Shocked and Floored-Chronic Pain Mgmt

[CrunchBerries]

I received quite an education this week. I have been a nurse for many years but for the first time I am on the patient end of pain management for MS. I find myself still slowly shaking my head over my experience. I guess I just want to share what happened and I don't know a better place to get some thoughts other than here.

I arrive at my 8AM appt about 10 minutes early to find about 10 people waiting. We all had 8AM appts. More people kept showing up to the point that there were no chairs left and people were standing outside. I gave up my chair to an elderly lady that clearly could not tolerate standing. I went outside and waited with a group of people.

They all knew one another, they knew one another's diagnosis, med list, history, the works. One lady mentioned she hadn't seen me before and I must be new. I said I was. She asked my diagnosis.... Really? Okay, I guess I don't mind and I explained that I have MS. A few asked some questions about MS and I responded.

The receptionist came out with a mound of paperwork for me to complete, some of it was... quite frankly, stupid. One was a page where I was supposed to draw a picture of how I perceive my pain. Not a silhouette where you put an "X" where you experience pain (that was another page) but an actual drawing of HOW you perceive pain. I just wrote no, this is stupid.

Then a consent for opioids with an explanation that they can be addictive, etc. I drew a line through the page and wrote "refused" with a note at the bottom "No narcotics please." That little note turned into a ****-storm later.

I turned the completed paperwork in and the receptionist came outside handing me a new consent for opioids and I explained I don't want any narcotics she asked if I was refusing treatment and I told her no, I was refusing narcotics. She said I *had* to sign it, I explained I do not have to sign anything. She rolled her eyes at me and walked back in the office.

The other patients hearing all this started quizzing me, what did I want if I don't want narcotics. I explained there are many options for pain management, not just narcotics. One lady explained to me that people like me make it harder for people who do need narcotics, two others agreed. Seriously??

I stood there for an hour listening to these people. I couldn't believe what I was hearing and seeing. One patient with his arm in a cast was sooo drunk he could hardly stand and he had a beer in his hand. Another guy was walking from person to person offering to sell "weed" and those that didn't have money he would deliver locally for a $5.00 fee. Let me tell you, he was quite the salesman and amazingly pushy.

Then they all started comparing withdrawal stories and laughing about how funny it is. One lady couldn't pay her rent one month so she sold her percocet and went into immediate withdrawal. I asked her what she did, she said she went to ER and they gave her 3 day supply. One man complained that he was being given too many meds and he just stopped cold turkey and spent three weeks vomiting and shaking. However, most complained that they were not getting enough meds.

Then they started talking about EMGs and epidurals. Everyone has had both. I asked, is this common with this doctor? They said yes, he requires everyone get them. I asked why, they said he won't give you narcotics unless you line his wallet and extra diagnostics are just part of the deal. SERIOUSLY?

Finally the medical asst called me back to an exam room and chastised me for not signing the opioid consent form. Again I was asked if I was refusing treatment and again I explained I am merely declining narcotics. Again, she told me I *had* to sign it and again I explained I do not have to sign anything. In comes a 2nd lady and it was a repeat of the above. Then a 3rd lady comes in and she's the office manager and another repeat of the above.

One of the reasons I got out of ER nursing was the constant influx of narcotic seekers, especially on weekends. When the very rare patient declined morphine and requested Toradol I wanted to HUG them and say THANK YOU! I was really surprised at all this.

The office manager went out and told the doctor that I refused to sign the opioid consent form and he asked what my problem was. She said I was refusing narcotics. HE asked,

"So she's refusing treatment?" He asked what was wrong with me, she said she didn't know. He blew up and said he was the doctor, he would decide my treatment options.

Finally the doc comes in the room and I just stopped him dead in his tracks. I was sincerely annoyed at everything I had experienced and I explained, "I heard the comments you made out there along with the rest of the building and I want to make something clear. I can't take NSAIDs anymore due to GI problems, I prefer to not take muscle relaxers anymore, and I flat out refuse narcotics." I went on to explain that with his education and specialty surely he knows of non narcotic options? He said he has a few tricks up his sleeve so yes, there are other options.

Then he said he was going to do an EMG, I asked why. He said he wanted to see if there was nerve damage. I asked if the results would change the treatment plan, he said no. I asked how it would benefit me, he said I would know if I have nerve damage. Again, I asked what value there is to ME? Longer story short, I'm not doing the EMG. Then he said he was going to do an epidural, I asked for what? Where? He looked at my file and said, "Oh yeah, you have MS. Nevermind."

I don't even have words to explain how this whole thing made me feel. If I wasn't anti-narcotic (for me) before, I would have been after seeing all these people and listening to them compare withdrawal stories and their behaviors and laughing about things that just aren't funny.

I just have no words, I am shocked and floored at this MD office. But, I did leave with what I wanted, Pamelor for nerve pain. I work full time, I enjoy my job, I do not want to have to quit so I can sit home and become an addict, you know?

Sorry, I know this is long but I just had to vent a bit. No responses are even necessary, just the vent.

[Pangea Reunited, ASN, RN]

That's exactly how I imagine a pain clinic to be, and I have never been to one. I'm glad you got what you needed in the end.

[LobotRN, BSN, RN]

Wow. I'm speechless, too.

[elkpark]

The unfortunate thing is that, nowadays, the words "pain clinic" can mean two entirely different things. One possibility is a legitimate pain management program in which specialized clinicians offer a multidisciplinary, evidence-based approach to pain management. The other possibility is a thinly veiled, quasi-legit, narcotics dealing operation. Sounds like you stumbled into the latter. What a shame. It's places like that that are giving pain management a bad name.

I would imagine that, if you shop around some (and are willing to possibly travel some distance), you could find a legitimate clinic that would better meet your needs. Best wishes!

[KatieMI, BSN, MSN, RN]

This is exactly what chonic pain management currently is. Precise description, and direct "yes" to every "seriously?"

There are other clinics and other doctors but they are few and far between. Otherwise, it looks precisely like described: money-making on unproven procedures (there are no EB studies showing clear benefits of so-called "back shots") and pushing people into addiction.

[CrunchBerries]

The next closest pain management clinic is 2 hours away, not sure I can bring myself to go back to any clinic.

I live and work in Mexico but my insurance is in the IS (I live in a border city). I can quite literally buy Pamelor without an Rx here. I might just do that.

I just can't believe these doctors get away with this. If nothing else, it was a huge education for me. Obviously I think we have all worked with this population but I have never worked directly in pain management. It's a safe bet to say I never will.

[TiredKitten]

Wow. You need to shop around for another doctor.

My husband has knee/leg, spine and nerve injuries from a drunk driver hitting him a few years ago. After 9 failed back surgeries and spinal fusion and hubs not wanting to do yet another surgery (based on spine docs recommendation), the spine surgeon said there was nothing left to be done except go to a pain management doctor. That doctor sounds nothing like my husbands pain doctor.

Any legitimate pain doctor will have many options, including non narcotic options. Our doctor made my hubby sign an agreement that he will only get his pain medicine from him and no where else. He's subjected to frequent drug test to make sure he's only taking what he prescribed.

In our several years of going to this doctor, he has never suggested having extra procedures. In fact, there has been times we asked about something only to be told it wouldn't change the treatment plan so it wasn't worth the money to have it done.

[Jules A, MSN]

To my knowledge there is not research that supports opiates as effective for long term management of chronic pain. Its disgusting and in my area the majority of pain clinics are as you described.

[TiredKitten]

There are so many people claiming to need narcs that don't that our state is clamping down. I was reading the state just passed a series of new laws that went into effect July 1. One being that you will be required to take your previous pill bottle to your monthly appointment so they can see how many you have left. Make sure you are not selling them or taking more at a time than prescribed. They also are setting up a drug monitoring program that will alert your doctor if you get something filled under another doctors name. There are new guidelines for when an ER doctor can prescribe narcotics. There are others, but those stuck out as biggies.

[CrunchBerries]

I quickly realized that these patients will submit to ANY diagnostic, sign any form, do absolutely anything they are told to do just to get their fix.

The HIPAA violations alone were shocking.

[elkpark]

I just can't believe these doctors get away with this. If nothing else, it was a huge education for me. Obviously I think we have all worked with this population but I have never worked directly in pain management. It's a safe bet to say I never will.

Not all of them do -- some lose their licenses, and even end up with criminal convictions and prison time. There was a "pain management" physician in my former state a number of years ago -- had no specialized training in pain management, and his "office" was a shack out in the middle of nowhere. Cars from as far as several states away would be lined up for, literally, miles down the dirt road leading to the shack waiting to see him and people would tell you that he had saved their lives, he was the only physician who understood how they suffered and was willing to help them. After the state busted him, the newspapers reported that the state investigators found that his "office" had no exam table or any kind of medical equipment -- it didn't even have running water, just a desk and a few chairs. Didn't even pretend to examine people; just took their word for it that they were in crippling pain and wrote them scrips. He ended up in prison (sans license). Sounds like the guy you saw was at least trying to maintain the façade of a legitimate medical practice ...

You don't want to try the next nearest clinic? If you had a bad experience at a restaurant, would that mean that you'd never be willing to try another restaurant? If I had serious chronic pain, I'd sure be willing to drive two hours to get some (real) help.

In any case, I hope that you get some relief and things work out. Best wishes!

[CrunchBerries]

No, I really don't want to go to anymore pain management clinics if I can avoid it. My employer (I'm sure) would be willing to oversee my titrating Pamelor. If that doesn't work I may have no choice but, going back to any clinic is going to be an absolute last resort.