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Article about the rational behind one offices pain managment practice

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Posted 6/16/2013 2:46 AM (GMT 0)
http://www.arapc.com/pdf/Journal-of-Pain-2009-2.pdf

This article was posted on my doctors website as part of their new smart opioid policy.  It is not a new article, it is from 2009 and is a position paper.

I found it interesting-it discuses how to select patients for long term opioid therapy, how to monitor them, what to look for in dose increases, when to rotate between opioids.

I like my doctor, she is a rheumatologist not a pain management specialist, and she doesn't think her patients should hurt.  She doesn't prescribe pain meds for me because I asked my PCP first and don't take more then my PCP is comfortable prescribing but she does prescribe for a large percentage of her patients.

Anyway I found this to be interesting.

Posted 6/16/2013 3:34 AM (GMT 0)
The referenced article helped me understand more about pain management before 2013. Thank you for posting it.

In January of 2013 the opoid reporting laws in my state became very restrictive. Now GIs and PCP doctors are very nervous about prescribing opoids for anyone that is not a regular patient. My Gi's practice does not prescribe opoids for anyone anymore and refers patients to a pain management clinic. It is very hard to get an appointment at the pain management clinic. In pain emergencies (when the pain is 8 or greater) I end up having to go the emergency room because I have no other choice. It gets very expensive.


Have you experienced this or do you have a recommendation?
Posted 6/16/2013 3:40 AM (GMT 0)
This article was the rational for my rhuemys office's brand new 2013 pain contract/prescribing policy etc. Which I thought was interesting-they want a guiding policy but not a restrictive one.

They only see regular patients.

I have only been to the ER once and that was for kidney stones.
On the other occasion I needed more than my normal pain relief my rheumy wrote a script for me for my torn rotator cuff-I think but am not sure, that she called my PCP who normally scripts for me.
Posted 6/16/2013 4:46 AM (GMT 0)
I tried to read this article, most of it was over my head, wish I could see a simpler worded summary of the main points, or does anyone here want to make a stab at it.

david
Posted 6/16/2013 11:46 PM (GMT 0)
Hey Daivd, I like research so I gave it a read. It's a detailed thesis of the idea that certain non cancer individuals may benefit using opioid based pain meds if the benefit outweighs the risk of using these types of meds.

These individuals must meet certain criteria where they have tried all other alternatives and have an irreversable documented condition.

In addition, it discusses the highly addictive nature of the use of opioids and the need to montior patients with high risk of addiction even if they meet the requirements of the criteria above.

 
It seems to be in line with the new regulations of the DEA.

Post Edited (Mossmi33) : 6/16/2013 8:18:57 PM (GMT-6)

Posted 6/17/2013 12:22 AM (GMT 0)
1.1 Patients on COT should identify a clinician who
accepts primary responsibility for their overall
medical care. This clinician may or may not prescribe
COT, but should coordinate consultation
and communication among all clinicians involved
in the patient’s care (strong recommendation,
low-quality evidence).
11.2 Clinicians should pursue consultation, including
interdisciplinary painmanagement, whenpatients
with CNCP may benefit fromadditional skills or resources
that they cannot provide (strong recommendation,
moderate-quality evidence).

As you see, it doesn't actually suggest that PCPs not prescribe-only that they seek consultation if the patient requires more skilled care.
Posted 6/17/2013 12:52 AM (GMT 0)
I know alot of drs tell their pts they can no longer write rx's for pain meds. But, there is No Federal or State Law that says a Licensed Physician cannot write pain meds. Nor do they state only Pain Management drs can write for chronic pain that is not cancer related. A dr may choose to not write them, but there a no law stating they cannot.
Posted 6/17/2013 1:38 AM (GMT 0)
Mercy&Grace- This isn't law. It's a research thesis. It's funny how doctor's play it off like law though. My pain doctor's exact words were if you can't come off of the Oxy I'm going to have to notify you to rehab clinic due to DEA guidance. I didn't question it. I've been off for a week now.

Sjkly- Good catch, I read over that. It still seems to suggest a pain doctor at least be consulted. I'm going to edit that out since it's incorrect.

Post Edited (Mossmi33) : 6/16/2013 8:18:39 PM (GMT-6)

Posted 6/17/2013 3:31 AM (GMT 0)
Mossmi33,
"My pain doctor's exact words were if you can't come off of the Oxy I'm going to have to notify you to rehab clinic due to DEA guidance." Are you saying that your dr said it was DEA law that you had to go to rehab if you didn't get off the oxy ?"
Posted 6/17/2013 3:41 AM (GMT 0)
Mercy&Grace,


He didn't say "law". He said things like the new DEA guidance does not recommend pain meds long term for post operational patients without cancer. He also said things like he would have to refer me to a drug rehab clinic if I could not come off of them myself and he would have to notify the DEA.

I know this is not "law." Let's just say he was highly persuasive for me to come off the meds without intervention. He even went to the extent to say that my employer might not find it acceptable.

In any case, he switched me to Neurontin which has been highly effective in controlling the pain and I've been off Oxy for a week now. Not sure I could have done it without the Neurontin.

Post Edited (Mossmi33) : 6/16/2013 9:44:25 PM (GMT-6)

Posted 6/17/2013 3:51 AM (GMT 0)
Wouldn't telling your employer be violating HIPPA ? Wonder where it says the dr has to inform the DEA when a pt has to go to rehab? I'm just so totally angry with drs lying to pts.

I'm glad you're doing well.
Posted 6/17/2013 4:00 AM (GMT 0)
Mercy&Grace,

Thanks, it's been a rough 5 months...I had 3 emergency surgeries and exuasted my FMLA of 12 weeks. They gave me an extention so I wouldn't lose my job but in order to do that I had to sign a waiver that gave my employer the right to view my medical records.

He could have been making it up for all I know. I am feeling much better after switching meds so I can't complain to much.

Mossmi33

Post Edited (Mossmi33) : 6/16/2013 10:03:45 PM (GMT-6)

Posted 6/17/2013 12:03 PM (GMT 0)
It is good to keep in mind that this article is a position paper written by a bunch of pain management specialists.
However, it is being treated as part of the basis for standard of care by at least some other doctors-such as my rheumatologist. Somewhere in this article is the suggestion for pain management contracts as well.
Posted 6/17/2013 1:51 PM (GMT 0)
Mossmi33 - I'm glad it worked out well in the end but I would be upset that the doctor tried to manipulate you with half truths to make it happen. It's defintely a HIPAA violation for him to discuss anything with your employer regarding your medical condition without explicit permission to do so.

I hope the nurotin continues to work for you. My stepmom takes it for her fibro and she swears it's a miracle drug. Good luck to you! :)
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