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.
I get that. However, what is not mentioned is that people will do ANYTHING to stop severe pain--it's the entire reasoning behind torture! When legitimate patients are denied needed pain medication they will do what they need to do to stop pain--be it doctor shopping or heroin. I, too, have a chronic pain condition so I understand where you are coming from. For 21 years I've had doctors treat me like **** because they wanted to paint me as a junkie when I have more than 20 THOUSAND pages of medical records, 5 botched back surgeries and needed high doses of opiate pain meds. Fentanyl patches were a godsend and prevented me from becoming addicted--much different that physical dependence. History is not going to judge us kindly for the way we treated people in chronic pain.
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.
Try being tasked with responsibility of managing opiate prescriptions in today's environment and act like somehow we aren't empathetic to the situation. Each of those problems with meds you listed off aren't unique as if opiates are somehow life savers without down sides. Just off the top of my head... Addiction, erectile dysfunction, tolerance, oversedarion and death, liver failure, nausea/vomiting, and severe constipation. All of which can be their own form of debilitating.
So while you may wish ill on me because you have some preconceived notion that because I follow guidelines of good medicine and therefore have no capacity to understand chronic pain or experienced it myself, that logic can bugger off. I'm expressing the realities of practitioners on the ground picking up the pieces of poor pain (and psych for that matter) management for over a decade.
Proper use is what we should all be striving for, but taking someone off of opioid medication because it's "not appropriate" without having an appropriate new plan is morally reprehensible.
I do think the anti-pain med push is going too far. Granted there are plenty of people that long term narcotic use is not at all appropriate for. I recently watched an HBO documentary profiling four cases where narcotics were clearly over-prescribed for an acute injury with catastrophic results. But there are also plenty of people where long-term narcotic use is the only thing that works for chronic pain. To suddenly stop prescribing to these people is just asking for trouble.
Healthcare needs to get over this one-size-fits-all approach to pain management. Opiate pain meds when used correctly are not the evil that current thinking would make one think, operative phrase is when used correctly. What determines correct and judicious use needs to be individualized to the patient, not determined by some cookie cutter formula.
Try being tasked with responsibility of managing opiate prescriptions in today's environment and act like somehow we aren't empathetic to the situation. Each of those problems with meds you listed off aren't unique as if opiates are somehow life savers without down sides. Just off the top of my head... Addiction, erectile dysfunction, tolerance, oversedarion and death, liver failure, nausea/vomiting, and severe constipation. All of which can be their own form of debilitating.
And don't forget my personal favorite -- opioid-induced hyperalgesia, in which the opioids eventually start making the pain worse instead of better.
And don't forget my personal favorite -- opioid-induced hyperalgesia, in which the opioids eventually start making the pain worse instead of better.
Yup. Evidence be damned. But nurses. We love to cite evidence until it negatively affects our practice or we realize or treatment might be impacted. And we are striving to be recognized as a real profession.
I agree with those who advocate for realistic reduction/taper with appropriate therapies in place (not just cutting off as this provider did). I take the same care with all of my patients. But my original point was simple... The path many are on has been deemed inappropriate by current evidence based medical standards. Expect changes and expect them to not meet what your preconceived notion of "appropriate" once was.
We have to do what we are comfortable with. If an uncontrolled diabetic who should be managed by an endocrinologist comes to me, I am going to refer them to an endocrinologist. Some providers don't know when to say "I don't know what to do". That is why we have experts in areas like pain management, where this provider wants to send OP. From what I read earlier she has a very complicated case that probably should be managed by a pain expert.
Pain medicine is very much a complicated world to navigate. It's very subjective. It has multimodalities of pathophysiology. I understand that it cost money to see a specialist. But clearly, if a provider isn't comfortable treating something they should refer to the specialist.
Specializes in Psych, Addictions, SOL (Student of Life).
CDC actual guidelines direct from their most current fact sheet. No where does it say Opioids are ineffective or inappropriate when managed carefully for Chronic pain.
I work at a smoke shop that sells Kratom. It's not only supposed to help with opioid withdrawals but I hear it does great with pain.
I began taking Phenibut in May. Absolutely amazing. Only side effect I noticed was I was a bit dizzy, and felt rebound anxiety. Doctor wouldn't give me the one drug I know that works for my anxiety, so I took those matters into my own hands.
I'm not saying take those, but you have to have an MI to get pain meds in the rural counties of California. My friend, just a few weeks ago had a Penile injury resulting in said man part being bent to the left in a shape of the letter "J" for quite a while. Broke his collar bone last year. Nope. NO pain meds for either.
Collar bone, fine. A injury resulting in my inability to use my man parts? Oh, I'd be begging for meds. Go ahead, life flight me 100 miles to Fresno if it means a 500MG tylenol. I'll start a Go Fund Me for the helicopter ride...
...... 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.......
Yes!
My doc prescribed 5% lidocaine cream for me and the cost of a small case was $1,400.!
Of course, I could not get it filled! But thirty Tyl #4, w/ 60 mg of codeine is five bucks! OTC 4% lidocaine is only a few dollars. Why the huge cost increase for 1% more?
If docs and whoever else want people off of narcs, then they need to come up with EFFECTIBE, and AFFORDABLE alternatives!
Find yourself a new Dr. One who will listen to you and care about your pain! It's b.s. that legit Ppl in chronic pain are being denied their meds! No quality of life when a person is in pain 24/7!!
TeriDavisNewman
9 Posts
I get that. However, what is not mentioned is that people will do ANYTHING to stop severe pain--it's the entire reasoning behind torture! When legitimate patients are denied needed pain medication they will do what they need to do to stop pain--be it doctor shopping or heroin. I, too, have a chronic pain condition so I understand where you are coming from. For 21 years I've had doctors treat me like **** because they wanted to paint me as a junkie when I have more than 20 THOUSAND pages of medical records, 5 botched back surgeries and needed high doses of opiate pain meds. Fentanyl patches were a godsend and prevented me from becoming addicted--much different that physical dependence. History is not going to judge us kindly for the way we treated people in chronic pain.