if any in front of me. You could be a total drug addled fiend with a history of selling drugs to disabled children or, much more likely, you've never had any sign of addiction whatsoever and the drug test misfired once. I don't know. This is a discussion of laws and practices NOT ABOUT YOU.
So, in a situation where you find a long term patient has had a bad complication of a drug you have given that is indeed addressable (hives from penicillan). Reasonably one would be expected to treat the complication and this might include referral to a specialist (testing for penicillan allergy skin test to confirm), and giving drugs (anti-histamine) that will be helpful for symptoms and complications from the reaction. So, booting someone from a program for misusing narcotics is just messed up. It's standard practice. That's the way it's done. But it's still messed up. With real addicts I find you can outline as many wonderful treatments as you want... referrals, paid spa rehab trips to the bahamas, unlimited clonidine and narcotic blocking drugs, and they will yell, scream, report you to the board, key your car, issue death threats UNLESS THEY GET DRUGS. Sadly, not a one of these is theoretical; absolutely all have occurred This Year to me. So, it wouldn't have hurt them to offer lots of treatment to addicts, they won't take it; won't be interested in it; mostly won't even hear it.
Yes, it is indeed standard treatment, no it is not good treatment, yes there would be many many alternatives that could easily be implemented and they could even get more billables from medical insurance by doing it. Which of the many alternatives they should do, is very complicated in someone who has pain and an addiction process. If someone isn't an addict, rather simpler and doesn't need very much discussion. Might mention suboxone (buprenorphine) has a role in this but is hardly a magical pill able to take all pain away and have no addiction problem. It has equivalent to about 30 mg oxycodone per day pain effect and is a narcotic, but less likely to produce fatal escalation and overdose.
Yeah, bad treatment even for addicts, but hey, that's how things are done.
Drug withdrawal from narcotics is based on the amount of narcotics someone takes on a daily basis. If one takes 5 mg oxycodone equivalent 3x day for 1 week withdrawal is NOT expected. 30 mg a day for weeks, is about the minimum for minimal withdrawal. The amounts you are mentioning are darn close to the absolute minimal amounts of narcotic one gives. (another reason it might not show up on a drug test ?) With minimal narcotic, withdrawal is minimal and would be expected to start at 1 to 3 days without drug and to last with physical symptoms of tremor, sleep trouble, gastrointestinal twitchiness (diarrhea.. mild) some change in skin tone (cold, maybe sweats) of a mild nature for up to a week. Clonidine damps down all but 1) pain, doesn't work on pain. especially doesn't work on pain that is actually there from a disk 2) gi symptoms, 3) psychological effects of cravings, resentment, anger, frustration, focussing on narcotics. Narcotic withdrawal is very unlikely to serious injure someone. If the withdrawal were mild, theoretically from, say, 30 mg oxycodone equivalent per day the withdrawal may or may not even be noticeable and certainly wouldn't be serious, life-threatening, needing follow up.
So, I cannot and will not say in your particular case BUT being on the absolutely lowest dose of a narcotic will produce significant pain issues if there is underlying pain. It will not produce serious nausea/vomiting/diarrhea fatal dehydration. It will have complex psychological issues for..... heck... if you had a cat or a car or a fountain pen for 14 years and lost it there'd be complex psychological issues. So, coming off a drug that one's been on even if it is NOT a controlled nor an addictive substance, will produce a sense of psychological anxiety and feeling a bit at see and some sense of loss.
It's a bit of an answer on part four which is unanswerable in your particular case and very complex in the general case.
look at your drug contract
Detailed Answer:
Murdering someone because they are black is a federal violation of civil rights; what does this have to do with you? Not one thing.
First I want to strongly state that similarly my mentioning of federal drug laws and policies implemented to comply with them is about the laws and not about you.
Second, we have outlined why you are not proven to be a drug dealer or drug addict; the tests have significant limitations. Do not take my outline of why you are being tossed out to my thinking that you are an addict or committing illegal acts. I am merely giving information about drug prescribing and drug laws that are in the US due to federal laws.
Me, and most primary care doctors have written agreements patients get outlining the rules. You certainly have received one. They can give you another or the one you already have (signed) on file.
It will say that not taking the drugs as prescribed will result in you not getting any controlled substances from the clinic. Here is why:
#1. They will be breaking the law if they do not do this and will be put in jail as drug dealers. The XXXXXXX Act of federal law states it is a FEDERAL CRIME to give drugs to people who are misusing them.
#2 Giving drugs to people who misuse them will harm people. Possibly the person getting the prescription, possibly the people they sell them to.
They have to NOT give ANY controlled substances, certainly not very very similar ones to people who have misused them.
Addicts frequently wheedle and manipulate and mis-hear simple things as part of the addiction process. Indeed, we've recently found that certain parts of the brain that determine how focussed people are on things are (temporarily) messed up from drugs of abuse making them focussed narrowly on drugs.
That would be the answer to question number one (they legally cannot give drugs to addicts).
Two and Three cannot be fully answered in your case. First, I am not answering ANY OF THIS IN YOUR CASE since I do not have you nor your records nor your criminal history if any in front of me. You could be a total drug addled fiend with a history of selling drugs to disabled children or, much more likely, you've never had any sign of addiction whatsoever and the drug test misfired once. I don't know. This is a discussion of laws and practices NOT ABOUT YOU.
So, in a situation where you find a long term patient has had a bad complication of a drug you have given that is indeed addressable (hives from penicillan). Reasonably one would be expected to treat the complication and this might include referral to a specialist (testing for penicillan allergy skin test to confirm), and giving drugs (anti-histamine) that will be helpful for symptoms and complications from the reaction. So, booting someone from a program for misusing narcotics is just messed up. It's standard practice. That's the way it's done. But it's still messed up. With real addicts I find you can outline as many wonderful treatments as you want... referrals, paid spa rehab trips to the bahamas, unlimited clonidine and narcotic blocking drugs, and they will yell, scream, report you to the board, key your car, issue death threats UNLESS THEY GET DRUGS. Sadly, not a one of these is theoretical; absolutely all have occurred This Year to me. So, it wouldn't have hurt them to offer lots of treatment to addicts, they won't take it; won't be interested in it; mostly won't even hear it.
Yes, it is indeed standard treatment, no it is not good treatment, yes there would be many many alternatives that could easily be implemented and they could even get more billables from medical insurance by doing it. Which of the many alternatives they should do, is very complicated in someone who has pain and an addiction process. If someone isn't an addict, rather simpler and doesn't need very much discussion. Might mention suboxone (buprenorphine) has a role in this but is hardly a magical pill able to take all pain away and have no addiction problem. It has equivalent to about 30 mg oxycodone per day pain effect and is a narcotic, but less likely to produce fatal escalation and overdose.
Yeah, bad treatment even for addicts, but hey, that's how things are done.
Drug withdrawal from narcotics is based on the amount of narcotics someone takes on a daily basis. If one takes 5 mg oxycodone equivalent 3x day for 1 week withdrawal is NOT expected. 30 mg a day for weeks, is about the minimum for minimal withdrawal. The amounts you are mentioning are darn close to the absolute minimal amounts of narcotic one gives. (another reason it might not show up on a drug test ?) With minimal narcotic, withdrawal is minimal and would be expected to start at 1 to 3 days without drug and to last with physical symptoms of tremor, sleep trouble, gastrointestinal twitchiness (diarrhea.. mild) some change in skin tone (cold, maybe sweats) of a mild nature for up to a week. Clonidine damps down all but 1) pain, doesn't work on pain. especially doesn't work on pain that is actually there from a disk 2) gi symptoms, 3) psychological effects of cravings, resentment, anger, frustration, focussing on narcotics. Narcotic withdrawal is very unlikely to serious injure someone. If the withdrawal were mild, theoretically from, say, 30 mg oxycodone equivalent per day the withdrawal may or may not even be noticeable and certainly wouldn't be serious, life-threatening, needing follow up.
So, I cannot and will not say in your particular case BUT being on the absolutely lowest dose of a narcotic will produce significant pain issues if there is underlying pain. It will not produce serious nausea/vomiting/diarrhea fatal dehydration. It will have complex psychological issues for..... heck... if you had a cat or a car or a fountain pen for 14 years and lost it there'd be complex psychological issues. So, coming off a drug that one's been on even if it is NOT a controlled nor an addictive substance, will produce a sense of psychological anxiety and feeling a bit at see and some sense of loss.
It's a bit of an answer on part four which is unanswerable in your particular case and very complex in the general case.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you so much. Your reply has been of great help to me. I now am more aware of the issues surrounding this regrettable situation and after feeling so lost and ignorant about this predicament, I feel somewhat better mentally prepared to begin to handle what is surely coming my way. I have already tapered down from 60 mg per day to 30 mg daily and am working on going down to 20 mg and finally 10 mg before stopping completely.
I appreciate your approach in spite of the fact that you have been victimized by addicts so horribly. I am not seeking these drugs, rather I actually think it's better for me to get off this medication in spite of the severe pain I am in because I never want to go through this situation again! So I am hoping and praying I can get through this withdrawal experience successfully.
To your knowledge, what supporting medication(s), (duration and doses), and other strategies are employed by those who have successfully withdrawn from this medication? Is one week of 0.1 mg of clonidine 2X daily enough to outlast the withdrawal symptoms? When I asked the pharmacist who filled the prescription for the clonidine, after she asked if I were taking it for blood pressure or withdrawal, she remarked "Do these people know what they are doing?".
I appreciate your approach in spite of the fact that you have been victimized by addicts so horribly. I am not seeking these drugs, rather I actually think it's better for me to get off this medication in spite of the severe pain I am in because I never want to go through this situation again! So I am hoping and praying I can get through this withdrawal experience successfully.
To your knowledge, what supporting medication(s), (duration and doses), and other strategies are employed by those who have successfully withdrawn from this medication? Is one week of 0.1 mg of clonidine 2X daily enough to outlast the withdrawal symptoms? When I asked the pharmacist who filled the prescription for the clonidine, after she asked if I were taking it for blood pressure or withdrawal, she remarked "Do these people know what they are doing?".
Brief Answer:
I don't know the method
Detailed Answer:
but.... if you are taking 15 mg of oxycodone and 15 mg of hydrocodone... you'd expect about the same levels being found of each, so, the level of hydrocodone seems way smaller than the oxycodone. I can see why they might get upset by it. But I'm also not convinced that a false negative cannot occur.
I don't know the method
Detailed Answer:
but.... if you are taking 15 mg of oxycodone and 15 mg of hydrocodone... you'd expect about the same levels being found of each, so, the level of hydrocodone seems way smaller than the oxycodone. I can see why they might get upset by it. But I'm also not convinced that a false negative cannot occur.
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Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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