They will not write any more narcotic prescriptions for me!

They will not write any more narcotic prescriptions for me!

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dilauro
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They will not write any more narcotic prescriptions for me!

I am pretty confident that you have either read a thread/post here or been in an actual situation that the subject line here covers.

The topic is important enough to start a new thread. There are facts and myths when it comes to dealing with this subject.

FACTS

1 - The DEA is cracking down on the disbursement of narcotic pain medications. Over the years, there have been so many examples of a too-laxed control of prescriptions.

2 - Doctor can and will continue to write prescriptions for narcotic prescriptions. However, with some of the DEA actions, many doctors need to be justified in writing those scripts. Therfore they need to ensure that their patient has a need for them. Doctors I know have no trouble writing these scripts. They know that their patient needs them and that it is easy to defend. I've been on narcotic medications since 2006, with some very high dosages to maintenance levels. No problem for my doctor, they see and understand the need.

3 - Some patients do not require narcotics any longer, so the doctor stops writing scripts. The patient on the other hand disagrees and wants more narcotic prescriptions. This is not the example of a drug seeker, but instead someone who realizes that narcotics seem to be the only way to manage their pain. The doctor then writes other prescriptions as necessary.

4 - Some doctors stop writing narcotic prescriptions for a patient. You look into the situation and you find that the doctor
has prescribed several different actions.. Go to Physical/Aqua therapy, go for some Tens Unit session, try Acupuncture, Lose xx pounds, do these exercises, etc. The patient refused to comply with any of those doctors directions, but instead just wants the narcotics. Its hard for any doctor to continue to write prescriptions for someone who has refused to follow doctor's instructions.

5 - VA situations. I have often heard about problems with some of those doctors and prescription writing. But in the past two years, I have personally seen two situations where the ex-veteran should have been on medication 'abc', but the VA doctor refused to write the prescription. I do not have near enough information here to provide accurate insight and information regarding this.

MYTHS

1 - Doctors are afraid to write narcotic prescriptions. Just read the facts and you might see that some doctors who do not do the complete job may fall into this category. But its that particular doctor, not doctors in general.

2 - There are no other ways to manage the pain except using narcotics. Pain medications are just one tool in the arsenal a doctor may have in treating and managing patients pain. Nerve medications, muscle relaxers, anti-depression medications, combined with a number of other conservative treatments (ie Physical/Aqua Therapy, Tens Unit, Massage, Acupuncture, Spinal Injections,etc) provide the total control package

3 - Stories about doctors not writing prescriptions. Many times you need to get all the facts regarding the circumstances behind it all. That could tell all the difference.

Many times all situations can be broken down to

Want

vs

Need
That is something that is private between the doctor and the patient.

odile53
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Joined: 12/04/2012 - 3:44pm
Pain control analysis

dilauro, a very well-written and thought out analysis of pain management. Many people assume that only a controlled substance will manage their pain to a level where they can function and be reasonably comfortable. Since pain is such a subjective experience, it's extremely difficult to assess, quantify, and prescribe accurately. I'm speaking from both sides of the bed, having been a nurse for a couple of decades.

Immediately postoperatively, I was given prescriptions for Lortab and Valium, with the instructions to "stay ahead of the pain," meaning to take them as frequently as ordered unless I was almost completely comfortable. Since my prescriptions would have expired the week after the New Year, and I was concerned that vacations might have been scheduled when I would need medication refills, I called and got the scripts refilled, even though I had a fairly good supply left. I've used about one-third of the second script of Valium, and haven't even opened the second bottle of Lortab.

Multiple modalities are used for pain management, as you pointed out. I'm actually finding out that changing positions, adhering to a light but frequent walking schedule (even if it's pacing in the house or driveway for twenty minutes three times a day,) and using my inferential TENS unit are frequently more effective in managing pain than the medications are. Additionally, the more I've increased the home PT exercises, within reason, the more comfortable I'm feeling. And one of the most important components of my pain management occurred prior to my spine surgery. In the incident in which I injured my back, both knees were injured. An orthopedic surgeon gave me a series of synvisc injections into both knees, ending the series two weeks before my spine surgery. The result was that I could bend my knees without pain, and thus was able to do more activity that helped manage my back pain.

But there are doctors who are suspicious about requests for specific narcotics, and the occasional "Dr. Feelgood" that gets busted, with plenty of press coverage, only increases these practitioners' index of suspicion. Last year there was a physician who was writing scripts for hydrocodone for $80 cash without physical exam (a line of addicts used to form outside his office prior to opening hours each day,) and got arrested after a narcotic squad sting. When some doctors (particularly primaries, who may or may not have experience with chronic pain management) see stuff like that on the TV news, they are far less likely to prescribe, and real chronic pain patients with real chronic pain are the ones who suffer.

I'd advise anyone battling chronic pain to keep a diary, including the following factors: Where is the pain? Does it travel or radiate, or is it localized? What time of day does the pain occur? What aggravates it? What lessens it? What does it feel like (burning, throbbing, aching, stinging, etc.) Other questions will come to mind. Bring the diary with you to your doctor's visits, and be prepared to discuss the pain itself (including medications that have worked for you and how effectively) instead of requesting a particular prescription. Being able to articulately state what is going on is probably going to get you more effective management than telling the MD what you think you need.

Great post, as is your habit, dilauro!

I'm not a spinal diagnosis. I'm a human being with a spinal diagnosis.