No I assumed you were being condescending because you were being condescending. Lots of smart people have different opinions than me I have no problem with that.
Disagreeing with you isn’t the same as being condescending.
Right. It was the way you did it.
Oh, and your repeated “you do know that, don’t you?” couldn’t possibly be arrogant or condescending? You’ve been rather snarky in your replies to everyone here, going on and on about how horrible opiate addiction is as if that wasn’t common knowledge. I still think your problem is that you weren’t instantly hailed as an authority and correct the moment you set food in this thread.
I am a doctor. I very quickly became cynical about drug seekers after working in a state where we had a computer database to show how many opiate prescriptions someone had had filled (that made it very easy to bust the drug seekers no matter what sob story they told us).
Opiate abuse is a huge, huge problem in medicine right now - bigger than most people who haven’t worked in primary care or an emergency dept probably realize.
Some of my colleagues in family medicine have experienced that if they prescribe opiates for one drug seeker then word will quickly spread through the grapevine to all the other druggies and then you have to deal with the headaches of a bunch of druggies trying to scam you out of opiates. This is one reason why some doctors take a hard stance and simply refuse to give opiates to anyone.
My suggested approach to discussing this with your doc would be this:
First, tell the doctor that your pain is out of control and ask him what else he can offer you. Don’t tell him what to do. Be willing to consider whatever he does offer you. If someone has excuses for why nothing except opiates will do then that does make me suspicious compared to someone who’s willing to at least give other options a chance.
If you feel like the doc has nothing left to offer you, then you might want to ask him if he would be comfortable with having you agree to sign a pain contract (which usually says things like that you agree not to get your opiates anywhere else but that doc and that if you are found to be double dipping that the doc can terminate you from the practice) and agreeing to do urine drug screens. Yes, I know that such things are a hassle, but it does show that you have legitimate intentions.
If he’s still not comfortable with that idea, then I would ask for a referral to whoever the doc thought might be able to offer some help.
That would be my suggested approach. Going there and demanding Vicodin probably will backfire, but if you can show that you’re serious about wanting to consider the options he can offer you and willing to play by the rules if he does write for an opiate then he might be more open to it.
My two cents, FWIW.
I’ve been there. Bone on bone knee pain, loss of mobility, inability to walk more than a block or two, and complete disruption of my life.
I got that way because of an accident. Unfortunately that accident happened during a really brief (like a couple of weeks) period of time when I didn’t have health insurance.
You show up in an ambulance not looking exactly like, say, Mitt Romney, combined with a lack of health insurance, and you’re apparently branded as a biker dope-fiend. You’re categorized immediately, without anyone so much as talking to you.
They stuck me in a room with about six other guys, all of whom were handcuffed to their beds. Turns out they were sent to the hospital from Riker’s Island (the local jail).
No insurance? Screw you, you’ll wait three days for surgery. Painkillers? Even though you had a spike driven all the way through your knee joint (literally), you’ll have to get by on Tylenol. After the surgery? You can have a couple more Tylenols. By the way, when you get the bill, you find out that they charge uninsured patients about twenty times what they charge insurance companies for everything, and those tylenols cost you about $15 a pill. No physical therapy for you afterwards, either.
And then, some years down the road, when you do have health insurance, and your knee has deteriorated to the point where, as I said above, my world had shrunk to about a one-block radius (I had to take a cab every day to work, 'cause I couldn’t even make it to the subway station, so I was well on my way to being broke, but at least I had insurance), doctors still won’t give you any kind of painkillers. I remember after knee replacement surgery asking the doctor for something, just so I could sleep. I could tough it out during the day, but I really wasn’t getting any sleep. A Vicodin, or even a Tylenol 3, would have at least gotten me to sleep.
But no. Seems like no doctor will write presciptions for pain relief any more. And I wasn’t asking for any drug by name. I wasn’t asking for morphine, or Oxycontin. Just something so I could get some sleep.
With all due respect to the physicians who have posted in this thread, who I don’t know and who may be far more reasonable than the doctors I saw (although the guy who did my knee replacement is supposed to be the rock star of joint replacement in New York), it does seem to me like doctors have gotten so cautious about pain medication that you’re just not getting any, no matter who you are. You’re a grown man, with no history of addiction to anything (well, except cigarettes, but I kicked that one eventually), and you don’t even like drugs, and you’re treated like some drug-seeking junkie.
It sucks.
Oh, yeah. And signing some contract, where I agree not to see any other doctor for pain, and promise to come in for piss testing on demand? No way in hell. That’s just degrading beyond belief. I’d rather have the pain.
Wow :(.
I went to the ER in a city 2,000 miles from home, after a fall in which I broke my elbow. I suspected it was broken (prior experience, other elbow), they X-rayed it and said nope, just a sprain… and GAVE ME A SCRIP FOR VICODIN. I have to assume that I didn’t meet any drug-seeking patterns: I sat quietly while they took more urgent cases (something a drug-seeker would, I assume, not do). Also I was (still am) a fat middle-aged woman, not that we FMAWs can’t be seekers… (oh, and the elbow WAS broken, as confirmed by an orthopedist a couple weeks after I got home, but it was a break that can be tough to see on X-ray).
For the OP: Is the primary care doctor one of long-standing? It’s boggling to think that a doctor would be soooo paranoid about being tagged for overprescribing, that he can’t work with a known patient to figure something out. As in, take the time to really evaluate what you’ve tried, recognize that you’ve had a history of being very careful, etc. At the least, maybe a scrip for 20 tablets or something with the caution that there ain’t no more of those for a few months.
Knee: a friend of mine (mid 40s) just had a procedure where they did some kind of resurfacing / artificial cartilage implant, might that be an option vs. a total knee replacement? Also push whomever you can for the synvisc injections to be approved: while they’re by no means a cure-all, especially if your knees are that bad, they may give some relief and are rather less disruptive than knee replacement.
Rereading, I noted that the OP has been with this doctor for 20 years, which at least eliminates the concern that he’s afraid of new patient / drug seeking behavior.
As another poster noted, there are alternative pain medications. Celebrex (mentioned) is pretty close to being an NSAID; it’s a Cox-II inhibitor (I think) and may well have the same contraindications as NSAIDs. Ultram is not considered a narcotic, though they’re lately finding that it does have some issues with dependence. Neurontin / Lyrica: not sure how helpful those are with joint pain like this, with a genuine mechanical trouble; I know they’re useful for nerve-based pain.
Saintly Loser: how awful :(. Adequate pain relief is so critical in helping people recover from an injury or surgery. I’m not a medical pro, but from anecdotes (and my own experience), be appropriately aggressive early on and you stand a better chance of being off it sooner. I had better pain relief after my gallbladder surgery; a friend who had the same surgery a few days later had less-powerful help. I was off the narcotics within 72 hours. She was not.
For those who can’t believe a doctor could be so stingy with pain killers, my father is in his 70s and has a history of kidney stones and in the ER he was lied to and told opiates were old fashioned, and this amazing new drug works best on kidney stones! They gave him a script for ibuprofen 800mg :mad: He came to me and I gave him a bottle of vicodin I had laying around.
Same deal with my mom who is the same age with no history of drug seeking, the doctor finally after sucking a office visit out of her just to tell he doesn’t RX pain meds period and that she would have to go to a pain management clinic. All she asked for was some small amount of low dose pain killer because she couldn’t sleep because of pain.
It has gotten REALLY bad in the USA, even normal patients basically have to go to the black market to get pain killers.
Sorry for your loss, but chronic pain sucks ass, and anybody who wants me to live in chronic pain because their relative had issues needs to be pitted.
I refuse to live in chronic pain, and I have a doctor that listens to me. I am in no way going to die of an addiction I don’t have, I already cold turkey’d morphine with no ill effects [I actually stopped accepting the morphine while still in hospital, I didn’t need that level of pain med at that time.]
Leaving aside the above-stated fact that opiates are not a good long-term option for chronic pain, how do you propose I tell the difference between those who have a “medical condition” and the criminals? Pain doesn’t correlate to physical exam, or MRI findings, or anything else objective.
Unless you’ve been there, I don’t think anyone can possibly understand just how much illicit drug-seeking behavior is out there. When I was in private practice (in, admittedly, an area that’s pretty famous for its pillheads–they don’t call it Hillbilly Heroin for nothin’) there were points when I easily spent over half my professional time dealing with narcotic abusers, and that’s not even counting legit and responsible users. Even now, when I only see a small number of patients on my own as part of my faculty duties, I’d say 2/3 of the new patients I’m seeing are asking for narcotics and have a questionable backstory–often they’ve been to another clinic and were fired for diverting or otherwise abusing their meds, or they’re just out of jail for a drug conviction, or some other variation.
Of the patients who come to me requesting narcotics, I’d estimate that 10% of them obviously have an objectively verifiable condition that they’re genuinely seeking relief from, and 20% are obvious turkeys that Dr. Nick Riviera wouldn’t write a controlled substance for. The other 70% are the hard ones–usually people claiming horrible pain with no objective findings and no obvious red flags. And in my experience, at least 60 of that 70% are feeding an addiction or planning to sell the meds, while the other 10% really do have severe chronic pain issues and don’t have addictions.
And for that “legit” 20%–narcotics are a horrible long-term solution. People will claim they work so the pills will keep coming, but in moments of candor they admit that they’re still in as much pain as they ever were despite four Vicodins a day. And even the responsible users don’t always stay that way. Someone who gets 120 Lorcet 10/325s (not an uncommon monthly supply around here) can sell that bottle for over $1000–a sum that’s hard to resist when the local economy is in the toilet. And you may think that little 80-year-old granny woman is not going to give her meds to anybody else, but what happens when her beloved grandson shows up in horrible withdrawal? Or when her neighbor just breaks into her house and takes them?
I’m sorry that you have to take a few minutes to sign a contract that clarifies the rules, and that you might have to submit to a drug test on occasion, or that we have to check the narcotic prescription database before giving you anything controlled. (These things are actually the LAW in the state of Kentucky now.) I’m sure that you’re a wonderful, responsible, and law-abiding person seeking relief from serious chronic pain. (No sarcasm there–I really mean it.) But you underestimate the extent of the problem that we’re dealing with here, you underestimate how lousy a long-term option narcotics are, and you underestimate how hard it is to tell the difference between you and the last person I caught selling her pills in the parking lot.
For the OP’s question–it’s a tough one, and I’m not sure what to tell you about it. I think the best thing you can do is just say that the pain is sometimes limiting your ability to do your job. And make it clear that you’re hoping the Synvisc injections are coming, but you don’t know when that will be and you don’t know if you’ll be able to keep the job up until then. That way he can document that there is a clear objective benefit to the meds (you keep your job) and a demarcated endpoint to the treatment (when the Synvisc injections start).
Also, stress that it’s only from time to time that the pain is truly unbearable and that you don’t want to use the big guns every day.
He still might not give you Vicodin, but he may have other suggestions.
Self awareness is not your strong suit. Do you realize I was parroting your own phrase back at you for effect? To show how arrogant and condescending it is. You noticed but still managed to miss the point.
And perhaps physicians underestimate how insulting it is for a legitimate patient to be confused with someone who sells pills in a parking lot. Or to be required to pee in a cup to get pain relief (not even long-term pain relief) after a horrific injury, or surgery. If that’s the law, the law sucks. Checking a database is one thing. Treating me like a junkie is another.
Wow. There are lots of strong opinions here! I just talked to my sister, who said she had to sign a drug contract for her long-term Vicodin prescription, but no drug testing involved. Just a promise to seek help if she becomes addicted. Since she said she keeps forgetting to take them, I’m not worried.
I don’t remember asking my doctor directly for Vicodin…I think I was discussing with him my recent injuries, and the fact that the cortisone I was getting didn’t help for long, and that physical therapy wouldn’t help anymore either, and I asked him what else I could be taking instead (since he had just recommended a liver panel because of the Tylenol). He listed all the stuff I COULDN’T have anymore (The NSAIDS like Celebrex, anything time-release) and said he’d renew the order to allow me to sit down periodically during the day, but other than that there was nothing. I told him then that the Vicodin had seemed to work better and last longer, and he said, no, he wouldn’t. I told him I’d made the twelve pills last a month, they didn’t make me sleepy, and he said to work towards the knee replacement.
When I then asked my orthopedic surgeon if there was anything that could help with the pain, his only answer was ice, tylenol and let’s get going on the Synvisc.
Now for those of you who haven’t had to deal with this situation, you can’t just walk in and say, "I’m ready for new knees, let’s schedule it! The insurance companies make you go through all the steps regardless of anything. So I’ve lost weight, thanks to the by-pass, but then the pain increased to where exercising was too painful, and I’ve put some back on. Physical therapy…several rounds of that, and TENS therapy (I liked that!) and then we moved on to cortisone. I swear, the anesthetic he injects before the cortisone shot helped more than the cortisone. So now in a month I might be able to start SynVisc…have to call tomorrow to see if it was approved. Then when that stops working or doesn’t help, then, maybe we can think about new knees. So, it’s a several YEARS process. And I’ve already told the surgeon that there is no way in hell I’m waiting until I’m 70, because I will be unemployed and broke by then if something isn’t done soon. I’m hoping that by the time the fake knees would need replacement the technology will have improved for a second set. If I even live that long. But at least with new knees I can earn a living and be more active and thus healthier.
The “Drug-seeker” thing bit my daughter in the ass a few years back before we realized how paranoid doctors were. She had wisdom teeth pulled out, and was prescribed…something…can’t remember what. It did nothing for the pain, so she called and asked for something different. Prescribed maybe Darvocet? Still did nothing, so she complained again and they then gave her Vicodin, which worked and pain was bearable. But having to keep calling, and getting different things prescribed (and paying for them) and waiting days for relief seemed very stupid to her, so when she went back to get the other teeth pulled, she told them about what had transpired the last time, and asked them to go straight to the Vicodin. Well, of course, telling them what med works best and didn’t make you sick makes you a drug-seeker, so of course the answer was no. An emphatic no. No chance, don’t bother asking. Luckily we discovered that she had never finished the last prescription, so the few she had left carried her through.
I’ve always been told that if a pain medication is working to relieve actual pain, your chances of getting addicted are lessened, because you’re not getting a high or a buzz, just manageable pain. Maybe that’s a myth. I just can’t even imagine getting addicted to Vicodin, because while it helps ease the pain, it doesn’t wipe it out entirely, and half the time I forget to take a second one, or even to take more Tylenol, even if I’m limping so badly I wonder if I’ll make it to the car or up the steps. I’ve taken less than 40 pills in 210 days, and that’s including the broken bone days when I almost had to crawl into the all-night pharmacy because I couldn’t walk, the three days I had to sleep on the couch because my bruised leg was so painful I couldn’t climb the stairs (I have lovely pictures of my purple leg) and the week of the excruciating pain whenever my teeth touched until I got the tooth pulled. I’ve never actually had Vicodin much before this year…maybe when I got my wisdom teeth out, and I know I never even filled the prescription I got when I had carpal tunnel surgery. I’m hoarding the last three pills now, for the really, really bad days until I can get the Synvisc, which I pray will work better for me than it did for my sister.
I have to get a complete physical in a few weeks, and I will ask my doctor for his suggestions, again. And if he refuses again, I think I will ask him a little harder why. My son turns 28 this year…I remember the foot and leg pain started in earnest right after he was born. I’ve been a good little brave girl for a long time. I need to work for the next 20 years at least. I know my pain isn’t as bad as some people suffer, but when you are sometimes too afraid to even move because of the crunching and popping and ache, it makes you less stoic. And when you know that every step causes more damage that can never repair itself, you start to really, really limit those steps and put off doing things that really need to be done.
My spouse was born with spina bifidia. This is known to cause chronic, life-long pain. He has had over a dozen back surgeries, which, although they did help his situation, have certainly not cured him. After half a century of problems with his lower limbs and gait his hips are deteriorating and this can be easily seen on x-ray. He has documented nerve damage to his left arm and hand.
What the FUCK does he have to do to convince doctors he really is in pain?** Is being born with your spinal column exposed to open air somehow not “objective” enough?**
He doesn’t go in demanding opiates. He goes in and says he’s in pain. When he says he’s allergic to asprin and NSAIDs he is immediately labeled as drug-seeking even though it’s a medically documented allergy. Then he is handed a contract - even before any specific medication is mentioned - and told to sign it, agreeing that he will come in when called for a drug test within X time period regardless of the fact his mobility is limited.
I’m sorry you have to deal with drug-seekers. I actually DO understand the problem - when we visit the in-laws we have to deal with them trying to riffle through our luggage looking for drugs because they assume the spouse had “the good ones”. I’m also sorry that a man with a pretty obvious pain-inducing problem is sometimes awake for days at a time because the pain simply won’t let him sleep.
We don’t mind having rules, we don’t mind you checking the bad-boy database, but seriously, what we’ve been through the past few years is just completely over the top. The assumption is that everyone is cheating, everyone is a criminal. Even if you’re NOT on a narcotics the pain clinics will still insist on drug tests because of course you must be dealing/using/cheating/breaking the law.
I also have an objection to those contracts because they lock you into just one doctor with absolutely no recourse. You can’t seek a second opinion because that’s “drug seeking” even if you suspect the doctor is neglecting other health problems or is incompetent. One place wanted an agreement to not have any pain medication for dental work. Excuse me? A root canal with no pain relief?
I’m sure YOU are an ethical doctor who actually tries to distinguish addict from genuine sufferer but in my recent experience such doctors are an exception to the rule. “Pain clinic” is just a euphemism for “drug treatment” these days, but what they don’t tell you when you walk in the door is that if you agree to their terms you’re automatically entered in the bad-boy database around here so even if you DO have a real, legitimate medical problem you’re lumped in with the addicts. Get in a car accident? You’re fucked because they won’t give you shit no matter how much pain your in from obviously broken bones because it’s right there in your records - you went to that pain clinic down the street so you must be an addict.
I actually have a major problem with the recreational drug testing done by employers, but being drug tested to assure I’m taking the medication I was prescribed doesn’t bother me a bit (although if it’s on short notice when I’m at work, of course that’s not going to happen). I’ve only been on Vicodin once myself, for a [del]softball covered in foil[/del]kidney stone, and it was so effective at combatting my suffering that, if I ever needed it again, I would be willing to get drug tested to get it.
I have several family members who are habitual drug abusers, and I understand that many doctors are unable to distinguish between people in legitimate pain and lying assholes. But please, rather than deny my request for pain medication wholesale, allow me to prove to you that I’m not a lying asshole. I would be first in line to sign up for a delivery service who puts the pill directly into my mouth. Treat me like a potential criminal if you need to, I don’t care as long as I get the freaking medicine I need.
I hate it when doctors become the moral police (“oh, you’re going to KILL your baby??” or whatever) and the idea of them becoming part of the local narcotics unit is even worse.
This is how I feel, minus the addicted family members.
The type of pain I have (nerve pain) doesn’t respond well to long-term opiate therapy, but if it did? Hells yeah, I’ll sign your contract. I’ll pee in a cup. I’ll swing by for pill counts. I respect those of you who are choosing pride over pain medication if this type of treatment comes along with it, but there are many nights when I’m up all night pacing the floor in tears, because my pain is so bad. If a relationship with a pain management clinic would help, I’d find the least asshole-like one I could and submit to their requirements.
Yeah, so do the choices open to pain management specialists. If you just let anybody have anything they want without any kind of screening or narcotic contracts, you wind up feeding the addiction/drug trade problem, eventually getting shut down, losing your license, and leaving your legitimate patients without care. If you tell people to use NSAIDS and exercise and refuse to even mess around with narcotics, your legitimate patients don’t get the level of care they need and deserve. And if you try to split the difference, using narcotics but only in patients who will agree to not get narcotics anywhere else and take random drug tests, some people get pissed off because you’re treating them like a criminal and refuse treatment.
I mean, c’mon, they’re not instituting these policies because they get off on treating people like shit. They’re doing it for the same reason your cell phone company requires a credit check or the video store required proof of address before opening a new account–it’s a direct reaction to the shitty, dishonest actions of shitty, dishonest people.