Six month ago I fell on my front steps and sort of bent my foot under itself when I landed. Ice and Advil did not help. It hurt a lot, was swollen with some truly wondrous bruises (one the diameter of a baseball on my ankle), and I couldn’t walk right. It got worse instead of better. So friends took me to urgent care. They x-rayed the foot. Doctor comes back in, where I sit hunched over and holding my foot because it hurts that much.
She tells me it’s not broken, call podiatry next week if it doesn’t get better. I stutter that I can’t walk without severe pain, what do I do? She says, “I don’t prescribe painkillers for this type of injury. You could try some naproxen.” I start to cry, because I’m in pain and I don’t even have crutches and no one ever explained to me what type of injury she was talking about. She finally agreed to give me exactly one vicodin if I took it right there in front of her. (Short end of a long story about a shitty doctor: Now that my fractured (surprise!) metatarsal has healed, next week I’m having surgery to repair 4 torn ligaments in my ankle)
At the time I chalked it up to just that, a shitty doctor. But then I’ve been talking to a couple of friends about stories of people having an obvious cause for pain-- such as recent surgery or a fresh injury that’s swollen and nasty looking-- that get no real pain releif. I know someone who was given just 4 Tylenol #3’s for major knee surgery, or someone who had part of her cervix removed and was given ibuprophen. My little sister broke 2 ribs and before my mom pitched a fit the ER wasn’t going to give her anything for the pain.
I get the muddy issues related to chronic pain, or hard-to-verify problems like back pain, and the worries about abuse & sales. . . but it’s pretty damn hard to fake a bad sprain or broken bone, let alone surgery that very doctor is performing.
What is this? Is it some kind of macho thing? I can’t think of any reason not to provide adequate pain control in these circumstances, at least for the first 72 hours (which is, in my experience, is the worst). Are some doctors morally opposed to painkillers? If so, why don’t they ever provide alternate pain management techniques (breathing, visualization, etc). The attitude seems to be to deny your pain exists at all.
Is there a logic to this, or some sort of standards, or is it all just the doc’s personal opinion?
In some cases it is the doctor’s personal opinion. I once saw a doctor for a bad abcess who told me “I don’t write for pain meds.” Not “you don’t need pain meds” but that he didn’t write for them under any circumstances.
My husband told me about a case he worked on while he was in the Army (he is a nurse) where a Marine had been pretty badly injured in a training accident. The Marine was “toughing it out” and refusing any pain medication at all following orthopedic surgery. The doctor tried to reason with him, explaining that pain could slow down his recovery time. When the Marine continued to refuse meds in spite of being in obvious pain, the doctor called in his CO who ordered him to take the prescribed medication.
When my mother-in-law was dying, the doctors at a local hospital told us the end was near, that there wasn’t anything they could do for her. They wouldn’t give her any pain meds. I pitched a fit with my husband until they got her out of that place and into the care of Hospice, who made sure she wasn’t in pain.
I don’t know how to fix the problem - how to get doctors to prescribe pain meds for those who need them, without giving strong drugs to people who only want them to get high or to sell.
My sister, who recently completed medical school, is of the opinion that part of the problem is doctors who have never been seriously ill or injured in their lives and thus do not have personal experience with severe pain.
Part of the problem, not the whole of it.
My completely subjective experience has been that doctors who do have a serious illness/injury in their background tend to be more sympathetic and willing to provide adequate medication.
I think it’s fear of trouble for facilitating abuse. It’s hurt me a few times foo.
Just to illustrate the pervasiveness of this, I had a scrip for hydrocodone but the drug store near the Dr’s office happened to be out. I called all 13 drug stores in the two nearest towns, and ALL said they were out. Then somebody clued me in that if you call a drug store to ask if they have hydrocodone in stock, they say “No” whether they have it or not. The first place I drove to with my scrip turned out to have it after all.
Part of the problem is that many doctors have to deal with patients who are seeking narcotics. Over time they become accustomed to refusing all requests rather than trying to seperate out the true pain cases.
Add to that the regulatory agencies breathing down their neck and it is a wonder any narcotics are ever prescribed.
As a veterinarian, I routinely prescribe pain control meds, including fentanyl patches. I have been audited by the DEA and it was not fun, but I came out of it fine. And I have had to deal with drug seekers. I wonder why an obvious mesomorph who cannot buy a shirt off the rack attempts to get anabolic steroids for his lean boxer dog wouldn’t at least wear something other than a “gold’s Gym” t-shirt.
I’ve had doctors who overmedicate and those who undermedicate. Because I’m allergic to most narcotics (well, I think allergic is the wrong word…I have really bad reactions to them, involving hallucinations and nausea), I have actually gotten into actual fights (screaming and yelling) with doctors who insisted I needed vicodin or oxycontin to manage this pain. I can’t take vicodin. Last time I took vicodin I was screaming that the dragons were coming to get us at 2 in the morning. Last time I took oxycontin I was sitting in a Schlotzky’s Deli bawling my eyes out because they were out of cheesecake. I don’t like strong painkillers and the way they react with me. The only prescription painkiller I’ve dealt with that didn’t make me unable to function was tylox, which is so addictive I’m afraid to take it. So, Mr. Doctor, I think I know what kind of medication I can’t take. Give me some 600 mg ibuprofen (naproxen doesn’t really help me, no idea why) over vicodin, thanks.
On the other hand, my father has severe back pain. It will never go away, as they will not operate on him because he has COPD. He will have chronic pain management for his entire life. He is a recovering drug addict and has a high tolerance to painkillers because that’s what he did for a good chunk of his life. Your normal dosage does not work on him. He wishes it did, trust me, because vikes are expensive even as a prescription.
His doctor prescribed him thirty pills for one month. Thirty pills. One a day. One freakin’ pill a day. The fucking things only last 4-6 hours, what’s he supposed to do about work? Plus the pills were so low a dosage that he had to take three to make them work for him. He blew through the entire month’s prescription in about a week and a half. It took my entire family reporting the doctor to the state’s medical board to get him to decide that maybe he should be worrying about my dad’s pain level and not whether or not he’s an addict.
So like everyone said, it does depend on the doctor. You get quacks out there who think that just because a patient claims pain they’re an addict trying to get painkillers, and you get the ones who refuse to believe that anything OTHER than a narcotic will help.
Personally, I think that both kinds ought to be stripped of their medical licenses, because they’re not doing the job, which is to limit suffering.
Fentanyl patches for dogs??? Wow. Humans can barely get that kind of thing when they need it. And that stuff has a huge potential for abuse.
When I was sick with endometriosis and adenomyosis my doctor wouldn’t give me anything except 20 Vicodin a month. That caused me to take my records and use them to get pain medicine online. Long story short, I got very addicted to having 120 Norcos every 25 days and that problem lasted far beyond my illness, which I had surgery for.
If the doctor had just prescribed me appropriate amounts of medication and monitored me on it I think I would have been much better off. But he wouldn’t do it no matter what, and I’ve always resented that I had to take matters into my own hands. But I’m glad that resource was there, even though it has obvious problems it is a real solution for patients with untreated pain.
Generic hydrocodone is about $15 for 30 pills, without insurance. That’s not expensive at all, IMO. Now, if you are talking street value that goes up. obviously, but I don’t think that’s what you meant.
This is another kind of craziness. . . how is there ANY justification for undermedicating a terminal patient? Even if they do get addicted, who cares? They’re dying.
My dad’s 30 pills cost $17 without insurance; that’s a lot of money when you can’t work because they won’t prescribe you enough pain medication. It’s not the $50 it could be, but it’s expensive if you don’t have money. Keep that in mind, not all of us have $17 to spare; that’s $17 that could buy food for a week if you stretch it, or $17 that could go into the gas tank, or $17 that could be given to the landlord to appease him until payday, when you can give him the last $40 on rent.
FYI, street value varies depending on stinginess of the dealer and prescription strength. I don’t buy the stuff but friends have when they see my dad upstairs laying flat on his back, crying because he has no pain meds and can’t stand up (this is the man who lost one of his fingers in a motorcycle accident, WHILE SOBER, and looked down, saw the stump, and shrugged…do you guys understand how much pain my father is? He’s in unending agony on a day to day basis). I believe the average is somewhere around $3-$5 per pill.
I don’t advocate doing it that way, though, because I don’t believe legal drugs should be sold illegally; I just turn a blind eye to it because I can’t stop it at the moment. I do believe that doctors who won’t prescribe proper pain medication should not be doctors, end of story. At this point, I don’t care if my father gets addicted to the vicodin, I just want him to not hurt.
I read a lot of state legislation on this issue at work (I’m a legislative analyst and many of my clients are pharmaceutical companies). On the one hand, doctors want to be able to prescribe for pain management, but strict regulations put them in danger of being investigated, so they err on the side of caution to protect their own butts. On the other hand, you have addicts who doctor-shop and pharmacy-shop. Much of the recent legislation I see concerns prescription databases for controlled substances, so the authorities can identify addicts and doctors who are over-prescribing. So basically, in many states, when you get a prescription for a controlled substance and get it filled at a pharmacy, your name, your doctor’s name, and your prescription go into a big database that the authorities monitor.
When I broke my rib, I got something like 10 days’ worth of painkillers (vicodin, I believe). About a week later I had a doctor’s appointment which was totally unrelated to the broken rib, and I mentioned it to the doctor who voluntarily offered to write me a prescription for 30 days’ worth of vicodin… So I said, OK sure!, even though I didn’t really need it. Then when I came back a month later (again, for something unrelated) he asked me if I needed a refill on my vicodin… two months after my broken rib healed!! This time I said no thank you.
In order to guard against any future pain, I ration my remaining vicodin, which has come in handy a couple of times for things like a killer headache, unbearable cramps, etc.