Thanks Doc and American Regulation of Pain Meds

General Blog
1

Beef!! At the end of May I went to my GP and I told her the usual pain control thing we have been doing for years. I take hydrococone for about 3 days if I have a bad flare that wont calm down and is putting me on the couch. Thats it. I hate taking them cause they constipate but I have ways of dealing with that. She has known me for 10 years. She knows I am not an addictive personality and I hate taking drugs and pills in general. We have had no problem. Now maybe because I just started on the Humira she did not want to give me that anymore. I think she just did not want to treat my pain anymore. She told me to talk to my rhumey about pain management. OK. I have to wait for my appoint with him set for a month later. No problem. Its summer and my pain level is low especially since I started the Humira. I got to my rhumey and what does he say? Just talk to my GP doctor about that. What she has been prescribing me so far is alright with him if it is working for me..... The summer goes by and now comes the rain and 80-90 percent humidity with the dropping temp. We live near the water so it is damp and yucky here in the winter and yes....it does rain 9 mos. out of the year here.

Today I call to ask if my doctor could call in a perscription for me and they tell me I have to come to the office to pick up a hard copy of the prescription for myself. I ask if this is a new policy and she told me no. Its a narcotic drug and that is the way their rules are. She did not really answer my question. I recall my dr. calling this prescriptioin in for me so I could just pick it up at the pharmacy. hmmm ???

I have heard from friends of mine that in the past few years it is getting harder and harder for them to get their doctors to prescribe them the pain managment drugs or come up with some kind of pain managment plan to help them with their illnesses. These are people that are not addicts or abusers in the least. They have real pain and its really bad. Some very dibilitating pain issues.

But I do understand that the doctors are being pressured too in some way to not prescribe pain drugs anymore. Im not sure what thier story is. What it is that they are dealing with.. I just know that there is a side to their story too.

So to all of you who are having problems with your docs about this, I wish you well. I hope you will be OK...

And me....?? I will have to a bit more of a squeaky wheel instead of being a wimp that suffers quietly. Squeak! Squeak!

2

Waterfairy, can you explain to me (a naive Canadian) what the objective is of this analgesic obstacle course?

3

Yes Seenie. I believe it is to keep people from becoming addicted to the narcotic drugs prescribed. Unfortanatly there are people who abuse the system so much and they have been wiley about how to get more drugs than they should be taking. Going to several doctors. Going to the emergancy room with horrible pain and getting them that way. Going to different pharmacists. I know there are other things they do. I dont know what they are but now the doctors are very wary and stingy with the drugs and thats not right for someone who goes to one doctor, has been with that doctor for a very long time and does not abuse the system or the drugs. I have friends who are in alot of pain and you know what I am talking about, and they are having a hard time now with help with pain management. Some have it worse than others and some, like a friend of mine who has RA, are still with a group of doctors that help her just fine with her pain managment. I have been irritated with my GP for a couple of years though and am tired of her passing the buck to the rhumey. Then the rhumey passing the buck back to her. grrrr.

I also understand that sometimes there have been terrible accidents with people who travel alot and if they go to a different dr. in a new town where they happen to be working temporarally and they forget to tell the dr. everything else they may be taking (and it can get hard to keep track especially if you are tired sick and still trying to work) the dr. may give them something that could result in a worse health crisis or death. So I see their point. But at least treat people for pain if you already know them and have been treating them for years.

I might mention here that 2 years ago my doc asked me if I wanted to go to a pain clinic. I declined. I did not feel I needed it at the time. Then this spring, before I started the Humira, I asked her if I could go to a pain clinic now and she said wait and see what my rhumey does. I started Humira, it works pretty good, but it has been summer and I am always fairly good in the summer. Now its close to my b day and I always start to get sick at this time because the weather changes. ick.

I ll see if I can find anymore info on the net about what is going on with prescription drug regulation here in the states. sorry I was so long winded. '~'

4

This was my battle in may and ended up going to a pain managment doctor. My gp who had been my doctor for years decided he was now uncomfortable prescribing pain meds for me because I was too young…as a pharmacy tech I get it people are crazy about pain pills our pharmacy had been robbed and fake scripts or multiple doctors writting crazy amounts have become one of the daily battles in our location. This is part of what scares doctors out of writing a prescription for pain meds now.

But at the end of the day pain managment has been great. They have given me so many new options and really focus on this aspect since all the other issues I have are another doctors problem. :slight_smile:

5

Hi Waterfairy,
Oddly enough I had an unusually long wait at the rheumatologist office ten days ago (waiting to get my first Humira shot–they insist you go to the office for it. Anyway, while I was waiting, three patients came in to pick up their meds. Apparently, they have a narcotic pain meds contract that they use with patients who routinely receive narcotics (phentanyl patches, for example). Some of these folks pick up their meds, others pick up their scripts but they MUST get them filled at the pharmacy of record (which is printed on the script and theres a phone call to that pharmacy). If they go elsewhere they nullify their pain management contract and the doctor will no longer treat them. One component of the contract is a urine screen. I saw one woman give her screen and wait before she could get her meds. There has always been a notice posted about pain management contracts but I guess I never really paid attention.
All this left me wondering if this protocol is used in all circumstances or only with certain insurance types, or if the patient has been on narcotics for a certain length of time, etc, etc.
I know that doctors who do a lot of pain management have to do this kind of thing to protect themselves from lawsuits and to dissuade people from selling their meds or from going doctor and pharmacy hopping to get more meds. But in your case it seems that your doctor knows you well enough to know that you unlikely to be selling your pills! But I wonder if your physician is under pressure from her practice to use some kind of protocol for all patients.
At the end of the day you have to find the right doctor who is responsive to your needs and concerns when they arise. If that’s your GP–awesome. If it is a pain clinic, cool. I hope you can figure out which is right for you.

6

I just had to go pick up an rx for more pain meds from my dr's office.... and when I finally got there the next day they informed me that they were CLOSED from 12-1pm (I didn't know, and the door was open), I got there at 12:30. Another dr. receptionist was there and kindly helped me before a new med. assistant came out to reluctantly find my rx for me (it was sitting there in an envelope). It just about killed me driving there to physically pick up the prescription, but there was no one to do it for me during office hours.

I understand the regulations, but it can be tough, especially because when we need them the most, as an emergency, between appts, that's when getting around is the hardest.

7

Hello there!

I also have a Big Beef and hopw I can vent here!

It is so encouraging to see that there are other docs out there who are being a pain-play on words-on pain meds. My PCP retired last year and I have seen her partner 4 times so far. She keeps saying she will need more time to get to know my case but has yet to ask any history questions. 2 weeks ago when I went for a routine visit, she was furious that I was changing Rheumatologists from one whom she referrs patients to to a larger practice with Orthopaedic physicians in a very large setting in Cleveland. I had seen the new Rumey the previous week and had most of my blood work done at the new facility. She was furious that I had done so even though the Rumey wanted more and different bld wk done (she only needed 2 fasting tests and I was fasting so she had the results that day.)

That became the entire focus of the visit!! She informed me that I'm on too much for pain; that Fibromyalgia is a "Waste Basket Diagnosis used when the doc doesn't have a clue; that my Gastro guy is nuts that I have Collagenous Colitis verified on Bx (he is nationally known in his field) and that the new Rumey "had better check my liver enzymes every 3 months" because she certainly wasn't going to do so. I had to ask her what I was to do about the rattling in my chest. "what rattling?" "Your chest sounds like crap. Go get a chest film done whenever it's convenient. Since you are on Methotrexate, you will need an antibiotic sooner than normal people so if you don't feel better in 5 days, get this Z-pac filled. See you in 6 mos. since you don't have anything really wrong with you."

The next day she had her nurse call me to ask if I was still or even taking my Lipitor-which she believed I was not-as my Chol has jumped big time. So she doubled my Lipitor which will increase my liver enzymes but she won't be monitoring them?

I'm a nurse who worked in Heart Surgery for years and I don't take kindly to this attitude! So needless to say, I'm on the track to find another PCP.

I'm in a major funk as I now have some goofy type of skin disease to go with the Melanoma and the Psoriasis. It is bumps that itch at first and are some type of deposit of thickened tissue similar to scar tissue under the skin. I missed the Dx from the Derm on Monday as she had just told my husband that he has CA-insitu on his back.

Is it a full moon?!?! I feel like I'm drowning!!

8

Oh my gosh. Matilda. Here. Catch! I am throwing you a life preserver. I am hearing you and feel your pain. Get yourself a new GP right away! When I first got sick I had a young GP that acted the same way. She had a temper tantrum because she could not diagnose me and thought I was lying to her about my symptoms. And waste basket diagnoses!!?? grrr. Drs. should have fibro for a year, cause that's how long it would take for it to sink in and them not blame it on something else like the flu or whatever, then they would know that it is real! I went through 3 gp docs. before I settled on the one I have now and still at times I get a little peeved at her but we work together. The best doc I had was a natural pathetic doc that also delivered babies. She was great and listened and spent much time and effort finding out what was going on with you and what would work but unfortunately we could not afford her anymore and my husband switched jobs and gone where those wonderful BOEING Regence Blue shield benefits. He works for DELL now and it is Ok but not wonderful. It is better than nothing.

Good luck with your search for a new doc. Never put up with bad treatment from any doctor. I am sure there are others here that could help you in your search for a good doctor in your area that knows about the health problems you have and will do you right. Hang in there!

9

As a follow up to this blog I have to tell you my doctor did come through right on time. The pain med was at my local pharmacy waiting for me the next day but the clinic never did call me to tell me they were there. Thats ok. The point was that she came through for me without question. This is why I am still with her. This year however I will be that squeaky wheel when the pain gets bad. I am not going to suffer needlessly this year. It is not necessary.

10

I am an American in Germany and thankfully here no issues with getting my pain meds, but sadly a thousand and one getting a doctor to test for anything, but that is a story for another day with because it would literally take enough space to fill an encyclopedia. With all of my family back home and old friends though I know the struggles they are having. A friend of mine who has a child with juvenile rheumatoid arthritis was left in tears after a trip to the pharmacy, script in hand she arrived to pick up her sons medications to be told it would take awhile because the new policy is they have to call and confirm with the doctor, his office closed in 30 minutes and so she thought the wait could not be that bad an so she waited after 45 minutes she was finally called up to find they had not even tried to call him until he was closed and now not only could they not reach him but because they had started to process the script she was not even able to get it back to go fill it somewhere else, and since it was a Friday she would just have to wait, only the meds were for her child who was in pain, they refused to make any exceptions, hes only 7 mind you and instead of helping her child she was made to leave empty handed and ended up sitting in the ER with him over the weekend because the pain was just too intense to wait. As any American knows an ER visit there meant they sat for 5 hours but thankfully the hospital had sense and once they saw what was happening they called the kis doc on his emergency line and he was able to stop the first prescription (the one she couldn't get filled and they would't give back) and have another one called into a pharmacy with 24 hour service, all in all it things ended on a good note, still though a child was left in pain Friday night through on til Saturday and forced to sit 5 long hours in an ER before getting the care he needed. My brother I will admit is an addict, he is my half brother and 20 years my senior so I was not raised with him and never really had any close contact with him either, but last year he was in an auto accident that left him having 5 surgeries on his spine and with some damages that means pain therapy will be life long for him, because of his known addiction issues his pain therapy is done with a contract, in fact he has his scripts filled at the clinic where he goes twice a week to be handed enough pills first for 3 days then for 4, and he is tested once a month but at a random visit each month to ensure that he is not taking anything other than what was ordered. This I find to be a perfect solution to pain therapy for anyone with addiction issues, because this means they get their meds and keeps them from being able to abuse them, if this were done everywhere then those of us who are not addicts who need pain therapy regularly would not be struggling to get scripts from doctors who are now under fire for having cause a nationwide epidemic of addiction to prescriptions, but sadly that is not the case any many Americans who have legitimate pain and needs for treatment are being treated by doctors, nurses, and pharmacists as if they are drug seeking addicts, belittled and at times even humiliated, in worst cases though they are even being discriminated against left with no treatment at all or forced to take medications for depression and other such issues because some doctors are not really informed enough to know that people in pain are emotional and if you treat the pain they can get back to their normal happy selves. I have had many missteps by doctors that lead up to some very traumatic experiences and added to that I lived a long time being misdiagnosed because of a doctors insane belief that a woman in her 20's was far to young to have arthritis and that misdiagnosis lead to the physical issues I have now, so it is hard for me to not be emotional around doctors because I am actually afraid of them, I won't even go to one alone anymore, which does get better over time especially when the doctor takes the time to listen to the issues and I feel he or she is doing everything possible to find the cause, treat the symptoms, and so on. Once I am comfortable with my doctor all the fear and emotions disappear but at first meeting I know they look at my emotions with a very critical eye, but once I tell them about the c-section I had where the epidural went up instead of down and it lowered my heart rate & BP and because my son was arriving at only 28 weeks (my water broke after being in a car accident - hit by a drunk driver!) the doctor did the section with NO anesthesia, as soon as he was out though they shot me full of stadol which then knocked me out, my son is now 14 and he is happy and healthy, the post traumatic stress of that experience however I still carry, nightmares of the surgery, the echoing voice of the doctor when he said I ha to remain still or they would have to tie me to the table, the look of fear in my husbands face, it all comes flooding back from time to time, especially when in the presence of a doctor who seems cold, distant and or not willing to listen, because the doctor who did the c-section was the one who did my prenatal care and I never truly felt comfortable with him to begin with. I am one of the patients doctors judge on sight, i have been left to feel helpless and in pain way more than any person should ever have to be. There has to be a change, the world needs doctors who combine their treatment from their knowledge of the illnesses, their knowledge of medications, but more importantly from listening to their patients, a doctor who doesn't have time to listen to the little things may end up missing the big picture, I had no skin psoriasis NONE until I was 32, my arthritis issues started in my early 20s, but with no rheuma factor found I was left misdiagnosed, had any doctor ever took into account the small detail of my nails that would curl and tear off and grew weird, that i often brought up and was treated for multiple times when they became infected they would have figured a decade sooner that I in fact had PsA. The devil is in the details ....