A rant on pain management, in this country.

[merrill]

You may well be underinsured in which case the medical insurance people could be saying no.

Are these pain controllers expensive?

Pain management can be expensive as well.

Do you have full 24/7 medical insurance coverage no co-pays/no deductibles etc etc etc.

This may be where the problem lies?

If it is a insurance coverage situation going to the ER may be the option. If I were experiencing your level of pain the ER would be my choice STAT!

 

[Gagafritz]

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.

 

[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.

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".

 

[hortysir]

Florida's definition of a "Pain Management" doctor is someone that's 60-75 miles away that has a higher co-pay.
No refills, so you get to make the trip every month.

 

[geauxtohell]

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.

 

[geauxtohell]

Florida's definition of a "Pain Management" doctor is someone that's 60-75 miles away that has a higher co-pay.
No refills, so you get to make the trip every month.

And someone that won't treat a patient that doesn't have insurance. I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.

Classy.

 

[hortysir]

Florida's definition of a "Pain Management" doctor is someone that's 60-75 miles away that has a higher co-pay.
No refills, so you get to make the trip every month.

And someone that won't treat a patient that doesn't have insurance. I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.

Classy.

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.

 

[geauxtohell]

Florida's definition of a "Pain Management" doctor is someone that's 60-75 miles away that has a higher co-pay.
No refills, so you get to make the trip every month.

And someone that won't treat a patient that doesn't have insurance. I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.

Classy.

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.

 

[Quantum Windbag]

And someone that won't treat a patient that doesn't have insurance. I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.

Classy.

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.

What works better? Massage? Acupuncture?

 

[hortysir]

And someone that won't treat a patient that doesn't have insurance. I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.

Classy.

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......

 

[Quantum Windbag]

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 can cite hundreds of cases where the feds have harassed doctors and patient pain advocates. Just because you can find a rationalization for two of them does not mean that there is not a problem.

[ame=http://www.youtube.com/watch?v=0PqfXc4XtXM]Will The Feds Ban Your Pain Meds? - YouTube[/ame]

 

[Gagafritz]

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?

 

[Quantum Windbag]

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.

 

[Gagafritz]

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.

I think we can show you plenty of evidence that opioids treat pain. As for chronic pain, there are many components to chronic pain which can also include acute pain. Just because it is chronic doesn't mean that there isn't acute pain involved that is amenable somewhat to opioids and acute pain type treatments. Sheesh.

 

[Kooshdakhaa]

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?

 

[Sarah G]

I don't blame you Mr H. Fentanyl is one of the drugs that I will refuse to give IV on the floor where I work. I've seen too many patients start declining toward respiratory distress on that crap.

Now, on the issue of the federal mandate, the latest one I see was in 2007. What were you asking for (specifically) that your doctors wouldn't give you?

I asked for 10 pain pills. I told them I didn't care...tylenol 3, ultram, lortab (the weakest strength)....or something other than the 3200+ mg ibuprofen that I was taking daily. I told them that I didn't feel like adding dialysis to my problems.

Ok, I was going to ask why not take 3 or4 Advil.

 

[Sarah G]

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?

I so agree with you. You get on pain medication and they only work for a short time anyway. Pain clinics do help manage pain, I realize I know absolutely nothing about what the OP is going through right now but it just seems like a better way to go.

 

[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.

 

[Gagafritz]

You wouldn't take a pain pill because you read the nasty side effects? Do you not think there are side effects and reactions to every medication in the world? Tylenol has caused liver failure. No drug is benign. Nsaids can cause kidney failure and opioids may be a better choice for long term use. As for mind over matter, yes there is a component of pyschology involved in pain. But, pain is real and to not treat it is inhumane. You wouldn't tell someone who just had a limb amputated to just suck it up and think away the pain. But, for a lot of pain syndromes you cannot see the pain but that doesn't make it less real. Just because some people get addicted isn't a reason to stop giving people pain medication or doling it out without people getting the proper effect.

 

[Kooshdakhaa]

You wouldn't take a pain pill because you read the nasty side effects? Do you not think there are side effects and reactions to every medication in the world? Tylenol has caused liver failure. No drug is benign. Nsaids can cause kidney failure and opioids may be a better choice for long term use. As for mind over matter, yes there is a component of pyschology involved in pain. But, pain is real and to not treat it is inhumane. You wouldn't tell someone who just had a limb amputated to just suck it up and think away the pain. But, for a lot of pain syndromes you cannot see the pain but that doesn't make it less real. Just because some people get addicted isn't a reason to stop giving people pain medication or doling it out without people getting the proper effect.

I believe people should be given all the pain meds they need.

In my case, however, I avoid taking all medications and drugs whenever possible. As it turned out, the pain meds the dentist prescribed for my root canal were totally unnecessary...all I needed was a couple of Bayer aspirin. And I only needed that for a day or so, which is good because I don't even like taking aspirin. Will not take Tylenol. So why take prescription pain pills with all those risks of side effects? Hmmm? The side effects were not just nuisances...they were baaaaad side effects. Not worth it for pain pills that weren't even necessary.

I like watching out for myself. Obviously the dentist wasn't. He just mindlessly wrote a prescripton that I didn't even need. A prescription for some pretty bad shit.