Pain Contracts

I just had a very interesting argument with a friend of mine. Her knowledge of the whole topic of pain management kind of threw me. She is a little older than I am and has had many different malady's over the years. She does suffer from MS, and her nerve pain is very similar to mine. While discussing my merry go round last week with my pain contract fiasco, and subsequent follow up meetings with my PCP as well as a new pain specialist.
I casually mentioned that my PCP has decided not to treat my pain any longer and refereed me to a pain specialist. We were discussing the reasons behind this decision, I mentioned that she has a limit as to how much narcotic pain medicine she is willing to dispense, and that I was a little miffed at the laws and regulations that are forcing more and more doctors to severely limit or actually stop prescribing pain meds due to fear of litigation and prosecution.
Well you would have thought I just told her the world is flat and Elvis is living in Tuscon. She explained to me in no uncertain terms that the only reason doctors won't dispense pain meds is because of to much paper work. It has nothing to do with the laws or close scrutiny being place on the medical community, as I had told her. She refused to believe my side of the argument so to protect our friendship, I relented. I was shocked, she has been dealing with medical issues far longer than I have, I just assumed she understood what was happening. Then I got to thinking, are there really that many people out there who really don't know of, or are just plain ignorant to the travesty going on regarding pain meds.
In the past week and a half, I have broken my pain contract, explained my actions to my PCP, set up a new contract with the stipulation that I be seen by a pain specialist to cover my pain treatment, so as to increase the dosage of my oxicodone. Met with and was happy with the results of the Pain doctors plan. She is now setting up a tri-lateral contract between her, my PCP and myself. The pain specialist will handle just my pain treatment in conjunction with my PCP who will still treat my other needs. I now have my pain medications adjusted accordingly and my PCP is now happy. I feel satisfied that I was able to have my pain needs addressed and still be associated with my PCP. There is less anxiety on my part regarding pain requests and now everyone is happy. Except my friend who is seriously misinformed to the point of angrily correcting my claims of doctors feeling threatened.
Has anyone else en-counted such disbelief regarding the stress law enforcement is putting on the medical community? I guess I have to watch my tongue when discussing this problem.........

I have a question about pain contracts. I know that maybe they are different between different docs/clinics, but are generally very similar. I am wondering, what if you need pain meds in an emergency, like at the ER or after pain clinic hours/on weekends/holidays? I know, I can contact my pain clinic on Monday and ask about it and get a copy of the contract, but I'm curious to hear how other people handle it.

I was given pain meds by my dentist on Thurs. after oral surgery, but I did call my pain clinic ahead of time and they gave me verbal permission (over the phone) to get the prescription from the dentist. Looking back on it, maybe I should have gotten something in writing?

And I had an incident this past December...I was in ER in the middle of the night, on a weekend, due to severe abdominal pain and hemorrhagic cystitis. I was given a short course of oxycodone. Never occurred to me that I might be doing something wrong.

Thanks for the response. Appreciate it! One last ? about ER visits....what if they want to give you pain meds while in ER? Occasionally I go to ER if migraines get really horrible or go on for a long time, and they usually give a shot of Tordol (sp?) or something. Do you think I need to call before getting treatment, or do I need to call the pain clinic after leaving ER and report it to them? I know, I need to call my pain clinic and find out for sure. I'm just scared I will do something wrong (accidentally) and get rejected by pain clinic or be branded a drug seeker!

M&G,

Thanks so much for all the information. You sure know a lot about this stuff! I will definitely call my pain doc Monday and ask them to mail me a copy of the contract I signed. (Not sure why I don't have one). I want to be sure that I know the policies and procedures so that I don't get myself into trouble and don't have to worry about it!

Thanks again!

It sounds like your pcp won't be prescribing any pain meds if your pain dr is prescribing them exclusively. As I said earlier, the pain contract is usually for opiates and other meds that are tightly regulated that are given to treat pain. Usually pain drs won't prescribe meds that are for other health problems besides pain. If a pcp is aware the patient has signed a pain contract, they won't treat any pain issues.

I can't get this thing to hotlink but you guys shouldn't have any trouble finding it. It's an interesting and accurate site I thought you may like!

WWW.drugwarfacts.org

Electrify,

You are right.

I got a letter from an ER some time ago that said I wouldn't be allowed to get pain meds there ever again. I went there because that was the specialty hospital where the surgeon who had done a recent operation was, and the pain seemed to be related to the surgery. It was a weekend evening, and I was seen by someone from the surgical service. I told the ER people I had a pain contract and gave them the name and phone number of my pain docs. I don't think there would have been an issue if I hadn't been honest. I'll probably be refused service there in the future.

All pain contracts are not created equal, there are different ones out there. Despite what they try to imply that it's to help you they are not for your protection, they are only to protect the doctor.

I had been seeing one doctor for a couple years when one day he mentioned about something being in my contract to which I replied, "HUH?". I had never heard of such a thing. He insisted I had signed one and went to look in my records.. Ooops, never saw one.

So he gave me one to read and sign and bring back.

When I read it I got really MAD. It basically gave away all my rights and let the doctor do whatever he wanted and the only consequences were to me. I never signed that one and he never mentioned it again.

My present doctor has a better version and he was even willing to remove/alter some stuff and I had no problem signing it.

Not to light a fire under your friends theory but I work at a medical center and am privvy to pain doctor continuing Ed courses. I was shocked when I read that the DEA gives the most fines to doctors self prescribing, 90% more than being fined for overprescribing.

No, will not give you anymore info on the medical center, and I don't have access to the exact fine numbers. I might be talked into sharing the exact verbiage of the findings but I will have to dig again. This was from a fy14. Class.

Shocked. Utterly.

If they don't live it, they are clueless.