Shocked and Floored-Chronic Pain Mgmt

Jules A, MSN · Jul 4, 2015

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.

Was the clinic staff divulging confidential information? As unappealing as it sounds to me a bunch of patients sitting around discussing each others diagnosis and treatment isn't a HIPAA violation. If the staff was doing it I would definitely file a complaint and perhaps the other concerns you have which sound valid to me might be investigated also.

CrunchBerries · Jul 4, 2015

Was the clinic staff divulging confidential information? As unappealing as it sounds to me a bunch of patients sitting around discussing each others diagnosis and treatment isn't a HIPAA violation. If the staff was doing it I would definitely file a complaint and perhaps the other concerns you have which sound valid to me might be investigated also.

No, I wasn't referring to the patients discussing anything it was the staff.

Examples.. everyone has to do a drug screen at each and every visit. They hand you a cup with your name written on the top. In the bathroom there is a counter with a sign that says to please place the sample on the table. They don't pick it up between patients. I did my drug screen as I was leaving the office and when I went in the bathroom and there were about 20 cups of urine with each patients name on it. Besides, patients could tamper with the samples of other patients.

Other patients heard me talking to the first lady about not signing any opioid forms, it was clear my sample would be clean. If anyone was going to mess with them it would likely have been mine! HA

A woman called the office and apparently she "lost" her Vicodin. The staff were speaking loud enough that the entire waiting room could hear. She was telling the OM that this lady (by name) was claiming she "lost" her Vicodin AGAIN! Then they went on discussing this person's history in front of all the patients.

When you go to make another appt all the Rxs for various narcotics are sitting right on the counter for all to see. The receptionist picks yours out and hands it to you.

I just hate that place, I can't go back. If my PCP won't manage this I will do it on my own and just get the meds from Mexico since I live here now anyway. I honestly don't mean to sound like a drama queen but when I left there I felt a bit like a low life drug abuser getting my fix. I have to admit, I had a bit of a mini anxiety attack when I wondered about my own future. As my MS progresses, might I end up like those people?? Shoot, I think I'd have to dig my eye out with a rusty nail before ending up like that!

ixchel · Jul 4, 2015

My clinic is a legit place and none of what you described would ever happen there. I'm so sorry for this experience, and I hate that these places destroy the credibility of decent places.

Cricket183, BSN, RN · Jul 5, 2015

I'm sorry you had such a negative experience but I have been to multiple pain clinics (please don't read anything into that) and none of them have been anything even remotely close to what you describe. I have a severe chronic pain condition called RSD (Reflex Sympathetic Dystrophy) aka CRPS (Complex Regional Pain Syndrome). It initially started with a nerve injury from a herniated disc. I have been seeing my primary pain management doctor (an anesthesiologist) for over 10 years.

Like you I started out not wanting any narcotics. He was fine with that. We started with epidural injections. As my herniated disc progressed to RSD and my pain increased tenfold, I still refused narcotics because I wanted to keep working. He was very concerned about me but always let it be my choice and never pressured me. I tried multiple treatments all of which failed. He then referred me for a spinal cord stimulator (he did not do them at the time).

Which is where I went to my second pain clinic. Also very professional. My SCS worked wonders initially but unfortunately only for about 6 months at which time it failed and I eventually had to have it removed. As my RSD spread and began to affect some of my internal organs (heart and stomach) I ended up in the ER and then admitted to the hospital in a severe pain crisis. After a serious heart to heart with several of my doctors (cardiologist, neurologist, hematologist, and pain mgt) I decided to go on narcotics and disability. For the next five years that was really the only treatment available to me and I ended up on a pretty hefty dose of both long acting and short acting opioids.

Eighteen months ago my insurance finally agreed to pay for ketamine infusions (newly approved by the FDA as treatment for RSD). Enter my third pain mgt doc. Also very professional. I have to travel across the state every 4-8 weeks for these treatments but they are amazingly beneficial. Some studies show that ketamine infusions are more effective when you are off all opioids so three months before I started the treatments, with the help of my primary pain mgt doc I began weaning off the high dose narcotics I was on. It was a miserable three months, but he was great and very supportive. Recently I fractured my tibial plateau which has necessitated me going back on a very low dose opioid temporarily and my pain mgt doc is overseeing that.

In the midst of all my medical issues my youngest son was suffering from intractable migraines. When they started he was 15. My pain mgt doc did not see pediatric patients (nor did any others where we live, fairly small town). We ended up taking my son to a larger city to a pain mgt clinic (after a referral from his pediatric neurologist who had tried every treatment she knew to try). It also was a great practice and nothing like what you describe. We tried multiple treatments and only used opioids on a very limited basis with my son. (I'm also happy to say that by age 21 his migraines finely began to decrease and now at age 24 he is doing wonderful is back in college and only on a very rare occasion has a migraine!).

Please do not judge all pain clinics by the one you went to. I've personally been to 4 and they all were very professional and were collaborative with me in the care I received. Please also do not judge all chronic pain patients by the ones you observed. I would dare say there are far more who are just like you and me. Good, honest, hard working people who through no fault of their own ended up with some terrible condition and are trying their very best to get through the day and to be able to function at a normal level without excruciating pain.

canigraduate · Jul 5, 2015

I am so sorry. That's an awful experience.

My dad has chronic pain issues and I hope to God he doesn't have to deal with that.

I have no words for the amount of shock I am in just reading this, so I can't imagine how you feel.

I hope you find a solution for yourself. (((hugs)))

MunoRN, RN · Jul 5, 2015

There are legitimate pain clinics and then there are "pill mills". You went to a pill mill, that's what they're like.

NurseGirl525, ASN, RN · Jul 5, 2015

What Munro said. You went to a pill mill. There is a huge difference between that and a pain management clinic. The tests are done so they can get paid from the insurance provider. I read you work in Mexico. Do you live there and you just come over the border to see other physicians? I ask this because I'm sure in border towns, pill mills can make a lot of money. It would be harder to track patients and stuff if they don't live in this country. I'm sure this guy is making a killing without any regard for patient's lives. If that would have been me, I would have walked out of the office without seeing the doctor. The reason for the opiate form to be signed is because it is required by law. Do you not have a family doc that can prescribe Pamelor? Neurotin is actually much better for nerve pain than Pamelor. Pamelor is a very old drug. But if it works for you, that is great.

The DEA has really cracked down on these pill mills recently. You cannot judge everyone by what you saw in there. I can see by some of your sentences that you have some preconceived notions about anyone who takes a narcotic. You are wrong on that. While Toradol can be helpful in some instances, it doesn't work for all. I had a migraine about a month ago for five days. I couldn't take it anymore. I went to my family physician and he gave me a shot of Toradol and Phenergran for the vomiting. It took the edge off my migraine and got it manageable to where Excedrin finished getting rid of it. My stomach is torn apart from all of the NSAIDs I have taken over the years to help with my chronic pain. I'm talking years. My GI doctor said no more, but sometimes its hard to avoid them.

Finally about 5 years ago, my family physician and I got my medications to where I can function on a daily basis. One of them is a narcotic. It doesn't work if I am in a flare-up or work on any acute pain, but it does help me to be able to get out of bed and do my stretches. It is a 12 hour ER drug. There is no "high" from it. I take it when I wake up and about 30 minutes later I can get in the shower and start my day. I only take one as I don't need a pain medication when I sleep. I also take Neurotin for nerve pain that comes with my condition, and a SSRI at night. On real bad days I have a prescription for a muscle relaxant but I will only take them at night or if I am by myself during the day as they make me super sleepy. I have done everything for the pain and this is all that has worked for me. My pain isn't completely gone, but it's manageable. I have accepted the fact that I will never be pain free. I exercise also which helps. But over the years I did physical therapy, Yoga, Tens units, a million different anti-depressants, anticonvulsants, NSAIDS, biofeedback therapy, special pillows to sleep. I have tried it all. This regimen is the only thing that works for me.

Due to new laws in my state, I see a pain management doctor. He is great and understands what I go through on a daily basis. I go every three months. I am drug tested each and every time. I have random pill counts at any time. I sign an opioid agreement that I will use the same pharmacy for each refill. I abide by the regulations that are put in front of me. I am one of the very few patients on opiate therapy. He's reviewed my large medical record and knows what the score is with me. I think one time last winter I was prescribed a Tussin cough medication for a couple of days because I had bronchitis. I immediately called them and told them that I was taking this for 2 days. It was not a problem. They noted it in my chart.

States are cracking down on these so-called pain management doctors that prescribe to anyone and everyone. But I implore you to not paint everyone with the same stroke. That's not fair. And to somehow have it in your mind that you want to just hug and thank the person that chose Toradol over morphine is a little over the top. You can't judge someone by how they treat their pain. It's not your call. It's the doctor and his license and what he feels is appropriate for that patient at that time. This is something that really bothers me.

I am so glad that Pamelor takes away your pain at this time. I took it years ago. But do you know TCAs are now on the list of drugs that can be abused. When I submit to drug tests whether at my school or at my pain management doctor it's something they screen for now. I don't fully understand why. I've asked and just been told they make you sleepy. Yes, I know that. I just wanted the rationale behind it. Lyrica is now a controlled substance. I can't figure that one out either. It's primarily an anticonvulsant. But some people claim to get high from it so now it's controlled. An addict is an addict and is going to abuse whatever they are given. Their mindset is different from those that are not. And now with the crack downs on the pill mills in my area, we have a huge heroin problem. So many overdoses in recent months from heroin. To me, an addict is missing something in their lives, that they are trying to numb themselves. Because I couldn't imagine a life where someone would actually want to live in a stupor all day just sleeping their life away. It's very, very sad. They are needing to get rid of some kind of emotional pain in their life.

What I and many other people have is physical chronic pain. It is there every day and keeps me from living my life. I like to live my life. It's so much better when I can do it with my pain under control. And I know this is long, but I am passionate about this subject. I hope I could shed some insight on this subject for you.

CrunchBerries · Jul 5, 2015

What Munro said. You went to a pill mill. There is a huge difference between that and a pain management clinic. The tests are done so they can get paid from the insurance provider. I read you work in Mexico. Do you live there and you just come over the border to see other physicians? I ask this because I'm sure in border towns, pill mills can make a lot of money. It would be harder to track patients and stuff if they don't live in this country. I'm sure this guy is making a killing without any regard for patient's lives. If that would have been me, I would have walked out of the office without seeing the doctor. The reason for the opiate form to be signed is because it is required by law. Do you not have a family doc that can prescribe Pamelor? Neurotin is actually much better for nerve pain than Pamelor. Pamelor is a very old drug. But if it works for you, that is great.
The DEA has really cracked down on these pill mills recently. You cannot judge everyone by what you saw in there. I can see by some of your sentences that you have some preconceived notions about anyone who takes a narcotic. You are wrong on that. While Toradol can be helpful in some instances, it doesn't work for all. I had a migraine about a month ago for five days. I couldn't take it anymore. I went to my family physician and he gave me a shot of Toradol and Phenergran for the vomiting. It took the edge off my migraine and got it manageable to where Excedrin finished getting rid of it. My stomach is torn apart from all of the NSAIDs I have taken over the years to help with my chronic pain. I'm talking years. My GI doctor said no more, but sometimes its hard to avoid them.
Finally about 5 years ago, my family physician and I got my medications to where I can function on a daily basis. One of them is a narcotic. It doesn't work if I am in a flare-up or work on any acute pain, but it does help me to be able to get out of bed and do my stretches. It is a 12 hour ER drug. There is no "high" from it. I take it when I wake up and about 30 minutes later I can get in the shower and start my day. I only take one as I don't need a pain medication when I sleep. I also take Neurotin for nerve pain that comes with my condition, and a SSRI at night. On real bad days I have a prescription for a muscle relaxant but I will only take them at night or if I am by myself during the day as they make me super sleepy. I have done everything for the pain and this is all that has worked for me. My pain isn't completely gone, but it's manageable. I have accepted the fact that I will never be pain free. I exercise also which helps. But over the years I did physical therapy, Yoga, Tens units, a million different anti-depressants, anticonvulsants, NSAIDS, biofeedback therapy, special pillows to sleep. I have tried it all. This regimen is the only thing that works for me.
Due to new laws in my state, I see a pain management doctor. He is great and understands what I go through on a daily basis. I go every three months. I am drug tested each and every time. I have random pill counts at any time. I sign an opioid agreement that I will use the same pharmacy for each refill. I abide by the regulations that are put in front of me. I am one of the very few patients on opiate therapy. He's reviewed my large medical record and knows what the score is with me. I think one time last winter I was prescribed a Tussin cough medication for a couple of days because I had bronchitis. I immediately called them and told them that I was taking this for 2 days. It was not a problem. They noted it in my chart.
States are cracking down on these so-called pain management doctors that prescribe to anyone and everyone. But I implore you to not paint everyone with the same stroke. That's not fair. And to somehow have it in your mind that you want to just hug and thank the person that chose Toradol over morphine is a little over the top. You can't judge someone by how they treat their pain. It's not your call. It's the doctor and his license and what he feels is appropriate for that patient at that time. This is something that really bothers me.
I am so glad that Pamelor takes away your pain at this time. I took it years ago. But do you know TCAs are now on the list of drugs that can be abused. When I submit to drug tests whether at my school or at my pain management doctor it's something they screen for now. I don't fully understand why. I've asked and just been told they make you sleepy. Yes, I know that. I just wanted the rationale behind it. Lyrica is now a controlled substance. I can't figure that one out either. It's primarily an anticonvulsant. But some people claim to get high from it so now it's controlled. An addict is an addict and is going to abuse whatever they are given. Their mindset is different from those that are not. And now with the crack downs on the pill mills in my area, we have a huge heroin problem. So many overdoses in recent months from heroin. To me, an addict is missing something in their lives, that they are trying to numb themselves. Because I couldn't imagine a life where someone would actually want to live in a stupor all day just sleeping their life away. It's very, very sad. They are needing to get rid of some kind of emotional pain in their life.
What I and many other people have is physical chronic pain. It is there every day and keeps me from living my life. I like to live my life. It's so much better when I can do it with my pain under control. And I know this is long, but I am passionate about this subject. I hope I could shed some insight on this subject for you.

I don't think it has anything to do with being a border town. My insurance is in the US but I live in Mexico. The US is 10 minutes away from me. I believe I was probably the only person there that had private insurance, everyone else was Medicaid because they were discussing it (authorization, specific clinics, etc). So all those people would have been living in the US, not MX. It's EASY to get narcotics in MX, it's more hoop jumping in the US. So I beg to differ with you, my comment was most certainly not over the top.

Samaritan Health did a study and they found that 75% of their ER visits were for narcotic seekers. THAT is what I was sick of and left ER work. Perhaps your experiences differ but I am going to have to insist you stop judging me. I have written nothing to justify your many inappropriate assumptions about me.

No, I have no issue with people that need narcotics but *I* am not traveling down that path, it is not for me, I don't want them and no pill mill is going to change my mind.

I am (of course) very familiar with Lyrica and Neurontin and I am not the least bit interested in either.

Heroin- I have a patient who is a therapist specializing in addiction. She said that since various states are cracking down on narcotic abuse many people who honestly do need the drugs are having them taken away. Older arthritic folks are the new heroin addicts. I had NO idea. She said they are desperate to treat pain. That's just wrong. It's wrong on all levels.

OCNRN63, RN · Jul 5, 2015

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.

Why not go to a neurologist since it's MS? Even a family doc could manage Pamelor.

OCNRN63, RN · Jul 5, 2015

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.

Try living with cancer and not having opiates for pain.

CrunchBerries · Jul 5, 2015

Why not go to a neurologist since it's MS? Even a family doc could manage Pamelor.

Since my ins is new I can't use my usual neuro. The ONLY neurologist on my ins plan is not someone I want to work with, I'm waiting for an appt with another guy in San Diego (about 2 hours away).

I have an appt with my PCP but I don't think he's going to do anything regarding pain management, That's fine, if he doesn't my employer will.

BuckyBadgerRN, ASN, RN · Jul 5, 2015

How did you find this guy and why didn't you do an about face after the second approach with the consent for narcs that you "HAD" to sign?

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.