FloatinYoda
Stranger
Reged: 02/01/04
Posts: 14
Loc: S.E. USA
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Hi to all!
I've got a deteriorated hip, and a couple years ago, I was suddenly facing some tough choices: Have a hip replacement at 40 yrs old, have it fused, or deal with the pain while I aggressively drop 100lbs. or so. I've lost 53lbs. so far,
...but the pain is a constant companion.
I had it under control with 20mg Oxycontin twice a day, until over the last Christmas holidays, my sister in law found out I was on that particular medication...she's a substance abuse counselor in upstate NY, and she immediately went 3 shades of crazy, and started on a personal crusade to terrify her sister (my wife) with horror stories of injury and death due to Oxycontin abuse. 
My wife really meant well, but SHE bought the campaign and called my doctor (at the sister's suggestion) and asked that I be taken off that medicine...AND MY DOCTOR DID IT cold turkey!
She put me instead on Duragesic, a fentanyl patch, but I went through 4 hellish days and nights of...transition...to put it mildy...from the physical dependency of 2 years on Oxycontin. This was 3 weeks ago, and I am not tolerating the fentanyl well. I have a constant dull headache, my heart is pounding, and I've had multiple nosebleeds.
I tried to explain to everyone involved that I was doing well on the Oxy, I was lucid and alert at work, and sleeping well at night, and the dosage was just right. It was all to no avail. My doctor's statement was "I'm about this far from never prescribing Oxycontin again."
This was my Primary Care Physician.
After the call, she basically washed her hands of my pain issues, and has referred me to a prominent pain management group in the area, who have agreed to see me.
Are they going to be sympathetic/willing to treat me with what I need?
Or does "pain management" actually mean "psychobabble to convince you that your body doesn't REALLY hurt"?
I have to admit I AM stressing a little over it, because I don't know if I'm going in to a group who will be looking at me and saying "dude's probably an addict-- let's take him off of everything", or "tell us where it hurts, how badly, and what you need to function", or somewhere in-between. Can anyone please comment on what to expect with a "pain management center"???
Thanks for any/all advice,
Ben
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Seek out Comfort and Joy daily...
Love people. Use Things.
Keep 'em straight.
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Steffie
Member
Reged: 04/11/02
Posts: 111
Loc: Southwest
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I've been seeing a Pain Management Dr. for more than a year now, and I am very happy with him. For your first visit, of course he'll want all the previous info, esp. why you're there, why the previous dr couldn't or stopped helping you. My experience (I've seen 2) is that you be totally up front with the PM dr. - the only thing they're into is helping with your pain, whether it be by meds, therapy, or other procedures, he is in it only for PAIN MANAGEMENT. When I asked for pain meds, my doctor told me straight out that he learned very early that it makes sense to help relieve pain via whatever means available and if that is taking medication, then so be it. The meds you've taken before do not sound anywhere near a med addiction problem. Anyway, after taking down the pain info, tell the doctor what has helped you in the past. Tell him that your previous dr was not a PM specialist and perhaps it isn't proper for a general practitioner to prescribe pain meds, just like maybe they're not the best informed for prescribing phsych meds like Zoloft or Paxil. The doctor may try different meds, different strengths, but again, your med dose was so low before, I don't know what he'd decide. For my back, my doctor tried various techniques in addition to my prescriptions, trying to help the pain. (A lot of them were different "shots" aimed at deadening the nerves causing pain, i.e. trigger point, epidural, facet injections, radiofrequency, etc. Tried them all) Your doctor my try these as well. But agin, just be up front, tell him why you're there, what you'd like to accomplish, what's worked in the past, and any new suggestions he may have would be very helpful.
Sorry this post is so long, but I really hope you get what you need out of this experience. PM docs totally understand the patient and what helps. Good luck to you.
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FreddieC
Journeyman
Reged: 01/11/04
Posts: 90
Loc: Texas
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That really gets me upset. Because a few people abuse the drug and it makes a good enough story to make 60 minutes, people in real pain are suffering for it. So sorry this happened to you. Hope all turns out well.
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Steffie
Member
Reged: 04/11/02
Posts: 111
Loc: Southwest
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Welcome, Freddie. I agree, because of BS press, good PM docs are getting bad rap, as well as legit med users. Did you read the total BS story about changing hydro to Sch II med?
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FloatinYoda
Stranger
Reged: 02/01/04
Posts: 14
Loc: S.E. USA
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Thanks Freddie and Steffie!
My appt. is Thursday, so I will take your recommendations and just go in expecting the best.
Needless to say, the meddlesome in-law (outlaw) sister won't be getting any Christmas cards from ME anytime soon!
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Seek out Comfort and Joy daily...
Love people. Use Things.
Keep 'em straight.
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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Floatinyoda-
In my state is not legal for anyone except the patient (unless the patient is a minor) to speak to a physician regarding another adult's (even a spouse's) medical issues.
I'm not saying it doesn't happen, but theoretically your doctor should not have disclosed or discussed your medical treatments/conditions with your wife without your written consent if you were not present for such discussion.
I'd be sure to ask for your doctor's privacy statement and ask why he felt justified in discussing your medical information with an unauthorized person.
Too little, too late, I know...
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Never underestimate the predictability of stupidity.
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FloatinYoda
Stranger
Reged: 02/01/04
Posts: 14
Loc: S.E. USA
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Thanks night_shade, and much respect to you!
I agree, it shouldn't have happened; but then, TN is pretty lax in lots of things, which can be good AND bad.
Best I can hope for at this point, is DC.
Damage Control!
Thanks again,
Ben
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Seek out Comfort and Joy daily...
Love people. Use Things.
Keep 'em straight.
Edited by FloatinYoda (02/16/04 06:00 PM)
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MAXICAT
Journeyman
Reged: 12/13/03
Posts: 73
Loc: TEXAS
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Hi,
I have been seeing a PM for almost 4 years now, because regualar doc had reached threshold. He is the most caring person regarding pain. Every time I had a hospital procedure, he was there for me, even came up at 11 at night because I was having problems.
However, watch out. There are good PM's and bad ones, and you don't have to go to the pain therapy although, sometimes it helps people deal with the mental aspect. I would definitely try one, but see if you can get some preliminary information from a source; not a referral system! They are paid and stink(only my opinion, of course.)
Anyway, that's my 2 cents, for whatever it is worth.
I hope you find some help, from my experience, most primaries don't really care about pain sufferers, they are only there to herd in the cattle. (Again, my 2 cents)
I just know it wouldn't hurt to try.
Good luck! 
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Steffie
Member
Reged: 04/11/02
Posts: 111
Loc: Southwest
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Maxicat - that was exactly my point - general docs don't really understand pain but I really feel that PM's do. I imagine there are some good ones & some bad ones, but that goes with any specialty I guess, I've met a few doosies in my time. One or two I'd like to shoot!! Jusy kiddin. PM's just understand you, that you're not a drug seeking addict, but genuinely looking for help either for resolution of pain or just like their names say, management. Also - When you go in, don't forget to ask questions of your own - like how much schooling and years of practical experience does the doc have. Does he do any surgical interventions - not necessarily actual surgery, but different procedures, like the trigger point and such.
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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I just got back from my 1st pain management appointment. It took 3 hours and I had to first speak to an RN, then a nurse practitioner and then, finally, the pain doc.
It went fairly well and I was brutally honest about everything in my sordid medical history including my 7 years on methadone maintenance. I am having some sort of nerve block done tomorrow and if that fails (the doc says there is a 50/50 chance it will) they will put me back on a higher dose of methadone for pain management.
I went in thinking I would be completely honest (including that I would simply get back on maintenance if they were unable or unwilling to help me) and expect nothing from them.
I gave a UA, signed an opiates contract and provided my medical records for the last 9 years at this appointment. I know my urine is clean (except for methadone, which I am currently prescribed--just in much lower doses than the PM clinic will provide me with) and I will be subject to random UA's at future appointments. All this is fine with me as I know I will pass.
So, I go for this test tomorrow and hopefully it WILL work. He says it will deaden the nerves around the fractured vertebrae and either completely resolve the pain for up to 18 months or it won't help at all. But at least they are doing something--and right away.
Good luck with your appointment. Mine exceeded my expectations. And, in this case, at least, honesty did not cause me problems.
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Never underestimate the predictability of stupidity.
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FloatinYoda
Stranger
Reged: 02/01/04
Posts: 14
Loc: S.E. USA
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Thanks for sharing night_shade.
My appt. w/PM Dr. is tomorrow, and I'll update at that time.
What's an "opiates contract"?
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Seek out Comfort and Joy daily...
Love people. Use Things.
Keep 'em straight.
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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The opiates contract I signed says that I will not get pain medications from other doctors (or if I do, I must report them to the PM doc right away.) I am also subject to random urine screens for the presence of drugs other than what I am prescribed. They can also call me and make me come in within 24 hours for a pill-count.
None of this worries me. I am perfectly content to follow the rules if they will help my pain. The PM group I use ONLY uses methadone for pain management. I guess they don't want the bad press associated with Oxycontin.
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Never underestimate the predictability of stupidity.
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Steffie
Member
Reged: 04/11/02
Posts: 111
Loc: Southwest
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That is awesome news!! I'm so glad the PM doc is really trying to help, and I hope you get some relief. For me, the methadone was too strong, and I've been on/tried everything else. Just keep searching, and stick with this doc, all will go well.
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Toberlone
Stranger
Reged: 02/12/04
Posts: 13
Loc: outside its America
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Does all PM docs require an opiate contract? My rheumy did, but my PM doc doesn't....and no UA's, no pill counts, a bit a lecture once a couple of a months ago, but thats it.
Is that a rarity?
Just wondering.
Glad folks are getting help. I am new, and looking for support and comaderie among fellow cper's, and it looks like I came to the right place! Thanks for being here.
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Baseball is like church, many go, but few understand. Unknown(to me)
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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PM doctors (and others) who do not want any hassles with regulatory officials utilize opioid contracts. They do this to protect themselves from prosecution, persecution and inquiries into their prescribing habits.
If a physician who uses opioid contracts suspects a patient of abusing or diverting their medications, they are able to discontinue prescribing without fear of malpractice suits because of the specific conditions of prescribing set forth in the contracts.
It really is a win-win situation for doctors and patients. It is not something that is punative or designed specifically for patients with prior histories of drug/alcohol abuse.
I would think anyone who was receiving adequate pain care from their doctors would be happy to comply with the conditions in the contract.
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Never underestimate the predictability of stupidity.
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FloatinYoda
Stranger
Reged: 02/01/04
Posts: 14
Loc: S.E. USA
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Well, it was a good experience overall.
I went, saw ONLY a Nurse Practitioner, who got a little harsh with me when I suggested it was a sham that I wound up in her office. I DIDN'T react, just got quiet and stayed calm, and told her I'm sure she saw lots of people come through telling all KINDS of wild stories, and she probably gets tired of them.
She totally changed her tune, was very compassionate from then on. Prescribed Kadian, a morphine sulfate 2x/day, and Hydroocodone for breakthrough pain. I had to sign an opiates contract, but it wasn't to be punitive, just to ensure that I take meds as prescribed (no problem here).
The Kadian IS addressing my pain okay, although I do have breakthrough pain at some point almost every day.
Can I go 'on record' as saying that I've got some real sadness over this whole melodrama, and that I'm just tired and sad and frustrated that someone felt the need to mess in my business and cause me great undue scrutiny, inconvenience, and a change of meds to something that, while adequate, is ONLY second-best. Geez. What a bummer. I guess I should count my blessings.
Hope everyone has a pain-free day,
Ben
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Seek out Comfort and Joy daily...
Love people. Use Things.
Keep 'em straight.
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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FloYo --I saw you once sign off as that, so hope it's OK!  )
I am glad you were able to get a "replacement" med at the PM doc's office. It is the nurse practicioner at my PM clinic who does all the decision-making, too.
I was on MSContin some years back and found it to be fairly effective with Percocet for breakthrough pain. Kadian is, I believe, just a longer-acting form of morphine than MSContin is.
I am glad you received help--even if not the med you had hoped for. GOOD LUCK!
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Never underestimate the predictability of stupidity.
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sasi
Member
Reged: 03/12/04
Posts: 116
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You are right to be sad and irritated at someone getting into your business like that. I hate that people think that dependence (not saying that you were dependent on the oxy) on a drug automatically equals abuse. Aren't diabetics 'dependent' on insulin?
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Pickledoo
Old Hand
Reged: 09/20/02
Posts: 411
Loc: New England
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I have a good one! I had been sent to a pain mngt. place last year. After seeing the dr. 3 times (1 pressure point injection, 1 epidural, 1 script for percs) he said there probably not much else he could do for me and we bid each other adiu. I was fine with that because I generally get the meds I need from my Ortho. This was about 6 months ago. The other day I got a letter from the pm group announcing a class being held over 2 days that is manditory for all patients on opiate therapy. "You are required to take this class and attendance will be taken. You will also be required to sign an opiate contract." ???!!!???
I had to laugh. I will not be attending but I sure feel bad for all those who go to this group for their pain. Seems to me that the ONLY thing these guys think about is covering their own butts not helping people feel better.
Thought you all might like to hear that one.
Pickledoo
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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If my pain management group had required me to attend an "opioids class" prior to institution of narcotics therapy, I'd have been glad to do so. I was also more than happy to sign the opiates contract.
I don't see anything wrong with pain docs "covering their butts" to avoid potential legal hassles in the future--that means they are WILLING to help chronic pain patients. The classes and contracts are not made to penalize patients, they are there to establish very difinitive rules regarding opioid therapy and educate patients about the drugs and what to expect during treatment.
I was willing to try ANY legitimate treatment modality available to help this horrid back pain--anything at all. All I want is an end to the pain, not the drugs from the doctor. So, if no treatment options are available for now, I'll take the narcotics so I can at least do housework, attend my childrens' school functions and hopefully, return to work in a month or two.
Still, it's a personal choice. Some people don't want to be "restricted" by a PM clinic. To each their own. As for me, I was willing to jump through any hoop, on command, to get help for my pain.
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Never underestimate the predictability of stupidity.
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Pickledoo
Old Hand
Reged: 09/20/02
Posts: 411
Loc: New England
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Night Shade,
I think you missed the point of my post. The irony lay in the fact that I hadn't been to that group for 6 months and I had only recieved 1 script for opiates from them. If this was my only option and I was a regular patient then I would have happily gone to class and/or signed a contract.
Anything else I need to add?
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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Pickle-
I'm still not "getting it."
Perhaps Pain Management clinics differ in other geographical areas? Mine is by referral only and that clinic then takes over ALL treatment of my chronic pain. I still go to the regular doc for my heart disease, colds and flu and other medical issues. The opioids contract only applies to treatment of my chronic pain issues and doesn't prevent me from getting narcotic meds such as cough syrups, post-op pain, dental pain, etc.
My point being that the PM clinic takes FULL responsibility for my chronic pain issue and that's it. I go there initially every 2 weeks for medication adjustment, then ultimately only quarterly, but will have to get my scripts from the clinic once a month.
I'm not understanding why you would go only once in 6 months for a single prescription? It seems very odd for a CP issue??? I really am mystified by what you referred to as the irony in your post?
Please understand that it isn't a personal judgment! I was only stating that I am willing (and I would imagine most people here would be willing) to do just about anything required of us if it assured us appropriate medication of our pain.
Edited to add: Perhaps I understand now...are you saying that they wouldn't give you MORE than the one script for opiates? If so, I can now quite clearly understand your frustration and the irony of such classes. Sorry! I'm a little SLOW today!
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Never underestimate the predictability of stupidity.
Edited by night_shade (03/18/04 05:59 PM)
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Daycamp72
Enthusiast
Reged: 06/29/02
Posts: 284
Loc: Tara
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Good thread. I've been under the care of a PM doc for almost a year now and I'm quite happy with him. My only questions: I recently had more breast cancer reconstruction surgery. I called my PM doc to tell him of the surgery. Thank the Lord the surgery went well this time. However, I was given a script for Percocet post op. I called the PM doc and told him of this script (like I was supposed to). His nurse informed me to throw away this script, that my daily dose would COVER my post op pain. (UGH!). I did.
THEN, I was told this week that I'm to have two more dental implants next week. Man, are THREE Percocets per day supposed to help THAT, post op, too???
I understand that if I have any opiate script filled, it's in violation of my Pain Contract.
I'm sorry, my daily dose of Bextra and Percocet did NOT help my post op pain from my reconstructive surgery. Granted, I was fine after three or four days, but they were hell to get through.
Any thoughts?
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