Opiate Medications and Respect for Patient Needs

[tikaani]

I am a patient who has been bumped around in the system for years, first as a member of a high class insurance program offered by my employers and now as a disabled person in my late fifties in a state-run health services program that is determined by need and my pre-existing health conditions. It is so depressing and disheartening that I am now at the mercy of the public health system and nurses and doctors that have villianized opiate pain medications that have made it possible for a person like me who has chronic pain to move and continue to be active. I live in a state that has made it literally impossible to receive these medications without paying exhorbitant fees to clinics who under-prescribe and have copious amounts of paperwork for me to fill out along with demoralizing drug testing. I have never abused my medications, always following the prescribed directions on the labels. I have not increased the dosage as I have been warned would happen to me if I was given these medications. I have been on the same dose of lorazapam for sleep and muscle relaxation for over seven years-1 mg-even though the doctor gives me 2 mg tablets I halve them. Yes, I do have a problem with NSAIDS and their gastrointestinal effects. I have gone to the hospital ER not being able to swallow it has been so bad, even taking omeprazole and and antacid like gaviscon. I have found that the ONLY people who get narcotic pain medication are those that lie on questionairres that ask if you are frustrated with your doctors (of course I am), and if you have anxiety over your pain (who wouldn't). If you mention that you get headaches, you will never get this medication, or if you are stressed out by your pain. If you say that massage makes it better, and it usually does for anyone, they won't give it to you either. You have to know exactly how to answer these questions and be very crafty. I know people who are very manipulative who are alcoholics and always use up their prescriptions early and their doctors prescribe them things like morphine and fentanyl. Yet my doctors hesitate to prescribe me 2 lousy vicodin a day, that do nothing to relieve my pain after a devastating injury that I experienced 3 years ago. I was a passenger in the front seat of a car that was driven into a ditch when my friend fell asleep at the wheel. Before the injury I had degenerative changes, scoliosis and sciatica. Doctors have recommended spinal fusion but I can't imagine the pain involved with a surgery that involves being cut from the front and the back, with no adequate pain medication. I had discectomy 3 years ago and that worsened my condition. They are also recommending surgery on my neck, I refuse to do this with this health plan that is really no plan at all when nothing is covered, not even lidocaine patches of physical therapy. This is Obamacare. It is not compassionate and neither are healthcare workers that refuse to relieve pain that is unrelenting when a patient is doing everything they can to get well, I have religiously done all my exercises, diet (kept my weight down), taken my supplements and followed my doctor's orders, except for the surgeries. So please, don't treat me like a drug addict when I come into your clinic looking for relief.

[salvadordolly]

I feel for you and Im sorry you go through that. Pain is not well understood in general. I was niave about how pain was treated for a long time because I worked in oncology and hospice, where we medicated people as their pain required. About 10 years ago, I developed a very painful condition of the nervous system called chronic immune demyelinating polyradiculneuropathy. I just woke up one day feeling like I was on fire. It took them a year and half to diagnose. I was going to specialists and pain clinics trying to do anything I could to find answers. I couldn't believe how I was treated! I had to take psych and personality tests, see counselors, all sorts of stuff and couldn't find any relief. Finally, I found a good pain specialist who apparently believed me and got me to the neurologist that diagnosed my condition. It was treated with plasmapharesis and then most of the pain went away. I take neurontin and amytriptiline for the burning sensations. Pain is horrible and takes over your whole life. I am the first to advocate for controlling pain in NON-cancer patients. I don't believe that cancer patients are the only ones entitled to pain relief. It took me less time to recover physically that it did from being "traumatized" by how I was treated as a person with chronic pain. I almost complete faith in humanity and the medical profession in general. That said, I have seen many drug-seekers over the years in nursing, so I try to be patient with doctors and pain specialists, knowing that they see a lot of this.

Try to find a good pain specialist to work with. Choices are limited on Medicaid, are a little better on Medicare. I paid out of my pocket too to avoid some of the BS that some pain clinics put you through. Best of luck to you! Know that there are some people that don't label you as crazy or med-seeking out there!

[iluvivt, BSN, RN]

I agree you need to find some MDs that are accustomed to treating chronic pain patients. A pain specialist is the way to go..many you will find are also anesthesiologist or former anesthesiologist,some are physical medicine MDs. You can sign a pain contract and when you abide by it they usually have no problem with prescribing. They also are very good at selecting a regime that is suitable for chronic pain vs acute with much longer acting agents.

[BostonFNP, APRN]

First off let me just say I hate to hear that you are living in pain; no one should have to do that. I hope you can find a provider to work with and develop a plan to get the pain under control.

I respond to this as a PCP, though I have some in-patient pain service experience.

I agree with you that chronic pain has become very difficult to treat in the primary care setting. In the past, if pain was consistent with physical exam findings I would put people on a multi- modal regimen that included opioids if appropriate; everyone signed a contract and everyone was random tested four times a year.

It does not work this way anymore. I will give a weeks worth of meds and a referral to a pain clinic.

That being said, a few caveats.

1.) Opioids are not always the best option. Not all pain responds to opioids and I am a firm believer in a multi-modal approach even when the pain does respond. This is especially true as people get older.

2.) Opioids need adjunct medications to make them maximally effective. Especially in nerve pain.

3.) Lorazepam is a medication that I steer clear of in chronic anxiety; it is inappropriate for sleep. Again, as you get older this becomes more true.

4.) You stated this is d/t Obamacare. The changes in pain management are due to the explosion in abuse of prescription opioids (prescription abuse now exceeds street drug abuse). Be prepared to sign a contract and be tested regularly.

A pain specialist will likely be more successful in treating your pain than a PCP. Embrace a multimodal approach.