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Pain clinic contract



  • Just three weeks ago had very bad infection involving three teeth. Due to my disabilities the dentist decided pulling one at a time would be better for me after being on antibiotics. I too, have a heart murmer but needed additional antibiotics for infection. He also said he had no idea how I was handling this pain and felt I should be on higher dosage of pain meds. I explained I was seeing a PM and he immediately got on the phone while I was in the chair, called my PM dr and wrote a letter to him. It was agreed my meds would be increased by PM dr. After my appt. with PM dr he commended me on the way this way handled. He continued to increase my meds for each extraction a total of 3 months and said this is how all patients should handle this scenerio. Make me feel good! After reading so many stories on this site which is wonderful I will not take any chances whatsoever. Just a good practice to notify PM first to avoid any problems.
    So important to have a trusting relationship with your PM dr as we all are suffering from painful spinal issues. Unfortunate we have to go through all this but so many have abused that dr.'s have to be tough.
    Glad everything worked out for you.
  • with my PM doctor about 2 years ago when I needed to have some female surgery. I was on the fentanyl patch at the time, but wanted to wean off. The anesthiologist who was putting me to sleep for surgery said not to touch the patch until after the surgery...she was afraid that I would have more pain issues without it. Then I asked my PM doctor what would be a good break thru pain med she would suggest for pain control fdor my surgery? She stated dilaudid b'/c I already took 2 percocets a day for bt pain for my back. I offered for her to talk to my surgeon and I conveyed this message to my surgeon and offered for him to talk to her. I guess they both trusted me and after my surgery, they gave me vicodin which was standard with that surgery, then the surgeon came around before I left and gave me a script for dilaudid knowing the vicodin would be too "weak" for what I was used to. I was very open and honest that I was under a pain contract, but I guess my PM doctor saw this as a different circumstance and didn't mind the surgeon medicating me post op.
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  • My PM doctor just left the practice, and I started having to work with a different doctor.

    He made a comment about my being quite compliant with my old doctor. My old doctor had not really talked about it, but I was sure he was watching. I never had any need to be non-compliant- he was always there when I needed help with pain.

    Anyway, it kind of made me think about how you just never know when you'll be in the situation of having to form a relationship with a new PM doctor, and having good compliance records can be so important.
  • HB you have it right but think about the definition of a contract. It's an agreement between two or more parties that specifies what each party will do and receive as well as penalties for failure.

    So in the case of the pain management contract the patient agrees to get all their meds from the PM doc, go to only one pharmacy, bring their meds to each appt, submit to random drug tests, take their meds as prescribed and be honest with the doctor. The doctor agrees to adequately control the patients pain, work with all doctors (including dentists and other unrelated specialties), and be available in emergencies.

    A contract goes both ways. If the patient breaks the contract they can be monitored more strictly or dropped by the doctor. If the doctor breaks the contract the patient is free to find a new doctor. What is unfair is that the patient is at the mercy of the doctor and his office. When meds have to be refilled on the exact date and pharmacies can make mistakes we are at their mercy as well.

    I guess as HB says having a good relationship with your doctor is critical.
  • Absolutely. I didn't need to be non-compliant because my doctor was always there for me, not because I'm some super human contract sticker-wither.

    But we were talking about situations that we all could find ourselves in- dental work, an emergency room visit, etc- that could put a ding on our compliance record. It's just something people who have pain contracts should know about, I guess, and prepare for.
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  • Teeth - ugh, I shudder to even think about it.. Yes, call you doctor (Pain mgmt) and tell them what is going on, give them the dentists name and number so they can check if they need too. That is what I did and then when I ran out early, she called me in enough to last me till I saw her. Had I not called her to let her know what was up - she wouldn't have done that. Good Luck
  • Mine wouldn't, nor would my pain doc want that. I have to give her the info and she has her nurse call the dentist. However, after my most recent dental fun and games I shouldn't have to deal with that for a while!
  • I wouldn't risk it! I'd call
  • Try that in the state of Utah - it's a joke. I would if I could. I know I'm undermedicated but there isn't a thing I can do about it, except chew my nails off and suffer.
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