How to get Dr's to give out pain meds...

How to get Dr's to give out pain meds...

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dmo
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How to get Dr's to give out pain meds...

Hello all,
This is my second post at spine health pain forums. I have moderate to severe foraminal stenosis at three defferent levels in my cervical spine. I also have spondylosis in the mix. Large osteophytes all over the place to. My pain starts out sharp in back of my neck then goes down into my shoulder blades. From there it goes into my shoulders and down both arms. The pain in my arms is a numbing tingling sensation that leaves my muscles weak. I have trouble with fine finger coordination. The pain in my neck is worse than the arms. I dont have severe pain all the time. Sometimes it is dull. Its an up and down cycle for me. One moment light pain then two hours later heavy duty pain.

I have gone to primary care dr. and they just give me relafen or naproxen. They act as if giving me anything more potent will turn me into an addict. I understand people have abused drugs but this is rediculas. I am also an established patient. They look at my mri and say yes you have quote: significant arthritis and other issues but because you dont have a herniated disc you cant have that kind of pain. I do finally have an appointment with pain management and nerve conduction studies. This is my doing as primary care just drags their feet. I have done enough research after going to hospital and getting my mri report that I know I have nerve impingement problems. The nurse that called me said I just had arthritis and didnt mention spinal stenosis at all. I only found out after I got the mri report myself. Anyway I would appreciate any advice from forum members. I just feel having to battle dr's as well as the pain is not fun.

Thanks for listening
dmo

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perkins2006
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same here

Hi
I have 3 herniated dics and scoliosis with nerve damage. I have been to three different doctors who have told me I am to young (25) for narcotics and I WILL become addicted..so I now am going to a pain management center so I hope to be able to get something stronger than voltoren just an nsaid.
so I know how you feel. I just dont understand docs!

-Natalie-

alexhurting
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Primary dr,s often dont

Primary dr,s often dont like to give out narcs, You best to get a referal to get in to see a spine specialist and if he feels surgery is not needed then he can give referal to pain dr to manage the pain,

I think it might be because they would rather see a patient either get surgery if needed more so then puting them on high dose of medications for long term,

But if spine specialist confirms there is an issue but he prefers to hold of with surgery then he will send you to pain specialist usualy anyways to try injections and if that dont help then combine injections with medications you need,

Sometimes treatment takes a long time before spine specialists consider surgery because they know the risk of posibly making things worse if surgery dont work,

They want to make sure you cant heal on your own or with conservative treatments with meds, Which sometimes is a good thing,

Pain specialist will be more helpfull for both of you i am sure,

Best of luck,

Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
2012 scs implant ,

dmo
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Dr's live in ivory towers

Hi Natalie
Sorry to hear about your bad discs. I dont understand dr's either. I guess its easy to judge when you live on Mt. Olympus. Dr's have more connections than you or I. They dont have to wait for the medical wheels which turn very very slowly. I wonder how they deal with pain?
dmo

Savage
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I have found that..

..primary docs will want to SEE me EVERY time I am in pain..and you can imagine how time consuming that becomes. So, the referral to pain doc such a blessing and the primary trusts the dosages ordered by pain doc.

Also, like you, when I have picked up my reports I have read things that no one ever told me. It gets aggravating at times, but...

If your insurance requires referral, good idea to get and see pain management doc. They will have new eyes and ways of treatment to hopefully make you feel better.

Let us know how you are doing.
Take care!

Disillusioned
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The approach is important

Doh I have fairly mild back problems compared to the vast majority of people on this forum, however my medical history is complex with lots of different illnesses all contributing to one another to some extent and of course to an overall increase in chronic pain symptoms.
I presume what you refer to as a primary care giver is the same thing as a general practitioner here in Australia? and yes they are very reluctant to prescribe opiates. i used to work in the pharmaceutical industry as a purchasing manager for a large distribution company (no names sorry) it was common practice for me to meet with pharmaceutical reps to discuss market trends and research findings. let me tell you there are millions of dollars being spent trying to control opiate abuse it is a massive problem and it kills people.
unfortunately tolerance to this category of drugs occurs very quickly and the patient will find what worked fairly effectively a week or two ago is now doing very little to manage the pain! The only way to achieve the same therapeutic relief is to raise the dosage and it does not take long at all before the patient is addicted. even while on very high doses their pain is largely uncontrolled.
In saying that using them at the lowest possible dose (which achieves relief) for no more than 2 weeks is really the best you can expect.
because of my knowledge and my desire to NEVER become physically addicted I have managed to succeed in getting my GP to prescribe them and my specialists support him doing so. They will usually only do this as long as i am not begging for them (it is standard policy in the medical profession to use that as an indicator of substance abuse - crap i know as you will beg for anything - even a loaded gun when you are in agony!!!)
another trick is to refer to them only as pain relief - NEVER call them by their "chemical" or "generic" name e.g hydromorphone - this to is an indicator that you may be an abuser. Most importantly don't get frustrated or angry - speak calmly and rationally - these drugs can de-stabilise moods and if you seem a little off your rocker or overly emotional that will most likely rule you out as a candidate for their use. Be honest with your doctor explain that you know the risks associated and you will use them responsibly AS PRESCRIBED (you mentioned that your pain is chronic but subsides at times - tell them that if you can go a day, a week or even a month without using them you ABSOLUTELY will) Tell him you will suffer through the pain at times if it means you will not become physically addicted - it's important to mean it as well. by no means am i telling you how to rort the system and become addicted - I am telling you though that if you use them responsibly and stick to your word to do so - you will improve your chances considerably for having prescribed. ;)
I wish you success and hope that in some way this helps!

dilauro
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This is a pretty straight forward situation

Doctors (PCP,Pain Mgt,Surgeons,physiatrist,etc)write prescriptions for various medications based on several factors:

1 - Formal diagnostic test results
2 - Clinical examinations
3 - Patient discussions

The three of the above should be in line and somewhat consistent for doctors to prescribe narcotic medications.

There are many situations where those items dont match. It then becomes the doctor's responsibility to work through all of that.

Many times, you will find people that have very low pain thresholds. The may claim they do, but in reality , they are looking for high powered drugs to numb everything.

On the opposite side, you will find people that have such a high pain threshold, that the doctor is puzzled as to why the person is not asking for narcotics.

Over the recent years with a lot of drug abuse, the DEA has had to clamp down a bit. But, all that is really doing is making sure that the doctors can provide rationale and justifications when writing narcotic prescriptions.

So, to answer the subject of this thread:

Work with your doctor(s), communicate with them so they have a total understanding of your situation.

Note: To some of the previous posters in this thread. Doctor bashing is not permitted, so please tone down your comments.

Ron DiLauro Spine-Health System Moderator
Dont laugh at me

patwhite101
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Addiction vs Dependance....

I get so upset when I hear of a Doctor or anyone saying that a person will become addicted if on narcotics long term!! This is just NOT TRUE! Less than 4% of long term CP patients on opiates ever become addicted!! Addiction occurs when a person does not take a medication as prescribed, get's the medication from different sources(Doctor shopping) and does not stop using the medication when their Doctor stops their treatment! They also lie about their usage!
Dependance can occur to anyone taking opiotes or benzos for an extended period of time meaning if they suddenly stop taking or reduce the dose to quickly they will go into withdrawal but that does not mean they are addicted!!
Addiction is phychological whereas dependance is physical. Dependance is an unavoidable consequance(sp?)of opioid therapy!!
No one should fear becoming addicted to any medication, even OxycodoneER as long as you take it exactly as your Doctor prescribes. Do not raise your dose without discussing this with your Doctor.
Also never ask for any pain medication by name. It's ok to ask for something for your pain and then discribe your pain with your Doctor.

Hope this helps.
Patsy W

terror8396
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pain meds

one needs to have all and i mean all tests aviable and take them to the dr. just having one does not cut it, the more the merrier, ie mri, nerve conduction tests, disectomey, x-rays and any that i have not heard of. you need to make sure there is an area of concern ie herniated disc and take all of this to a pain dr not a clinic. pain drs seem to be more sensitive to people in pain than pain clinics. so get as many tests as you can and take them to a pain dr. by the way arthritis seems to be a condition that seems to warrent NAISd's and not narcotics.
jon

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.

Cath111
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I'm with Alex on this one

I think you need to address the problem with a spine specialist who knows what stenosis is, how painful it can be, and will be willing to give you the narcotic bandaid until treatment can be established.

But with nerve pain that comes with stenosis, it's more likely that a nerve med like Neurontin or Lyrica would help more than a narcotic like Vicodin or Oxycodone. And there's nothing that will take the pain away completely.

PCPs don't understand what all this spine stuff is about. When I first started having problems, my PCP looked at my cervical x-ray and said, "Oh, my, you've got some real problems here. I'm going to send you for PT." That didn't work, then she said, "You really have some very serious problems here" and sent me for an MRI. Lastly, she said, "Oh, you're cervical spine is gone, you must see a surgeon." But the whole time all she'd give me were muscle relaxants and that helped the back but not the other stuff. The first appointment with my surgeon, after he looked at my MRI, out came the prescription pad and asking me what I thought might work best.

He's actually never sent me to pain management and still manages my pain. When things get bad, he marks on my record that I'll be taking more than usual.

You can find a good pain management doc out there, but be sure to address the root of the problem too. If you're just looking for meds and not a solution to the problem, that in itself can be a problem.

Cath

Disillusioned
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Pain is complex

I can certainly relate to you dmo - NSAID's just aren't that effective alone, and it can feel like your pain is being trivialized by denying you access to drugs which will actually BLOCK the pain signals and give you some real relief.
I'm not getting drawn into an argument about how severe ones pain is compared to anothers - its a silly argument and one i really don't think anyone should really want to win.
I understand that there are definitely clinical differences in the source of pain. What is physically wrong can be more severe from one person to another. On that note pain cannot be measured diagnostically this seems to be the real problem facing the medical profession.
The real concern is here is the pain itself and to what degree it impacts upon an individuals ability to function day to day and whether or not medications can help relieve it.
i continue to use NSAID's daily as they are mildly beneficial and my doctor recommends them but i find that oxycontin provides so much more relief when the pain is on the upper end of the scale. my specialists and doctor agree with this approach (well at least here in Australia).
I apologize patsy for not differentiating clearly between physical dependence and psychological addiction (thanks for making the difference clear). i don't know what the exact percentages of patients who end up with addiction issues are, but from an industry insiders perspective - governments, doctors and drug manufacturers are very concerned by it and are spending a fortune enforcing guidelines and regulating their distribution in order to prevent it.
You are very right that recreational users are the major concern and main offenders when it comes to long term abuse and addictive behavior.

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