Sunday, March 21, 2010

Narcotic Pain Control: Physician Pushers Should Pull Back


Photo Credit Eva Kocher

First, let me state unequivcally that I am against all varieties of pain, foreign and domestic. Indeed, I wish that we could snuff the varmint out every time and place it surfaces. Pain is a wily opponent that can be difficult to vanquish. In recent years, physicians have been resorting to a ‘shock and awe’ strategy of using excessive force against it. While this may be sound military strategy, in the medical arena it has led to unintended and predictable consequences. I think that we physicians are pulling the narc trigger too quickly and too often.

It’s easy to advocate for a more parsimonious approach to pain control, when your humble blogger is pain free. Indeed, my own pain threshold cruises at low altitude, and has never been fairly tested. While this may limit my credibility, I maintain as a physician that my profession, including me, needs some narc reform.

When I was in medical training, during the days when my kids insist that I took the pet stegosaurus out for a walk, we prescribed narcotics for serious pain. Of course, all pain is serious, if you are the sufferer. Nevertheless, in those days we prescribed morphine, and its cousins, in specific clinical situations. We prescribed them in patients who were enduring the agony of kidney stones, myocardial infarctions, intestinal obstructions, acute abdomens, traumatic musculoskeletal injury and post-operatively. These medicines, in general, were reserved for acute pain. This bedrock medical practice has not changed.

Additionally, in those days, we physicians were taught to refrain from prescribing narcotics to manage chronic pain, in order to avoid causing medication addiction. Some doctors were also concerned that writing prescriptions for controlled pain medicines would invite scrutiny from medical boards and other oversight institutions. As the medical speciality of Palliative Care developed, physicians were reeducated that narcotic medications had a necessary role in the treatment of chronic pain, particularly in patients who were suffering from a terminal illness. Palliative Care taught us that we had been overly dogmatic and we needed to loosen up.

Another medical specialty, Pain Management, has emerged in recent years that treats patients with all sorts of chronic pain, often without a specific diagnosis. Gastroenterologists, for example, refer patients with unexplained abdominal pain to these specialists, not for diagnosis, but to manage the pain. This is is tough specialty, as the bulk of their practices are chronic pain patients, most of whom have exhausted other therapeutic alternatives. For many of them, these pain doctors are their last best hope.

Enter Morphine Mission Creep. When I was an intern, gazing out the window at flying pterodactyls, physicians didn’t prescribe enough pain medicines. Now, we have more than made up for our prior pharmacologic stinginess by turning the narcotic hose on full blast. Physicians now prescribe addictive and powerful narcotics routinely to patients with a variety of chronic painful conditions, particularly in the hospital. I witness this regularly on my hospital rounds, and am sure that other physicians can corroborate this observation. Patient come to the emergency room, often already on narcotics, complaining of breakthrough pain. The emergency room physician will then prescibe a stronger agent to be administered intravenously (IV) every 2 or 3 hours. This narc cycle goes on for several days. These folks are so tolerant (‘immune’) to narcotics, that they require high doses to achieve pain relief. Often, these patients will complain that even high doses at frequent intervals are not sufficient. Many of these individuals are truly experiencing pain, although nurses and physicians often observe that some of them seem too comfortable to warrant IV narcotics.

It is now common, for example, to medicate patients with chronic abdominal pain – stomach aches – with IV dilaudid, a powerful and addictive narcotic. Unlike acute pain, which will terminate, chronic pain lives on. Therefore, if a physician opts to prescribe addictive medicines to these patients, then what is the exit strategy? When we physicians go narc, we create an expectation that the patient’s ongoing condition needs narcotics.Over time, the patient becomes tolerant and addicted to these medicines. In many instances, the narcotic dependence and addiction becomes a much more serious disease than the original illness.

The medical profession needs to pull back from fostering narcotic ‘free love’. We all agree that the enemy is pain. Physicians should remain devoted to our mission to relieve pain and suffering in our patients. In many instances, we have been giving patients the wrong tools for the job. I’m not suggesting we adopt a narcotics moratorium on chronic pain, but that we be more judicious about their use. New specialties and medical expertise in pain management and control have many strategies and techniques that can be safer alternatives to chronic narcotics. We need to learn about them from our colleagues.

When we physicians held back pain medicines decades ago, we were wrong. I don’t think that we have it quite right yet.

44 comments:

John said...

Excellent advice, except for palliative care in hospice.
But heck, the only time I get stoned any more is when I go to the dentist. Otherwise my life if virtually pain-free. I can't recall when I last had a headache, my joint issues take the form of tingling or numbness rather than pain and indigestion is as bad as it gets for my tummy.
Is there anything left for me?

NYC reader said...

Who are these doctors and where can I find them? I suffer from monthly migraines that keep me on bed or vomiting. My doctor/s insist Tylenol will work. Makes me feel like an addict when I ask for something stronger and confess to taking OTC sleeping pills to pass the time I'm in pain. Still, nothing stronger has been granted. Sounds like I'm just seeing the wrong docs!

Joseph Arpaia, MD said...

I'm not sure how many patients you see with chronic pain. I am a specialist in psychiatry and addiction medicine and do about 20 hours per week seeing patients who have chronic pain who are being followed by a pain specialist.

The scenarios you describe may be the ones that stand out in your experience, but I do not think they are representative.

The reason for giving narcotics, at least when I am doing an addiction medicine consult, is that they improve the patient's ability to meet social or occupational obligations. If someone's functioning is improving then they don't meet criteria for substance abuse or dependence.

I'm sure there are people who prescribe narcotics willy, nilly. I have had patients who were being prescribed narcotics with no evidence that they were improving the patient's function. But the prescriptions weren't written by a pain specialist. The pain specialists I work with are extremely strict on following amounts and effects of narcotic medications.

Michael Kirsch, M.D. said...

Thanks for the comments. @Joe, you point out the advantages of having pain specialists manage pain that requires narcotic medications. Perhaps,if you were to query physicians who round regularly at your local hospitals, you might find that the situation is different than it is in your own practice.

Evinx said...

I think the situation is far worse than you state. Pain meds are routinely given out and with refills that are no more difficult to get than a simple phone call to a "bot" of some sort.

But, pain has now been re-defined to anxiety. If you feel a little sad or down, you are depressed + given anyone of a host of drugs that are advertised multiple times each day.

Simply ask around + you will find many people on some sort of anti-depressant. It is frightening. It seems to be these are being prescribed more than antibiotics were years ago when drs oftentimes would use then as glorified placebos (and some still do).

IMO, many of these "depressed" simply need to grow up - even if they are 40 or 50 years old.

Jdach said...

Michael,

I like your writing style and flair! Great stuff.

I quite agree with your view on long term opiate use as another example of the treatment becoming worse than the disease. The ancient doctors of our medical school years were right.

We all know that opioid narcotics are highly addictive and come with severe adverse effects. They cause profound suppression of the endocrine system, and in men, profound inhibition of testosterone production. This type of low testosterone is quite common, and yet, may go unrecognized by the busy primary care doctor.

Another adverse effect of long-term opioid use is opioid-induced hyperalgesia. This is a form of hypersensitivity to pain. The original painful condition becomes worse. Other adverse effects include impaired cognitive function, and suppression of the immune system with tendency to develop infection.

Although quite common, Opioid-induced androgen deficiency has gone largely unrecognized by the medical community. Low testosterone is caused by opioid drug inhibition of LH (Leutininizing Hormone), a pituitary hormone involved in testosterone production, as well as direct inhibition of testosterone itself. Similarly, there is also inhibition of the entire endocrine system, and adrenal hormone suppression.

for more:
http://www.drdach.com/Low_Testosterone_Opiates.html

jeffrey dach md

Anonymous said...

You are right Dr. K no one respects pain until they have it and it won't go away.

Dr. S

Sidney Seal MD said...

In my medical school the folks who went into anestheisiology were the ones who were not into the whole "get into the patients head" part of disease management. What are they doing managing chronic pain? They do a great service by performing the nerve blocks, but they are way out of their field with medical management of chronic pain. The proliferation of narcotics is part of primary care physicians abdicating responsibility for the care of time-consuming patients under FFS reimbursement, and inflated patient expectations in the "majic pill from a specialist"

Thanks for bringing up the topic

Anonymous said...

My name is Jeff. I'm 42 years old and pretty healthy. A little overweight at 5foot 9inches and 170 lbs but healthier than most. I can only speak from personal experience. For the past 5 years I've suffered chronic pain as a result of 3 herniated discs in my lower back and spinal stenosis. Up until 3 years ago, my physician was managing my pain with the use of short acting Oxycodone, 4 to 6 30mg pills per day totalling 180mg per day at max. Then my insurance company decided patients with pain should be handled by a pain specialist. It was about 3 months and thye pain specialist I was seeing at UCSF had me on a combination of narcotics (Oxycodone, Oxycontin, Methadone and Morphane Sulphate) to the tune of 560mg per day. After I told her I was too out of it to function most of the time and the doseage of meds was too much, she prescribed a stimulant, Provigil. Then my physician told me he would only allow me to take it for 2 months as it is highly addictive. Nevermind the Oxycodone and all the other narcotics. Which by the way, no one ever mentioned addiction when I started these drugs. When I told my pain specialist this she said she has had no problems and prescribes it to many of her patients indefinately.
After another 2 months of this and my pain specialist wanting to increase my doses, I had a mini breaksown in her office and told her I'm on too much medication and need to get off as much as possible. By now my metabolism had slowed so much that I was gaining weight on 1200 calories a day andhadn't had a regular BM in months. Her answer was, "That's not possible" with a snide and sarcastic voice. So, long story short, I fired her, tried another at a different hospital and he was just as bad so I fired him too. And yes, I have had numerous Epidurals. Some helping 10% for 5 days and others 5% for 10 days but never a great result and surgery isn't an option I'm told until I'm dragging a foot or start peeing my pants. It's taken about a year but now all I'm on is 3 15mg Oxycodone per day and plan to cick that as well. I take Ibuprofen for the pain at night sometimes but for the most part had to modify my life. The way I move and do things has a huge impact on my pain. Simple things like putting on my shoes can send me to the floor for 2 days so I am very careful how I do those things. Don't get me wrong, I have good days and bad days and have had to accept the fact that I have limitations. In summary, I haven't had good experiences with pain specialists. The two I saw were both in the "pusher" catagory as far as I'm concerned. It seems like there should be more information given to patients before they start down the narcotic road and all other treatments should be exhausted. Exercise, chiropractic, massage and Accupuncture have all helped me and many others I know. Everyone is different, so is there pain and should be treated as such.

Anonymous said...

i want to report dilaudid abuse by dr's to pts @ my hospital..who do i contact and remain anonymous?

Anonymous said...

I think in the USA land of the so called free maybe land of the rules would be better anyway I am an adult and should be able to get any narcotic I want self treatment is the only way I dont care who abuses drugs it there right in thus country the government thinks they need to protect us from harmful drugs like I need that I am not an idiot maybe some are but not me I have no medical insurance and I suffer with pain like you couldnt believe I round up money go to the Dr and carry my records and all they do is schedule test they know I could never afford, I think to much money is being made at our expense you want to lower health care years ago people never went to the doctor like they do today and the biggest reason is drugs it was alot easier to get them before the computer age now most are there for 3 things pain killers benzos and cough syrup I would say 70 % are there for that. I guess I have a problem when others dont care what kind of pain I have its kinda like out of sight out of mind.

Anonymous said...

Some people really are in pain. I suffer everyday and have to drive over 100 miles to see a Dr that knows a little about what he's doing. Dr's are not the ones suffering in pain. I had to go the ER once and they were SO rude to me I will never go back agian. Dr's need to understand people do suffer and to not always expect everyones addicted to everything... If they are addited then thats on that person. Dont make US all suffer.

Anonymous said...

Most doctors have no idea of the sheer agony of migraine, when you want to do a deal with the devil to sell your soul just to stop the pain. Surely doctors did not become such to witness this sort of suffering. if I present at emergency ER I have treated like a drug seeking addict, I don't bother I just exist in my pain ridden hell until the pain decides to go whether it be hours or days. Addiction to narcotics, yes I would gladly risk it for relief.

Anonymous said...

I have suffered from chronic pain for 20 years, multiple surgeries, and more ignored pleas to doctors for help. I am a trucker, and when WCB said I was fit for work I was taking in the neighborhood of 200mg of Oxycontin/Oxycodones a day, plus dilaudid. I couldn't think or work, so I couldn't return to work, I have suffered and suffered, no disability, no WCB and no job. I hate the fact that I was ignored until the pain was so bad that I couldn't cope, then it was too late to do much about it, SCARRING. The fact is I go insane without the pain meds, and with them I am just a vegetable, My last five years is a fight with doctors who are all arrogant, and automatically assume you are drug seeker, and in the end all it means to me is I don't get enough, and just want to scream or die, cause the pain is more than I can take, unless I just sit in my bed all day. Its a shitty way to live and really sucks, more has to be done.

Anonymous said...

I See that the comentary on this subject has become more from the patients point of view as opposed to the MD's. This is key. There are two players in this game of pain managment and that's all there should be. I am with deregulation of some of the more basic pain pills. Vicidin, percocet and basically anything in pill form or patches as it is in some countries. The alternative is to keep trying to keep these medications hard to get for the poor. Basically if you have a good inscurance plan and money and are white, you have no prblem getting the relief you need. If not, your considered an addict by the medical community. MD's and nurses admit it: most of you discriminate on race sex age and of course money when considering treatment.

Anonymous said...

I am a chronic pain sufferer. I was diagnosed with Trigeminal Neuralgia/ Neuropathy after botched dental surgery. The pain I feel is akin to a hot knife stabbing me in the jawbone and under the tongue. Even with narcotic painkillers, there are days that I just cry, moan, and suffer from this horrible pain and just want to die. The only reason I don't end my own life is because of the great love for my son, who is too young to take care of himself. If I ever did end it, you can be sure that I'd leave the pain pills ( Opana ER) where they could be carefully counted to see they weren't abused, and I'd use a gun. This would be my statement to the world about how I feel is a ridiculously cruel policy toward chronic pain sufferers: I am one of the " lucky" ones: I have had superlative doctors who knew just by looking at me that I would not abuse medication. Yes, I've had hundreds of pills given to me, with refills, of these powerful narcotics,... and I never signed a contract for them. Guess what? I went back to graduate school, pulled a cumulative 4.0 average, and never became addicted. Moreover, the times that called for me to take these pills saw me getting rides to school and back rather than drive,... I won't jeopardize others on the road.

Now, Im being treated with a new drug: Opana ER. Even though I still have break through pain, I feel like this medicine is a miracle. It is the only med that Ive tried that provides the duration of pain relief I need. For what it's worth, I don't like the sluggish feeling narcotics give. It makes me feel like my brain is dipped in syrup. However, it is my understanding that opioid pain killers are a lot safer than drugs like Tegretol, Dilantin, lyrica, neurontin, etc. And the opioids work better! Many drugs cause physical DEPENDANCE, which is not the same thing as addiction, some drugs have withdrawal symptoms that are far worse from what Ive read. And shouldn't the patient have the say in whether they want to risk various side effects? I'd take the risk of addiction over liver failure. After all, I am being monitored by a doctor.

Right now, the pain is so bad, it actually feels like I just had oral surgery. This is two hours after taking my am dose of Opana ER.

You said it all when you said you don't have chronic pain, so you don't know how it feels. I want all of the doctors on this board to think about what I'm going to state next: I'm one of the lucky ones. My doctors believe me, and are treating me. It's the only reason why Im alive right now.

Anonymous said...

God bless all of you pain sufferers. There are many of us, and like having children, there is no way to truly comprehend how it changes your life until you experience it. I'm in Maryland, and my long-time primary care doctor retired in 2004. Because I occasionally took pain killers (darvocet and sometimes lortab) for flareups due to a crushing spinal injury and several surgeries, she suggested that I see a pain management specialist, so that the specialist could evaluate what I should be taking and certify it, with the goal of transferring the month-to-month management of it back to my primary care doctor. For six years, I have been on the treadmill of the pain management circus: the looks you get at both the office and the pharmacy (even though you shamble in there like Quasimodo), the humiliating monthly urinalysis (seriously, at age 40-something, do you really think I'm suddenly going to take up heroin or meth?), the extra expense. I've had all sorts of injections, procedures, therapies. I let them do whatever they thought would work, and I always performed above board. After all this, I reminded my pain doctor of the goal set forth in writing from the beginning to eventually transfer my care back to my primary care doctor. The pain doctor agreed that I was at an acceptable level of medication (regular narcotic use, but less than when I entered treatment), and sent a letter with all the requisite imprimatur to my primary care doctor. I verified with my primary care doctor's office that they had received all that they needed.I went to see my primary care doctor today, because it was time to do so. He explained to me that the law enforcement climate is such in our state and county that primary care doctors are losing their licenses left and right for supposedly overprescribing narcotics for chronic pain management. He tells me I am not alone, and I already know that, but it is of little help. Now I have to continue to see the pain doc whose office is on the other side of Baltimore and very high volume (it's basically between half a day and a whole day on every visit, counting the commute).

All of this is to say that there is a very good reason that other developed countries ridicule the way we undertreat pain. The real risk of addiction (e.g., drug-seeking, as opposed to dependence) is less than ten percent, but a handful of sensational stories about coddled celebrities who abuse their medicine have contributed to a climate wherein the legitimate patients are the only ones who truly suffer. After all, the addict who fakes a condition to feed his/her habit is no worse off when they are turned away; they just go find another source, one would assume. I find it galling that I have to continue to see a high-priced specialist who is not going to do anything other than prescribe the medicine that allows me to do some things I couldn't otherwise do -- like play with my children and other such things that are never taken for granted by pain sufferers -- this is what works, and I'll gladly take dependence and occasional constipation in order to continue to earn an honest living (rather than accept disability). What ever happened to "first, do no harm?" Just as it is worse for one innocent person to be found guilty than for one hundred criminals to go free, it should horrify all doctors -- and those whose job it is to interdict in matters of drug diversion and illicit sales -- when any (let alone a substantial number) person should have to suffer agonizing pain, if we live in a world where a relatively inexpensive pill will temporarily reduce that pain. Trust me, when you experience that pain -- and chances are, you will at some point -- you will surely rue the thoughts you once had about it; I know I did.

Anonymous said...

I am also a chronich pain sufferer.I have systemic lupus,chronic joint pain,divertiticulitis,diabetic neuropathy,among other things.I am a 29 yr old female,I have one child.I have been on a pain magement plan now for about 2 yrs.I take 5mg oxycodone 5 times a day,and 500 mg naproxen 2 times a day.Before my diagnoses I was working full time,held down my job for 5 yrs.During the last few years I was woking,my health problems really started to interfere with my daily life/activities.I was not sure what was going on with my body,I just knew that something was not right.my joints hurt,I was getting boils on my face, I was getting reacurring kidney stones,and it seemed like I wasnt getting blood flow in my legs,my veins were bulging,I had 1 rupture during work.I ended up losing my job because of always having been sick.I was then able to get on some goverment health insurace,see a doctor,and get some tests going.I finally had a diagnosis!I was just so happy to figure out what was going on with my body!My Dr. fully explained the effects of my meds,and we read the entire pain managment plan,but I was definatley wanting to give them a shot.I am so thankful to be able to get some relief in my day.I can now go for walks,take my son to the park,and not feel like I'm in total pain!I swim every week.I know that I have some limitations,but my days are much more pain free.I am so thankful to have a doctor that is personal,caring,and thourough,and he has never judged me,or downplayed my pain,like alot of other docs have done to me.There is a reason for these meds!I think alot of ER docs tend to treat patients very poorly,for pain probs.We should never have to walk out of a hospital and feel ashamed,or mistreated!I think thats a big issue that needs alot of attention.

Michael Kirsch, M.D. said...

For those interested, Washington state targeting excessive prescribing of narcotics for legitimate purposes.
http://nyti.ms/aXZfGx

Anonymous said...

Actually, getting prescribed painkillers is tougher than pulling teeth. Drs. are so concerned about being charged with excessive prescribing that they simply don't do it - and their patients suffer for it. It is hard to find a physician willing to treat chronic pain or look for treatment options on behalf of their patient - with or without opioid painkillers being a part of the picture. It took me about a year and a half and several doctors and clinics just to find a dr. sympathetic enough to even try to treat my condition. I NEVER asked for painkillers, but I was treated as if that's the only thing I was seeking. I only wanted relief in any form.

Getlowerbackpainreliefnowcom said...

Although pain killers are effective, I don't think they are the best choice. Most of them have ridiculous side-effects and they can cost you a fortune. Unless, your pain is absolutely unbearable, I don't think they should be used.

Lily said...

nice blog

Anonymous said...

Spinal cord trauma.Motorcycle accident years ago.Pain has been so bad over years I had to buy a huge combination safe that my wife is only one that has combination #.Otherwise I would take one of my many handguns and stick the point of one in my mouth pull trigger firmly.No doubt I would have done it years ago if not for the love of my wonderful wife.I have had serious conversations with her about this many times.
I loved life before my accident.I was voted most outgoing in school and work all my life.I wrote stand up comedy just for family and friends.I can count on both hands the days I have had a smile on my face since the accident.Life sucks completely.This was 12 years ago.
All that time Dr.'s would give me vicoden,perc's,roxicet 30mg.Until I was given oxycontin at what some would consider a high dose I had no life.Only been on it for the past 2 years but they have been the best 2 since the accident.
Under prescribing someone with the problems I had I think was a crime.I understand I was in my 20's and Dr's didnt wanna get me hooked.But someone needs to explain to these Dr's not every patient is a drug addict and crushes or takes to much of their medicine.It is rediculous how I have been treated in the past for having to take oxycontin.I never tell anyone even friends what kinda pain meds I take.
This whole pain management thing just ticks me off.I get sooo angry when I drive by a pain clinic and it looks like the front of a methadone clinic.I live in a state with no prescription monitering system.So to say the least it is out of control here and they need to do something about it without disrupting or hurting the true pain patients.There goes my blood pressure again..
I use to drink alcohol allday to numb the depression and pain.I was and still am kinda short tempered cause of pain.Pain rules my life but with this medicine I have atleast some kinda life.I dont know what else to say but I would love to ask sincerely what do I do Dr?I really dont have a big problem with taking this med until I have any real side effects.So my question is keep taking the pain medicine or stop and go back to the life I had been living prior to this medicine.I figure it this way.If I can get another 20-30 years of enjoyable life it is worth it right?Rather then live a miserable existance in severe chronic pain allday?Also I never take more then prescribed and always have lots left over at end of month so I never abuse my meds.I think it should not be given to anyone without solid evidence of chronic problem.God Bless All.

Mariano Rivera said...

If you want to relieve severe pain caused by cancer, fibromyalgia, chronic pain, migraine is better to take powerful drugs such as hydrocodone, lortab you can buy online without a prescription but considering their side effects.

Anonymous said...

i live in canada & have suffered from severe migraines (excruciatingly intense pain, nausea, basically the whole shebang) for past 10 yrs...only seem to get very bad when seasons change...but are extremely painful...my question/comment is when i go to ER after X amount of hrs in agony...why do some of dr's treating me basically knock me out (Demerol w/ gravol)& when wake up ...headache is pretty much gone...am a little wiped out from treatment combined with previous day's whole migraine experience, but, headache & accompanying side effects are gone.....
other physicians that have treated me insist on traditional migraine treatments (Toradol, Stimatil), which simply have no effect in relieving my headache/nausea when at that stage....Physician has explained he/she wary about administering pain med for migraine treatment....only succeed in prolonging my "nightmare" which after initially receiving IV to restore fluids (45min)& then approx additional 45min-1 hr for each med to determine if any improvement...so usually about 9-10 hrs to this pt (100% of time when my headache is at particular pain level where i feel i have to go to Emerg...these meds have not worked)...in addition have been holidays past 2 yrs in FLA & experienced severe migraines both times on vacation at approx same time of year....was in & out of ER within 1 hr after attending doctor administered U.S. equivalent to Demerol w/ Gravol in Canada...Headache again was very severe but after receiving treatment I.M...migraine dissipated within 30 min...was just dizzy, etc from medication, but, most importantly my migraine was gone...so, getting back to my initial question...i guess i am looking for some kind of advice on what to say to physicians here in Canada that insist on NOT "Knocking me out" so to speak even though it seems from my experiences that is most effective treatment for my headaches when they reache that stage...I am by no means drug addict ..just want relief from extremely excruciating pain in my head that has been going on for hours....find physician's lack of understanding to my plight extremely disconcerting & unwillingness to listen to what works for me very frustrating....is even more compounded due to condition i am in when i am in the ER & basically am in no mood to debate migraine treatments .....appreciate any input you may have on this....thank you

Anonymous said...

I'm 36 yrs old and have been on an increasing narcotic schedule since an auto accident 8 yrs ago. Currently I take 6 or 7 30Mg Immediate Release Oxycodone a day. The pain docs want me to go on a long lasting med (oxycontin) but i have resisted that these years because my goal is to find a way off of these meds forever. They make my life live-able, but i hate them. HATE them. It's been so long of constant use now I have extremely low testosterone -- i get the testosterone gel but just about never use it becasue my goal is to get off the narcs and have my testosterone come back naturally. Artificially using testosterone can impair the ability for my body to rebalance itself once the pain meds are gone. Low testosterone sucks.. my libido is gone, I'm overweight, and I want my zest for life back -- I don't think that can happen until i find homeostasis.. which will require the removal of these narcs from my life. It truly is a trade off: pain or peace? At least in my experience. At this point its been too long without peace and i don't want to face the continued manifestation of long term affects of these meds. What will i do for the pain? I don't know. But first I'd like to find a way off of them and center my mind body and soul, and then reassess from there. Any advice out there for kicking these meds to the curb? I've had some success in the past, but nothing very significant, or that has lasted... obviously. Wean? Detox?

This is a great forum full of good people with unique situations. It proves there is no cookie-cutter practice of medicine that is effective. People, patients,and their needs and priorities differ greatly.

Ultimately the meds are keeping me from being as healthy as I need to be.. regardless of the pain. I've got to get healthy again and then find a less "heavy" way to deal with my pain. I'm confident i can do this. I'd just really, really, REALLY like to do it now. It's so difficult for me to take the steps to lower my med intake and make the progress I long for. I have to find a way to do it, and soon.

I do regret my pain mngt doc tries to get me on more and more meds every time I'm forced to see her. Throwing more and more meds at a problem doesn't seem to be good treatment to me.

I'll come back to this site to see if anyone has any suggestions for me. I need support. I need to find a way to refresh and recharge and feel like a man again -- be it with pain or not.

Thanks.

Anonymous said...

I am a chronic pain patient due to a cervical syringomyelia. The diagnosis was made in February, 1998 but the pain did not become intolerable until 2000.

I was first placed on a 75ug transdermal fentanyl patch which worked well to control my pain.

Recently, I had to change my insurance to a HMO and while I now have no co-pay for my meds for most of the year, my physician will no longer write me scripts for fentanyl as he says he gets nasty letters from the HMO whenever he writes for an expensive script. Even the generic for Duragesic, which is the fentanyl patch, costs $206 around here. The brand name is at least another $100 more.

So he now has me on extended-release morphine and Etodolac which takes care of most of the pain but nowhere near the amount that fentanyl did.

So because now in this country, insurance has taken control over the way doctors practice medicine, I have to suffer with my pain especially when I get breakthrough pain.

There has to be a better way of doing things and in the over twenty years that I worked in the medical field as a radiologic technologist, I never saw any politicians or other group come forward with a plan that covered all the areas that need fixing with the delivery of health care in this country.

They did not come up with any thing then and they have not done any thing now.

Thanks for listening.

pain management emr said...

Yeah! Physicians should remain devoted to our mission to relieve pain and suffering in our patients. Very well said. I believe that this is really necessary. Thanks for sharing.

-mel-

Anonymous said...

I have degenerative disc disease and sciatica. My prescription is fairly lightweight (one or two 10mg hydrocodone once or twice a week for breakout pain) yet getting this refilled is like running a gauntlet.

I am made to feel like an addict - signing contracts and urinating into cups. And the doctors I've worked with are completely ambivalent to my suffering. If I have to wait 4 weeks for an appointment, too bad... I should have called sooner. (!)

I'm white, with good insurance, so this is NOT race related, as one poster suggested. Quite simply, if you are a chronic pain sufferer, you are a liability to doctors who fear losing their licenses to a DEA witch hunt, and that's the root of the problem. It would be far easier for me to get heroin than my prescription meds. What's wrong with that picture?

Anonymous said...

To the above post, it would probably be cheaper too. There is a LOT wrong with the picture.

Pain management said...

Oxycontin is basically used as a narcotic pain reliever but many a times low dosages of Oxycontin are prescribed for temporary relief of diarrhea. It is also prescribed for patients suffering from diabetic neuropathy, post herpetic neuralgia, unilateral total knee arthroplasty, osteoarthritis, ambulatory laparoscopic tubal ligation surgery and abdominal or rather gynecological surgery.

Dee Larry said...

pain management new jersey saved my vacation! I would of spent the entire week in bed with heating pads and medicine, but instead my sister told me about pain management new jersey.

Pain Management United States said...

Hydrocodone is a prescription pain pill that is most commonly used to treat pain. Every tI’me people feel a pain in the head or back or neck for that matter, they sI’mply pop a pill, without even knowing or bothering to know the effects the medicine might have on the individual. However the fact is that these narcotic pain pills have a lot of side effects and they can cause addiction as well if not taken with proper care and precaution.

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Anonymous said...

Stick to your colonoscopies, doc.
I can speak from 20 years as a chronic pain patient with severe rheumatoid arthritis:I have NEVER been offered opioids WITH REFILLS. Every other treatment option was exhausted before making the serious decision to begin opioid therapy. I ended up with a ulcer from NSAID use before starting pain management. My pain management doctor had me sign a contract, and I have my urine tested randomly to make sure that I am taking the prescribed dosages of the medications, and no others. I come back for a visit every 30 days or I don't get my medications. Yhis is the way it is done in Florida. Maybe there are some states that don't monitor as well, but no matter where you are you can always find a disreputable doctor, In FL, at least, he or she will get busted pretty quick. I have a wonderful, empathetic doctor who has helped me find some alternative ways to reduce my dosage of opioids. However, I remain on a that lower, fixed dosage. Most importantly, I know that I can always count on her to treat my pain.

Sandra Hughes said...

I have been suffering from chronic acute pain from degenerative disc disease - result of a car accident in 1983. I am told there is no treatment for the condition - no cure. My only recourse is to manage the pain. "Addiction" becomes a moot point when life long dependency is the only course of treatment. I am dependent, not addicted. I am prescribed only the amount of morphine needed to reduce my pain to the highest level I can possibly tolerate. At 47 I can barely manage the chores of daily living, never mind fulfill my potential as a human being. With a higher dosage of morphine, the resultant pain reduction and improvement in mobility improves the quality of my life to where I am actually living, not just existing. Studies have recently demonstrated that individuals suffering from long term acute pain actually are becoming brain damaged as a result. The damage is reversible, once appropriate relief is provided. (JAMA, May 11, I think). What we experience, those few, it seems, who do not abuse their medication is tantamount to government sanctioned torture.
Peace,
Sandi

Anonymous said...

The doctor got my hsuband hooked on oxcontin.He woke up very sick one morning and went to the emergency room.He laid there the entire day and went into a hard withdrawal and died.

Anonymous said...

Hello, I'm an investigator and have recently been working a case against a doctor who has lost over 50 patients to overdose in the past two years. I think pain management doctors have an obligation to recognize red flags such as failed UA's, calls from law enforcement reporting diversion and increasing doses after the patient tells you he/she has been abusing them. If doctors show conscious disregard for their patients health and continue to give out thousands of high dose narc's and the patient dies, they should be responsible for said deaths. I believe the phrase "do no harm" is in the oath for a reason.

Anonymous said...

I feel all of your pain!! I too suffer from severe chronic pain from Fibromyalgia, Spinal Stenosis, several Herniated Discs fron rear end car accidents! Plus 3 bouts with Cancer since 2006 (Anaplastic Lyphoma), severe anemia and Lymes Disease (1999), IBS, Interstitial cystitis.... I know what PAIN is! My problem is it became so difficult to fill an Rx which really helped me (same dose since 2005), Methadone, all the pharmacies say "can't get it" (or at least not in Tampa FL). I was able to functiom pretty well @ 20 mg day plus Lyrica, Flexeril @ an occaisional Hydrocodone. I decided to taper down to 10 mg then 5 and then went off Methadone completely 4 days ago, 9/6/12 , when i told my doctor about not being able to fill Rx for Methadone. She put me on a highrr dose of Hydrocodone 10/325 every 4 hours but this made me really made me nauseous and did not control pain, went back to the lower dose Hydrcodone 7.5/750 4 x day. It hS been PURE HElLL since going off Methadone, fhe physical withdrawal is horrible! I would like to find a non Narcotic way to control really severe pain, I don't want to create another dependancy with Hydrocodone 7.5//750. Any suggestions??!

Dr. Michelle Rodriguez said...

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Chiropractors Kansas City said...

It is also prescribed for patients suffering from diabetic neuropathy, post herpetic neuralgia, unilateral total knee arthroplasty. Acupuncture Kansas City

Sean Carter said...

Until i was able to find some pain management doctors in NJ I really thought I would always live in pain, they really helped me live a more normal life

Aisha said...

I had Nasophrygeal cancer in 2002 and had feeding tube during my treatment. After 37 days of radiation I was glad I had it a had it because it gave me lots of nutrition and it was a necessity. I was 43yrs old. I am cancer free now but the radiation and surgery created scar tissues. As time goes by I am having a hard time swallowing. In January I had heart attack and at the same time lost my voice. My major issues now is swallowing and eating. Lost a lot of weight recently. My Oncologist told me I need a feeding tube which might be permanent. I am going to be 54 soon. Do I want to lived my life with feeding tube for the rest of my life. It is a tough decision, however friends and family says it's a no brainier question. I should go with the feeding tube. I was admitted Twice for aspiration pneumonia. Should I do this for myself(no feeding tube) for selfish reason or do it for my family and lived my life with a feeding tube. If anyone can give me info of other alternative, keep me posted.

Jordan Mallory said...

I have had many lower back problems in the past. I recently found a Back Pain Doctor in NYC and it is working out great. I now can do a lot more activities without have to lay down for hours after.

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