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pain contracts

Jess JustjessJJess Justjess Posts: 44
edited 06/11/2012 - 9:02 AM in Pain Medications
Hi everyone, just wondering if pain medication contracts and urine tests are standard. Do people only start doing them if there is an issue or do some doctors do them with everyone. You'd think I'd know this because I've been dealing with chronic pain for 8 years now but I've never signed a single pain contract. I've also never asked for a refill before its due though so I'm not sure if thats why or what. I'm wondering because I wouldn't be surprised if my new doctor (actually she's a PA) asks for one since I did get hydrocodone from another doctor since my last visit. See I had fallen and landed on my back so then I called the PM doc and they couldn't get me in so they told me to go to PCP so I did and he gave them to me and then I called the PM doc the next day to report to them what I had gotten (I wouldn't have had to because they are from 2 different systems but you should see the look I got from the pharmacist so I'm sure they called anyway. I don't lie so I would have even if I hadn't gotten that look). I'm hoping its not an issue since I did what they told me to do but I'm nervous. I need to have different treatment started, I need stronger medication or a higher dose because since I fell I've been in a ton of pain, I'm miserable. I'm nervous that I am going to get some trouble with it. Hope not. I'm not a criminal so I hope they don't treat me that way. I'm just a person that wants to feel okay most of the time so that I can do my job and play with my kids. I don't think its too much to ask. Anyway, I digress, just asking about pain contracts. Thanks.


  • dilaurodilauro ConnecticutPosts: 9,842
    are becoming more of the norm in the recent years. They are put in place to protect both the patient and the doctor.

    There really isnt different systems. The way the medical , pharmacy and health insurance data is tied together, everything is available.

    That is probably the reason you the pharmacist raised an eyebrow (surprised they didnt question you more)

    I am also a bit surprised by your statement regarding needing stronger medications or higher dosage since you have been dealing with chronic pain for 8 years now.

    Asking a doctor for higher or stronger medication is one of the biggest red flags for doctors and pharmacists to see. Pain medication is not designed to eliminate the pain, just help you manage it with other medications and treatments.

    This all seems to be centered around your fall. Since your PCP prescribed narcotics, did they also setup a MRI appointment? How does anyone know if you did any damage to your back or is it just bruising and muscular?

    If you walked into a doctors office and asked for stronger medication,
    You: Doctor I need stronger medication
    Doctor: Why do you think you need it?
    You: I had a fall and landed on my back
    Doctor: Who did you see about this?
    You: Tried my PM, couldnt get an appt, went to my PCP
    Doctor: What did the diagnostic tests (XRay, MRI, etc) show?

    If you did cover all of this in detail, but just omit it from your post, I apologize.

    But it is so important for readers to understand the rationale for pain medications and pain contracts.
    I think the first response would be Why?, you would reply, I fell
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I'm sorry, I had an injury 8 years ago and have had chronic pain since then in my neck and midback. I fell and it made everything much worse. I do not know why but I feel terrible. No, the PCP said "oh, you'll be okay, it was just a little fall" and then he gave me hydrocodone. Apparently that wasn't a big deal afterall, my PM doc didn't care. I had an appointment today. Thankfully, she doesn't play games with what you can and cannot say. But no, I did not say "I need stronger medication" I just know that my current regiment was not working for me and I think its okay for me to say so, what should I do? Lie??? and then continue to feel miserable??? I told you guys I need something stronger, or at least different. Anyway, she didn't ask for a urine sample or mention anything about a pain contract today, I was just curious about how often that is done.
  • Jess, It is often a toss of the dice. I have went to the same dr for 15 yrs and it was not until last year they had me sign a pain contract. Never had to do a pee test or anything either. Then last month I was asked to do a pee test.

    The FDA is making things really really rough on our Drs, and in turn they have to cover their selves more and more.

    I cross my T & dot my i with my meds. I have done the same thing you did, called when I had to take a different pain med from a different Dr.

    I also agree that you have to speak up if meds are not working well. I think the point was you should not ask for stronger pain meds specifically. Instead you explain that your still suffering & ask what else YOU can do to help get some relief. Then leave it in the Drs hands.

    Hope this helps :)
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • Thanks Ms Humpty Dumpty (I like your nickname by the way). Yeah, thats what I did, I explained that it wasn't helping. I just said to you guys that I need something stronger or higher dose or something, not my doctor. I actually need a procedure, but my HMO apparently disagrees which is why I'm firing them. Unfortunately, they probably feel "don't let the door hit you on the way out" since I cost them money. But I work for them and make them much more money than I cost them as one of the most efficient workers according to their stats but I guess they don't care about that. I just wondered what doctors are doing with those contracts and what they are told to do. Thanks for your response, it does help! :)
  • It's really up to each state but over the next few years it will most likely be in all 50 states that require contracts, drug testing, and pill counts...

    As well as 40 states now have the Prescription Monitoring Program...If this is in your state....then that is why the Pharmacist would perk up a bit if you are filling a narcotic all of a sudden from a different DR....They are then legally allowed to contact your Dr. to let them know...

    This allows all Pharmacies and ER's to be able to "talk" to one another and alert if a patient is filling multiple scripts or going to different Drs..

    It's not about choosing to do this "just" for suspicious or problem patients but to do this across the board to be able to easily catch those who are Dr. shopping..This should be in all 50 states soon as well.

    Same with the contracts...just last year is when our state started requiring urine tests and pill counts...We had always signed a contract...

    Again...for those of us, like yourself, that take medicine for pain and follow the rules...it's really no big deal...We don't take more than prescribed...we don't sell our meds...we don't Dr. shop...So they can test and count away! LOL

  • Contracts are pretty standard stuff now.

    Thanks to illicit use Dr's need some CYA now.

    Nothing to be much worried about if you a good pain patient.

    I have only been tested once and it was random. Had no idea till 5 secs before.

    It was A OK with me as I am a good patient. I actually laughed and said "$20 bucks says I test positive for Percocet... haha"

    Any good physiatrist will usually be doing them until a good repoire is in place.

    Then maybe once a year or whenever they need to reassure somebody else.

    I am not a fan of guilty till proven innocent, but since I do everything I am asked, I never worry about it. After a few A+ tests and everybody relaxes a bit and things become more productive with the relationship

    Cheers :-)
    Jun 2011 -TLIF @L5-S1
    Mar 2012 -NonUnion @L5S1
    May 2012 -Multi Level Discography
    July 2012 -XLIF 2Cages @L3L4/L4L5
    Aug 2012 -All New Hardware @L34L45/L4L5/L5S1
    Mar 2013 -FBSS = Pain Management until they figure it out.
  • I was seeing a PM, who then sent me a referral to a NEurosurgeon because my second MRI found a grade 4 tear (later confirmed by discogram). I was and I guess still am naive about pain doctors and pain contracts. I thought it was standard procedure tossing a pain contract with the PM. Well anyway, he sent me to the neurosurgeon who said he wanted me to try aqua therapy but was pretty sure I would need to have surgery. I asked him "sorry if this is a weird question, but do I continue seeing you, or keep seeing my Pm AND you?" he said "I will handle your meds going forward so you don't have to see the Pm doc anymore."

    Well I told him that I was currently taking 5/325 hydrocodone and that was it, and that I was finding myself needing to take more lately. So he wrote me a script for tramadol and told me if that wasn't enough and I found myself still needing the hydrocodone, just to call his office.

    Well I took the tramadol to my pharmacist and told them I would be back later to pick it up. They always send me an automated text when my rx is ready, but this time I didn't get one. So I called and they told me my insurance rejected the rx because I had filled it at another pharmacy! I had not though, I only use one and I told the lady it wasn't true, the only thing different was it was from a new doctor.

    She said she would call the insurance and see what was going on. Well no longer than 15 min later, I got a text that it was ready to be picked up. I chalked it up to they called the insurance and found it was a mistake, so I didn't question them when hubby picked it up.
    In the mean time I called my PM and explained to them that the NS told me I was eventually going to have surgery and that he would take over my pain meds for now. They didn't have a problem with it.

    Well I ran out of hydrocodone about 4 days later and just the tramadol wasnt cutting it, so I called the NS office and explained to the lady who takes messages that the doctor had told me to call back. Later the doctor called me back himself wanting to hear it from me. I told him that because I wait to take anything strong until the end of the day when I am getting off work, the pain builds up pretty bad. He already knew I work as a software engineer and can't have brain fog. So he calls in 10/325 hydrocodone.

    Wel again, the pharmacy tells me the insurance blocked it. But it was the same lady so I asked her what was going on. She says it is because I was getting narcotics from another doctor. That's when it hit me, the insurance must think I am "doctor surfing" or whatever they call it. I stil have a lot to learn. Reading this thread has educated me even more.

    So I guess anytime you are switching doctors who prescribe narcotics, you might want to talk to your insurance company first! My pharmacist didn't raise an eyebrow, we have used them for years, my whole family uses them so that was good! So if you are dealing with a big chain pharmacy, I could see them being skeptical. We stick with Kroger (grocery stores in Texas and not sure where else) where they have a small but fast and convenient pharmacy.

    Grade 4 tear in l4/l5 was missed in first MRI so did injections for a year
    SI joints "messed up" not sure if I will get them fused at a later time
    Had Open PLIF L4/L5 5/28/13
    Woke up to permanent nerve damage in legs and feet.
  • techgirl - you may have heard me say this before as I say it often.

    Back when I was raising a family I was best buddies with my butcher. Now I am best buddies with my Pharmacist ;)

    However it is SO important to make "friends" with these people. Mine walk the extra mile for me any time it is needed. I ask them about their kids and such when I am waiting and they are not busy. At the least I say "hi" and "hope you have a good day" and "thank you". My pharmacists are a very important role player in my care.

    Example: my insurance raised a ref flag as I had some pain meds filled a few times at a different pharmacy. They wanted to kick me off! I called my normal place for meds. They immediately called my insurance and told them that on the dates I had meds filled else where was because THEY were out & THEY had told me to go to X pharmacy.
    Issue was done & over with within 1 hr :D
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • Yes, that is a good motto! Keep your pharmacist as your friend! I have never filled my RX early. However this week I knew I was going to run out of my hydrocodone on Saturday and I had no refills left. So I was at my doctors office for a pre-op visit and asked him if I could have a new RX and just hang on to it until Saturday. Well they do ePrescribing so did that instead before I could stop them. After the visit I immediately called and left a message for the pharmacist letting them know not to run the prescription for insurance just yet because I wasn't out until Saturday and I would call them Saturday to fill it.
    *phew* I didn't want them thinking I was trying to get some early. What do you all do when the RX is going to be out on a weekend and you don't have any refills?

    Grade 4 tear in l4/l5 was missed in first MRI so did injections for a year
    SI joints "messed up" not sure if I will get them fused at a later time
    Had Open PLIF L4/L5 5/28/13
    Woke up to permanent nerve damage in legs and feet.
  • I also am friends with my Pharmacist for the last 11 years. It really does help when anything comes up.

    Since all my prescriptions (and most peoples) are for 30 days. It's certainly ok to fill a prescription a day early if it falls on a Sunday. Or to fill it after 30 days on a 31 day month.

    Most insurances/pharmacies have no issue with a day early once in awhile. Or going on vacation/work trip and filling a bit early for this or letting your Dr./insurance/pharmacy know that you are filling it at another pharmacy where your destination is.

    The key is not doing this often as they keep a running tab. So if you fill it a day or two early every month you would have a lot of medicine leftover at the end of a year. They take into account February which this year was a leap year, but obviously other years it's only 28 days.

    And if you fill it early one month, than you should have enough for a day extra the next month.

    So, the bottom line is that it's all about a 30 day prescription should be lasting for 30 days.
  • Thanks lovetotravel, currently for whatever reason my doctor only gave me 10 day prescription with 3 refills. I was on my last one and it was going to run out on a Saturday. I felt weird asking the doctor, but maybe that is just me. Their policy is they only accept refill requests through the pharmacy. So I would have had to call the pharmacy on Saturday, then wait until Tuesday or maybe Wednesday for my doctor to respond.

    It just happened I was there for a preop visit so I brought the bottle with me and asked. He was like "Oh sure!" and acted like it was no big deal. I just felt weird about asking.

    Grade 4 tear in l4/l5 was missed in first MRI so did injections for a year
    SI joints "messed up" not sure if I will get them fused at a later time
    Had Open PLIF L4/L5 5/28/13
    Woke up to permanent nerve damage in legs and feet.
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