Recently, it has come to my attention that MDs have been targeted for over prescribing narcotics for pain control. My mother has become one of the victims of these new laws that have made it difficult for primary care physicians to assist patients with managing their pain. First of all, I would like to say that this is a quality of life issue and for those that do abuse drugs under a physician's care, their plight is not what I am writing about. This is not the case with my mother. Her pain medications have been well controlled.
My mother has back pain and tremors that have caused her much distress since her mid-50s and before 2 years ago, she had never been on narcotics. Getting her to go to the doctor was a strain and now it has become a necessity. Her pain is constant with intermittent acute episodes. It is also difficult to deal with because she has progressively become more forgetful and confused with personality changes over the last 5 years. She fell and broke her hip 1.5 years ago and her shaking makes her a much higher fall risk and her pain makes her a suicide risk. My sister and I are trying to keep her at home, but the anxiety and pain keep her awake.
For fear of loosing her pain management regime, she had elected not to change physicians. This was a mistake. This primary care doctor has a wonderful nurse practitioner that understood her condition. Her doctor was asked for a neurology consult and pain management consult and instead was condescending and rude. She has been on Norco 7.5 and Ativan 1 mg BID for 1 year and intermittent use before this for approximately 1 year. Her medications where well controlled and changing them had been discussed repeatedly with no results.
Upon her final visit to her doctor's office, my mother had been complaining about a strange intermittent sharp pain in her peri area. My sister had requested the nurse practitioner for the pelvic exam and the doctor insisted on doing it himself. He abruptly cut my mother off about her pain complaints and stopped all pain medications and prescribed her Prozac. At other visits, I requested attention be given to her signs and symptoms of dementia that have made her anxiety and pain control worse. At her last visit he accused my mother of being a drug addict and refused to listen to her or my sister. I can go on and on, but I know that had she changed her MD sooner, this may not have happened.
She did change physicians and her new physician was as rude as her previous one. This time I was present. It was obvious this doctor had in some way communicated with her previous physician. Her new doctor was up front about not prescribing narcotics. I told her that I understood her position, but could she at least prescribe enough to get her through till her pain management appointment. My mother interrupted me by having a fit in her office, but not directed at the doctor. It was due to lack of sleep and her mentality. It is obvious that my mom has progressive dementia and that her actions were directly from her frustrations. The dementia symptoms started years before the narcotics were in place and her demeanor was always calm and kind before.
We, as medical providers, can debate the side affects of anxiolytics, especially on the elderly and why, but the big picture is informed consent and quality of life.
I have been a nurse for 20 years and I was trained repeated that we are NOT rehabilitation nurses and that pain is subjective. Any nurse with experience, knows what I am talking about.
