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Doctors, Patients and Pain

dilaurodilauro ConnecticutPosts: 9,859
Warning This thread is my personal opinion only and does not reflect anyone on Spine-Health

I've been do a lot of reading recently into the subject of pain management, the responsibility of the physician and the responsibilities of the patient.

Here is something worth reading
American College of Emergency Physicians said:

Despite a heightened awareness in recent years, health care providers still fail to treat pain consistently and adequately. Patients don't get analgesics early enough, often enough, or in correct dosages. When they are discharged, patients leave with inadequate prescriptions to treat their pain while at home.
Some patients return to the emergency department prior to or instead of seeing their primary care physician for follow-up because of unrelieved pain.
This failure to properly alleviate pain stems from clinician barriers such as a lack of knowledge and a reluctance to give analgesics under certain medical conditions or in specific patient populations. It is the duty of health care providers to relieve pain and suffering. Therefore, all physicians must overcome their personal barriers to proper analgesic administration.
This piece centered around the Emergency Room and not with private practices or other pain management centers. The research paper went on about some of the problems that arise in the emergency rooms. Part of it is lack of total understand of the physicians, part of it is the patients expectations. One thing that always stood out was the number of chronic pain patients who use the emergency room as the primary source of pain medications. Digging into the problem, it seems that those same patients were discharged from other private practices for abusing pain medications.

But in reality, that is not everyone. There are so many patients that need and deserve the right amount of medications to manage their pain. Its seems that we have gone from a period where some doctors would prescribe narcotics as easily as they prescribed an ace bandage, to today that it is so very difficult to get a normal consistent approach across the board. There really isn't a federal statue in place, some states have some regulations about pain control, but even though are not that complete.

I dont have any answers, but I do hope that someday that there will be a just system in place. Take care of those they really need it and avoid those that only want to abuse.
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


  • That those who really need medications need to be able to get them, and there needs to be a middle ground in preventing access to those who abuse/misuse but not punishing those who don't.

  • For some its hard to exist in today's day and age. There has to be a better way for Dr's to weed out the good from the bad. Where I'm at Dr's have gotten to where they don't prescribe period. I've suffered for a few yrs now, had a surgery in Jan to hopefully help and still have pain along with new symptoms from other levels already being stressed and giving out. MRI confirms this. Unfortunately my surgeon has brushed me off and left me to suffer cause I didn't fit his mold for recovery.

    I'm trying to maintain hope that I will eventually get a compassionate Dr to help me, by whatever means. I want a solution not a bandaid. I don't want to live on medications, and right now I'm not getting any. Instead I'm only getting 3-4 hrs sleep/night, I cry a lot from pain and depression from being in pain 24/7, and my quality of life sucks right now. But I'd rather deal with it than deal with the looks drs give me, the judgement from drs and family and being labeled. Its taking it's toll but when you have no options then suffering is the only option you have sadly.
  • SavageSavage United StatesPosts: 5,476
    Did your surgeon " brushed you off" because he can't help you surgically? So you need to go elsewhere for your pain?

    Can you ask your primary doc for referral to pain management?
    Second opinion, third if you need to ??

    I have never been candidate for surgery, so I need the meds to keep me out of the ER, to take edge off pain so I am not totally out of my mind.

    I too sunk into depression . I too had years of those sleepless nights..
    There are meds for the sleep, meds for the depression and also therapy.
    Those meds don't need to be forever, just to get you through this painful transition in your life.

    There is help out there. Continueing to tell your primary doctor of your symptoms, asking and looking for doctor to control your pain.
    There are options.

    Please don't let a fear of other people judging you, even if they come right out and say it,
    dont let them stop you from you getting the care you need.

    You know you deserve a chance at the best quality of life as possible!
    Isn't that what you would tell a loved one who was feeling judged and in pain and feeling little hope? Sure you would

    Please don't let the opinions of others keep you from the care that is available to you and that you richly deserve.
    Hang in there!
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • jessconnor26jjessconnor26 Posts: 35
    edited 06/03/2015 - 9:38 AM
    I'll message you on here if that's ok? I don't want to hijack Dilauro's thread.
  • in patients who do not get proper relief, not seeing the right type of doctor for the right medical condition, using a primary doctor automatically precludes a lot of the options available that you get when you see a phsyiatrist or proper pain management clinic in many cases, and more often than not, limits the type of medications a primary is willing to prescribe, and they are often unfamiliar with treating different types of pain or alternative treatments that may be helpful at least a little.
    It's all of the variables that complicate getting proper pain management, including not having access in some areas without driving distances to find the right doctor.
    It's been said many times that there are issues that could be improved, both on the physicians side and the patients that contribute to alot of the problems in getting pain treated.

  • itsautonomicitsautonomic LouisianaPosts: 1,807
    edited 06/04/2015 - 3:48 AM
    I don't mean to say " I told you" but I posted an ER report basically stating the same a couple years ago documenting all the barriers to proper pain treatment that was written by a board of surgeons. And a past member basically discredited this report. I to have been reading heavily for last three years and it is happening in private practice also sadly, it's my opinion also but for me the evidence is there and continues to increase for some that they are not getting proper treatment and it's not just small rural towns , but it' can happen anywhere and is unfortunately . Like I've alwasys said it does not seem to be the majority of the good pain clinic or doctors, but it's real and I passionatly beleive after many discussions with doctors, posters here and reading medical reports across not just spine issues that undertreatement exists both in ER and private practice.
    It such a complicated problem so many variables and I just wonder where it's going over the next 50 yrs, but by then hopefully some better options than meds will be available for many.
    When I was researching central pain after I was diagnosed with it, there was a pain dr who wrote an article that talked about her many, many visits to ER go more pain meds, she was viewed as a drug seeker, had stopped working and life was crumbling, once she came to see him he properly diagnosed her pain as not just chronic but central and this called for different , stronger pain meds, morphine was one. But she did not continue to get worse in fact she had not been to ER in two years, returned to work part time, and actually had been able to taper down some of her meds since once her pain was under control she was able to get into some alternative therapies and such. It was a strong , powerful story this doctor had written and he questioned where she would be if not properly diagnosed and treated. Drug addict, dead, broke ??? He was challenging other doctors to look into central pain after failed back surgeries or injuries instead of the norm if patient does not respond.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • itsautonomicitsautonomic LouisianaPosts: 1,807
    Sandi the last statement you wrote is exactly where it's at, people who refuse to see this are blind to the real world and what's happening. It's definitely a two sided fight to improve. It boggles my mind that people will say a PM doctor knows everything about pain and how to treat it. This is not true , they are continually discovering new things about pain, differnt types, different treatment and how the brain plays into pain . It's a constant learning and there are so many types of pain, so many differnent conditions that cause pain in differnt ways. In 2015 there are still pain conditions that if you read about them there is no good trwatment or drug they have found that gives the pin relief doctors hope. I believe in people , especially ones in chronic pain I really do I am not naive but I beleive the majority are good but just want help and I've seen what horrible pain can do to change a person ( myself) amd my entire view changed and I see things from a differnent perspective sometimes now. As I've experienced a different type of pain. But I truly believe that many of the chronic patients not working, not succeeding in life, struggling lives could be changed by proper pain management and then a huge effort on patients part to recover. It's all my opinion but one I am sure will be validated over time. Suffering is optional saying is not always true , we are all adults but there are many children that suffer terrible pain from things like CRPS, POTS etc and it's a struggle for drs to treat them since many don't want children on heavy pain meds , there are many reasearch articles and such about it. Your heart breaks
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • and it is a nightmare to treat and to live with. There is much that is unknown about many medical problems and how our bodies nervous system deals with pain, it's many forms and treatment for those conditions is spotty at best, and in some instances still in the dark ages.
    I hope for a day when people are able to get treatment they need , in order to function as best they can and are able and that the barriers we see and the gaps in Healthcare are removed.

  • itsautonomicitsautonomic LouisianaPosts: 1,807
    edited 06/04/2015 - 10:13 AM
    Sandi, yes the CNS is crazy. I am very sorry for your RSD ( reflex sympathetic dystrophy) , that was something it was believed I may have at one time, but has been ruled out for most part. What I do have in common is the autonomic dysfucntion that is present in RSD and its tough, tough to deal with. Without changing subject can I ask if you have ever had nerve testing such as EMG or punch biopsy for the RSD? One of my doctors has had patients that they thought RSD and turned out to be small fiber neurapathy with autonomic dysfunction, can mimic. You can PM me the answer , i am very interested in punch biopsy in different disorders since mine was positive for small fiber neurapathy when no other neurological testing really tests the small fiber nerves that are sensory nerves.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • Sympathetic nerve blocks, stellate ganglion blocks, etc. No punch biopsies, thankfully .
    I was lucky enough to find a doctor who specialized in RSD in florida, who was able to refer me to another specialist near where I lived. He was my salvation for almost 8 years.

  • itsautonomicitsautonomic LouisianaPosts: 1,807
    edited 06/05/2015 - 2:58 AM
    Did the EMG and nerve studies come back negative? Actually my punch biopsy were easier than Emg and any injections , very small sections they sample. I am asking cause one of the drs that is big with small fiber neurapathy believes it is present in many cases of RSD from her testing. I have it and get the same cold l,burning, dis colored limb that is present in many cases of RSD. Just me being curious
    I am glad you found that right dr who helped you
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • The emgs showed damage, and the blocks confirmed the diagnostics. Perhaps that's why he didn't do the punch biopsies at the time. All of the other testing gave a conclusive diagnosis. It was several months of different testing, radioactive and other stuff...it certainly was no picnic, most of it was just plain brutal.

  • dilaurodilauro ConnecticutPosts: 9,859
    I understand your dialogue here, but this was not the intent of this thread.
    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
  • sandi123ssandi123 Posts: 456
    edited 06/05/2015 - 8:16 AM
    sorry the thread got off track.

  • I am about to state the obvious to most of you. I'm also lumping all surgeons together which is probably unfair but it has been observed by me so here goes. Surgeons do not believe pain medication is the answer to pain. Surgery is the answer. Sure, if you have surgery, your surgeon will prescribe pain meds for the first month after you are released from the hospital, maybe even two months. And thats it. You need more, see your primary care doctor. If you are still in pain, you must need more surgery.
    This has been my experience regarding all my back surgeries and my knee replacement. Four different surgeons, all with the same belief. This has also been my experience with my recent back troubles. In 2012, the orthopedic spine surgeon said surgery was needed and my pain meds were no longer effective. Skip to last week, and a neurosurgeon told me exactly the same thing. I decided to not keep my mouth shut on this subject and told him he was wrong. I told him my pain meds were the only thing keeping me functioning. To that he responded that my body was dependent on the pain meds and when I stop taking them I am going through withdrawal. I shot back that of course my body was dependent on the meds because they dulled the pain enough for me to be active and live some sort of life. I also said I was dependent on my monthly retirement check in order to live. Being dependent does not have to be a bad thing. He chose not to argue anymore but he did ask who my primary care doctor was. I see her in a few weeks and I'm wondering if she will tell me she was contacted by this doctor or maybe even turned into some agency keeping tabs on this type of thing.
    I can say with certainty that my PC knows me, knows my living situation, and knows I take the drugs needed to live and nothing more. She isn't a surgeon.
    Emergency surgery in March of 2006 for spinal infection of L 2 and L 3. During surgery, discovered I had Cauda Equina Syndrome. Spine became unstable after surgery and had 360 fusion with 10 pedicle screws, plates and rods in April of 2007.
  • I was asked to participate on a Discussion Panel by our local Board of Public Health regarding drug abuse in our county. I was there with three other people who were either with law enforcement or were former law enforcement. As the discussion went on and on, one of the officers made the comment that anyone taking opioid's after six months of injury were not getting any value from the drug and doctor's are wrong for prescribing that long.

    At that point, I had to chime in. I mentioned that I have some "history" with dealing with chronic pain and that I believe that legitimate chronic pain sufferers are getting painted as users, addicts and seekers and it was totally misguided to do so. I went on to explain that legitimate chronic pain sufferer's have no desire to deal on the street, they do not take more than what's prescribed and I challenged them to find an opioid user in the crowd based on physical demeanor or behavior and appearance. They all looked around and no one said anything. I then told them there was a person I knew of in the room who takes narcotic pain meds 24/7, functions normally and that you would never guess who it was. My point to them was that those who use medications for chronic pain aren't the stereotypical seeker with drawn eye's, slurred speech, stumbling cantor, etc.

    I was talking about myself being the 24/7 user. I wanted to dispel the myth that anyone taking pain medication was a bad person and that the medication DOES work after six month's. I'd hate to think of what I would feel like if I didn't have medication to use for my pain. I would certainly be retired on disability. Without the meds, I can't get around and bend because of the pain I have. I never told them it was me I was referring to. Simply because I was sitting next to police officers and in my state, I will get a DUI for driving even if it's a prescription medication I'm taking.

    Studies show that people who take controlled medications long term have the same cognitive abilities as a person who has not taken anything nor ingested alcohol. But, the problem is perception. And I think that's where our biggest enemy lives. Doctor's don't want to prescribe, pharmacists don't want to dispense and employers don't want the liability of having someone work for them because of perception. I really wish I knew the answer, but I don't. Society and politician's have vilified us.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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