A rant on pain management, in this country.

[Sunshine]

I finally got some pain management. I just spent two nights in-hospital. Diagnosis-4 gastric ulcers.

As soon as my endoscopy was finished, my fiance (pissed) walked into my neurologist's office and demanded to speak to someone. The ulcers were caused by the 10-day prednisone dosage I was taking, and the massive amounts of ibuprofen I was ingesting...for pain management.

Demoral and zofran every 3 hours, IV. This controlled the excruciating pain in my gut, and while off the prednisone for 2 days, once again, I was unable to walk-due to the almost unbearable spasms in my left hip and thigh. So then the demoral was administered for the hip.

And I've FINALLY got some pain pills and an injection-in or around my sciatic nerve (geaux, you understand how that works better than I) so that I can have SOME quality of life. I don't want them for the rest of my life. Just until this flare is over with, and MAYBE I can return to work. HATE sitting at home.

That injection did an amazing thing. I can now walk heel-to-toe on my left foot again. I was having to walk toe-to-heel, and sit down every fifteen to twenty seconds.

Gosh I would love to go to medical school!

Those nerve blocks are good. But they wear off. Several years back I had rotator cuff surgery and they gave me a nerve block to incapacitate that arm. Just so happened that is the side where I have a disc bulge between C 6 and 7. Even after the arm came back to life, I had no pain in that side for months. It never really came back as bad as it was. But had the pain reverted to where it was before the block, I would have gone to a neurologist for another one. I know people who get them on a regular basis. And they get good relief from those blocks.

You can do this. I have known incredible pain in my life. It would have been oh so easy to just yield to narcotics. I'd probably be dead by now though. But I wanted more out of life than drugs.

I believe you have a protected disability. Keep the job as long as you can. When you no longer can do the job, look in other directions. You have to be in good health to go to medical school, but there may be something else. Just remember that MS is a disease that is often in a state of flux. There can be remissions. Hope for the best.

I don't know which government you work for but in TN the state has a great plan. I'm guessing Metro probably does as well. When I was teaching, I took a 65% pay cut to teach rather than practice in order to have more time for law school. Since I wasn't making much I took the best plan they had a 90/10 PPO. I had 2 major surgeries under that plan. $1300 dollars out of pocket was all I had to pay and I only got that high on the second one. It was way better than what I have now which is $5000 out of pocket before everything goes to 100%.

 

[Gagafritz]

I am in no way advocating any illegal practice whatsoever and how dare you would imply that i do. There are people with real pain syndromes that do present to ERs and that are treated by ER physicians and that is in no way "illegal". If you wish to assume that every patient presenting to the ER is a drug seeking Ahole, then i guess that is your perogative.

 

[Gagafritz]

Really. I am not sure how advocating treatment of people in pain elicits such an angry reaction from you. No doubt there are people who abuse the system. It comes with the territory. But, would you rather err on the side of giving an addict their fix versus assuming someone is lying? Obviously, clinical judgement comes into play but i wonder why you seem so angry about this?
As for how i "sound" i am not sure why that is a concern to you or am i not entitled to voice my opinion or what? You seem like the one with a chip on your shoulder.

 

[OohPooPahDoo]

Geaux, are you an LSU grad? My fiance is LSU through and through!

B.S. LSU 2000
Ph.D. LSU 2011

GEAUX TIGERS

 

[OohPooPahDoo]

I would just like to rant about the current status of pain management in the USA!

Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011. I'm not looking for pity; and this is totally not the point of this thread.

What I am PISSED about, is the the quality of pain management that we as patients receive.

For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares". Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.

I recently had a flare that lasted for 7 days. My left hip began to spasm on New Year's night. I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg. I couldn't walk when they would start. I found myself on the bathroom floor three nights in a row, unable to walk back to bed. The pain was excruciating, that I thought I'd fractured my hip, spontaneously. Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few. (TMI? Okay....I'll get to the point.)

3 days into this, I finally contacted my neurologist. Pain medication? No. Even though I was biting my lip not to scream on the phone. I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there. And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations. I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort. Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned. Gee thanks, doc.

I received the infusions, which stopped the contractures. And now, it feels like I've spent a week hiking and rock climbing. And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days. I was in fantastic shape before all this began. Also, rheumatoid arthritis hasn't been ruled out, yet. We're just trying to halt the (MS) disease process, right now. One lesion on my cervical spinal cord is enough.

And finally down to the point of this entire thread:
The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions). I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well. This didn't even strike a c-major in this woman. "Well......Dr. (no giving name) wants to try botox injections."

I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever. Nope. SOL and JWF!

I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for. Nothing more. Nothing less. I wasn't asking for 90 oxycontin, or 50 fentanyl patches. This is the FIRST time I have asked for something narcotic-wise since this disease process began. And now, I feel like a criminal. I have been referred to a "pain clinic". I find that very insulting. All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities. I'm getting physical therapy, trying to exercise...doing all the right things.

I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell. Has it ever crossed your minds to get off your duff and get a job.....do something with yourself? You make me sick to my stomach.

What do I do? Write my representative. My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.

So what if you have bulging disks in your lower back. I have 2, and have managed to work...FOR YEARS....without pain medication or disability. Now, I have a true disability, with occasional disabling pain, and I can't get the help I need. Life is not fair...but this is BEYOND UNFAIR. Just 10 pills please, doc. That's all I'm asking.

Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.

I think you will find this relevant:

SACRAMENTO, Calif. (AP) -- The first U.S. clinical trials in more than two decades on the medical benefits of marijuana confirm pot is effective in reducing muscle spasms associated with multiple sclerosis and pain caused by certain neurological injuries or illnesses, according to a report issued Wednesday.

Marijuana Provides Pain Relief, New Study Says

If I weren't a licensed healthcare provider, I would definitely try marijuana. But if I were to test positive for that on the job, my career in healthcare would be over.

I believe that it probably does make one feel better. Although, injections into the sciatic (sp?) feel awesome too! I got my first today. It's working very well.

Jeez, how often do they test you? That's fucked up. I'm sorry to hear that. I think the pot would really help you.

Move to California.

World's a messed up place. Here we have a drug that is a) all natural b) easy and cheap to produce c) effective at treating a wide variety of problems (including MS) d) has very few negative side effects - and someone with MS can't use it.

Many of its medicinal effects can be felt long before one gets really "stoned", too. E.g. nausea. My brother got married this past October, and I got way too drunk at the wedding. Woke up nauseated out of my mind, couldn't sleep because of it. I lingered in misery for hours, then remembered I had some pot. I took one hit - didn't even get high - and the nausea went away almost instantly. Went to sleep almost right away.

 

[Sunshine]

I am in no way advocating any illegal practice whatsoever and how dare you would imply that i do. There are people with real pain syndromes that do present to ERs and that are treated by ER physicians and that is in no way "illegal". If you wish to assume that every patient presenting to the ER is a drug seeking Ahole, then i guess that is your perogative.

And you have disagreed with the LEGAL ways that chronic pain is treated as put forth by myself and gaux. Of course you are advocating something illegal. You don't like the way it's done legally.

 

[Sunshine]

Really. I am not sure how advocating treatment of people in pain elicits such an angry reaction from you. No doubt there are people who abuse the system. It comes with the territory. But, would you rather err on the side of giving an addict their fix versus assuming someone is lying? Obviously, clinical judgement comes into play but i wonder why you seem so angry about this?
As for how i "sound" i am not sure why that is a concern to you or am i not entitled to voice my opinion or what? You seem like the one with a chip on your shoulder.

Angry? Gaux or me? LOL. WE are not the ones posting in huge letters and arguing for something illegal. We tell you the way it is and you argue with it. Sorry you don't like it. But that's how it is.

 

[Gagafritz]

What am i arguing for that is illegal that you are accusing me of? Exactly what did i say or what is "illegal". An ER physician can legally prescribe and give medications for conditions that warrant whatever drug and condition they are treating. I didn't say that ERs should be a 24/7 pharmacy for whomever and whatever. If that is what you think i am saying then you can't read. And, again, i really dont' know why you are so defensive about it. I certainly didn't say give anybody anything they want whenever they want it, so grow up.

 

[Gagafritz]

Really. I am not sure how advocating treatment of people in pain elicits such an angry reaction from you. No doubt there are people who abuse the system. It comes with the territory. But, would you rather err on the side of giving an addict their fix versus assuming someone is lying? Obviously, clinical judgement comes into play but i wonder why you seem so angry about this?
As for how i "sound" i am not sure why that is a concern to you or am i not entitled to voice my opinion or what? You seem like the one with a chip on your shoulder.

Angry? Gaux or me? LOL. WE are not the ones posting in huge letters and arguing for something illegal. We tell you the way it is and you argue with it. Sorry you don't like it. But that's how it is.

What i "like" or don't like i really don't get your point. I am talking about adequately treating pain. I find it interesting that you are trying to imply that i am a drug seeker or whatever. I don't take pain pills or have pain so whatever you are trying to accuse me of is BS. But, apparently that is your approach to your patients and that is too bad.

 

[geauxtohell]

What suprises me is that i am arguing for adequate treatment of pain and the realization that some people do present to the ER with pain and for some reason this is viewed as controversal and met with hositility. And, there are lots of providers who are hostile and supsicious towards patients. Sometimes rightly so. But, there are also a host of mental health issues that we simply choose to ignore and not address. And, i think untreated mental illness is often and underlying factor because of the stress and distress it causes and the stigma so people do the only thing they can do which is self medicate. And for those with inadequately treated pain, what else do doctors expect them to do? Yeah, they are going to drink alcohol and/or show up in the ER when they can no longer stand it. Funny how things like West Nile virus and Lyme's disease and other illnesses were all in your head until somebody did enough research to come up with tests to prove these things were real. But, i am sure there was a lot of untreated pain and suffering prior to those things being diagnosed because they weren't real until there was a test to prove it was.

It's Lyme Disease, after Lyme Connecticut. Pain is a symptom. Pain should be addressed in the ED, however, the issue is the underlying problem that is causing the pain.

Treating chronic pain that is known to the patient and has been adequately worked up and is not an emergent condition is not what the ED exists for. I have not claimed that people should suffer. I claimed that people need a primary doctor to manage that condition.

There are obviously exceptions. I've seen patients with terminal metastatic cancer be admitted for pain control. That's obviously different than the patient with a bulging disk who presents for pain control because they burned through their norco prescription.

 

[geauxtohell]

I finally got some pain management. I just spent two nights in-hospital. Diagnosis-4 gastric ulcers.

As soon as my endoscopy was finished, my fiance (pissed) walked into my neurologist's office and demanded to speak to someone. The ulcers were caused by the 10-day prednisone dosage I was taking, and the massive amounts of ibuprofen I was ingesting...for pain management.

Demoral and zofran every 3 hours, IV. This controlled the excruciating pain in my gut, and while off the prednisone for 2 days, once again, I was unable to walk-due to the almost unbearable spasms in my left hip and thigh. So then the demoral was administered for the hip.

And I've FINALLY got some pain pills and an injection-in or around my sciatic nerve (geaux, you understand how that works better than I) so that I can have SOME quality of life. I don't want them for the rest of my life. Just until this flare is over with, and MAYBE I can return to work. HATE sitting at home.

That injection did an amazing thing. I can now walk heel-to-toe on my left foot again. I was having to walk toe-to-heel, and sit down every fifteen to twenty seconds.

Gosh I would love to go to medical school!

This goes right to the heart of "pain is a symptom and should be worked up and not simply have pills thrown at it".

I am glad the injection helped you. I hope it lasts for several months. I am also glad you got adequately treated. I know NSAIDs are famous for causing gastric ulcers (because they inhibit prostaglandin production, and prostaglandin is protective to your stomach). I didn't know that steroids had an effect on that. I'll have to look into that.

At any rate, I am glad you feel better.

 

[geauxtohell]

Geaux, are you an LSU grad? My fiance is LSU through and through!

No, I went to Tulane for undergrad. The name is kind of an inside joke.

My wife got her Master's from LSU, but I have no connection to the school at this point.

 

[mskafka]

Geaux, are you an LSU grad? My fiance is LSU through and through!

No, I went to Tulane for undergrad. The name is kind of an inside joke.

My wife got her Master's from LSU, but I have no connection to the school at this point.

My SO was a pharm instructor at Tulane years ago.

 

[mskafka]

I remember at 8 years old, I wanted to be a physician more than anything in the world; and this was a possibility, as I was a "gifted" child. Parents divorced...fell into the wrong crowd.

Some of my fellow students went on to pre-med after paramedic school. I think one has actually made it to med school. Would've, should've, could've. Maybe PA school.

 

[mskafka]

So you must be a medical student now. I can't imagine that as a resident you would have time to blink or breathe, let alone be posting in here. Unless some things have changed; which rumor has it that it has. That's a good thing. A physician who hasn't slept in 30 hours is a menace to society.

 

[Sunshine]

Really. I am not sure how advocating treatment of people in pain elicits such an angry reaction from you. No doubt there are people who abuse the system. It comes with the territory. But, would you rather err on the side of giving an addict their fix versus assuming someone is lying? Obviously, clinical judgement comes into play but i wonder why you seem so angry about this?
As for how i "sound" i am not sure why that is a concern to you or am i not entitled to voice my opinion or what? You seem like the one with a chip on your shoulder.

Angry? Gaux or me? LOL. WE are not the ones posting in huge letters and arguing for something illegal. We tell you the way it is and you argue with it. Sorry you don't like it. But that's how it is.

What i "like" or don't like i really don't get your point. I am talking about adequately treating pain. I find it interesting that you are trying to imply that i am a drug seeker or whatever. I don't take pain pills or have pain so whatever you are trying to accuse me of is BS. But, apparently that is your approach to your patients and that is too bad.

Well how about this: How about you just go enroll in school now to be an MD or NP. You can be an MD in 8 years and an NP in 7. OR you could throw in another 3 or 4 and get a law degree as well like I did. THEN you could stake YOUR OWN license on your theories.

 

[Sunshine]

So you must be a medical student now. I can't imagine that as a resident you would have time to blink or breathe, let alone be posting in here. Unless some things have changed; which rumor has it that it has. That's a good thing. A physician who hasn't slept in 30 hours is a menace to society.

I think you are right. Last I heard the VA in Nashville had put their NPs in charge of the psych units and freed the residents up so they could learn and not just be slave labor. I heard everyone was loving that. Especially the patients.

 

[geauxtohell]

I remember at 8 years old, I wanted to be a physician more than anything in the world; and this was a possibility, as I was a "gifted" child. Parents divorced...fell into the wrong crowd.

Some of my fellow students went on to pre-med after paramedic school. I think one has actually made it to med school. Would've, should've, could've. Maybe PA school.

I went to med school after a change of careers. It's doable. The hardest part is getting in. After that, it's hard, but statistically the odds are in your favor,

 

[Sunshine]

I finally got some pain management. I just spent two nights in-hospital. Diagnosis-4 gastric ulcers.

As soon as my endoscopy was finished, my fiance (pissed) walked into my neurologist's office and demanded to speak to someone. The ulcers were caused by the 10-day prednisone dosage I was taking, and the massive amounts of ibuprofen I was ingesting...for pain management.

Demoral and zofran every 3 hours, IV. This controlled the excruciating pain in my gut, and while off the prednisone for 2 days, once again, I was unable to walk-due to the almost unbearable spasms in my left hip and thigh. So then the demoral was administered for the hip.

And I've FINALLY got some pain pills and an injection-in or around my sciatic nerve (geaux, you understand how that works better than I) so that I can have SOME quality of life. I don't want them for the rest of my life. Just until this flare is over with, and MAYBE I can return to work. HATE sitting at home.

That injection did an amazing thing. I can now walk heel-to-toe on my left foot again. I was having to walk toe-to-heel, and sit down every fifteen to twenty seconds.

Gosh I would love to go to medical school!

This goes right to the heart of "pain is a symptom and should be worked up and not simply have pills thrown at it".

I am glad the injection helped you. I hope it lasts for several months. I am also glad you got adequately treated. I know NSAIDs are famous for causing gastric ulcers (because they inhibit prostaglandin production, and prostaglandin is protective to your stomach). I didn't know that steroids had an effect on that. I'll have to look into that.

At any rate, I am glad you feel better.

Exactly. Here I sit having degenerative arthritis of the spine since I was 40, a hysterectomy in 81, rotator cuff in 06, and two knee replacements. And a poster talking to me like I have never even heard the word pain. I have had patients with just the spine problem on morphine through their PC providers. And here I am at 64, never having taken any kind of opiate long term. I have used holistic therapies like massage, good chairs, and a super expensive mattress for the spine thing. I still have pain, but it is bearable and I stay busy as a distraction. And I have had an active and full life. And you know the new disease I have now, not painful but debilitating, but I'm still in the swim. There is SO much more to life than pills. But to some people pills are the easy way when in fact they are the deadly way. If one does manage to survive by some miracle they have no life BUT pills! IMO that's no life and I would rather be pushing up daisies!

And steroids can lead to a GI bleed. I had a coworker yesterday ask me about a symptom I won't mention. She was on 3 medicines that can do that, steroids being one. I referred her to her medical provider ASAP.

 

[Sunshine]

I remember at 8 years old, I wanted to be a physician more than anything in the world; and this was a possibility, as I was a "gifted" child. Parents divorced...fell into the wrong crowd.

Some of my fellow students went on to pre-med after paramedic school. I think one has actually made it to med school. Would've, should've, could've. Maybe PA school.

You might want to think NP. PAs have to retest every 6 years. I know one who didn't make it the last go around and she had been one for several years. NPs recredential every 5 years by getting CMEs.