Right Facet Block

[Cindylou]

Good morning all,

I met with pain management the other day for my monthly re-check. Now I meet with the nurse practioner, not the Dr. anymore, but I reviewed what happened at my appt. with the SI Joint surgeon, him saying my right SI Joint was fused, and how could the pain doc inject the joint when there was no joint left, blah, blah, blah. She said she would talk to the doctor about that. Meanwhile, my pain levels have not been good so we discussed my facets. I know they are arthritic, but I haven't had a lumbar MRI in a few years, so not sure how arthritic they are. We agreed a right sided facet block would be a good next step. My insurance is such that before I can have facet cauterization, I have to have a series of 2 blocks, spaced a few weeks apart, then that is submitted to insurance, and hopefully, I will get approval for the rhizotomy. So, my first block is tomorrow. Have to have a driver again. Running out of friends to ask for rides. Meanwhile, I managed to lose a script the nurse practioner wrote out for my fentanyl patches when I went in to see her 2 weeks ago to schedule the SI joint injection. I didn't know why she wrote it out, because I had enough till my regular appt. which was this week, and I was in the midst of all the grief with my bestfriend dying......so I think I accidentally threw it away. I remember first tucking the script in the box with my other patches, now it's not there. I just had too much going on, and of course they don't refill lost scripts, so I am without any fentanyl patches for the next month. She did refill my oral meds, so that's good. What a mess. I will keep you posted if I get any relief from this block on my right facets. Sure hope so.

[KBear]

Oh my, so sorry you lost your script I was always terrified that I would lose or misplace mine back when I had them on paper. Seems like they could check with the pharmacy and see that you didn't fill it and replace it, especially since this hasn't happened before.
I hope the facet injections give you some lasting relief.

[Cindylou]

They did check with the pharmacy and they show it hasn't been filled, but still their policy, unfortunately. I do get where they are coming from though. I think I accidentally threw it away....I am so pedantic with things, sometimes I am my own worst enemy.

[Gilbert P]

Hi CL

I always have my Doc Call or email my script to the pharmacy and its ready when I pick it up. I have lost several scrips this is why they call it in .
I am a space shot and always loose important papers.
Like loosing my first wedding ring

All The Best

Gil

[KBear]

Hi CL

I always have my Doc Call or email my script to the pharmacy and its ready when I pick it up. I have lost several scrips this is why they call it in .
I am a space shot and always loose important papers.
Like loosing my first wedding ring

All The Best

Gil

Certain scripts for the stronger drugs (Fentanyl, Oxycodone, Morphine, etc.) have to be on paper and can't be called in- at least in Texas that's how it is.

[Justin]

CL, good luck with the injection and sorry about the script.

______________________________

Schedule II medications include morphine, oxycodone, codeine, hydromorphone...(vicodin [acetominophen + hydrocodone] is a Schedule III)

Protocol: Schedule II Narcotic Prescriptions (DEA regulations, States may have additional rules)

• Pharmacy must receive an original signed prescription before dispensing
• Prescription may not be changed by pharmacist on contacting provider for clarification
• Exceptions in which alternative to original prescription is acceptable
• Fax is sufficient in long term care patients, Hospice patients, or parenteral Narcotics
• Limited quantity emergency prescriptions may be phoned to pharmacy
• Require that pharmacy receive original signed prescription within 7 days
• Prescription may cover up to 90 day supply
• Total of 90 day supply may be split over multiple prescriptions (e.g. 1 month each)
• Each prescription must have the date today (not post-dated) and an earliest fill date
• Partial filling of prescription is allowed for terminally ill and long-term care patients

References
(2008) Prescriber's Letter 15(1):1
FDA Rule: Issuance of Multiple Prescriptions for Schedule II Controlled Substances
Rule - 2007 - Issuance of Multiple Prescriptions for Schedule II Controlled Substances

[Cindylou]

Yep, thank-you all. Yeah, the doctor can't call the script in Gil for fentanyl patches, unfortunately. Opiate scripts have to be hand delivered and original copies. I just wish she hadn't written it out early. I was in the midst of my friend dying, and I should have just handed it back to her, but that's why they call it grief and suffering.....you just really aren't thinking clearly.....and remember, I wasn't sleeping either.

[Cindylou]

Ok, so I had my right facet block, 3 different needle entries, this afternoon....and it was so frickin' painful I was screaming! I had no idea it was going to be so torturous! Unbelieveable. I wasn't allowed to take any pain meds all day either before it. I have to go through this same process 2 weeks from today and have another right sided block, and I am going to definitely ask my pain doc for a script of sedation. My pain doc didn't do it. He sent me to CDI (Center for Diagnostic Imaging) and I had it done there with a radiologist. The good news is I got incredible relief after wards, so my facets are clearly a culprit, at least on my right side. But I am not going to go through that again without sedation. Way too painful. And a solid 15 minutes of it. I was swearing and biting the pillow and trying to scream into the pillow. I was not prepared for how painful it was going to be. The lidocaine lasted a good hour, great relief, and poof it was gone. ....at least I know a solid pain generator.

[Greg]

CL,

Hell of a ride you've been on the past few days. I am SOOOO sorry about your missing script. I hate how pain management offices have such strict rules and policies that have little to no room for exceptions when things like this happen. Reading about the troubles and bumps in the road you are hitting remind of the stuff that happened to me a little less than a year ago. I would be the person to lose a script....I think about a month and a half before my surgery I was 2 weeks into my monthly scripts which for some reason I had sitting on the edge of the counter in the bathroom. I couldn't believe it happened but somehow they got knocked into the trashcan next to the counter and that trash taken out shortly after without noticing and of course the trash truck came several hours after that. Everything lined up and played out perfectly for a horrible disaster to happen and my pain meds were thrown away and gone. I called the doc to explain what happened freaking out on the phone because I remember from pain management (which thank god I wasn't at) that the contract stated they would not replace lost medication. I kept apologizing to the nurse asking what I could do because I thought I was screwed but to my amazement they were perfectly ok with writing a new script and talking to the pharmacy to make sure my insurance would pay for it. I couldn't believe it. I guess having a good clean established history with the doctor proved that I wasn't abusing them and they trusted me....THANK THE LORD FOR THAT But I know how you feel because I knew for sure they wouldn't be able to refill them but I got lucky....FOR ONCE IN MY LIFE!

Have you tried talking to your doctor to see if maybe they could prescribe you something different to take the place of the fentanyl patches? I'm sure you've tried it all but had to throw it out there. Obviously you have proven yourself to be going to pain management to try and fix the issue and not just get pain meds and the pharmacy confirmed you didnt fill it so one would think that even though policy says they cant rewrite the script but what about writing something different? I hope the best for you and am so grateful you got some relief from the facet block. I remember reading an article around a month ago talking about the facet blocks and how most insurance or doctors require you get 2 blocks to receive the treatment you are seeking when the study showed that the required blocks werent completely necessary and most of the time just add cost to getting pain relief. Here's the article if you care to read and havent already. Diagnostic Medial Branch (Facet Joint Nerve) Block Treatment Paradigms before Lumbar Facet Radiofrequency Denervation Hope you can get something squared away with the doctor, get sedation for the next treatment, and manage the next month without ridiculously crazy pain

[Cindylou]

Thank you Greg for your support. I really haven't tried any other avenue to replace the fentanyl patches. I truly understand where a pain management clinic is coming from about not refilling lost, misplaced scripts. I know the nurse practioner believed me, it's just the rule. Unfortunately, addicts ruin it for the true pain relief seekers. The nurse practioner told me that another patient, an older lady, came in and one of her visiting adult children stole 42 of her pain pills! Outrageous! Can you imagine? She doesn't even know which one, because apparently all three of her grown children were visiting. My thought was: is there not 1 black sheep? Sad that you would suspect any of the 3. Very sad. And of course they couldn't replace them. Thanks for the article Justin had previously posted. Yes, amazing at the cost difference. I sure hope my insurance will approve the facet rhizotomy since we now know it's a definite pain generator. How are your pain levels holding up Greg? I have been thinking of you......