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Pain doctors that refuse to prescribe narcotics?

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Posted 2/3/2013 5:44 PM (GMT 0)
Hello everyone. I hope this message finds all of you in as little pain as possible.  Could I ask for some feedback regarding an upcoming visit with a pain management doctor?  I'm getting stressed about this visit and whether or not I should keep it.

I have stage IV endometriosis, which causes crippling pelvic pain for 2 weeks out of every month.  I've had seven surgeries for it, yet I remain in severe pain that is only getting worse with time.  I have taken Lortab for the pain for quite a while, in addition to Anaprox and Motrin.  The pain is now so severe that the Lortab barely controls it anymore, but without it, my pain would totally consume me.  It's gotten so bad that I don't know how on earth I'm going to cope with it anymore.

I have a family doctor that is now prescribing the Lortab, but it is very clear that he doesn't want to give it to me anymore.  I also take Valium for a severe case of anxiety and PTSD, and he's also acting reluctant to give me refills on that.  All of a sudden, he's reducing the amount of meds when I need refills.  For example, he only gave me one third of the quantity of Lortab that I regularly get, and he also only gave me a tiny quantity of a med I have to take to prevent diarrhea.  (I have a lot of endo in my intestines.)  On Friday, I received a certified letter from his office, but the mail man just left a paper slip in my mailbox to pick it up because I have to sign for it.  Either he's suing me for an unpaid bill, or he's going to abandon me and tell me to get another doctor.  If he does the latter, it's going to hurt like crazy because I have always been responsible with my meds and have never "doctor shopped."  But, as probably many of you know, doctors are becoming more leary of prescribing pain meds and other controlled substances now....so this is why I'm worried he's going to give up on me. 

A few months ago, I found out that a new pain management doctor is going to start practicing in the city where I live, and I immediately got my family doctor to make the referral for me.  My appointment with her is Feb. 19th.  This past Friday though, I was told by one of the ER doctors that this pain management doctor "does not prescribe narcotics and instead will control your pain with Neurontin, Lyrica, etc."  (I was injured at work, and I had to go see him as part of the workers comp process.)  I just told this ER doctor, "Okay," but I instantly began wondering if it's even worth going to see her if she's not going to be willing to prescribe for me the meds that I have proven ineffective in giving me pain relief.  Because my insurance is not covering any visits relating to my endometriosis (it's a pre-exisiting condition), I will have to pay this doctor $500, which is definitely money I don't have now.  

Have any of you encountered pain docs that refuse to prescribe narcotics, even to patients with valid conditions that cause severe pain?  

I've tried Neurontin and Lyrica with no success, and I'm just at the end of my rope with this pain.  I don't want the narcotics to get high.  I actually can't stand how they make me feel.  The pain is just so bad now that I can't tolerate it anymore.  I just want relieve from the pain when it hits a 10 out of 10 on the pain scale.  It hurts that doctors are seeing many pain patients as drug seekers when, in fact, we're looking for relief from the pain. 

Do any of you have any suggestions on whether or not I should attempt to contact this pain management doctor's office and ask what types of pain control modalities she uses?  I know that if I call and ask whether or not she prescribes Lortab, they'll instantly think to themselves, "She's a drug seeker."  I'm crying as I type this because I'm not a drug seeker.  I just can't take this pain anymore. 

I truly don't know what to do and feel like I'm at the end of my rope.  

Any suggestions/feedback would be appreciated. Let us hope and pray that doctors become more educated about chronic pain and less paranoid about prescribing pain relief in the future.

Take good care, everyone.  And thanks again. 

Posted 2/3/2013 7:45 PM (GMT 0)
Hi Luvs, I imagine the reason your GP is doing this is because according to the new guidelines if he wants to treat patients that have CP then he is going to have to take classes and do some continuing education courses. Most GP's are not interested in doing this. Between this & worrying about the DEA breathing down their necks they want no part of it.

What you can do is call this PM drs office and just ask if the dr rx's pain medication to patients if he feels it is necessary or does he do injections & procedures only. Tell them you do know some drs will do procedures only and no medications. That way you can find out if you need to keep your appt or cancel it. If you are paying out of pocket I would want to know this info before I possibly wasted my money.

Take care...Susie
Posted 2/3/2013 9:05 PM (GMT 0)
Hey luv!

I just wanted to let you know that I recieved a letter from my doctor Friday that I had to sign for and it was a 30 day notice that I was being dropped from their office.. But this is because I'm turning 18 and he is a pediatrician.. So, I completely understand your concern of this letter being one of abandonment. shakehead

Good Luck!
Posted 2/3/2013 9:32 PM (GMT 0)
Hey Luv....

Few thoughts -

As Susie said, as more and more conditions are put on prescribing narcotics - less GP docs are willing/able to script narcotics, especially long-term.

I know it's hard to not take something personally (trust me - I take things to heart all the time and try not to!).... but it has nothing to do w/ taking meds responsibly and so forth. You can do everything *right*.... and, like I said, it just has to do w/ the climate of scripting meds these days.

So, try not to view it as the doctor "giving up on you".... but really for what it probably is... and that is that most non-pain docs won't/can't script narcotics (even Lortabs) long-term. It's not a reflection on you.

Re: new pain doc: I personally would keep this appointment. ER docs are the worst (just my opinion) when discussing chronic pain issues.... so, I wouldn't entirely trust their judgement whether they will script narcotics or not.

Over the years - I've learned to really advocate for myself. If narcotics help as a part of your pain management, you need to be really upfront and let that be known. And don't feel bad about it....

Of course, they are meant to be used as a part of a comprehensive plan.... for me, I use narcotics, a muscle relaxer, nerve med, trigger point injections, botox, epidurals and on and on it goes :) Be open and willing to try different modalities... because you never know what will work, even if it hasn't worked in the past.

So - be open to going to the PM doc. You never know - it could go really well... if not, I'd start looking at other pain management docs - even if it means driving further, etc.

Good luck to you. I know the stress that these changes cause.... but try not to worry and just really be open and direct. I think one way that we can help educate doctors about chronic pain is learning to feel secure about our pain conditions.... knowing we AREN'T drug-seekers.... and knowing it's ok if narcotics help our pain.

Take care --Tina
Posted 2/4/2013 1:10 AM (GMT 0)
Hello Luv:
I have stage 2-3 endometriosis, so I know how you feel. I have chronic pain from it every single day, and even though I have had surgeries to try to prevent the pain they have done little to relief it.. I was put on Lupron, which put me into a chemical menopause, and it worked ok. However you can only be on it for 6 months at a time.

I am on Dilauded, and oxycodone now for the pain, and even my Dr. is a little reluctant to keep prescribing me these pain meds. I also suffer from PTSD and anxiety issues, and have found the best way to get my valium is through my psychiatrist.

I have wound up in the ER many times. And when I get there I ask them to admit me for pain management. They know my history, and they know that If I am showing up at the ER its for a very good reason. It helps to have my Dr on my side when it comes to this though because all I have to do is call his office after hours if I am in a flare, and they tell me to go in. Once I am there, I am instructed to ask for the resident on call, who in turn calls my DR that is treating me. This has been a life saver at times for pain relief.

Not sure if I have helped you in any way, but please know that I am keeping you in my thoughts!

Best of luck.
Posted 2/4/2013 2:59 AM (GMT 0)
Luvdogs I would definitely call the new pain clinic and ask what type of treatment that they do for pain management, if they ask you what you have had in the past tell them. I was going to move down to kentucky, and I got a PCP down there and everything and he made me an appointment with the Pain Management Center there that was affilliated witht he hospital he works out of. Now he knew my complete history, anyway when I receive a welcome packet from the pain clinic I sensed that they were more a holistic type pain management center. Anyway I talked to them on the phone and asked them about there pain management treatment, and I told them all about my past and present pain management, and what worked and what didn't and what my current Spinal Pain Management doctor was doing, and prescribing. Well she told me right off, that if I came there they would not continue me on my pain meds at all, that they don't prescribe any pain meds that are narcotic based and they use mostst guided imagery and ten units and injections. I have had all those and they didn't work, she did tell me that most pain clinics down there were changing over from using pain medications. Anyway I cancelled the appointment and did not move down there, although I would still like to because I have a sister and all her family live there. But I think I have one of the best Spinal Pain Management doctors in the country right here, and I am hesitant to give him up, he treats the whole person, and he even referred me to a marriage counselor that took Medicare and TriCare while I was going through a divorce. He just does everything from everytype of injection, to prescribing pain meds if needed, He does require urine tests once a month at your monthy refill appointment, but he does personally see his patients every time at the refill appointment and goes over with you any new problems, you may have and will order the appropriate test, and even referrals to other clinics and doctors and surgeons. So as much as I want to move and be near my family I am really hesitant about giving up what I have.

Anyway I feel if especially if your insurance is not paying for your pain management, then you definitely have the right to know what they provide before going to your appointment, it is your money and you have the right to know what your spending it on! Don't waste it if they are not willing to treat you properly. With your condition, have you tried going to any other doctor that specialized in that area of medicine, to see what they can do for you and maybe recommend a pain management center that specialized in treating your condition!  I hate the new attitude that is being adopted now, in treating pain! I personally feel that taking pain meds is the same as taking any other type of medications that treat a long term chonic condition, high BP or diabetes or a host of other things, it is all the same, you take the medication to control the condition. So why is treating pain any different???

I just don't get it, I use to work as an RN on an Oncology unit, and I know what pain is for patients, and I think the attitude of some of these doctors now days is criminal! I personally would rather see a person be treated that is not really in pain than have people that suffer terribly  with chronic pain go untreated! It is wrong! I do feel for your situation, and wish you all the best !!!

White Beard

Posted 2/4/2013 6:48 AM (GMT 0)
Luv most definitely call the pain clinic and just tell them what you are currently on and ask if that's going to be a problem with the Dr. If they give you a lot of BS and avoid answering directly,stay away they most likely not write any narcotic meds.

Holdon your peds Dr doesn't have a choice he can't treat you once you are an adult also concerning the fent,never seen a ped Dr use it so you caught a break. Also peds drs have less writing and prescribing power of narcotics then any other drs,so he would warrant a visit from the authorities that be were he to have written long term for you.

Sadly enough oxy is the biggest problem and that's why we see so many Drs choosing to not prescribe narcotics any longer. Just telling a Dr your on oxy triggers reaction that is unfavorable. If they are writing Oxy they are already tagged to be watched and monitored by the DEA.

So Luvdogs ask,don't throw away money you could pay another Dr.

Vickie
Posted 2/4/2013 2:16 PM (GMT 0)
First I wanted to say that it's SO good to know that you are ok as you left us hanging last time with your head injury and we were all telling you to seek out the ER immediately..we were worried as you never came back to update us!!

One of the ways that I've learned to ask over the phone when I had to find a new PM many years ago was to ask, "Do you all have a comprehensive pain management program that includes all modalities both medicinal and non medicinal?".

Unfortunately because they get so many calls a day from people who are just seeking pain meds, a lot of times they will automatically say no over the phone even if they do prescribe.

I would certainly find out what your Dr. now wants though and if you owe them money, you need to go directly and speak to their office manager to work out a payment plan. Even if you just pay a small amount this is better than doing nothing.

I guess it really boils down to whether you can afford to see this new Dr. or not to find out what their real PM treatments plan are.

Let us know what you decide...
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