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Pain Medication and the DEA



  • i have never had to produce an ID and my doctor prescribes what he thinks are necessary. at times he prescribed more due to surgeries and then cut back. he has never complained about the DEA. the scripts written are in a data bank to make sure there is not doctor shopping going on. a lot of the complaints that you have voiced do not happen in my case or my doctors. i am not on disability so i do not know what is happening with workmans comp patients. but i believe a lot of your complaints are unfounded at least in my and my doctors experience. i also never heard of the medicare issue you talked about because i have it and nothing has happened like that to me.
    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.
  • In the past, when I've discussed my pain journey with friends more often than not I've been asked 'Why won't your doctor give you more or stronger pain medications?'. I think it's part of our culture to believe that narcotic pills take any pain away. It seems to be one of the hardest hurdles to get over for many. When I first arrived in the USA I had a tooth filling that needed replacing. I was given an injection & a small pain med prescription. In England the only time I'd even received even an injection was for an extraction. I completely understand why people get so frustrated & think they're being treated poorly when a doctor refuses to prescribe narcotics for back pain.

    The first time I took Hydrocodone I was 'Comfortably Numb' to say the least so why not give me more & more to battle increased pain? You live & learn. I now know that there is no quantity of narcotic that will completely relieve my chronic pain (if I want to be conscious) but that knowledge is part of the journey. Maybe some doctors assume that this is common knowledge & doesn't have to be explained fully? Maybe narcotic medications have become so culturally ingrained that patients don't want to hear it? I take narcotics daily & they do help me to function but although my spine damage & pain has increased I'm actually taking a lot less than I have in the past. Higher quantities & doses do not help more, it just turned me into a depressed zombie with an incredibly high tolerance!

    I have read so many angry posts from people feeling offended & neglected because they've been told to practice physical therapy, relaxation & meditation, heat & cold etc. as if these modalities equal cruel dismissal of their feelings. I can honestly say that these therapies are as important in my treatment as narcotic medications. If I had to choose between muscle & nerve meds or narcotics it would be incredibly hard. One does not work without the other for me.

    For a doctor to continue or increase narcotics they have to weigh the risks with the benefits. If you state that your current prescriptions do not help with your pain why would the doctor increase the dose? If you're not getting any relief & your standard of living isnt improved it's not worth the risks. If a patient is unwilling to develop their own 'blend' & they refuse other therapies they are setting themselves up for failure. Chronic spine pain takes teamwork between you & your specialists.

    I know this sounds really harsh. I'm not addressing those that are doing everything they can but still need medicinal help. There are members on this site that I believe should of been offered the chance to try narcotic therapy & it's wrong that they weren't but that's individual cases. I just think the days of saying 'nothing else works' & being allowed to live on narcotics have gone. If adding pain meds to an extensive pain management regime allows a patient a better quality of life then & only then should prescriptions be written. Doctors are learning from past mistakes & modern studies. That's a good thing for patients.
    Osteoarthritis & DDD.
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  • epidural3eepidural3 Posts: 10
    edited 04/19/2014 - 6:05 AM

    I totally agree, it takes a combination of therapies, whatever they may be. Finding that sweet spot is not always easy, that's why we read these great forums.

    Meds alone are not always the answer, however there are some chronic sufferers that cannot tolerate PT or excercise, especially without pain meds.

    I think pain threshold has to be considered as well. I cannot speak for anyone else, but it seems the older I get the lower my threshold becomes.

    To Jon:
    You are fortunate. All I stated in previous post is true. As far as medicare goes, my drug plan denied my script for Robaxin because of medicare guidelines [ over age of 65] My Dr. has to submit more paperwork to get it approved. Also, the hospital pharmacy I go to informed me it is the law that requires ID. Once it is on record you do not have to produce it repeatedly. State Laws in CA. may be different than laws in Pa. , but Medicare is the same.
  • the only limitations for medicare and my meds is that i can not get compounded meds and that comes from my pharmacist. i do not know of any other issues or laws. workmans comp also denies certain drugs as do other programs. that is not a big deal. one can get another med that is just as good.i do not understand what the big deal is with getting permission to get it approved. also why are you going to a hospital pharmacy? they are notorious for jacking up the prices of prescriptions. aaron it is up to the doctor to say and do what they think is best for the patient. this goes with narcotics, therapy or injections or other things for chronic pain. my doctor has had me on pain meds for 13-14 years and that is his decision. i have tried all of the other things such as therapy and injections. i get injections once a year and i do not need therapy since all i have is metal in my back and i have done therapy before. it just gets my goat of some who have this obsession with pain meds for chronic pain. if a doctor prescribes them for some so what? that is the doctors decision. i have never given the impression to my doctor that i cheat or lie about meds or that i do not need them. we both talk to each other about what is best including the use of narcotics. i find the complaints from some about doctors not giving them narcotics problematic at best. that seems to be all that is on some peoples mind. like has been said hundreds of times, if one does not like the treatment from a doctor , get a new one. so we have rehashed this argument too many times and we do not need to keep it going do we? aaron some people will always blame the doctors and some will always blame the patient and there is a common ground in all arguments you tend to side with patients and me i tend to side with doctors. that is why we are both brilliant people who are wise beyond our years. correct?
    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.
  • aaron one benefit of only seeing one doctor and not changing for a lot of doctors is that one doctor will have a better feel for you and your condition. if one keeps going to new doctors, there is not enough time to get to know the patient. it is like my school district that keeps changing the way to educate students. they keep changing every 2-3 years and the new system of education does not get a chance to cure itself like curing a wine. you keep it around for a while. the same goes for doctors. one needs to keep the same guy to get the best treatment. keep changing and the new doctor does not have enough time to get to know you and your condition. there are a lot of doctor bouncers around and it is worse for them medically. i have had one family doctor for 10 years and one pain guy for 7 years and the old one before he retired for 5 years. i have had the same urologist for 15 years. they all know me, my family and my medical issues. in fact my old pain guy moved 150miles away and instead of hooking up with a new one, i drove 150 miles to keep my old one. at least he lived in lake tahoe so it was a good drive and i only had to see him every 2 months. then he retired and referred me to a new guy and he is only 10 miles away and have seen him for 7 years and better yet they all know each other because they worked together with my back and urology issues. cant get better than that
    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.
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  • Rheumatologist could not help me so sent me to pain management. I never asked for narcotics but these were prescribed as I was unable to exercise. I was doing well with 2-3 percocet per day, exercise, walking, have never been overweight..feeling cocky, then, on 3/3/2014 ended in ER. Pain management doctor has referred me to neurosurgeon due to herniated disc and compressed nerve root. Pain is off-the-charts my legs buckle under me. I am full of fear. More narcotics drugs have been prescribed with the neuro and PM doctor both telling me I must take the drugs and get pain under control or there could be no assessment for surgery.i guess my writhing on the table, crying out, with blood pressure up and body jumping with spasms at any touch does not help. So i now take the drugs with a Tues appointment.
    I have participated on this site only a few days and already see a division. Two groups separated by a pill. I guess it is not much different here than in the real world. I guess I was hoping for more.
    If I am offered the surgery i will just stick to that forum on ways to get well quickly and preparation tips. That will be helpful and positive.

  • I hate starting again with new doctors too but sometimes a fresh pair of eyes is exactly what a patient needs. With complicated cases it could take a lot of eyes to get a diagnosis in the first place as you (Anelsen15) have found. You know you're one of the members I was referring to when I said "I'm not addressing those that are doing everything they can but still need medicinal help. There are members on this site that I believe should of been offered the chance to try narcotic therapy & it's wrong that they weren't". I don't understand why all of my PM docs have prescribed ER & breakthrough medications for me & none of yours have offered anything. I wish they would explain their reasoning.

    Even if it's just gentle stretches & walking its essential that we all keep our bodies moving & if narcotic medications allow a patient to get started then I agree, they should be prescribed. The guidelines I've read for European & USA doctors have clearly stated this. Quality of life is so important but narcotics don't always improve the situation, they can make things worse for some & doctors consider this. I do question the thinking of PM docs who will never, under any circumstances prescribe narcotics for non-terminal cases. I believe they should be open to any kind of therapy that has been proven to be effective.

    There are so many recent studies that show the physical changes that take place in the brain of a chronic pain sufferer & the toll that uncontrolled pain takes on the whole body. I hope that in the future more doctors will take these into account when they're considering the options. I have wondered if your current medical problems have been created or increased by living with unmanaged pain for so many years Anelsen.

    Osteoarthritis & DDD.
  • Sorry, with all the new policies and changes, doctors don't want to deal with it anymore. So now everyone is being referred to pain docs and many of the pain docs have quit because of either being harassed by the DEA or because it is now so complicated because of all the paperwork that they simply don't want to do it anymore. There is NO way this does not affect pain patients.

    In addition, insurance companies are now making it harder for pain patients to get the meds. Most now need special prior authorizations(more paperwork for the docs) for drugs that never needed them before. And insurance companies have now places a limit on how many meds a patient can get. Yes great for those abusing but what about the legit pain patient who 4 meds a day do not cut it. It's gotten so bad I routinely hear of people in the ER with serious bone breaks or other issues being given Tylenol. It's like we have regressed in pain treatment back to the 1970's!

    I agree certain things needed to be done, but where is the balance? Why does the pendulum need to swing all the way back to where you can't get pain meds even in the ER??? What you think they deliberately broke their leg for pain meds?? No, docs are scared if they prescribe a pain med the DEA will be breathing down their backs and that is ridiculous in the medical environment. There is plenty more very important issues they could NOW be dealing with than to continue to push and monitor doctors, hospitals, patients and pharmacies the way they do. The policies they places have helped. Florida is not even in the top 100 places that prescribes the most Oxy anymore so they have done their job, ease up a bit so we pain patients can still get GOOD pain care!

  • I sense your frustration but a lot of what you are stating is not actually factual......the DEA went after doctors who were obviously over prescribing. The PMDP is available now in most every state, and in some cases, it is interstate as well.
    There is a lot of misinformation out there regarding "laws", and limits of quantities , but not all of it is because of the DEA or other changes put in place by the government.
    Some pharmacies, have put limits to quantities in place because of concerns in their own business practices .......some have added extra measures to help avoid further issues with diversion. Not because of any law put in place but because of previous problems that they had.
    Some doctors did leave pain management, no doubt, but maybe some of them should have......they had no reason to fear prosecution if they were running a legitimate facility. If their records showed that patients were being properly treated, had the proper tests, and were given reasonable amounts of medications for their conditions, then there is no reason to fear.....those who didn't, who gave unreasonable amounts of medications, to anyone who could pay the cash necessary to obtain them, shouldn't have been in the realm of pain management to begin with and deserved to be run out .
  • LindaC49LLindaC49 Posts: 10
    edited 04/26/2014 - 4:57 AM
    This last week I had a visit with my PMDr following tender point injections and back issues. I had shortness of breath due to rib impingement and was given PT. While talking with my Dr the conversation turned to the health care law and the dispensing of pain meds. My Dr. is a physiatrist affiliated with a sports med. and PT clinic. The cases he general deals with are severe. He said the DEA is pushing the PCP's to send patients who need pain meds to him to manage. Cases that normally the PCP could handle. I am an example of that. I've severe osteoarthritis (2 partial shoulder replacements,and a knee replacement, all sorts of spine issues and fibro. I do get my pain meds from my PCP. For my back arthritis I go to PM for the x-ray guided injections a procedure my PCP doesn't do. PM is over whelmed with people who's conditions could be handled just fine by the PCP. My PM Dr.( of 6yrs) was referred by my PCP (of 15yrs) New patients for PM have to wait months for an appointment and if you're in pain that's awful. These are people who have serious issues or been in bad accidents.
    I agree with what someone said in an earlier post about the stigma of pain meds. The uproar on narcotics usually occurs after some well known celebrity has over dosed on Rx meds from some shaky doctor. (Michael Jackson, Elvis Presley, Keith Ledger) Then the use of narcotics come under fire. And yes I did my stint of other therapies before moving on to narcotic pain meds. Thanks to Celebrex I'm on another med for ulcers. Some of us will always need pain meds as the source of our pain will never improve and often deteriorate. At the Drs I always tell them when asked my pain level it's hard to tell because I'm usually comfortable. There are times when I'm not but I don't seek more drugs. Patients need enough medication to have quality of life and get through the bad days. Often we need more than just pain meds. Often pain makes it impossible to get a good nights sleep. Again my PCP helps me with this issue. I consider myself very lucky to have 2 great doctors who do listen and help me.
    linda clark
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