Don’t feel alone. This doctor is worn down and just saying no. Opioid poisoning as a cause of death more than tripled in the US between 1999 and 2006. Death from prescription opiates is now more common than death from heroin and cocaine combined. (USA Today)
Today a new patient came to the office looking for a physician to prescribe the opiates she wanted to take for her fibromyalgia, interstitial cystitis, and chronic low back pain. She proceeded to say she just wished the good doctors who had previously been prescribing her massive doses of opiates were still around. She thinks one of them must have done something wrong, because his office was just closed down suddenly and all his medical records were taken away. I’m sure this is the Lakewood, WA physician who lost his license for inappropriately prescribing opiates. She was a caricature of the opiate-seeking patient. She had not just one of the ill defined painful conditions that are impossible to exclude, but at least three. She had been prescribed both Oxycontin, as well as large doses of “breakthrough” oxycodone. I am not accepting new pain management patients into my practice. This made it easy to explain that I would not be able to treat her for these problems with opiate medications. Actually the abuse of opiates have become such a rampant problem that I don’t know of a physician in the county who is accepting new pain management patients. This is sad for patients new to the community with legitimate need for pain medication, but just an impossible position for physicians. Any physician who becomes known as accepting chronic non-malignant pain patients would be quickly overwhelmed by the droves of new patients needing pain medications who would show up to receive care. Years ago a wise older physician (he was probably as old as I am now, and likely far wiser) told me we all have our albatrosses. These he described as very needy and difficult patients that you’d just like to find a way to get out of your practice. He explained that if we all just keep a few then no one will be overburdened with too many. Otherwise they will just keep circulating in the medical community, and all of us will still need to take care of them. It’s best to just buck up and keep doing our best for them. These days I feel like these patients are not like rare albatrosses, but rather like common crows, just everywhere, and dashing in to pick me apart like road kill.
There seem to be so opiate seeking patients now that an open door to see them would just overwhelm anyone. Cynically yet realistically I know that this is in part because no one physician will knowingly prescribe the quantity of drugs that they want, so they need to have multiple physicians prescribing their meds who are unaware of each other. (this problem to be the subject of another post soon) Anyway this episode made me smile because this patient was either incredibly naïve, or a very good actress. I suspected the latter. Most opiate seeking patients are very smooth and make me at least feel like maybe I should try to help them by seeing if I can help them manage their pain with less opiates and good care. In my experience this very rarely works, because the customer really just wants the drugs. I know that although there are some patients for whom opiates for non-cancer pain is the best available treatment, there are so many professional patients who resell the drugs on the street and others who are addicted to the meds and overuse them in vast amounts, that as primary physicians we are in an impossible position. We either become suppliers of the prescription drug culture, or we turn away some appropriate patients. Which is worse? This depends on your viewpoint, but at this point I generally just say no.
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I have been dealing with chronic pain in my lower back, knees and legs for most of my life and gave up looking for help. Every time I go I am put through very test under the sun and am always given the same crappy medications that dont work all because a doctor is petrified to help those of us that ACTUALLY NEED PAIN MEDS FOR PAIN. It got so bad that I gave in and found someone going through pill mills and had to buy them on my own from those who are prescribed them even though they have no pain at all. Does anyone see a problem with this? Why do I have to spend a fortune buying them off the street to feel better when those who dont need them get a months supply for a copay? It’s sad when you cant get help from a physician but you can from a drug dealer. So now I am stuck! It’s too expensive to buy off the street and I cant find a doc to help but if I dont take anything I am a prisoner to my on chronic pain. I cant do anything when I feel the pain including play with my daughter or take care of my house or even use the second floor of my home as I cant climb stairs very well without feeling excruciating pain. I know its not right to buy them illegally but the pain is so bad sometimes that I dont know what else to do. I feel so defeated by this.
IM SO FRUSTRATED DISCOURAGED THAT ITS GETTING TO THE POINT THAT ALL OF US HAVE TO PAY FOR SOME THAT ARE DISHONEST OR SEEK MEDS, DR SHOP OR SELL MEDS. I HAVE HAD OVER 30 SURGERIES, HAVE MANY OTHER AILMENTS, DISEASES BOTCHED SURGERIES AND PAID OF MANY TYPES, I HAVE BEEN ON PAIN MEDS STARTING IN THE 80′S I HAVE NOT ABUSED AND AM ON OXY 15MG TABS 1 OR 2 3 XS DAIDILY FOR BREAK THRU PAIN .5MG OXYCODONE W OUT TYLONEL. MY DR AFTER YEARS OF PERSCRIBING WENT TO A NEW PARACTICE AND THEY WONT PERSCRIBE TO ANY PAITENTS, SCREEN ON PHONE NO APT IF THEY ARE ON ANY TYPE. I AM IN PAIN MANG TOO. THEY DONT PERSCRIBE JUST RECMEND AND HAVE TO GO BY WHAT MY DR SAYS. SENSE CUTTING BACK AS IM BEING FORCED TO I HAVE BECOME BED RIDDEN, HAD 2 BLEEDS IN BRAIN, VERY HI PULSE AND BP FROM THE STRESS, I USE TO TO ON MORE POST OP I HAVE AUTO AMUNE TOO. IM VERY CONCERNED AND HAVE STARTED HAVING SUCICIDAL THOUGHTS DUE TO I CANT BARE THE PAID. IM NOT GETTING UP GOING ANYWHERE AND AS U STATE NO DR IS GOING TO TAKE ON A NEW PAIN PATIENT, EVEN MY DR IS AFRAID HE WILL LOSE HIS LICENCE THAT IS WHAT ITS ALL ABOUT. HE HAD NO PROBLEM GIVING ME THESE MEDS FOR YEARS. UNTIL SEPT OF LAST YEAR. IVE BECOME DISTRUSING OF DRS DISCOURAGED AND DIDNT OR DONT GET HI OFF THE MEDS I TOOK AND HAVE STAYED AT A CONSISTANT DOSE. THERE HAS NOT BEEN GIVEN TO ME A SINGLE WAY TO DEAL W THE PAIN AS IM GETTING TABERED. I HAVE TACHACARDIA HI BP, HAVING PVC DIDNT HAVE PRIOR. THE DR I HAVE HAS CUT HIS DAYS T 1 1/2 WEEKLY AND IS NOT TAKING PROPER CARE OF ME. I WOULD RATHER LIVE A SHORTER LIFE IN COMFORT THAN GO ON FOR YEARS SUFFERING AND BED RIDDEN. IT SEEMS ANIMALS ARE MORE PROTECTS AND HAVE MORE RIGHTS THAN US. USE TO SEE PAIN CHARTS IN HOSPITAL AND CLINICS FOR RIGHTS TO CONTROL PAIN NOW THERE GONE. ITS GONE TO THE EXTREME OF THE OTHER NOW. IM BEING DISCRIMINATED AGAINST, FEEL TRAMTISED AND HOPELESS. IT SEEMS MOST DOCS NOW ARE MORE WORRIED ABOUT THERE LICENCES THAT PROPER PATIENT CARE. I FOR SEE MORE INCREASE IN SUSIDE, ALCHOLSIM, ILLEGAL DRUG USE IN THE FUTURE. I HAVE RECIEVED NO INFO ON WHAT TO DO OR EXPECT AND JUST AM READY TO GIVE UP. WHAT IS WRONG WITH THE WORLD. PAT MOODY AGE 57
I understand your pain as I am a physician trained in neurology – a specialty that does accumulates fair # of albatrosses as u say.
However, in my mid 30s I began having progressive “lower back” pain- worse w each pregnancy. MRI showed a small tear at L5 on left, w a hemi L6, & spina bifida occulta. So why was my pain on right? 5 yrs later, I had a resurfacing of my femoral head scheduled – only plain films show congenital dysplasia & apparently 2nd peak of diagnosis is after pregnancy w decoditioning & weight gain. When they operated, my labrum was sawed thru from arthritis so they did not complete the posterior acetabulum re shaping. Because my pain obviously was coming from that since “you shouldn’t be able to walk across the room, let alone work 80 hrs a week” w a severed labrum. 3 yes later I had a hip replacement that demonstrated a posterior femoral head that was the shape of an ax instead of round. Surgeon took pics, w a plan to speak at the conference in Switzerland b/c he always thought Patients could have posterior dysplasia when the consensus was that there was none. (It’s a ball & socket joint. Really?). With the delay in diagnosis, I have had progressive spinal issues. With at least 3 dessicated disks, & a cervical fusion & impending lumbar fusion.
In the mean time, my tolerance has sky rocketed. Studies show that patients who have chronic pain are very resistant to addiction, & if there is an acute increase in pain, it is likely there is a new issue anatomically, not addiction.
Pain management is a very poorly managed issue in our country that victimizes those who do not have the common diagnosis. If your pain does not fit in a common niche, the patient must be addicted.
I had a doctor help me with pain for 8 years I was electricuted at 17 legs are dying.What happend he wanted to do needless procedures for money I said no and he threatend me and then thay lied said I did not take a med I went to see them thay told me it is true thay lied to drop and said thay are god and can do what ever thay want.I tell you it’s all about money it took me a year of bad doctors and wrong meds my family helped me and now I have a great doctor it was worth wait now I can play with my kid she is 8 now please dont give up!!!!!!!!!!!!
A Patient: I would argue that the diagnosis of interstitial cystitis is difficult, often a diagnosis of exclusion, i.e. one made because no other apparent cause of symptoms is discovered, and is often ill-defined. We will likely disagree on this point. DrP.
For this doctor’s information, interstitial cystitis is not an “ill defined” condition…..I have it and it’s been diagnosed by top specialists in the field, not once but TWICE, so please don’t act like IC is some weirdo disease that the patient is making up to get pain meds. The fact that you said this at all shows that you aren’t even up to date with basic medical understanding, much less an understanding of pain meds and how they are used in such cases. This is the kind of nonsense chronic pain patients out here are putting up with all the time!
I was a nurse, worked for years on the floor and finally could no longer do it due to multiple health problems that cause pain. I fought it and was determined to work as long as I could but I finally had to give it up. I had been prescribed the same medication for 2 years, I never asked for an early Rx or an increase, never failed any drug screens, underwent whatever injection they wanted to do, I was very compliant. I just wanted relief, I didnt care what they did to me, if it helped I would do it. I was just dismissed last week, without my refill of meds, with no notice. I showed up to my appointment, like I did every 2 months, I sat, waited, drank a ton of soda so I could do the usual urine sample, I was in shock when they told me they would no longer prescribe my medications, not even my migraine medicine (which is non-narcotic) because Im no longer able to work. THAT was their reason… Im not working now so I shouldnt need them. THAT type of practice is unethical, bad faith, poor care. Now to attempt to find a new doc who is willing to do all the care, including injections, steroid epidurals, and meds will be very hard. In the meantime, the shock to my system is horrible. I can barely function. I didnt take them to “get high” I took them to get pain relief. Now I have NOTHING and no one to help me. Doctors have become heartless because of the drug addicts. Im sure its hard to distinguish the true pain from the seekers, but you cant “just say no” to everyone because of that. What then do the people do who have true pain? I wish there was some way to distinguish between the two so that people like me can find a doctor who cares.
I have cervical cancer and 2 norco`s a day do not help with my pain and that`s all the doctor will give me. I feel I`m destined to die a horribly painful death, and I`m looking into ways to avoid that. I have no quality of life anymore. What`s the point of living like this?
I believe in what so many people are saying. My story is different because although I was in pain I also lost control and abused the medication. Now 2 years sober but in extreme pain everyday I feel the pain will win and eventually kill me. Im not the person I was 2 years ago and I would even be willing to have my wife lock up the medicine if need be. All I know is I cant stand more than 5 minutes without shaking and in severe pain. Ive had artificial disc replacement, fusion and also have herniated discs in my neck due to car accidents. But I have to go into work smiling as if nothing is wrong with me. I really feel for the people on this board. It makes me want to cry. A few bad apples always ruins the bunch. I hope you all stay strong and dont give up.
Well,I just found out today that my so-called pain management doctor refused to refill my pain med. just because I refused to take the shot in the back! How do I know it’s not 1 of those that causes menginitis? How can dr’s treat patients so cruel and heartless? We are not all “junkies”. I am in constent chronic back pain 24-7 and my(used to be) dr. doesn’t care. I have never abused med. Only 1′s that abuse med is the 1′s that don’t have pain. How do dr’s think we are going to function? It’s not only the “junkies” that kill themselves (with overdoes) but it is people that commit suicide with no relief from their dr.s. I hope all the unconcerned dr’s sleep well at night, because I (we) don’t. A person can only take so much pain.
Doctors; You guys are HYPOCRITES and JOKES. You have no clue what the opiate medication really IS. Although it is a drug many can choose to abuse, it is a GODSEND for us in actual pain. It’s a miracle for pain. Who CARES if a patient becomes addicted? For the the severe pain patients, if they choose to live happily-while-dependent, it is their choice. People with specific sickness (not life threatening) do it daily. You as a Doctor, are trained to HELP – yet – Did you study to become a psychologist? Is your specialty addiction? Did you study your entire life to judge every patient, with such malice? as if your last name is Drew? Sure there are and always WILL BE pill-mills, but that’s their business. Literally. If your patient is in pain, do not act like you do “all you can” to solve it. Doctors these days just assume anyone is pain is a “drug seeker” and purposely beat around anything but pain medication. The Doctors that prescribe it? Will overthrow your business and LEGALLY. You will be patient-less and laughing at yourselves. Realizing your “15 year” patients have moved on, the new age with chronic pain choose wisely and guess what? When your homes are under foreclosures, or you lose that foreign car, that hot wife and are alone, you may actually realize you were WRONG. Because you guys sure love to charge up that insurance, huh? With pointless practice. So guess what? The GOOD DOCTORS will thrive. Leaving ridiculous surgeries, prolotherapies and relaxants that leave you half alive, OUT OF IT. Opiates thrive in pain therapy because you can actually FUNCTION AND LIVE, ON THEM.
- I hope the best for pain patients who are still trying to function, or find a good doctor.
Ever since yet another one of my pain mgmt. doctors lost his liscense 3 years ago, not a day goes by that I dont contemplate suicide. I have NO quality of life now. Its only a matter of time befofe the pain kills me or I kill myself. I am no longer proud to be an american, Im ashamed!! Not to mention the isolating depression. I hold no hope for the future. Cant wait to say goodbye cruel world!! You doctors who turn away people in pain are terrorists no different than Osama Bin Laden.
What is happening with the Lack of pain control is and will end up killing innocent people. I have massive chronic pain. I have an chronic inflammatory condition. in the worst places possible. I suffer from a chronic disease. (Ulcerative Colitis.)I do not have any addiction and am not an pain medicine. I lay in the fetal position in pain for hours at a time. and there is never any time when I am not in some kind of pain.
I’m talking about serious mind altering pain!
Zombie pain! I’m a fricking zombie. I can’t and don’t go out, except to appointments. I feel very vulnerable and unsafe I can’t protect myself now. I have been to the CHERRY HILL CLINIC in Seattle Washington over 18 time with the same condition I have seen about 8 Doctors including specialist and no one will give me any Meds, that will help. they last prescribed me patches that were over $800.00 they will not treat my pain! I have no insurance. Thank you America Thank You So so Much! I treat my Dog better than these people treat human beings! Special judgement will be in store for those Doctors who refuse to treat the suffering. I am praying for it everyday. what they are refusing to do, goes against the Moral fiber of the Medical Arts. They are Called to Help the suffering. You should see my Medical Bills! and I am still suffering. It really seems Criminal to me. To let people hurt.
Phyllis,
You are frighteningly misinformed. I suggest reading something other than conservative fantasy emails and watching some TV other than FOX.
It was our buddy Dubya, whose greatest hits included the re-introduction of torture and tax breaks for billionaires, who sent the DEA into the states with medical marijuana laws to threaten the docs who dared to write opiates for legal/prescribed users of marijuana.
Alleged concerns of drug diversion (that may be grossly overstated) have resulted in a “Drug Diversion” division and they have issued a DEA medical practitioners manual. States and Dr’s are “expected” to adhere to it. That’s the real “government between me and my Dr.” problem we have.
What do you think happens if a Dr. doesn’t strictly adhere to these “guidelines?” You might want to look the guidelines up.
And further, the Dr’s (I’ve spoken to recently)statements just don’t ring true. Does anyone believe that opiates are the only medication resulting in deaths, or that they cause the most deaths? Even “safe” medications like Aspirin and Proton Pump Inhibitors (Prevacid, Prilosec) have sent many people to the hospital, and killed some. (NSAIDS like aspirin increase the risk of heart attack and PPI’s can result in dangerously low magnesium and salt levels in the bloodstream after years of use). You can look this information up on the FDA’s Adverse Event Reporting/Warning pages.
This relatively recent unwillingness (perhaps fear) of Dr’s to provide “effective” pain medication smacks of a “prohibition era” for pain meds. Let’s face it, one cannot make an informed decision without facts. Well…some can. One shouldn’t make a medical decision based on politics or threats rather than clear and accurate scientific evidence.
It’s a crime I can’t get pain medications after 35 years of rheumatoid arthritis have ravaged my body. You would cringe if you saw my X-rays. I wonder which pain medications, if any, I will be given whenever I am able to get my knees replaced?
Don’t blame Obama, the other side has tried to block everything he tried to accomplish. Can you say “filibuster?”
It seems that some in our country would regress us to the 1950′s (the “good old days”); including all of the ignorance, intolerance, and lack of education.
well i hate too say this but some people just do not under stand that there are times when people need pain meds. but the dr. will not give it to them you are hurting in your lower back or you have rain that goes on for days whats a person too do go to the hospital but they refuse to help that’s what i really get up set about like my husband he hurt he’s back on sat.& STILL NOT ANY BETTER does not want the hospitals help cause of inc. resons thank to obama no good for nothing yes i’m upset with the way things are now i remeber when you did not have this to worry about but all that has changed we need obama out of the white house & fastno one can afford health inc.
I agree with Shae, there is NO reason not to treat someone who says they have chronic pain. If you are that scared to do your job than find another type of work, or work in a morgue or funeral home. There has also been a rise of real chronic pain patients committing suicide because they cannot handle the pain and are no longer getting help from their doctor or any doctor. This, in my opinion, is like all the doctors killing them poor chronic pain patients. Yes, they take their own lives, but so do the one’s overdosing on meds. Either way, there is death. I agree with Shae, that chronic pain patients should not have to seek medication from dealers. They should be able to go to their doctor, have the doctor test them monthly and have regulations. There is also a thing called tolerance, you do not give 240 pain pills to someone who has never taken pain medication, you also do not give Tramadol to someone who is tolerant and who’s pain is only managed by morphine sulfate. I understand that doctors do not want their patients to overdose, but I would hope that more doctors would learn about pain management and help their true chronic pain patients. They do not deserve to be in pain because of drug addicts. They should be treated, tested, and if so be it, have their pill bottles brought in if they need to come in the office sooner than their initial next visit. What is so hard about doing that??? It is because you do not care about those in pain to go the extra mile and as far as I am concerned, you have NO right being a physician. Chronic pain is a huge problem and if doctors are not going to help, then the crime rate and drugs on the street will grow. They do not all get those drugs from doctors, or the United States. Drugs will never go away, but I no, I would rather be under a doctors care for my pain and all my illnesses, than a dealers care. In addition, I am assuming since heroin is less dangerous, we should all become heroin addicts. it would help with pain and help knock us all out and not bother the poor doctors in helping us.
I totally agree with you, im a 27 year old chronic pain patient, and as soon as i walk into a place, they think im in it for the meds!!!!!!!!!!!!! Yes i need them, but im not a junkie, i dont take every single pill out of the bottle, i lost insurance for 10 years, and when the pain is soooo unbearable, i go to the emergency room, and charity helps me pay my bills, its been a year and half since my last visit to the er, and ever since i been overloading with OTC meds, that im surprised i have functioning organs. I just cant bleive a dr couldnt pin poiint out a junkie from someone who REALLY needs them, submit me drug tests everyday,count my pill bottle everyday, have me sign a waiver to submit tests or whatever, i dont care, i dont have a problem with it. I just need HELP cuz i cant move, im currently looking for a dr that can help since being put on medical card after having a baby over a year ago, which was a miracle, since i have severe endometerosis. Dont judge everyone as being junkies, cuz EVEN THE YOUNG ONES LIKE ME, i have severe pain issues, and DO need a dr’s help!!
And people wonder why there are so many illegal drug issues in this country. When normal people can’t even get the meds they need to function and keep their jobs from a physician instead of having to go out on the streets and seek them from a dealer. People will get the meds they need, one way or another. People like you just make decent lay abiding citizens have to do something illegal just to keep their homes and feed their kids. Shame on you and your way of thinking. Perhaps you should find another line of work.