How can being a CP patient be a strike agaist you in the hunt for a new doctor

In another thread some one commented

Somebody said...
I can not fathom how being a CP patient on narcotics is a strike. After all, a majority of CP patients are on narcotics; I am on that list.

and I felt this was a very important topic in its own right to be discussed.

If you are looking for a primary to look after your general health needs then finding a new doctor is usually not to difficult for CP patients, but when you are needing/wanting a primary to also manage your pain management it becomes a lot more difficult. A lot of PCP are very uncomfortable prescribing narcotics, especially for long term use. Between the way the government looks upon long term opiod use, those who abuse the system (patient and so called doctors), and a fear of losing either their licenses to prescribe medication or to practice medicine in general it is something many just do not want to get into.

Sure, if you have a doctor with whom you have a long term relationship with before getting CP s/he may treat you, but their attitude changes dramatically when they consider taking on a person's case who already has it and does not have another doctor who is handling the pain management aspect.

So why don't CP patients have a PMD handle their pain meds? The answer there is two fold. The first is that there really are not that many pain management doctors to begin with and second the largest percentage of those that are only do procedures. They do not or rather will not prescribe pain meds. (In my area for example, 60 mile radius) I know of at least 8 pain clincis and a over 15 PMD's. Out of that I only know 2 who will prescribe narcotics and one of those I know for certain will only do it after you have tried EVERY other solution which can take years in some cases.)

Most PCP only recieve an overview of pain treatment ( acute mostly and a bit of information about chronic pain) in medical school and we all know that there are so many variables in treating chronic pain, the medications, dosing , conversion formulas, etc that on top of there not being a big paycheck, there are too many regulations and too many potential problems with staying on top of the new and ever changing DEA regulations to make it feasible both financially and professionally. There is also the problem of doing it for one patient who then recommends this PCP to his friend, who recommends him to another and so on and so on, until he has new patients, not for the general scope of his practice but seeking pain medications and then he opens himself up to a whole new slew of potential problems, so most will not do it. My PCP has been mine for 18 years, I have never asked him for pain medications, even when I fractured and displaced my tailbone and while I know that he probably would write my scripts for me, I won't ask....I don't want to put him in an uncomfortable position and honestly, while he is a great GP , and he was the former director of the ED at our largest hospital, I don't feel that he knows enough about the treatments of chronic pain and it's complications that I just am not willing to take any chances, for him or for myself.
Sandi

Man, if that isn't the truth about new Doc's and CRPS/Neuropathies...BTW, howdy to all from a newbie to the forum; a sufferer of CP/spreading neuropathies since late 2009 when i was involved in a Motorcycle accident (got smacked by a kamakazi deer on an Interstate, and was shoveled off the road...lol. Actually not funny, but I live in reality). My wife and me had just moved to another State...we figured it would be difficult, but WOW!

What I have found that really makes it rough are the 'junkies', the ones who Doctor-shop, the ones who flat out lie...the ones who 'walk' in and laugh it up in the waiting room...then stagger in with their 'walkers' and say they are a "10" and cry once in the office (I have seen this), then grumble and gripe in the parking lot when they are told what we are told and given a scrip for motrin. (haha)

I feel like slapping them in the mouth...And I have relatives who are junkie-scammers. We had to keep our meds under lock and key...and still watch them closely!

CP sufferers, even with records, x-rays, body-scan results and Dr recommondations from prior Pain-Clinics in hand are just not believed! (and I don't even compute my own as a "10"..."7-8" on a bad day) Complete new tests are ordered, while the new patient suffers and hopes their last scrip carries them through...to the point of halving them to make sure!

The junkies are clever...and were the ones who got obscene amounts of meds...which made it onto the streets for a nice profit. And the sad thing is...their 'best' customers are, you guessed it; CP patients who can't get meds!!!

Is it time for legit CP patients (who can prove it) to get loud and not shut up? or is it already too late?

fentanyl patch/100mcg/hr

percocet 10/325

neurontin 2400mg

celebrex 100mg

wellbuterin 200mg

prozac 60mg

Post Edited (Davy Navy) : 3/6/2011 2:22:36 AM (GMT-7)

I hear you on that...My G.P is my clearinghouse as well...PT, Neurology, Pain-Clinic, which ever other little 'lovely' that comes along. Anymore, you have to see the G.P, who sends you to a Pain Clinc...that sends you back to G.P to write scrips. 

Isn't it insane?

Somehow I wonder if I am being punished for the sins of my youth?

Naw, no one would go NEAR those...lol

--------------------------------------------------------------------------------------------

Getting spread down a highway near you!!

Post Edited (Davy Navy) : 3/6/2011 3:50:48 AM (GMT-7)

Jim, that was my comment.

I guess alot of my inability to grasp this is because CP patients are typicially perscribed, at least by PM doc's, narcotics. Personally my PM seems opits as the devil's candy, but also understands that sometimes they are the only thing that works... if you can call what they do working.

Oddly enough it was my Physicians Assistant, the very one who saw me the day after my accident that spawned my CRPS, that was my greatest ally in my combat against my pain. PA Tarrant understood my condition, though at the time he only suspected CRPS, and he was the one to eventually write the referal to my current PM doctor. When I was in a rock and hard spot and had no insurance, Tarrant was who I saw. Against the law he understood that it was costing me $50/visit to come and see him, and another $80/script to get my generic pain meds. So he would write my script and then give me two refills as well. Technically this is a big no-no, and I'm not sure how he got around it. When Tarrant had to go on permanent medical leave (he was diagnosed with terminal cancer and given 6 months saddly) I started seeing Dr Bady. Not a bad man, though after 6 months, every month I saw him he would look at me. "Why are you here?" To get my script refilled. "Why again are you taking Loritab?" Um... hello, file in your hand, diagnosed CRPS stage 2.

Now with insurance I am back to seeing my pain Doctor again. And from what I hear from my friend, her PM doc is just as wonderful as mine. He is generous with his scripts, they can be refilled when ever needed for his established clients, etc. In some ways he makes pain management easier then my doc does, and it's tempting to switch, but aside from the pharmasutical bennefits I see no logical reason to leave a doctor who is treating me well, has my best interests at heart, and has been trusted repeatedly with my life in his hands.

I suppose I could understand how seeking just a generic practioner could pose a problem as a CP on narcotics. I guess it was a missunderstanding of apples and oranges. I hope though Jim that you find that Tarrant... that doctor who knows, cares, and takes good care of you without making you feel like you're being ignored, that you're not important... none of that.

  

    When I first came here I didn't understand. I was naïve, I suppose. The stories, the realities I read just shocked and horrified me.

    Once I became sick my doctors created a web of particular specialists that all care for me and communicate regularly with one another. Occasionally they would bring in outside specialists for different aspects of my care that came up along the way. Even when my insurance changed and technically I could no longer see them... I was charged bare minimum and was still allowed to continue my care. Even when all my teeth crumbled out of my mouth in just a few short months. I didn't realize at the time what they were doing for me and to what extent. I soon learned as the bills came pouring in. Many were donating their time.

     It is easy for me to say "Hey! You shouldn't be treated like that!" But in all reality the few medical professionals that treated me badly were removed from my care, never to be seen again. My other doctors took care of those problems. One even apologized while I was being wheeled in for procedure. I forgive him, but he treated me badly. Even see him to this day and he is always concerned and wanting to know how I am doing.

    In other words, I have been seeing my GP since my only concerns were moderate acne and birth control. Many many years. He brought in a few specialist when I became sick who have looked over me constantly from day one. I have no clue what would happen to me if I was faced with needing new doctors. How would I be treated? I don't know. My spine is progressing no matter what doctor I see. Would I be treated with care and understanding like I am now? Maybe not. Would my pain be a strike against me? Gosh, I just don't know. Back to the original thought.. my spine is progressing anyway.

    The truth is, I have never had anyone question my pain. One specialist early on (the one that is very sorry and I run into at the hospital often) and a couple of nurses who didn't see what I was hiding under my unusually long sweaters. They are all very sorry now. But I have no doubt that if it were not for my deformities I would be treated very poorly by any "new" doctors.

    The medical community can be cruel to "us". In short we hate to know that any of "us" are being treated badly. Sadly, there is little we can do about it in this day and age.

*hugg*
  dani