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Discharged from pain doctor for depression?

brafixbbrafix Posts: 3
edited 06/11/2012 - 8:57 AM in Chronic Pain
Hello to all my fellow spinal patients.

I'd like some insight into some fallout which occurred after my most recent visit to my pain management doctor. First however some insight into my history, I am a patient in my mid 20's suffering from intractable cervical spinal pain for the past 2 years. This stems from scoliosis and kyphosis caused by an underlying connective tissue disorder.
The pain has been very severe and isolating, often very cruel with no doctors offering me any treatments aside from the one thing that seems to help, opioid analgesia.

Back to my visit, all seemed routine as pain management sessions usually seem to go. i discussed how the precious month felt, describing how I felt as though my pain was increasing and I was losing further mobility. I stated i was afraid, not an unlikely emotion given my prognosis has been ever evolving negatively (further degeneration may leave me requiring my entire spine to be fused, C2 to Pelvis) My doctor seemed to understand my having a rough month, refilled my meds with a modest increase (I have had no increase in over a year, in fact I have actually returned unused scripts and voluntarily ceased dosage completely of diazepam)

Four days letter I receive what appears to be a discharge letter, stating that the clinic is not qualified to treat depression with opiods. If i see a psychiatrist, then I will be allowed to be weaned off and a weekly basis, otherwise I am considered discharged.

First and foremost, I am hurt. I feel deeply betrayed, as I have been receiving care for 18 months and in that time have conducted myself admirable, following all rules and laws. I was never disrespectful and dishonest, and have extensive documentation (and post-op scar tissue) to prove my condition. Worst of all, I left my last appt. with no knowledge of any sort of problem. While I have turned down previous suggestions to see a psychiatrist, those decisions were based on my previous negative experience with anti-depression/psychotic medication, furthermore I do not feel I am medically depressed ie 'chemical imbalance' Yes I mourn for my lost future and my lifetime of pain, but this is not due to a disease per se.

I've heard of discharges for drug seekers, but for being depressed? Is this is anyway standard practice? What should I do?


  • I would ask your pain management doctor for a referral as it's obvious he feels there is nothing more he can do for you. If he's not willing, then as your pcp for one.
    APROUD CANADIANveteranButNOTa doctor, my thoughts are my own
  • SavageSavage United StatesPosts: 5,427
    ...I,also, find your situation very surprising.
    It is so disturbing when communication gets so messed up as to be non existent. Not even a courtesy warning to you?

    Maybe if you talked with doc to get better understanding and if it were me..and they wanted me to see a shrink...I would go.

    Maybe doc has a plan in his head and is frustrated with the overall difficulty of your situation. They like successes. And if he feels any non compliance, well he may feel you're not working as a team.

    I'm sure there are different ways to look at this. This is what comes to my limited mind.

    Hopefully, it gets cleared up sooner rather than later and you are not at risk for out of control pain management.
    Please keep us posted.
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • You said you need to be fused from C2 to pelvis. Does your Pain Dr. have all your records? When are you going to have surgery? What are your symptoms? Do you have sciatica? What kind of surgery have you had already? It doesn't seem fair to be in pain and have no relief. I hope you can find another Dr. to help your pain. 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
  • Double posted
    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
  • Thanks for replies everyone

    First to clear up I am not in need for immediate surgery, but I have been advised future fusion dependent upon further degeneration will be all but necessary.

    I was fused from T4-L4 at age 11. Currently L5 is wearing out quickly and will most likely need surgery first, extending T4-L4 to T4-Pelvis.

    My cervical spine is also degenerated but fusion higher than T4 is still up in the air in the future. I may decide to never do it even if death occurs simply because i refuse to lose the movement.

    I don't think my Pain Mgt Doctor has ALL of my records, but he has the most pressing and current ones, along with a full background. As for sciatica not that I am aware of.
  • After thinking about your post for awhile, I get where your PM may be coming from. You are one of those lifelong patients and it may benefit you in the long run if you work with a different type of doctor like he is suggesting.

    I do agree that he was very cold in sending the letter and should have spoken with you in person about his thoughts on you care. That was a little rude (not unlike a lot of MD's).

    So in closing, being the open minded person I am, I woud definately try the shrink. I have heard from many chronic pain patients and they cherish theirs. Who know it may be worth it.

    I will seeing one soon since it is part of getting a SCS.

    Good luck & feel better,

  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    his reasoning. What made him decide that you were clinically depressed. All spinneys that I know of suffer some form of depression. It was suggested that I see a pain Psych. But there was no demand to do so. It was my choice. And furthermore a spiney that suffers from pain and maybe some degree of depression still needs a pain management Dr. or team to control the pain. Obviously he has decided that your depressed and need a antidepressant. And possibly he dosen't feel comfortable prescribing an antidepressant. (which I've never heard of) But at any rate anti depressant drugs and pain management drugs should work in tandem. If your depression is treated will your pain just magically go away?
    What did you say to make him so alarmed? Talk of suicide? or something else?
    Good luck, Jim
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • I don't think this is quite the same but I wanted to share it anyway. I saw a PM doctor recently to decide if I wanted him to treat me. He said that they used a multidisciplinary approach and that I would need to see a shrink if I wanted to be treated by him. That was their total multidisciplinary approach.

    I didn't know whether to laugh or cry when he said that because if one looks up what multidisciplinary pain management means it includes alternative medicine too. You know, massage, Chiropractic Bio-feedback, PT, etc. But most insurance companies won't pay for it so we're stuck with a shrink and a PM doctor.

    I would do exactly what numbskull said once you blow off some steam and the hurt you're feeling. Ask for a referral and walk don't run to the next PM doctor. They are obviously looking for some loophole to get out of treating you. They might be on a watch list by the DEA or he might have done something in the past that is coming back to haunt him. You just never know. These Feds don't mess around and since they are pushing to get rid of pain clinics all together you need one that is not worried about treating your pain.

    I've been burned more than once by PM clinics. It didn't have anything to do with my behavior it had everything to do with their comfort level prescribing medications and of course there are all these new laws.

    Doctors are between a rock and a hard place right now with the crack down on pill mills and the governments new stand to throw more money at the "War On Drugs".

    Please try not to take this personally. I know that's hard to do. We feel like we must have done something wrong even when we haven't. But business is business and you need to look out for number one.

    Gentle hugs,
  • Dumped me when the going got tough. I ended up in the hospital for 6 days and all the docs said this is not uncommon with this particular PM.

    If it's a tough case they will dump you for what ever reason they can make.

    My GP handles it now since no other PM place will touch me ( and no i never abused or violated the contract). In fact I am allergic to oxycontin and morphine

    As with everyone here this is only my opions and experience and I only have a couple herinated disks and DDD.
  • jlrfryejjlrfrye ohioPosts: 1,110
    I think I would have to place a call to the doc and ask what has made him make this decision,then ask for a referral to another doctor. I know here in Ohio there are pain clinics and then there are pain clinics for chronic pain sufferers that will require meds for the rest of their lives. One criteria of seeing a chronic pain doc is having a mental exam. Here it is just part of the process. You also have the right to your medical records. Perhaps they could give you some answers as to why the doc made this decision
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    Are that they don't have to give you a reason for the dicharge BUT ..... by law they are obligated to maintain your current treatment for a period of 30 days - and refer you to an appropriate similar provider that can continue your tratment as is/warrented based on your condition.

    That referral my simply be to the state medical association and similar state organization BUT they ARE obligated to to continue your treatment for 30 days folling the receipt of your letter. I'd make an appointment with this doc and get a face to face for further explainantion.

    I could understand that action if the provider told you that he wanted you to be seen by a psychiatrist in addition to you care from him and you refused. That you put you in the classs of a "non-compliant patient" which is the most common "stated" reason for a dicharge.

    I used to managed group physician practices so I have been involved with the process on the other side.

    Get in his face ..... he has a 30 day obligtion to continue to see you - treat you. (in my understanding) Let us know how it proceeds - OK??


    Spine-health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!

  • Thanks for all the replies so far everyone

    To clarify a few points of the letter's content:
    I have 2 options as followed

    1. Don't see a psych and consider myself formally discharged.

    2. Bring in proof of a psych visit for one last visit to allow for a winding down script of 1 pill less per week, followed by discharge.

    The reason stated for this action is not that I specifically rejected the idea of a psych (Which I feel as a patient is my choice given that I declare full autonomy over my own booty and mind. Additionally, the clinic's contract I signed made no mention of mandatory psych visits.) No, the reason was that as a pain clinic they are not qualified to treat depression with opioid therapy, which seems to be insinuating that I was self medicating my depression with opioids. This is false of course, no evidence of misuse has ever come up, and it seems strange to me that they are qualified to diagnose depression, but unable to treat it...

    I will be going back in about a week, I've scheduled a visit with a rehab center that treats chronic pain patients full time with a psych on staff
  • I would request your records from this doctor. Do that in writing though, not over the phone. It does sound like he thinks that you were taking your pain medication to help with depression. I'd be very interested in seeing what his records say.
  • brafix said:
    Thanks for all the replies so far everyone

    I will be going back in about a week, I've scheduled a visit with a rehab center that treats chronic pain patients full time with a psych on staff
    If you don't mind my asking (and you don't have to answer :-) is this a center to help people come off medications? Or is it for physical rehab?

    The only reason I ask is because if it's for medication withdrawal it could have long term repercussions, unless this is what you want, ie; to come off your medications indefinitely.

    FWIW, I was once weaned off my medications, because the PM doctor said it was in my best interest. Their rule of thumb was to reduce my dosage by 10% each month. I checked around and this seemed to be in-line. Just something else to consider if your going that route and want to know if they're using a compassionate model for weaning.

    If this is a physical rehab center I hope they offer you all sorts of soothing and feel good treatments like massage and whirl-pool, and good old fashioned understanding. I would personally love to find a rehab center that works with chronic pain patients, but Medicare doesn't pay for that, and I've already spent all my savings, sold my home, blah, blah,blah. for medical care.

    Congrats on your decision either way. I wish you all the best and hope that the psych is golden.


  • I think the answer is in your first post. You told him that you were afraid and had a very bad and troubling month. By practice a PM doc should be referring you to psychiatric services if a patient expresses or exhibits signs of depression. Fear is a classic sign of depression.

    Getting this info in a letter is a little strange. I'm guessing one of two things happened...either he tried to suggest this to you and you refused so he felt he had to use the threat or your records were reviewed after your visit and he and/or another doctor decided that this was necessary.

    Given your situation having someone to talk to would be a good thing. It make take a few tries to find the right fit but this will be someone who can help you for many years as you deal with your on-going medical problems. Doesn't sound like you have an easy road ahead of you so having someone who is trained to help and who has medical knowledge can only help.
  • Hello,
    As Howie said, depression and chronic pain are inexorably linked and for some it is problematic separating negative experiences of previous treatment going forward. You have to find what works for you, knowing we might be depressed is far from acknowledging we may need additional help.

    “The effective treatment of chronic pain demands then, that individuals are considered from a multidimensional perspective that includes consideration of their physical, psychological and social states.”

    Fordyce Roberts and Sternbach 1983.

    I went on a residential pain management scheme and for the most part they picked those individuals who were less depressed and more feasible of a positive outcome. If you are not confident that this individual can help you then moving might be recommended, although you will now carry that history of resistance as a new patient elsewhere. It is important with pain to go one step at a time and you seem apprehensive of what a depressive diagnosis may infer. PM may be about doing things we have not done for a long time and challenging our own physicality and belief system, and depression may stifle that transition. Although I may have known I was depressed I was not fully aware of the implication for myself and my family and the true severity of my clinical condition.

    Those who embrace Pm are individuals more adaptable to change and not restrict yourself from improvement.

    Waiting rooms are full of people who surmise they know better than the doctors and only you are going home with that constant pain, you need to find and do all those things that will make the pain feel you have some control, rather than it controlling you. Ask the rehab center what they would do in your situation and be honest with yourself, discuss those fears and natural apprehensions we all had at this time.

    Take care and good luck.

  • I went to a psychiatrist who specialized in pain. At first I was angry because I felt my doctor was forcing me to go. I didn't know at the time that I was done working and didn't really want it on my record.
    I think the doctor thought the psych. was going to find that either the pain was all in my head or that I was a drug-seeker but in the end the psych. was on my side and I think played a part in my getting approved for Disability.
  • I am now afraid I was gonna make an appointment with my PM doc this week because he started me on Fentynal about a month or month in a half ago and I have become depressed, breakthrough pain is horrible and he says they do not prescribe breakthrough medications, honestly what does pain management mean because my pain had not been managed since I started seeing them . Anyway as usual I am getting off track, I think the patch is making me crazy I mean whacked almost, I cry several times a week for no real reason and if my husband says Sheryl why are you crying the tears stream faster and I have to say please do not ask me that or talk to me cuz I do not know, he just stares but that is all I can say until it passes. I have woke up and it has instantly started. Also I am incredibly irritable, very quick to yell and be nasty to my family, I think I am depressed at times , because of the pain but that is normal with chronic pain patients
    I am so mean I can't stand myself.... now I am thinking I should keep my mouth shut or I will loose what little relief I get
    Hugs :)
  • did you sign a pain contract? i believe all pm dr's have new patients sign one and they are very specific about what one can do and can't do. It also mentions things that they can discharge a patient for. I believe most and i think it is probably 95%, my own opinion. I don't think they dump you as one poster said. i believe most go by the contract and if something is not right, they will warn you. mine says he sends a letter with a warning, then if it is not corrected, a dismissal letter. i don't believe there is any obligation to treat a patient if they go against the contract. they will refuse to treat you. i don't know if they are obligated to give a new pm name but i believe if theyf did, they would probably warn the dr about what the patient has done. pm drs have a tight community and word gets around about patients who break contracts. if it is real bad like counterfit scripts, then the police can get involved. i believe most pms are nice enough to give people breaks. my pm nurse says he will let a person off the hook a couple of times if someone says they "lost"meds etc. i don't think they are mean, pain doctors. this is the jest i get from some posters when they have problems with pain drs. i think it goes both ways. most are not in it for the money, they get in it to help people. pain drs is a stressful job. people wanting meds, upping dose, treatements they see on the internet etc. one more thing, my pain dr shares his office with a psychologist who specializes in pain and they work together. so a lot of pain drs deal with depression either with a referral or having a psychologist with them.
    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.
  • Not all doctors who provide "pain management" services are expert in all areas. Some, like physical medicine and rehab (PM&R) docs for example, have primary expertise in pain treatment injections; they often do not consider themselves qualified to prescribe pain meds beyond the more basic levels of medications. And while any doctor can be empathetic, and can also prescribe anti-depressants (mostly for situational depression, as opposed to clinical depression), I can totally respect a doctor who realizes that a patient is likely in need of an expertise beyond his scope of practice.

    Serious depression is not something to be handled with a pill, although our society has become more geared to expect a pill for everything, no muss no fuss. The fallout of depression, its effects on the patient, their family, their social and work relationships -- these are not things that can be addressed in 10-20 minutes that need to be focused on physical condition, treatments, and future planning. Doctors are not miracle workers, and patients deserve more than someone who will merely hand out meds and hope you can work things out on your own, good luck and see you in a month.

    So no, I don't think the doctor is wrong for wanting to send a struggling young person with already severe physical limitations (given the extent of current fusions) to someone who can actually help that person make some positive changes and develop a new set of coping skills. Does it not make sense, given that seriously depressed patients comprise one of the groups found to be at higher risk to experience problems with pain medications?

    What I potentially have a problem with -- given what we know about the situation, which is not everything -- is that the doctor felt this patient could not be treated by both specialists concurrently. Giving him the benefit of the doubt, perhaps he felt that the patient's depression is so great that it should be the primary focus of treatment for the present time. But we just don't know.

    It seems clear to me at least that he was not comfortable prescribing meds for depression to a patient who refused his medical advice to seek psychological help. That is non-compliant behavior, unfortunately, and given that, he may just have felt that he could not give his patient what was needed. He would, in essence, be put in the position of someone who mainly serves to hand out prescriptions for controlled substances. I can't blame any doctor for refusing that role.

    I'm truly so sorry you're hurting in so many ways. But please don't think it's because this doctor doesn't care about your well-being. I think he cares more than you may ever know.

    I hope you get the help you need and wish you only the best. Take care.
  • hey sherly,
    wow i had same reaction with the fentynal patches, i really wanted them to work but I got so wacky on those and didn't help with pain at all. and doc said move to different area on body and slowed my breathing down. I took it off and called him said never again, seemed like I was pms in 100%.
    neck,bone spurs pain started 04, back issues and fusion l4,l5 06~hardware removed.
    good few yrs. 09 pain sharp, numbness feet,legs, diagnosed fibro, neurop. legs.lung issues.
    daily goal do good thing for someone.
  • sounds to me, if your not getting treated the way that your comfortable with get new doc.
    You have seen this doc for 18 months, and to get a letter as you did, I feel is unprofessional sounds as if he didn't want to discuss face to face.
    I have been to few different pain mang. docs all who I didn't care for they wanted me on so many meds. And if their injections didn't work, they seem to be upset.
    So for me personally I don't care for pain mang.
    I would call and set up appt. with this doc and tell the doc how you feel receiving this letter. Perhaps he just wants you to get some help after expressing the rough month you had.
    And as someone suggested get copy of your records always.
    good luck to you
    and I hope you find a doctor that helps you and not dumps you off, I sure know that feeling.
    neck,bone spurs pain started 04, back issues and fusion l4,l5 06~hardware removed.
    good few yrs. 09 pain sharp, numbness feet,legs, diagnosed fibro, neurop. legs.lung issues.
    daily goal do good thing for someone.
  • Awesome way to put it ...
  • I want to say how sorry I am about what happened to you.. Getting dismissed, for whatever reason, can send "Us" into a very steep downward spiral..and for it to happen because you were "HONEST" is so Wrong on so many levels. I also see a PM Dr. and last year they incorporated a Psychiatrist who specializes in Opiate Dependency, and we were Forced to see him or be dismissed. I haven't seen him yet because my insurance doesn't cover him. Personally I think it should be mandatory to see a Psychiatrist if you take Pain meds for any length of time...but if it's not offered where you go they shouldn't penalize you... Having Chronic Pain and taking Pain Meds will almost always lead to depression...
    Sorry to ramble on so long, I just know how you feel about losing your Dr. and your Pain meds...it's scary.
    All I can say is maybe talk to him...maybe start seeing a Shrink so he won't worry so much. I think your Dr. is actually more worried about being held responsible if anything happens to you while under his care...That's mean, but true in many cases
    Good Luck...and keep us posted...
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