But those pain management clinics may not really be helping people. Some push B12 shots and magic vitamins. (Of course trying to Google “Pain Management Denver” just gets you a bunch if dispensary and chiropractor hits.)
No, that’s not what’s happening - what’s happening is they’re making you sign a contract that you will not ever seek a second opinion. You can not see another doctor without their express permission. So if they decide to prescribe NSAIDs to my spouse who can not take them due to an allergy to them (he has tried one of the new ones that was supposed to be less likely to cause a reaction in allergic-to-asprin people under careful medical supervision but after three weeks it was hives and wheezing again) and ice packs and fuck any other alternatives he would not be allowed to seek a second opinion. He would have had to take random drug tests even if he wasn’t prescribed narcotics.
He didn’t sign the contract and didn’t go there because too often in the past he’s needed to seek second opinions. A pain specialist might (or might not) be able to help him manage chronic pain but he’s not a urologist, a neurologist, a nephrologist or any other specialist he is likely to need, but being told no, he can only go through Dr. Pain and if Dr. Pain doesn’t think it’s important he can’t seek a second opinion - yeah, I think that’s unreasonable.
Because he isn’t in the bad boy database he has been able to get appropriate medication during instances like his pancreatitis and most recent tooth extraction. If he had signed he might not have. We’ve been advised by his several doctors to NOT go to the local pain clinics and our current primary care guy is doing what he can to help him and we’ll go with that for now (including appropriate referrals to specialists for his medical issues outside of chronic pain).
Really, though, I think all too often “pain clinics” are a bait-and-switch. If we weren’t all screwed up about addiction we’d have places for addicts to go and places for people with chronic pain to go, and maybe a third place for those real unfortunates who are both.
I have heard anecdotally of several people with real chronic pain medical issues eventually going to methadone clinics designed for opiate addicts, because at least there they can get as much pain killer as they need. Supposedly the clinics were even noticing new patients that were not strictly speaking addicts, just people sick of the bullshit and ready to get drugs for their pain.
I know someone who is a hemophiliac who deals with chronic, intense pain issue who attends a daily methadone clinic. It’s really a tough situation, honestly. Hemophilia, an inherited disorder that makes the person’s blood not clot as quickly (sometimes if at all) when bleeding, causes all sorts of peripheral pain. She has no other alternative to the methadone, and it is clear that she has at least developed a physical depedency on the medicine. She has suffered from the effects of the methadone, through no intentional fault of her own, because of a rare inherited disorder that has no cure. Like I said; it’s tough.
If you’re taking the pain killers for pain with the same constancy and frequency as an addict, in the end, what’s to distinguish you from the addict? Eventually you’ll reach a point where discontinuing the drug will result in the same withdrawals, and eventually there will some kind of dependence. It’s not like addicts are a different species of animal, or that suffering from chronic pain makes you immune from addiction, or that there’s this very clear, distinct line dividing addicts from “regular” people who are merely in physical pain–though that seems to be the underlying discourse in this thread. No one sets out to become addicted. Usually it’s only after the fact that one realizes it has happened.
And now for something completely different…
I’m horrified by how many pain killers some of my patients are given without a second thought by their doctors. The guy I’m seeing tomorrow as a new patient? I just got his med list from his last nurse:
Aspirin
Celebrex - once a day
Gabapentin - three times a day
Metformin
Simvastatin
Enalapril
Trilipix
Glipizide
Amitryptiline
Hydrochlorathiazide
Percocet - every 4 hours
Hydrocodone - twice a day
Cyclobenzaprine (Flexeril) - three times a day
Endocet - as needed
Plavix
Metoprolol
Docusate (gee, ya think?)
Do we see an issue here? THREE forms of essentially the same medication: Percocet, Hydrocodone and Endocet. AND Celebrex AND Gabapentin for, I assume, neuralgic pain, because I see no history of epilespy or seizures AND Flexeril. WTF? And he’s on a Tricyclic Antidepressant AND a drug that, according to my book “acts like a Tricyclic Antidepressant”…and all this for a guy who clearly has liver issues, given the DMII meds and cholesterol meds and anticlotting meds. I’m freaking out here. I’m going to have to fight with his doctor and try to “take away” some of his pain meds or his liver’s going to explode on my watch.
I’m going to be shocked if the man isn’t a drooling puddle on his sofa. How can he possibly be functional with all that running through him?
So…uh…find another doctor, I guess? There are clearly some who still prescribe painkillers like Tic-Tacs.
Exactly.
:eek::eek: How does something like that even happen? It seems like someone dropped the ball somewhere along the way with this guy; to say the least. Geezus.
Someone legitimately taking opiates for pain is not seeking to get high, they’re looking for pain relief. An addict seeks the high and will take more and more in pursuit of it. Someone who is dependent but not addicted can usually be weaned off the opiates when the original problem is gone without too much trouble, without the psychological issues of an addict, who will resist being tapered off.
There actually IS a difference, although the line is not as sharp as some people would like.
If the weaning/tapering is done properly there will not be an “agony” of withdrawal. Many people who are dependent but not addicts have chosen to go “cold turkey” and suffer the physical unpleasantness of withdrawal (which isn’t fun, but hardly the worst of all possible torture) because they want off the drug badly enough to do it quickly despite the side effects. For addicts, a significant part of the “agony” is psychological and they’ll suffer even on a very controlled and slow taper. Someone who is dependent but not addicted will look forward to getting off the drugs. Someone who is an addict will dread it.
Someone who was dependent but not an addict will not want to resume using the drug once they’re off it. An addict, as we all know, wants to go back to the high.
Basically, addiction has a psychological component that physical dependence doesn’t.
Why Not, I have no idea what most of those are, but a quick question- is this patient elderly? I could not understand all those medications unless they were going to croak anyway.
Nope. 55 years old. Something’s up, but I don’t know what yet - maybe he’s a drug seeker and those are all from different doctors, maybe it’s just a clerical error (I hope, I hope, I hope, but that med list was signed and approved by his primary care provider 2 months ago)…we’ll see.
The other way to get lots of painkillers seems to be to be a veteran. The VA is very generous with the painkillers; my SO has over 1000 Vicodin and 200 Dilaudid pills laying around because they just keep sending them, even though he doesn’t order refills and takes maybe 3 Vicodin a month for breakthrough pain and hasn’t had a Dilaudid for 8 months. Same story with half a dozen veterans I’ve seen.
But the problems with painkillers don’t end with access - the real problem, as alluded to above, is that they just don’t work well for very long. Our bodies are really well wired to feel pain, and do so in several different ways, so blocking one chemical or neurosensor for pain still leaves several other ways for your body to feel pain. We haven’t figured out a good way to stop pain long term without turning people into zombies or destroying their stomachs, kidneys or livers. Honestly, for reals. People in pain don’t want to hear that there’re no good medication options for them, but it’s often true.
Thanks. My dad is in a Nursing Home and they seem pretty relaxed about his pain medication. He is a vet (WW 2) but he is also into his 90’s and I think a pain free life is more important now than worrying about him being a junkie in 10 years. Plus it is a controlled environment.
From reading this thread, though, it appears that the complication is when the original problem is not going to go away, and in fact is going to get worse (and the OP’s doctor may feel the OP’s situation is one of these).
I do think we have a fucked up situation where people in acute pain often don’t get relief that would be nothing but a positive for them–I’ve spoken here about the time I had blood and pus running out of a badly infected ear and the doctor wouldn’t prescribe me anything for the pain. I really don’t understand why doctors won’t prescribe five of something: for many situations, like my earache, or a root canal, or whatever, something to get you through 24 hours would make a tremendous difference, and what good does five pills do an addict? However, every doctor/dentist I’ve had prescribes 30 or nothing–the thinking seems to be that either it’s severe pain where you need enough pain relief to be laid up for 4-6 days, or it’s not that big of a deal and you can take Advil.
What pain meds doctors are willing to prescribe varies wildly. I had an elderly couple who hadn’t shown me any pain meds when I asked to see their meds. When I specifically asked what they took for pain, bottles of morphine and dilaudid came out of their pockets! He takes 60 mg morphine twice a day, she takes 30 mg morphine 3 times a day plus dilaudid twice a day.:eek:
Another patient takes morphine 100mg twice a day, plus 25 mg up to 3 x day for breakthrough pain. He takes all of this, every day.
Whynot, you can call the VA Pharmacy and get the deliveries stopped.
As stated - opiates are a tool, and part of the toolkit of pain control.
I agree, they shouldn’t be handed out like candy. However, even with chronic pain they can play a role. In many cases, chronic pain isn’t constant but waxes and wanes. Opiates can play a role when pain flares up. For example, someone with chronic knee or hip pain might not take them every day, but if they have a circumstance where they wind up walking more than unusual having the option might allow them to get a decent night’s sleep instead of being in pain to the point of being unable to sleep. Saying “no opiates ever for chronic pain” is just as wrong as saying “give 'em opiates to shut them up.”
Ideally chronic pain management uses a variety of things, from simple distraction to an array of drugs of various types of action, to manage a condition that isn’t curable. You’re right, medicine doesn’t have a good answer for chronic pain. Unfortunately, the messed up relationship our society has with drugs (both medical and recreational) leaves some people over medicated and some under. Much suffering ensues.
My brother in law seemed to be given as much as he wanted as well, but since he had terminal cancer, neither addiction or building up a tolerance were things that they were too worried about.
I keep a stash of Tylenol-4s, a few Vics, whatever, just for this reason. Don’t most people have a few “emergency use onlys” in the med cabinet?
Thanks. We’ve mentioned it a couple of times to his doctors, who just shrug and say to use them as needed. But I’ll bring it up with the pharmacist on Thursday. She rocks, and will probably do what needs to be done. It must be something glitchy in the system, because getting lisinopril out of them takes an act of congress and three phone calls every month! 
kayaker, I don’t have an emergency stash because I’ve never been prescribed anything I could stash*. But I’m probably an anomaly; doesn’t seem like many people make it to 37 without having opioids outside of a hospital setting at least once.
*Oh, wait…not true. I was given a scrip for 10 Vicodin post c-section. But my husband lost the scrip somewhere in the grocery store, and I was too afraid of being labeled a drug seeker to go back to the hospital and ask for another. Ibuprofen and Tylenol did the job instead.
Well I don’t, at least not for me personally. I am fortunate to have seldom suffered pain and feel no need to stash for myself.
My husband has done this on occasion. I think he’s been hanging on to two vicodin since he had that tooth extraction back in December of last year.
It seems to me that when you have a situation where someone prescribed X number of pain pills for an acute condition (like a tooth extraction) deliberately takes half the number prescribed to save the remainder for months down the line when they have an exceptionally bad flare of up of pain is not an ideal pain management situation. I mean, yay for him not taking more than he really needs during the acute condition, but the hoarding seems a sign of fear you won’t get the help you need when you need it.
Heh Why Not- I could beat you on the opoids- and I would doubt my father even knows what they are.