Pain patients being denied their medication!

While I empathize with the situation, the reality is that evidence shows that opiate therapy isn't an effective option for long term pain management. Given the current climate, everyone from providers to pain patients need to rethink their ideas of pain and options to minimize that pain. Maximizing multimodal therapies as well as holistic approaches need to be explored and tailored to individual patients. Use off opiates may be appropriate for breakthrough situations while other therapies are being utilized, but not at the levels many are getting (often 30-60 pills a month). If you need opiates, I'd argue your pain isn't being managed and you need a better workup.

Rethinking is not the same as telling a patient she is not experiencing what she is experiencing, as well as completely discounting what she just told you. For her, opioids are an effective way to deal with breakthrough pain, which is not the same as using opioids as first-line treatment of chronic pain.

You won't get very far in managing chronic severe pain if you don't learn to listen to what's going on and avoid slotting patients into your little pre-determined boxes.

ETA: frankly, I think a big unmentioned factor in iatrogenic opioid problems is lazy practitioners using a one-size-fits-all approach to treating chronic pain. That and the greasy wheel syndrome that keeps the patient high and happy, thus out of the practitioner's face.

heron said:

Rethinking is not the same as telling a patient she is not experiencing what she is experiencing, as well as completely discounting what she just told you. For her, opioids are an effective way to deal with breakthrough pain, which is not the same as using opioids as first-line treatment of chronic pain.

You won't get very far in managing chronic severe pain if you don't learn to listen to what's going on and avoid slotting patients into your little pre-determined boxes.

ETA: frankly, I think a big unmentioned factor in iatrogenic opioid problems is lazy practitioners using a one-size-fits-all approach to treating chronic pain. That and the greasy wheel syndrome that keeps the patient high and happy, thus out of the practitioner's face.

I've gotten pretty far managing chronic pain for an array of patients over the past 2+ years doing the exact things I described and reducing opiate use. Studies are backing CDC pushes to reduce opiate use and they should have never been used to the extent they are now in the first place. She never indicated she was strictly taking opiates for "breakthrough". Only that she tried all others out there first. I don't discount the fact that opiates are helping her. I think they would help a lot of people because being numb is certainly better than pain. But the risk of overdose, addiction, and long-term side effects of opiate use make them a non-starter.

For someone with chronic pain, it will never completely go away. The goal is always pain reduction with function improvement. The conversation she had with her provider of "if it comes back, I will refer you" tells me she was punted by someone who really doesn't get this concept (and maybe she has unrealistic expectations of pain management). Multi-modal therapies (multiple drugs at the same time) plus holistic approaches (acupuncture, massage, physical conditioning/therapy, mental health medicine) can all be utilized to round out the picture and improve outcomes.

Greasy wheel syndrome and provider laziness is why we are in this predicament. And certainly something I am not willing to be a part of.

I still think that your response to the OP reflected a distinct lack of attention to what the OP actually said about her opioid use.

And two years experience is a drop in the bucket - barely enough to know what you don't know. I have 18 year's experience in clinical setting where pain management was a critical part of our work: hospice x 7 years, end-stage AIDS x 11 years. While I'm no APRN, I've seen enough to know that such a categorical dismissal of the appropriate use of opioids is every bit as lazy as throwing OxyContin at every sprained wrist just to shut the patient up.

heron said:

I still think that your response to the OP reflected a distinct lack of attention to what the OP actually said about her opioid use.

And two years experience is a drop in the bucket - barely enough to know what you don't know. I have 18 year's experience in clinical setting where pain management was a critical part of our work: hospice x 7 years, end-stage AIDS x 11 years. While I'm no APRN, I've seen enough to know that such a categorical dismissal of the appropriate use of opioids is every bit as lazy as throwing OxyContin at every sprained wrist just to shut the patient up.

To be fair, I have 9 years total working in settings where pain management was essential. My actual management experience was off of the past 2 years working in in/outpatient pain as well as now primary care (since we're puffing our chests and throwing out numbers). And I never categorically dismissed the use of opiates. I categorically called for the appropriate use of opiates for the right situation. Those situations include new onset acute pain and for significant breakthrough pain where all other medications actively being utilized fail to improve (both of which are short/limited duration situations). I also noted the importance of tailoring these regimens to the patient and the simple fact that opiate management is not pain management.

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.

I recently heard excerpt on NPR from a local MD conference, which was aimed at stopping opiods from being prescribed for chronic pain.

The doctor speaking said that physical therapy could be used instead of opioids.

Right... the cause of my chronic pain was misdiagnosed for many years. I was sent to physical therapy over and over again.

This only served to exacerbate the problem, and make the pain worse.

I have spent thousands out-of-pocket on every OTC, and alternative therapy available. None of it has worked.

With practitioners cutting people off of opioids, without coming up with effective alternatives, FIRST- I predict that a lot of people desperate for pain relief may turn to street drugs, or purchasing pharmaceuticals on the street.

(That's already been happening, for a long time.)

Word. I have mixed feelings about this because people are in this position because for so, so long opioids were pushed by big pharma (hellllo, oxycontin!) and labeled as "safe" by JCAHO. Won't get into the politics of all that except to say now we have a literal and figurative mess on our hands. The healthcare industry aided and abetted in this crisis and what the crap are we going to do about it now?

I watched a TED talk on chronic pain several years ago and it was fascinating... About chronic pain being a disease itself and showed this amazing example of a girl that sprained her wrist and how it adversely affected her life and then what they did to fix it. It's Elliot Krane and the mystery of chronic pain. It's fascinating.

To the OP, I am sorry you're in this situation. I feel that this is going to be increasingly more common in the next few years and I do hope you are able to find a way to successfully live your life opiate-free, or at least opiate-almost free. There have to be answers out there somewhere.