A rant on pain management, in this country.

[MikeK]

[...]That is wrongheaded thinking. The issue is not the "pain", it's what is causing the pain. No physician should simply treat "pain". Pain is a symptom of an underlying problem. So if you are treating pain, you should be doing the appropriate tests to address the underlying etiology behind the pain.

[...]

So I will assume you, as a GP, would refer my condition (cervical stenosis) to an orthopedic surgeon, who probably would decide to operate -- mainly because it is me who is at risk of paralysis, not him, but also because he needs a new swimming pool.

Am I correct? Or is there another treatment for my condition which my present GP isn't aware of?

My present GP is an Indian woman who is adamantly opposed to spinal surgery at my age and for my condition. We've tried Cymbalta but it caused severe constipation, so that's out.

 

[geauxtohell]

She's willing to try anything that works.
it's just that when you show up at the ER asking for something for pain there's that "look".
Sometimes there's a rude dismissal to go along with it......

No offense, but that's because she is misusing the EMERGENCY room as a primary care center. That pisses off every EM physician.

In doing so, she is putting the EM doctor in an untenable condition: Let her leave while suffering or be force to mismanage her medical condition with narcotics. Since EM doctors don't have their own patients and don't do follow up, they aren't going to start her on a long term medication like an SSRI or pregabalin.

Your daughter needs to establish care with a primary care physician for long term management of her chronic condition so that it can be adequately managed. Since EM physicians are required by law to give patients a follow up appointment with a PCP, I can't imagine they haven't tried to do this.

No job, no income, and nobody wants to piss with share-cost medicaid.
I've tried to get her to at least go to the county health dept.
She's too deep into the pill-mill culture, though.

So, since your 35 year old daughter can't afford to establish care at a PCP, she uses the ED as her primary care center?

Tell me there isn't a healthcare problem in this country.

 

[geauxtohell]

[...]That is wrongheaded thinking. The issue is not the "pain", it's what is causing the pain. No physician should simply treat "pain". Pain is a symptom of an underlying problem. So if you are treating pain, you should be doing the appropriate tests to address the underlying etiology behind the pain.

[...]

So I will assume you, as a GP, would refer my condition (cervical stenosis) to an orthopedic surgeon, who probably would decide to operate -- mainly because it is me who is at risk of paralysis, not him, but also because he needs a new swimming pool.

Am I correct? Or is there another treatment for my condition which my present GP isn't aware of?

My present GP is an Indian woman who is adamantly opposed to spinal surgery at my age and for my condition. We've tried Cymbalta but it caused severe constipation, so that's out.

Not at 75. There is a world of difference between a 75 year old with a high spinal cord lesion and a 45 year old with the same.

 

[geauxtohell]

[...]

[...]There is no way in hell I am going to facilitate a patients early demise due to respiratory failure from opium or liver failure from the shit ton of tylenol they are co-ingesting.[...]

[...]

Your reference to co-ingestion concerns me because the makers of both hydrocodone (Vicodin) and oxycodone (Percocet) add acetaminophen (APAP - Tylenol) to this narcotic, which might soon be affecting my requirements.

While my daily limit of either narcotic is 10 mg. I'm forced to co-ingest either 700 mg. APAP with oxy or 1G APAP with hydro. I'm on the safe side because I'm well under the dangerous dose level of APAP, which is 4G. But what if my condition worsens, which it is sure to do, and/or my tolerance for oxy or hydro increases and I need more?

The only alternative treatment for my condition is surgery, which my GP (and another) believe is extremely risky because of the position of the growth within the vertebra. So it seems that unless I die within the next few years I'll be banging heads with these goddam DEA constraints on the medical profession and the legitimate distribution of narcotics.

Yeah, I know. I don't think people are aware of the fact that they are ingesting tylenol on a chronic basis. Again, these pills were never intended to be long term pain management regimens.

I don't have an answer to your question. I would abstain from alcohol and ask your doctor to check your liver enzymes periodically.

I would also think you would have a hard time convincing a neurosurgeon to operate on you at 75. It's a risk/reward thing.

 

[geauxtohell]

The tread is about how the government interferes in medical choices involving pain meds.

Not really. You are trying to make it about that, but that was never the OPs complaint. You perceive that her physician won't give her narcotics because the DEA is up their ass with a microscope.

Do you honestly think that the first thing you learn in an ER would be about addicts scamming you to get drugs if it were all drugs, even addictive ones, were legal?

That's a separate issue. As it stands, I have my doubts that drugs are going to be universally legalize in the next decade, so the problem still stands.

Why sin't cocaine, one of the best pain meds known to man, legal to prescribe?

What? Cocaine has no analgesic properties. It is an effective local anesthetic. Using it for systemic pain is absurd.

As it stands, it is used medically for what it is indicated for: local anesthesia - like all the alkaloid anesthetics that end in -caine (i.e. lidocaine, bupivocaine, etc).

Is there a medical reason not to use it in cases where it would clearly be effective?

No. That is not pain management. See above. Other than that, "getting high" is not a medical indication.

Why does the DEA and the FDA insist that there are no medical uses for marijuana at all? Do you think some pain patients would be better off if marijuana was legally available to everyone? Do you think the OP might be better off with marijuana to help manage chronic pain?

Yes. That's a separate issue. If I were in charge of the world, I just skip the canard of medical marijuania and legalize it. Before you ask I would not legalize cocaine, opiates, or amphetamines that carry the potential for acute overdose.

Please, tell me again I am just wrong about the problem being the government.

In regards to narcotic pain pills, you are wrong.

I do not have access to medical journals, but I do appreciate the way you are trying to assert your authority instead of actually addressing the issues. Do you dispute that some doctors would rather give addicts a fix than see them steal, or murder, to get one?

Oh lord....... You have access to google, right? I am not trying to "assert" anything. Medicine is an "evidence based" venture. That means decisions are made, not on what you or someone believes in their gut, but on what the research shows. I am not being snooty or flippant, I am asking if you can produce a shred of evidence beyond your opinion that would make me reconsider what I have been taught or researched myself.

That is addressing the issue in an academic matter. If we were on medical rounds, the standard would be the same. Stomping your feet and insisting that you are right and I am a dick is not.

I am not disputing that physicians do the wrong thing. I am just pointing out it's the wrong thing. We frequently have patients who try and extort pain pills by saying the same thing: "I am just going to get them off the street". That statement will turn even the most pain-pill liberally minded doctor into a draconian and you can bet your ass we are going to document that statement and that patient isn't going to get any pain meds from any provider with access to our records again.

I do not need help dealing with chronic pain, I learned all I need to know over the past 20 years. What i need, occasionally, is access to opiates to deal the the acute pain that occurs without someone telling me I need to learn to manage chronic pain I already manage. I also know people who are in acute pain on a chronic basis, and they need your advice even less than I do.

You still aren't grasping the point I am making about using narcotics on a chronic basis (i.e. daily for years) versus occasionally for acute pain.

Are you denying that some doctors are more sympathetic to patient than others?

Capitulating to a patient's every wants and needs isn't "sympathy".

 

[Kooshdakhaa]

Last time I had any pain pills was when I had a root canal. I got the prescription filled and then read the warnings. No way would I take those pain pills after I read the possible side effects. Called the dentist and told him. He said I needed to take them for the inflammation. I said what about Bayer aspirin. He said okay, so that's what I took. Put the pain pills in my emergency survival kit.

However, the pain wasn't that bad. If a person is in a lot of pain they deserve to have relief. That is for sure. But rather than take those nasty pain pills my whole life I would sure be exploring other ways of managing pain. Someone I knew was paralyzed from the waist down, yet he had terrible pain in his legs. Ghost pain, I guess, but very real to him. He told me that out of desperation he had finally learned to block the pain out of his mind. What power that would give a person, if they could learn to block pain that way. Much better than pain pills.

Ever read about the side effects of aspirin?

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Aspirin:

Heartburn; nausea; upset stomach.

Seek medical attention right away if any of these SEVERE side effects occur when using Aspirin:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; confusion; diarrhea; dizziness; drowsiness; hearing loss; ringing in the ears; severe or persistent stomach pain; unusual bruising; vomiting.

This is not a complete list of all side effects that may occur.

They are required to list side effects by law. You did not need the pills, which is great, but not taking them because you are afraid of a side effect is a bit like not leaving the house because people get hit by cars. IF you get one of them worry, otherwise take the pills if needed.

Yes, I am aware of the side effects of aspirin. I think it's pretty obvious that I'm the type of person who reads labels. I am not allergic to aspirin, so that isn't a problem. As for the other possible side effects, I've never had so much as an upset stomach from taking aspirin. Even so, I take it rarely.

If I hadn't read the side effects, I probably would have just gone ahead and taken those pain pills. which is what most people probably do. But that would have been ridiculous...I didn't need them.

I'm not the kind of person to gaze with wide-eyed trust at my doctor while he writes prescriptions for me. I had a doctor give me a free sample of Welbutrin to take because I have panic attacks. He said if I "like it" he'd write me a prescription. I didn't take them, I did some research first. Came to find out that Welbutrin makes many people's panic worse! Thanks, Doc, but no thanks. I've learned to manage the panic on my own, without drugs.

 

[merrill]

Once you need pain pills even for a legitamite medical condition, you become labeled as a drug seeking ahole addict. Doesn't matter that you need them to get up and function, that it allows you to continue to be a contributing member to society or whatever. There is a lot of phony lip service give to pain management. And, some types of pain seem more real or legitimate than others. If you have fibromyaligia or other type of harder to pin down pain , then it must not be real cuz other people have never experienced. It is pretty obvious why we have rampant alcohol and drug addiction in this country because many people are just trying to do whatever they can do to suffer through the day. Even billionaire Michael Jackson couldn't find relief for his condition without going to drastic extremes. if someone would have truly helped him medically deal with his condition and given him adequate and proper medication he would still be here today as well. I can see where people just give up and find solace in the bottom of a bottle. Sad but reality.

Becoming strung out on pain medication can come quick so all must approach pain accordingly.Then again no one should be left alone lying on a floor due to a medical condition = very risky business.

However the person opening this thread should have zero qualms about using the ER.

This situation could develop into a much more intense problem perhaps even bringing on seizures thus compounding a not by choice problematic lifestyle.

 

[Sunshine]

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.

Is your MS being treated appropriately? Have they given you anything like Baclofen? Or a beta blocker or seizure medicine for the fasciculations? Maybe you should change neurologists. I don't know who your employer is, but you need to contact your benefit person and let them know you aren't getting the services you need.

 

[Sunshine]

I think you should go to the pain clinic. What's your problem with the pain clinic?

That's the purpose of a pain clinic...managing pain. You should at least give it a try.

What happens with other people suffering from MS? Do they also have pain? How is it treated? Sounds like a forum for people with MS might provide you with some help and answers. Maybe?

There is a stigma attached to pain clinics. I'm just recalling how many people I've intubated and treated from OD's from pain clinics. In THIS state, they are considered legal drug pushers; and this area....not very highly respected.

I have and do belong to an MS forum/chat. The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue. I'm here, because this to me, is a political issue. And because I belonged to this forum LONG before I was diagnosed with MS.

And yes, I'm totally with Ron Paul on the "War on Drugs". I believe it has been a disaster. Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).

And no, it's not constant pain. But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore. This makes perfect sense to me.

Now there is constant numbness in certain areas, but pain? Only after a flare. And it sux.

There are non narcotic drugs that will help the muscle contractions. Aren't they giving you anything for that?

I go to Vanderbilt for this illness I have. Have you been there?

I understand what you mean about the pain clinics, though. When I was practicing in Nashville, one of them called me up and insisted that I guarantee that the patient they were seeing would not kill herself with her pain medicine. LOL. I just laughed, but sent a statement that there is no guarantee that anyone will not suicide, but the patient did not have any drug abuse history, was not suicidal, nor psychotic.

 

[Sunshine]

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.

I don't know why they wouldn't give you Ultram.......... It's non-narcotic.

Other than that, you've hit the nail on the head. If you think the current crop of doctors is bad, wait until my generation gets in there. We've been conditioned (by drug seekers) to hate narcotic pain pills. You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam. Why? Because shit bags prick their fingers to contaminate their urine to malinger.

Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.

Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.

FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.

Ultram is a synthetic narcotic, and it is a schedule drug. Didn't start that way, but is now.

 

[Sunshine]

I don't know why they wouldn't give you Ultram.......... It's non-narcotic.

Other than that, you've hit the nail on the head. If you think the current crop of doctors is bad, wait until my generation gets in there. We've been conditioned (by drug seekers) to hate narcotic pain pills. You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam. Why? Because shit bags prick their fingers to contaminate their urine to malinger.

Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.

Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.

FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.

Unfortunately, the government does not agree with you. This is the same government that some people want to trust with health care.

Doctors have a lot of latitude to prescribe medications and no one is going to get in trouble for using narcotics for pain control when it's legitimately indicated. The physicians that get in trouble are the ones that are completely loose with their script pad for several patients.

This isn't a government regulation issue. It's an issue of narcotics having a horrible rap now due to all the drug seekers.

When NPs got authority to order schedule drugs, I had to go to a DEA workshop. At that workshop they told us that more providers lose their licenses over stimulants than any other drug. There is a law which prohibits giving narcotics to known drug abusers. Some do, but they make it really clear that the risk of not giving it outweighs the risk of giving it.

 

[Sunshine]

Would you like to bet on that? If no one is get in trouble for the legitimate use of painkillers why are doctors offices being raided? Why are pain patients in prison for using prescription medications?

Port Townsend clinic reopens after search by drug agents -- Port Angeles Port Townsend Sequim Forks Jefferson County Clallam County Olympic Peninsula Daily news

Punishing Pain - New York Times

The problem with your statement is that the government has a different idea of a legitimate need than some doctors, and juries tend to side with the government in cases like the ones above. You are a doctor, you need to educate yourself on the realities of government response to prescriptions for narcotics before you end up being forced to chose between lying about a patient and going to prison. The evidence does not support your naive trust in being right.

If that link was supposed to be persuasive, it probably wasn't the best example as that physician hasn't been charged with anything and it appears the raid was unfruitful.

As for the second link, it's more of an example of how stupid mandatory sentencing is for drug crimes. The patient in question maintains that he didn't forge scripts (a felony), the prosecution managed to convince a jury of his peers that he did. I am not going to simply accept OPED that the physician lied under oath. Sorry.

For the first link, if you hold yourself to be a "pain specialist" and prescribe narcotics, you know you are going to be under the microscope by the DEA. It's the cost of doing business. Most medications aren't monitored by the DEA, so if you choose to deal in pain management, you accept that the DEA is going to be up your keester with a microscope.

Of course, if there weren't well established patterns of wrong doing by physicians and patients for medications that are chemically the same as heroin, then the DEA probably wouldn't care.

http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf

As for me, after four years as a student, I have seen more patient scams to get narcotics then I can imagine. From the patient who complained of massive belly pain to the point of crying on physical exam (and then walked out of the hospital tear-free when told she wouldn't get narcotic pain pills) to the "I am allergic to everything but dilaudid" canard to loath narcotics. They have their place, unfortunately, about a decade of over prescribing them as a whole by the health care community "Pain, the 5th vital sign", there are some real bad actors in the world.

Underlying any physicians actions is (or should be) what is best for the patient - and not fear of legal sanction. Over prescribing pain pills is bad medicine.

Years ago when I had migraines I came to understand the 'acting' though. The neurologist asked me on a scale of 1 - 10 what my headache was that day. I said 8. She cocked her head and said, 'you don't look like you have an 8 headache.' Over time we compensate for pain and it is not reflected in vitals or in the way we look. I had to fire her and go to another. The new one actually figured out the migraines were from Synthroid. It took a year for the triggers to stop being triggers, but I haven't had a headache in years.

 

[Sunshine]

If that link was supposed to be persuasive, it probably wasn't the best example as that physician hasn't been charged with anything and it appears the raid was unfruitful.

As for the second link, it's more of an example of how stupid mandatory sentencing is for drug crimes. The patient in question maintains that he didn't forge scripts (a felony), the prosecution managed to convince a jury of his peers that he did. I am not going to simply accept OPED that the physician lied under oath. Sorry.

For the first link, if you hold yourself to be a "pain specialist" and prescribe narcotics, you know you are going to be under the microscope by the DEA. It's the cost of doing business. Most medications aren't monitored by the DEA, so if you choose to deal in pain management, you accept that the DEA is going to be up your keester with a microscope.

Of course, if there weren't well established patterns of wrong doing by physicians and patients for medications that are chemically the same as heroin, then the DEA probably wouldn't care.

http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf

As for me, after four years as a student, I have seen more patient scams to get narcotics then I can imagine. From the patient who complained of massive belly pain to the point of crying on physical exam (and then walked out of the hospital tear-free when told she wouldn't get narcotic pain pills) to the "I am allergic to everything but dilaudid" canard to loath narcotics. They have their place, unfortunately, about a decade of over prescribing them as a whole by the health care community "Pain, the 5th vital sign", there are some real bad actors in the world.

Underlying any physicians actions is (or should be) what is best for the patient - and not fear of legal sanction. Over prescribing pain pills is bad medicine.

You think the raid was unfruitful? I am willing to bet you that, after the government seized all his patient records, he was unable to actually treat them, and that he lost at least half his patients who, understandably, do not want the government prying into their health. The raid was nothing more than intimidation, and its sole intent was make sure the doctor got the message that treating patients for pain is a risky business.

How is the second link an indication of mandatory sentencing? Did I miss something in the article that talked about prior drug convictions? He was getting pain meds for personal use, the government got his doctor to lie on the stand, and he went to prison for selling drugs. By the way, if you think the doctor was not lying you will have to convince me that the pharmacist, knowing that federal and state laws would hold him responsible for giving to many prescriptions for opiates to a customer never called the doctor to verify them. I only had one prescription for 20 pills, non refillable, and they verified it.

Do some doctors and patients abuse the system?

Yes.

Does that justify the government restricting everyone?

No.

Did you read either article? The first article was about how the clinic was back in business a few days after the raid. The second article noted that the man was sentenced to 28 years due to mandatory sentencing guidelines for anyone with over 28 grams of painkillers.

In the second case, it only works if you buy the statement that the physician lied and the patient did not falsify scripts. That's a leap of faith. You can make it if you want, but it's hardly a "slam dunk" for what you are arguing. I am not going to try to convince you of anything. A jury has already decided this case. I am just pointing out that this is a house of cards. There are plenty of people who "never broke the law" or "never tried drugs" or "never touched alcohol" who get in deep with prescription narcotics. I am sure this guy was in obvious pain. That doesn't mean he should get whatever he wants when it comes to pain pills. You see one side to this story, I read between the lines and see another based on the patients I have dealt with. Who knows what the truth is.

The nature of the drugs and their addictive nature, coupled with their ability to kill people, makes government restriction practical. However, if you think the DEA is preventing patients from getting narcotics, you haven't been around healthcare in this country.

I think Oxycotin is #3 on the "most prescribed list".

I have had numerous patients on Oxycontin who come in for treatment of depression. I just have to tell them that I can't treat their depression as long as they are on Oxycontin. They are not depressed. They are narcolyzed.

 

[Sunshine]

Once you need pain pills even for a legitamite medical condition, you become labeled as a drug seeking ahole addict. Doesn't matter that you need them to get up and function, that it allows you to continue to be a contributing member to society or whatever. There is a lot of phony lip service give to pain management. And, some types of pain seem more real or legitimate than others. If you have fibromyaligia or other type of harder to pin down pain , then it must not be real cuz other people have never experienced. It is pretty obvious why we have rampant alcohol and drug addiction in this country because many people are just trying to do whatever they can do to suffer through the day. Even billionaire Michael Jackson couldn't find relief for his condition without going to drastic extremes. if someone would have truly helped him medically deal with his condition and given him adequate and proper medication he would still be here today as well. I can see where people just give up and find solace in the bottom of a bottle. Sad but reality.

Not quite. Women get narcotics after vaginal or cesarian delivery. People with broken bones get narcotics. People who get wisdom teeth extracted get narcotics. None of these people are "drug seekers". Narcotics work well for acute issues where pain control is needed as the body mends itself.

People become "drug seekers" when they become convinced that chronic conditions (baring certain conditions like sickle cell anemia) can only be managed through narcotics. After a while, there is no differentiation between organic pain and the pain that comes with withdrawal. There are two parts to this equation. One side is a doctor who enables it. The other side is the patient that either lacks the motivation or desire to try and get "better" however that might be.

You referenced fibromyalgia. Guess what is emerging as a mainline treatment to fibromyalgia and has the best treatment results in the evidence based literature?

Antidepressants. Go figure.....

http://www.fmcfs.ca/FMresearch-abstracts-2009.pdf

And yet, the "mean doctors" are lambasted by fibromyalgia patients when they don't want to give them a sedative to control their condition that keeps them on the couch as it stands in favor of trying something that actually works.

As for Jackson.... He was a addict. If you need propofol (a powerful anesthetic that should only be administered in a hospital when a patient is on a monitor and intubated) to sleep, you have real problems. These are most likely psychiatric problems at root (and addiction is a psychiatric problem) and not some overt pathology. The root of his problem wasn't his pain or his inability to sleep. It was his underlying addictions. His doctor was a quack too (he was a cardiologist) and deserved what he got for such malpractice. He wasn't trying to "help" Jackson. He was doing it for the outragious sums of money. I would be willing to bet that Doctor Murrey wouldn't have been willing to try his unique insomnia treatment on a regular person with regular insurance.

That is right. When I have a depressed fibro patient my first line of treatmetn for the depression is Effexor. It cuts both ways. Cymbalta is good as well, but much more expensive.

 

[geauxtohell]

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.

I don't know why they wouldn't give you Ultram.......... It's non-narcotic.

Other than that, you've hit the nail on the head. If you think the current crop of doctors is bad, wait until my generation gets in there. We've been conditioned (by drug seekers) to hate narcotic pain pills. You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam. Why? Because shit bags prick their fingers to contaminate their urine to malinger.

Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.

Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.

FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.

Ultram is a synthetic narcotic, and it is a schedule drug. Didn't start that way, but is now.

I guess I have always thought of it as the "non-narcotic" option, since that seems to be the way it is perceived. I really think the "dependence" issue over tramadol is bullshit.

I believe you are wrong about it being scheduled.

http://www.deadiversion.usdoj.gov/drugs_concern/tramadol.pdf

 

[Sunshine]

That's where the drug-seeking-addict label comes from, tho....

My daughter has Fybro and no insurance.
She has share-cost medicaid but no income.
Sometimes the only way she can meet her share of cost is to go to the ER.

Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.

I don't dispute that she has chronic pain. I dispute that narcotic pain pills are the best treatment for her chronic pain.

Show me the evidence based literature that disputes that, and I will take a look.

She's willing to try anything that works.
it's just that when you show up at the ER asking for something for pain there's that "look".
Sometimes there's a rude dismissal to go along with it......

Effexor. Cymbalta. It takes a while to get enough in the system to work. I dont know about Lyrica. It is mostly used for diabetics. Pristique. Not more efficacious thatn Effexor.

 

[Sunshine]

Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?

The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.

He is not the only 'medically trained' person on this thread. And I don't think that is what he is saying. I have seen my share of drug seekers as well. Probably more in my 23 years as a nurse than he has. They exist. They are out there. They have a pattern of behavior, usually.

 

[geauxtohell]

Would you like to bet on that? If no one is get in trouble for the legitimate use of painkillers why are doctors offices being raided? Why are pain patients in prison for using prescription medications?

Port Townsend clinic reopens after search by drug agents -- Port Angeles Port Townsend Sequim Forks Jefferson County Clallam County Olympic Peninsula Daily news

Punishing Pain - New York Times

The problem with your statement is that the government has a different idea of a legitimate need than some doctors, and juries tend to side with the government in cases like the ones above. You are a doctor, you need to educate yourself on the realities of government response to prescriptions for narcotics before you end up being forced to chose between lying about a patient and going to prison. The evidence does not support your naive trust in being right.

If that link was supposed to be persuasive, it probably wasn't the best example as that physician hasn't been charged with anything and it appears the raid was unfruitful.

As for the second link, it's more of an example of how stupid mandatory sentencing is for drug crimes. The patient in question maintains that he didn't forge scripts (a felony), the prosecution managed to convince a jury of his peers that he did. I am not going to simply accept OPED that the physician lied under oath. Sorry.

For the first link, if you hold yourself to be a "pain specialist" and prescribe narcotics, you know you are going to be under the microscope by the DEA. It's the cost of doing business. Most medications aren't monitored by the DEA, so if you choose to deal in pain management, you accept that the DEA is going to be up your keester with a microscope.

Of course, if there weren't well established patterns of wrong doing by physicians and patients for medications that are chemically the same as heroin, then the DEA probably wouldn't care.

http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf

As for me, after four years as a student, I have seen more patient scams to get narcotics then I can imagine. From the patient who complained of massive belly pain to the point of crying on physical exam (and then walked out of the hospital tear-free when told she wouldn't get narcotic pain pills) to the "I am allergic to everything but dilaudid" canard to loath narcotics. They have their place, unfortunately, about a decade of over prescribing them as a whole by the health care community "Pain, the 5th vital sign", there are some real bad actors in the world.

Underlying any physicians actions is (or should be) what is best for the patient - and not fear of legal sanction. Over prescribing pain pills is bad medicine.

Years ago when I had migraines I came to understand the 'acting' though. The neurologist asked me on a scale of 1 - 10 what my headache was that day. I said 8. She cocked her head and said, 'you don't look like you have an 8 headache.' Over time we compensate for pain and it is not reflected in vitals or in the way we look. I had to fire her and go to another. The new one actually figured out the migraines were from Synthroid. It took a year for the triggers to stop being triggers, but I haven't had a headache in years.

Imagine that. Someone actually go to the root of the problem as opposed to just treating your pain. It's almost like someone was practicing good medicine.

Sounds like you found a good neurologist.

 

[geauxtohell]

I have had numerous patients on Oxycontin who come in for treatment of depression. I just have to tell them that I can't treat their depression as long as they are on Oxycontin. They are not depressed. They are narcolyzed.

Couldn't agree more. Also can't figure out why you would every give a depressed person a depressant.

You might as well hand them a 1/5 of whiskey.

 

[Sunshine]

I think you should go to the pain clinic. What's your problem with the pain clinic?

That's the purpose of a pain clinic...managing pain. You should at least give it a try.

What happens with other people suffering from MS? Do they also have pain? How is it treated? Sounds like a forum for people with MS might provide you with some help and answers. Maybe?

There is a stigma attached to pain clinics. I'm just recalling how many people I've intubated and treated from OD's from pain clinics. In THIS state, they are considered legal drug pushers; and this area....not very highly respected.

I have and do belong to an MS forum/chat. The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue. I'm here, because this to me, is a political issue. And because I belonged to this forum LONG before I was diagnosed with MS.

And yes, I'm totally with Ron Paul on the "War on Drugs". I believe it has been a disaster. Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).

And no, it's not constant pain. But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore. This makes perfect sense to me.

Now there is constant numbness in certain areas, but pain? Only after a flare. And it sux.

Wait...you were saying you wanted pain pills. And now you're saying the trouble with pain clinics is they give people too many pain pills, to the point that they OD? What do you care what other people think, the stigma of pain clinics? If you want pain pills, sounds like you should go to the pain clinic. Sounds like you have a medical background, you should be able to properly handle the pills they give you and not OD. Doesn't it seem?

I used to work in Nashville. She is right about the stigma of going to a pain clinic there. There is supposed to be confidentiality, but the waiting room is not empty nor confidential. A medical person who goes to a pain clinic in that area casts doubt upon him/herself. If I had ever had to go to one, I wouldn't have gone in that city.