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Forced to change Pain Doctors, new one obviously dislikes meds

I've been seeing the same pain management doctor since 2008. Started with low dose of Hydro....over about a year it increased to Norco 5 x a day. Once I got to that level 5 years ago, I have remained and it's just been routine ever since. It changed my life and for the past 5 years I have been great. I have my liver enzymes checked twice a year, I don't drink, I don't smoke, I am in good health otherwise. 35/yo male.

Because of the stigma and laws and everything that has been mounting against prescribing opiates in the past few years..... my pain management clinic has decided to no longer prescribe meds. Procedure only. They informed me of this last month and said they would continue to prescribe for 3 more months, and in the meantime I was to go back to my primary care physician and get a referral to another pain management clinic.

I did that, and finally got in to see the new pain doctor today. He explained that he disagreed with my former doctor's plan, and wants me to immediately start tapering off opiates and do only physical therapy, anti-inflammatory and muscle relaxers.

I just want to continue on the Hydro and explained that I was eating Naproxen (Aleve) like candy for years leading up to seeking medical help. Also, I have been prescribed Flexeril and Soma in the past and no matter what dose.... they put me immediately to sleep. But he was emphatic that opiates are his absolute last resort and that maybe 1% of his patients are prescribed them and it is because they are incapacitated and/or elderly.

Obviously this is not what I wanted to hear. I want to just continue on the Hydro. But with the aforementioned stigma and scrutiny that prescription opiates are currently under, I fear that I am screwed.

I want to get a second opinion, but I'm not sure how to go about it? 1.) I'm afraid I might seem to be looking for an opiate hook-up but 2.) Do I just go back to my Primary physician and ask for a different referral? Or can I just call another pain management clinic on my own? This is all through insurance of course, but I've never dealt with this before so I'm looking for some advice?

I am in Las Vegas, and there are a ton of other pain management clinics here, I just don't want to appear like I am doctor shopping for opiates. I just know what has worked, and I do not want to veer off the course.

Thanks for reading, and I appreciate any help/advice.
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Comments

  • sandisandi Posts: 6,302
    edited 04/04/2014 - 4:46 PM
    Welcome to Spine- Health.........Why are you taking opiates? What is the medical condition that you need them for? Have you had any recent imaging or testing done to confirm or check the status of the problem that you began taking the medication for? When is the last time that you had any evaluation for that condition? Other than renewing the prescriptions?
    One big problem that you will run into , is that without any updated imaging or other confirmation of a condition that requires the use of opiates for treatment, you are going to find that any new pm doctor that you see is going to require that you start over, at the beginning. No doctor is required to continue the care of a previous one, based on what "works" for you .
    In the current environment, pain management doctors are under a lot of scrutiny, so they have to prove that the opiates are the only treatment that will offer some relief.
    Therefore, you may very well need to start at the beginning, physical therapy, anti inflammatories, and other modalities and they may also want to see what your current status is, and each doctor wants to come up with what they feel is the best treatment plan for you.....based on his exam, the studies, and test results, your symptoms and may offer things like injections, etc long before you are even considered for treatment with opiates.
    Read the link at the bottom of my post..........it is the step by step guide to getting pain treatment.
    The good news is that after 5 years, you may find that you really don't need the opiates at this point, and you may be better off with out them or using a different combination of medications that offers you better relief.
  • andrewuofpaandrewuofp Posts: 3
    edited 04/04/2014 - 5:02 PM
    Herniated/compressed L5 and Osteoarthritis in the neck. I haven't had any new imaging since I began treatment in 2008, but this doctor has ordered all new CT & MRI, which I will be scheduling on Monday.

    The main question that I have is about a second opinion. Do I need to go back to my primary physician to get another referral or can I just contact another pain clinic and explain that I want a second opinion?

  • sandisandi Posts: 6,302
    edited 04/04/2014 - 5:12 PM
    It depends on your insurance. If your insurance requires a referral, then yes, you would need another one. If not, then you can make an appointment on your own, however, I would be very careful about how many doctors you see, since too many repeated consults with different pm practices will show up on your insurance and they might question why so many consults, especially since you are looking for someone who is going to continue what you were getting and that happening is pretty unlikely.
    Each pm doctor is going to want to make his treatment decision based on what he sees in his exam of you, your reported symptoms, the imaging studies, and any other testing. Also, you can expect that at the first appointment at each pm office you are going to be subjected to a urine test......most pm practices have new patients do that at their first appointment.....and also sign a contract. Even if they do not prescribe pain medications at the first visit, which is often the case, they still have the patient sign the contract and if you do that and accept pain medications from ANY doctor once you have signed a contract, you can be found in violation of the contract. Do you have a contract with your old pm? If you do, you need to make sure that that contract is void before accepting pain medications from any other physician. Did you read the link above that I gave you? http://www.spine-health.com/forum/pain/chronic-pain/chronic-pain-treatment-step-step
  • SpicyFuschiaSpicyFuschia Posts: 20
    edited 04/06/2014 - 1:55 AM
    I am sorry to hear about your pain. One angle I would consider is joining a group practice that offers many specialties in one practice. My spine surgeon has a pain management doctor (he has horrible patient reviews) who does not give pain med's they push shots because they can bill thousands for that instead of $180 office visit, they have a neurologist, physical theraphy, a med spa, a pcp and more. I could have stayed in that group for everything, but I chose not to.

    I am only with a PM now that I had surgery and need long term med's. Did you go in and ask for med'? I honestly think kf you have not had a work up with MrI's and xrays you need that first. You have been treated for the same thing for 6 years. A group approach is necessary these days.

    I did not like the PM care at my surgeons office, the doctor was graded very poorly and did not like to give med's. The pa there had me take 10 pain pils and valium after surgery. I was useless. When I chose to go to my own PM the surgeons office blew up at me and the PM's office. My PM is out of my insurance network, but I can afford my out of pocket non network cost.
    L5/S1 TLIF July 18, 2013
    4 Screws 2 Rods and BMP
    Post surgery L4 Dermatones
  • It may be best to wait until you get the test results back before you start looking elsewhere. The PM your seeing now may offer other treatments based on those findings. If you start tapering off your pain meds and it makes the pain worse and interferes with your daily life, that is the time to discuss options. If you're doing well, you may no longer need them. Plus Doctors won't prescribe such meds if you're not following the recommended treatment plan. I agree that use of narcotics can be very beneficial when treating chronic pain, but if you can manage without that's the better option.
    Progressive DDD
    Osteoarthritis
    Chronic S1 Radiculopathy
    Discectomy L5-S1 2002
    Discectomy, Laminotomy/Foraminotomy L3-S1 January 2014
    Bilateral SI Joint Fusion and 2 level spinal Fusion October 2014
  • Hi Andrew.

    Your situation, strange enough, is exactly what I'm going through. I also have been taking 5-6 Norco a day for 6 years (along with valium as needed for spasms and anxiety) and have changed insurance where the primary care doc does all the medicine prescribing. Like yours, mine wants me off all meds.

    I've lost the surgeon that has done three spine surgeries on my spine, one 3-lvl cervical fusion and 2 1-lvl lumbar fusions - all three 2 years apart and has handled my prescriptions for all these years. I'm about 16 months out from my last surgery. On my last x-ray about 2-1/2 months ago, done by my surgeon right before my insurance changed, they found that I have loose hardware and am now missing discs at L1-2 and L2-3, just above my latest fusion. My surgeon said I must be in a tremendous amount of pain, so I thought was doing pretty good because of my meds.

    I have no choice but to titrate down and according to my new primary care doc, it's contingent on what the neurosurgeon says after looking at the latest x-rays next Thursday.

    What I wanted to tell you is that I too was scared about changing my routine with my meds, but it's really not as bad as you think. They work with you to help titrate down, and in my case I was given flexeril instead of valium and I'm ok with that. They aren't making me sleepy, though. He also gave me some gel containing amitriptylyn, ketamine, and gabapen to rub on my lower back 3 times a day which really does seem to help. I'm actually feeling good about seeing what I'm like without taking all those narcotics a day. I'm to the point now where I'm down significantly without more pain. I'm surprised that I'm forgetting the times to take my meds and sometimes I only remember to take the Norco because I start feeling withdrawal symptoms. Sometimes it's good to start over so that even if you do get back on narcotic medication, it will have more effect.

    I agree with Sandi and a few others that imaging may change your doctor's mind, and if you're still hurting with all the Norcos you're taking, maybe it's time for a new pain management that might make you feel even better.

    So, I just wanted you to know you've got company out here with pain management, and that if you get to a point you have no choice but to titrate off them, it isn't as bad as you may think. It's something you have to come to grips with mentally and physically, sometimes you may not feel more pain in getting off narcotic medication.

    Take care,
    Cath
  • I have chosen to reduce my pain medications, after being on moderate doses for the last 8 years, and wound up reducing my fentantyl patches from 150 mcg patches down to 50 and then changed over to Opana at a much lower dose than I was at previously.....and pleasantly and surprisingly, my pain levels have not jumped through the roof.....I also reduced the total number of breakthrough meds that I am allotted per day, simply because I want to see where I am at, pain wise......I do get this idea in my head periodically but am finding that I like where I am now, and my pain control is just as good as it was, at higher doses.....
    I wanted to give my body a break, and so far it is working out well......I know that I may never be one of those who are off pain meds completely but if I can keep the doses lower now, then it leaves more options for later when this isn't working anymore.
  • I'm glad to hear what you've done and that you're reaction is similar to mine. I guess for me it took some soul searching because it is now mandatory. I would've probably just stayed the course had I not had a doc tell me to. But like you, I'm pleasantly surprised my pain levels haven't skyrocketed.

    I am anxious for a second opinion as well, because I haven't ever had any other surgeon look at my imaging. It will be interesting if she says something different than my trusty spine doc I've had so many years.

    Take care,
    Cathie
  • Thanks everyone for your responses! I've never really discussed any of this before so it is nice to know there is a community here.

    Once I have my new imaging, I am going to try one more PM clinic. Before contacting them, I'm trying to do research to hopefully find the right doctor.

    I still have one final appointment with my original PM doctor. I'm going to talk to him about what happened at the other clinic and get his opinion and hopefully a recommendation.

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