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Pain clinic contract

jlrfryejjlrfrye ohioPosts: 1,110
edited 06/11/2012 - 8:46 AM in Chronic Pain
I am a patient with a pain clinic that I have signed a contract with that I will get no narcotics from other doctors.
I have an abcessed tooth and cannot get the tooth pulled until
I am on antibiotics for 3 days due to a heart murmer. My dentist tried to give me a script for pain meds to which I told him I could not accept due to the contract. He reccommended that I increase my oxycodone from 3x a day to 4 to control the pain. 3xs a day was not controlling the tooth pain so I have increased my dosage. Here is the problem now I will run out of my meds before I should per my contract. Will the pain clinic take this into consideration? Will they write my next script before 30 days due to having to take more because of my tooth? Should I call them now and let them know of the situation? Has anyone else been in a situation like this and how did you handle this?


  • Just based on what I've read here about PMs, contracts and issues, I think I would call them today (before you're out too many pills) and explain the situation, giving them the number of your dentist so it's all up front and above board for them. Maybe you can call the dentist first and ask them if they'll take the call from the pain clinic...?

    Maybe it's me, but I think, knowing how strict these contracts are, your dentist maybe could have offered to call them while you were there so as to keep you as comfortable as possible and still within your requirements.
  • I think the dentist should have called your pain doctor and worked it out with them.

    Usually they just call and notify that they are prescribing extra for a specific procedure and get the other doctor's OK (since I believe the contract usually says that you won't get opiates from other doctors for THIS injury or without their permission or something, not that you can't ever).

    This is a bummer, I think the dentist messed up :(

  • Dentist should be calling your pain clinic Dr.
  • i've taken pain pills from dentist and no one found out. If he did i believe he thought it was not worth the effort. i think most pain drs would cut you some slack. i also had pain pills for gal bladder surgery and nothing came about it. i was even on morphine pump.i don't think this gets back to pain dr and if it did just explain to him. not enough to worry about
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • i've taken pain pills from dentist and no one found out. If he did i believe he thought it was not worth the effort. i think most pain drs would cut you some slack. i also had pain pills for gal bladder surgery and nothing came about it. i was even on morphine pump.i don't think this gets back to pain dr and if it did just explain to him. not enough to worry about
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • I don' tknow. My husband has Crohn's Diease and has to be on pain mends sometimes due to flares. He ran out and could'nt get into the doc for a week and he got so sick and in pain I took him to the ER. There they gave him a morphine drip and sent him home with 10 pain pills. Well a week later he told the doc about it,what meds was given to him. Well the doc took a urinalysis and it came up pos for morphine and darvecet, so she terminated him.
  • I would contact your PM Dr. and let them know your Dentist prescribed you take more of your pain meds for your tooth surgery. Hopefully they'll work with you. Hope it works out for you. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • jlrfryejjlrfrye ohioPosts: 1,110
    I called the pain clinic and they asked if I could have my dentist call them. No problems and the issue is solved. They asked me if I had taken a script from the dentist and I told them no and their reply was good. I have an injection the 10th and they said they would take care of my meds then
  • It's all good, hopefully the dentist will know how to handle his next patient on a pain contract. I'm surprised he didn't have experience with it already.

  • should be not only with your doctor, but the DEA (drug enforcement agency). Call your doctor or whoever is on call for him/her and get your meds that way. I just had rotator cuff surgery and, when the surgeon offered me norco, I had to tell him I was unable to accept the prescription and would have to get by on what I had. I think he was amazed that someone refused drugs! Keep it legal or risk a painful future.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Just three weeks ago had very bad infection involving three teeth. Due to my disabilities the dentist decided pulling one at a time would be better for me after being on antibiotics. I too, have a heart murmer but needed additional antibiotics for infection. He also said he had no idea how I was handling this pain and felt I should be on higher dosage of pain meds. I explained I was seeing a PM and he immediately got on the phone while I was in the chair, called my PM dr and wrote a letter to him. It was agreed my meds would be increased by PM dr. After my appt. with PM dr he commended me on the way this way handled. He continued to increase my meds for each extraction a total of 3 months and said this is how all patients should handle this scenerio. Make me feel good! After reading so many stories on this site which is wonderful I will not take any chances whatsoever. Just a good practice to notify PM first to avoid any problems.
    So important to have a trusting relationship with your PM dr as we all are suffering from painful spinal issues. Unfortunate we have to go through all this but so many have abused that dr.'s have to be tough.
    Glad everything worked out for you.
  • with my PM doctor about 2 years ago when I needed to have some female surgery. I was on the fentanyl patch at the time, but wanted to wean off. The anesthiologist who was putting me to sleep for surgery said not to touch the patch until after the surgery...she was afraid that I would have more pain issues without it. Then I asked my PM doctor what would be a good break thru pain med she would suggest for pain control fdor my surgery? She stated dilaudid b'/c I already took 2 percocets a day for bt pain for my back. I offered for her to talk to my surgeon and I conveyed this message to my surgeon and offered for him to talk to her. I guess they both trusted me and after my surgery, they gave me vicodin which was standard with that surgery, then the surgeon came around before I left and gave me a script for dilaudid knowing the vicodin would be too "weak" for what I was used to. I was very open and honest that I was under a pain contract, but I guess my PM doctor saw this as a different circumstance and didn't mind the surgeon medicating me post op.
  • My PM doctor just left the practice, and I started having to work with a different doctor.

    He made a comment about my being quite compliant with my old doctor. My old doctor had not really talked about it, but I was sure he was watching. I never had any need to be non-compliant- he was always there when I needed help with pain.

    Anyway, it kind of made me think about how you just never know when you'll be in the situation of having to form a relationship with a new PM doctor, and having good compliance records can be so important.
  • HB you have it right but think about the definition of a contract. It's an agreement between two or more parties that specifies what each party will do and receive as well as penalties for failure.

    So in the case of the pain management contract the patient agrees to get all their meds from the PM doc, go to only one pharmacy, bring their meds to each appt, submit to random drug tests, take their meds as prescribed and be honest with the doctor. The doctor agrees to adequately control the patients pain, work with all doctors (including dentists and other unrelated specialties), and be available in emergencies.

    A contract goes both ways. If the patient breaks the contract they can be monitored more strictly or dropped by the doctor. If the doctor breaks the contract the patient is free to find a new doctor. What is unfair is that the patient is at the mercy of the doctor and his office. When meds have to be refilled on the exact date and pharmacies can make mistakes we are at their mercy as well.

    I guess as HB says having a good relationship with your doctor is critical.
  • Absolutely. I didn't need to be non-compliant because my doctor was always there for me, not because I'm some super human contract sticker-wither.

    But we were talking about situations that we all could find ourselves in- dental work, an emergency room visit, etc- that could put a ding on our compliance record. It's just something people who have pain contracts should know about, I guess, and prepare for.
  • Teeth - ugh, I shudder to even think about it.. Yes, call you doctor (Pain mgmt) and tell them what is going on, give them the dentists name and number so they can check if they need too. That is what I did and then when I ran out early, she called me in enough to last me till I saw her. Had I not called her to let her know what was up - she wouldn't have done that. Good Luck
  • Mine wouldn't, nor would my pain doc want that. I have to give her the info and she has her nurse call the dentist. However, after my most recent dental fun and games I shouldn't have to deal with that for a while!
  • I wouldn't risk it! I'd call
  • Try that in the state of Utah - it's a joke. I would if I could. I know I'm undermedicated but there isn't a thing I can do about it, except chew my nails off and suffer.
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