Pain patients being denied their medication!

Specialties Pain

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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.

Specializes in Psych, Addictions, SOL (Student of Life).
On 8/7/2019 at 5:59 PM, mmc51264 said:

My PCP wouldn't prescribe pain meds (Tramadol!!!!), so I got a referral to pain clinic. Best thing I ever did. Dr. is fabulous and the NP I see most of the time is really helpful. I get to pick their brains about the latest in pain management too.

Exactly all medical care should be a collaboration between the patient and his/her physician. Government has no right to insert themselves into that relationship!

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I'll add my .02 on this topic. I have lived with chronic pain since age 12 (juvenile rheumatoid arthritis) I took massive doses of ASA through college. After MAJOR (5 hours!) surgery 7 years ago for stage 3 Melanoma with recurrence x2, I now have been diagnosed with psoriatic arthritis, fibromyalgia and recently added lumbar spondylosis and cervical spondylosis. I am very thankful for my pain management doctor. 7 years ago, I was prescribed PO morphine and then changed to Vicoden with limited results. To be honest, my first thought was "I'm now a cancer patient, what is going to happen when I am end stage and nothing touches my pain"

My pain management doctor has me on a regiment of Ultracet and Motrin and my Rheumatologist has added Gabapentin. This has made my daily pain level a 5 on a good day. I wish it could be a 2...

I think it is very unfair to judge what you haven't lived. Perhaps they opiods WERE over prescribed at one point, but to now make patients spend weeks or months on every other option, living with debilitating pain before they are finally offered them is cruel.

Labelling true pain patients as "needy" or "med seeking" is unfair. We need to address the addicts and not the chronic pain patient. We didn't ask to live with pain that often forces us to leave careers that we once loved.

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Specializes in ER/School/Rural Nursing/Health Department.
On 9/3/2019 at 12:26 PM, wearingmanyhats said:

I'll add my .02 on this topic. I have lived with chronic pain since age 12 (juvenile rheumatoid arthritis) I took massive doses of ASA through college. After MAJOR (5 hours!) surgery 7 years ago for stage 3 Melanoma with recurrence x2, I now have been diagnosed with psoriatic arthritis, fibromyalgia and recently added lumbar spondylosis and cervical spondylosis. I am very thankful for my pain management doctor. 7 years ago, I was prescribed PO morphine and then changed to Vicoden with limited results. To be honest, my first thought was "I'm now a cancer patient, what is going to happen when I am end stage and nothing touches my pain"

My pain management doctor has me on a regiment of Ultracet and Motrin and my Rheumatologist has added Gabapentin. This has made my daily pain level a 5 on a good day. I wish it could be a 2...

I think it is very unfair to judge what you haven't lived. Perhaps they opiods WERE over prescribed at one point, but to now make patients spend weeks or months on every other option, living with debilitating pain before they are finally offered them is cruel.

Labelling true pain patients as "needy" or "med seeking" is unfair. We need to address the addicts and not the chronic pain patient. We didn't ask to live with pain that often forces us to leave careers that we once loved.

Psoriatic arthritis sucks! And I don't think a lot of doctors realize the extent of the pain. I was diagnosed with PSA when I was 28.  Now, at 39  I have an amazing Rheumatologist and a decent plan in place--but like you said--I'm still around a 4-5 as "normal".  A year ago on of my fingers was so swollen from the arthritis I have what is called Boutinnierres syndrome-the tendon literally came away from the bone and my finger can't fully straighten.  I now have severe swelling in my thumb and wrist.  Rheum does what they can but I couldn't imagine working, having two small kids, and working around our farm without some of the meds I take.  I never get high, I'm never pain free. I'm also on biologics and Indomethacin. 

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Specializes in ER, HH, CTICU, corrections, cardiology, hospice.

I’m not a fan of hiding behind studies to deny effective treatments. Aren’t we in the, “everyone is a unique individual snowflake” world now? So, go with that. Pain effects people in different ways. Sure try the guidelines of best practices, but know when to get off the beaten path. 
 

Here is where documentation is so important. If the provider before you has tried all or most of the alternatives, then why fix something that isn’t broken?

Here is an example, a middle aged man with peripheral neuropathy that is refractory to neurontin, tens unit, and so on. Basically chair bound due to pain. Same man gets the diagnosis of pancreatic cancer and put on hospice, where he gets all the opiates he needs. Wouldn’t you know it, the pain in his feet is tolerable and he was ambulatory almost to the day he died.

Now studies prove, beyond a shadow of a doubt, that opioids DO NOT WORK for neuropathy, right? So this was placebo effect, right?

I detest dogma, especially when people are victimized by medical dogma. It is within our ability to help, but we cower behind studies that get refuted in time. This is a practice, not an exact science. I’M A NURSE JIM! NOT A DAMN ROBOT!

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Specializes in Psych, Addictions, SOL (Student of Life).

I am officially stopping my opiode which I am been taking for several years for pain management. I haven't taken it for a month  month and the fibro pain is bearable so no better time to try this than now

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Specializes in Mental Health, Gerontology, Palliative.
MattNP said:

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.

Yes, however it's bloody irresponsible to take over an established pain management plan and up end it. 

If you arent comfortable with the pain managment plan. don't take the patient on

Simple

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