I have heard of this happening all over the US- but I didn't think it would happen to me!
My old Dr. who was also a pain management specialist retired and my new Dr. who is not a Pain management doctor calls me in and tells me that the CDC has a new recommendation that no person be on long term opioid management and he plans to take me off my opioid by the end of the month. This is a regimen that my old Dr and I came to after trying every non-narcotic option and it's working. I only went to opioids when the pain became so excruciating that I couldn't get out of bed, was not sleeping and had reached a point of near suicidal depression. For the last year I've been as close to pain free as I have ever been with no issues what so-ever. But I agreed to try it his way and see if I could
Manage without the opioid
Caveat being he will send me to a pain management doctor if the pain returns. Then I find out the co-pay for the PM evaluation is a thousand dollars! I sent my doc an email stating that since going off an effective regimen was not my idea - I expected my insurance company to eat the cost of the eval.
Then I read the CDC recommendation which said nothing about opioid never being used for chronic pain but rather they should not be the first line treatment.
I feel totally defeated that I have to let this doctor who is half my age and probably has no experience with chronic unremitting pain. Tell me all this without even doing a proper history and physical.
Thank you for your input however I have been on every non-narcotic medicine known. And my pain management journey started when I fell from a horse at thirteen, Had my skull and spine fractured in an abusive assault by my own mother when I was 14. I have never relied on opiates until two years ago. I've done all the alternatives you mention and while some work for a time none work effectively by themselves. I hardly think you know what I have been through and quiet frankly I've read those studies. While they may not be appropriate for some patients they are absolutely appropriate for patients that could not be helped by non-narcitc medications. Before I went to taking 2 5/325 norco a day two years ago I was taking up to 5000mg of Tylenol and over 1000 mg of Ibuprophen. I was developing fatty liver and kidney problems from these alternatives. I eat a hollistc diet, exercise and have been throughly worked up by a PMS. Along with the opiate I use a TENS machine. The past two year with low dose Opiet therapy have been almost pain free. Contrary to the current popular belief Addiction is actually quite rare when opiates are used to treat legitimate pain in a responsible manner.
I work psych and one thing I never do is try to tell my patients who have a working regimin that they should change their meds because studies show they don't work as well as we once thought when for that patient they are clearly working. One of the joint commission and CMS standards is that patient care be patient centered and individualized. These new guidelines do not meet that standard. In fact just this year our own hospital got cited for not providing adequate pain relief because we did not give opiates when non-narcotic options were clearly not treating a patients pain.
Before you try to tell what some study says about my pain management _ I invite you to walk a day, week or maybe a year with widespread, chronic unremitting pain and get back to me.
Not meaning to go off on you but you might want to actually talk to some us rather than think the studies tell you everything you need to know.
If I could find something that worked better at helping me be a functional human being I would do it in a heart beat. But I will not go back to the zero quality of life two years ago.
Hppy
Well I'm not here to argue about what will or will not work for you, but I'm here to tell you straight up the guidelines don't support use of bid opiates for your pain no matter what your anecdote tells you. You WILL find a dwindling number of providers willing to risk their license to continue a regimen they can't rationalize clinically. Those providers will face government scrutiny and will be finding new lines of work (or retiring) as their risks go up.
And you noted you work in psych. We see psych lament about patients on bid Xanax from their pcp because it's such a hard medication to break a patient from and not considered appropriate for long-term use. Studies clearly show the long term negative effects of benzos on neurologic function and psych providers typically try hard to ween off and minimize the use because they should only be used for rescue. You probably see on the regular patients swear up and down their "xanies" are the only thing that works. Well consider yourself no different. You were fed a load of garage about your only alternative when you hit the end and eventually you grabbed that line. Sorry that it came to that... But it doesn't change the facts of both appropriate medicinal practice guidelines and the reality that we have an opiate epidemic courtesy of people selling you on your need for opiates. If every patient got their meds "tailored for them", we'd go back to handing opiates and benzos in lethal doses like it's candy.
Things in medicine change. Good providers take that evidence and work it into their practice. They don't rely on old thought just because it worked at one time.
Sounds like you and your previous doctor worked out an optimal effective regimen.
You don't say how you got stuck with this new guy but I hope you can unload him soon. There are many out there who continue to educate themselves about pain management using all the tools responsibly, and I hope you can find another good one soon.
I'm sorry for what you are going thru and the many others who are now being denied pain meds that helped them cope. Also the arrogant rude attitudes of people like Djmatte here who have probably never dealt with serious pain and so condescending toward you and his patients who are struggling with pain. Maybe one day he will get a taste of his own medicine and experience what terrible pain feels like and then have some empathy.
I have dealt with pain in my life too and for many things advil worked wonders, but you can't live on it and it is well known to cause kidney problems, ulcers and recently discovered high blood pressure and I suspect NSAIDS are also known to cause heart problems! Personally, I think Tylenol is completely useless and will destroy your liver, if your kidneys get wrecked you can always go on dialysis, but there is no cure for liver failure! I once took care of a young single mother who was dying from liver failure from overusing tylenol for pain from a gynecological surgery where she couldn't afford the pain meds her Dr prescribed and didn't realize the consequences of overdosing on Tylenol before it was too late. She was hopefully going to be put on a liver transplant list and I don't know what happened to her, but it was so sad!
My worst pain has been from migraines and before I had narcotics I could go 24 hours with a bad migraine, puking my guts out and my only relief was to sleep it off! My Dr is under pressure to stop prescribing any narcotics, even codiene. I don't use mine everday so I have enough to last a while. Triptans you can only get 9 a month and they can cause CVA, MI's and brain bleeds so they are not without side effects. At my most desparate point I actually spent a thousand dollars on botox. It worked but only for one month! I simply couldn't afford to keep shelling out thousands of dollars and if it worked like it was supposed to you'd still have to get it 4X a year! Who can afford that, and by the way if it becomes systemic in your body you can face paralysis, inability to swallow and breath and possibly die!
I hope you can find a Dr willing to help you, but from what I've heard even the pain management Dr's are withholding narcotics these days partly from the govt pressure over the narcotics crisis in our country (not caused by you or I and other responsible people with chronic pain), and also because they can make more profit off surgeries and procedures like epidurals! I wish you luck in finding relief from your chronic pain.
I had not read that particular article, thank you! I am pretty familiar with Purdue Pharma and what I consider to be their unethical (at best) relationships with MDs who then influenced JCAHO policy, etc. Hard to comprehend really, but not at all surprising.
The provider has a right to determine what they are comfortable with and you have a right to find another provider to take over your care.
And that isn't meant to not show sympathy. But if the provider isn't comfortable adopting a plan of care, they should not do it. Wish you best of luck.
The problem is as soon as you have to try to find another Dr to prescribe pain meds you are already viewed suspiciously as a drug seeker and probably will have an even harder time finding someone willing to prescribe the meds you were on that were working well for you. I can't tell you how much this pisses me off. I know eventually I will find myself in the same boat where I will have to suffer again with a migraine that will last 12-24 hours and puking my guts out and my only remedy is sleeping it off if I can do that and hopefully not aspirate on my own puke while I'm asleep. I think it is a very sad state of affairs. I think there is a difference between a person using pain meds responsibly for real pain and others who are using them to get high such as those who discovered they can get an immediate high from crushing narcotics and snorting them. It is disgusting and unfair to the people that depend on pain medicine that are now being denied because of irresponsible idiots!
As a nurse I witness all extremes from druggies who misuse pain meds, to others who are denied pain meds and suffer every day, some using alcohol to numb the pain to some who are very stoic and reject pain meds, yet don't seem to realize how crippled and disabled they have become where they are losing their independence and the simple ability to walk and get around!
To Djmatte, I doubt you are as successful treating pain patients as you think. I imagine some people left you searching for another provider to help where you refused and some I imagine have even found a way to get meds illegally off the street or whatever it took to find relief!
On another note, I'm really sick of the trend toward cookie cutter medicine whereby "providers" are told they must do this, that and the other thing and prescribe particular meds and not allowed to use their own brains, knowledge, experience in treating routine diseases! But I have no doubt that the govt is breathing down the neck of Dr's these days who even dare prescribe narcotics. I guess it's just too bad for the poor patients caught in the middle of this pointless drug war!
You realize opiates actually cause rebound headaches which is why you are most likely getting so many a month?
I personally use sumatriptan and have had good results with it.
Migraines run in my family, my grandma, mom, aunt all struggled with them. I have tried elavil which helps but causes weight gain. For several years I was pretty well controlled on verapamil and only got migraines around my period and then for some reason it stopped working. Over the years I've had a few surgeries and saved those pain pills for a bad migraine so a handfull would lost several years! Finally I found a neurologist who prescribed mild pain meds and have used elavil and topamax and increased my verapamil. I recently had a bad headache where I was puking my guts out and it lasted 12 hours and I had to call in sick.
This used to be a common occurrence in the past and I don't want to live like this. I didn't go to the ER one because of the outrageous cost and two figuring they wouldn't help and would label me a drug seeker. Although maybe if I'd been given some IV compazine it would have aborted the nausea and vomiting and hopefully the migraine.
I use magnesium and ice packs. I would even reconsider botox if it was available, but my neurologist doesn't offer it anymore because he's had too much trouble with insurance reimbursement. I do have triptans but am reluctant to use them because I have high blood pressure. I've found when I do they work for a while, but eventually after a few hours the migraine returns.
I once went to a headache clinic where they ran me thru just about everything from diet to physical therapy to psyche of all things. They gave me some freebies of IM triptans and I made the mistake of using it one time. Scariest experience of my life, my whole head felt like it was going to explode and I started have chest pressure and squeezing of my chest and throat. After about 5 minutes the headache and other symptoms went away. I threw the rest of the freebies out even if they work it is not worth the fear of having an MI and I never want to feel like that again.
My only consolation is my migraines are fewer and usually less painful since I've went into menopause, but unfortunately they haven't gone away like I had hoped. My grandma had them till she died and my mom and aunt still live with them so I doubt I will be able to get rid of them.
I've even had a bone tumor and that pain was terrible although it did respond to advil better than anything else, but I had to take 800 mg around the clock to keep the pain at bay. It took over a year for me to find the true cause because an HMO had misdiagnosed me and misread my XRAY as arthritis when I showed that XRAY to a new Dr they could immediately see a bone tumor. Thankfully surgery was successful and it never came back. Advil is a wonder drug but it doesn't work for my migraines.
I think there is a difference between a person using pain meds responsibly for real pain and others who are using them to get high such as those who discovered they can get an immediate high from crushing narcotics and snorting them. It is disgusting and unfair to the people that depend on pain medicine that are now being denied because of irresponsible idiots!
The problem is that the difference is a much finer line than you and many others realize (or want to think about, maybe). A large part of the current opioid abuse epidemic is people who started out using medication prescribed by their providers for legitimate pain or other concerns, that they started out using appropriately. Nobody starts out wanting to become one of those people you dismiss as "druggies." But an awful lot of people end up that way.
Change doctors. This guy is a sadist--I've seen them so many times. In NO field other than medicine can sadists actively practice their kink on non-consenting individuals. When you go see your next pain doc, take your records and films. Legitimate patients are getting screwed over the behavior of addicts. I once did rounds with an ortho who cut his patients pain meds off 3 days after surgery and told them it was good for them. I turned him into the state board after watching him during those rounds. What a jackass.
I was on Fentanyl patches for pain for 19 years. I made an absolutely sure I used them exactly as directed no matter what--and with TD meds there's no addictive behavior--no med spike to learn to love. Anyone on pain pills for a chronic pain condition knows exactly where their pill bottle is at all times. TD meds end the 6-8 hour pain cycle. For 19 years every 72 hours I peeled off a patch, stuck on another one and kept right on trucking. NO med spike--but constant, durable 24/7 pain relief that allowed me to continue working for many years past when I would have had to retire without them. They are underutilized and shouldn't be. That's not the best part. When I decided I wanted to go a different way with pain management, I weaned off of it and when the last patch came off I braced for the horrid withdrawal with Phenergan and such--but NOTHING happened. No withdrawal, no cravings no NOTHING. I'm still shocked about that--but I've been using nothing but medical cannabis for pain for the last 2 years and I am good to go.
Specializes in Psych, Addictions, SOL (Student of Life).
Just to clarify. I never said that I was unwilling to try the new doctor's recommendations only that I feared losing my safety net. Also I clearly stated that this Dr. who knew nothing about me did not even do an H&P just came in and started dictating. Also to find out that a pain management consult was going to cost $1000.00. If Dr.s really wanted people to be successful in an effort to come off pain meds the pain management consult would be up there with free mammograms.
I'm not going to say anymore on this matter. Thank you all who were kind enough to comment on my behalf.
djmatte, ADN, MSN, RN, NP
1,248 Posts
Well I'm not here to argue about what will or will not work for you, but I'm here to tell you straight up the guidelines don't support use of bid opiates for your pain no matter what your anecdote tells you. You WILL find a dwindling number of providers willing to risk their license to continue a regimen they can't rationalize clinically. Those providers will face government scrutiny and will be finding new lines of work (or retiring) as their risks go up.
And you noted you work in psych. We see psych lament about patients on bid Xanax from their pcp because it's such a hard medication to break a patient from and not considered appropriate for long-term use. Studies clearly show the long term negative effects of benzos on neurologic function and psych providers typically try hard to ween off and minimize the use because they should only be used for rescue. You probably see on the regular patients swear up and down their "xanies" are the only thing that works. Well consider yourself no different. You were fed a load of garage about your only alternative when you hit the end and eventually you grabbed that line. Sorry that it came to that... But it doesn't change the facts of both appropriate medicinal practice guidelines and the reality that we have an opiate epidemic courtesy of people selling you on your need for opiates. If every patient got their meds "tailored for them", we'd go back to handing opiates and benzos in lethal doses like it's candy.
Things in medicine change. Good providers take that evidence and work it into their practice. They don't rely on old thought just because it worked at one time.