mdp3
12-30-2005, 05:36 PM
anything i should expect my doctor has refered me to pain managment doctor my story is 2 back surgeries the last one a fusion at l5 s1 have been in constant pain for 2 years the doctor has diagnosed me with failed back syndrome i have been taking 8 10-325 percocets a day for a almost a year and before that vicodin norco and so on what a help the post ware i read the difference between addiction and dependance my own mother has said i will need rehab after this is alll over people just dont know how it is to be in pain 24hrs aday it takes a tool on not only myself but my wife and kids any advice on what to expect or what kind of procedures they do would be so helpfull
thanks so mike
thanks so mike
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Shoreline
12-30-2005, 07:34 PM
Hey Mike every doc has their wn phylosophy, Ideally you find a clinic or group of doc that uses a multi faceted apraoach to pain, aseveryone doesn't repond to the same methods. Some folks need opiates, some need PT, some need morphine pumps. I would want on that can do it all. I have met plenty of PM docs that don't use opiates but times are changing. It may take interveiwing several differet docs. It took me a dozen PM doc and 3 PM clics after 3 failed back surgeries, the last was a fusion from L1-S1 that failed and the hardware is breaking, loosening or togglng out, one piece at a time.
There is no quick road or gaurentee with any PM doc but being physically dependent is not the same as being addicted. I have yet to meet an addict whos life improved from using a drug unlke chronic pan patients who can dliver improve their quality of life. Would she rather have a sobor bed ridden son or a functional son dependent on pain meds. It just means if you stop cold turkey you experience withdrawal. If you have tried every other way to manage pain, opiates are an option .
Some docs use them as a last resort and some are quick to prescribe, You might want to try some other modalities before making a lifetime commitment. Hence the multi faceted aproach.
Good luck, Dave
There is no quick road or gaurentee with any PM doc but being physically dependent is not the same as being addicted. I have yet to meet an addict whos life improved from using a drug unlke chronic pan patients who can dliver improve their quality of life. Would she rather have a sobor bed ridden son or a functional son dependent on pain meds. It just means if you stop cold turkey you experience withdrawal. If you have tried every other way to manage pain, opiates are an option .
Some docs use them as a last resort and some are quick to prescribe, You might want to try some other modalities before making a lifetime commitment. Hence the multi faceted aproach.
Good luck, Dave
tracer
12-30-2005, 08:36 PM
well first off is a drug screen and no opit meds til u pass.then if ur on narcotics it will probaly be a longer lasting drug and maybe some,lortab or such for bt pain.also most want u to sign a contract as not to get any narcotics from any other docs.most like nerve blocks and often use them.
mdp3
12-30-2005, 09:38 PM
Dave Thanks For The Advice Hopeing To See The Pain Managment Doctor By The End Of The Month But It Is Workers Comp So No Telling How Long This Will Take Mike
dango
12-30-2005, 10:53 PM
I don't really know what you were trying to get at w/that "no opiate screen" prior to seeing a PM Doc--but most of the incoming patients are already on some level of pain treatment--it's just the GP doesn't feel equipped, and nor should they, to do long term pain management. It's a real specialty. When I went to my PM doc I was prescribed 90 10/325 percocet a month from my GP. The PM doc didn't tell me to get off them, or take a urine screen or whatever. He made a contract with me that I would cut them in half and use them for BT pain--and then, in 2 weeks (when I was out of them) he would prescribed 5/325's for BT pain. W/MScontin ER 3x a day--he felt that the 10/325's were too much drug. Seeings how they used to make me vomit--I'd have to agree. Now I don't take Percocet at all. I still take MScontin ER, w/morphine IR for BT pain (and assorted muscle relaxants and anticonvulsants). My PM guy IS very strict and DOES have a contract with everyone--that you get your meds at a certain pharmacy all of the time, etc--no early refills for any reasons, no pain meds from any other doc unless it's an emergency--or scheduled surgery and he's been informed. He kicks people out of the clinic ALL the time--because they just can't follow the simple rules. But he's SO busy. It takes 2- 3 months to get in to see him if you're not a regular patient.
Shoreline
12-31-2005, 12:12 PM
Hey Guys, I think tracers just dropped a few words in his post lke I often do. My fingers can't kee up wit my brain, add in some dyslexia and a stickey keyboard and a simple typing error may cme off the wrong way.
Many PM docs do UA's prior to beginning treatment and random UA's durng treatment. This shows the"DEA" each doc is making their best effort to stop diversion. They do randoms for several reasons, 1, to ensure a patient is not abusing illegal drugs. and 2 even more important, The drugs prescribed to a patient are actually in the patients system. If your prescribed MSContin they want to find the morphine mtabolite. Try explaining why a sn easy drug to detect can't be foound when you were given 180 morphin tablets just 3 weeks ago? I'm sure he meant no offense, but to expect to have to sign a contract explaining the docs policies and need for absolute compliance. If a patient can't function without these meds, compliance really isn't hard. I wouldn't risk filling a script early and getting discharged over taking an extra pill every now and then. Every PM doc has already heard every excuse for running out early that you could possibly think of. So if they really do fall into the toilet, the contract tells you not to even bother to call and ask for more medication as this call alone may end oyour relationship with your PM doc. What to expect was asked, and the answer is absolute compliance. If your dsose is not working, allow your doc to adjust it, don't take it upon yourself or go to your GP to fix what your PM doc is or isn't doing.
If your GP is presently prescribing, I serriously doubt you have a contract or have random UA's. A PM doc that is prescribing class 11 meds to hundreds if not thousands of patients draws the most attn from the DEA. These PM docs must comply with every wish of the DEA or risk being investigated. A simple compliance investigation will shut a PM doc down for weeks because he can't prescribe if the DEA has hauled every chart out of your PM docs office to do an audit.
This is something I doubt your GP or surgeon will ever have to worry about unless he happens to be the towns soft touch for weight looss pills, pain meds and tranqualizers. GP's do get into trouble, but are not under the same scrutiny a PM doc that uses the most potent opiates every day is. SO whatever word was left out of the UA explanation, I'm sure that's all it was.
You want your doc to demand compliance, to take steps that ensure he will still be in practice next month when you show up for your apt. IF he's prescribing opiates, even 10 mg percs, you do become dependent. If your PM doc gets busted or investigated for his prescribing methods, you and every legitimate patient gets left out in the cold and gets a good taste of withdrawal. Simply being a patient of a doc who gets busted throughs red flags up when you look for a new doc. Many of the patients of a doc that gets busted will have a very hard time finding a new doc without intense scrutiny from other docs.
Unfortuntely legitmate CP patients pay the price for people that take advanatage of PM docs willing to believe in your pain that can't be seen and prescribe opiates to treat pain. This draws addicts and people looking to make money on meds with extremely high street value. That script for 90 10 mg perc is worth between 450 and 900 bucks on the street. So it draws the local dealers and if they happen to have medicaid paying for their meds, IT means every pill is pure profit.
Most likely big brother is watching, It's not paranoiya when The DEA does have your PM doc under a microscope, simply because he treats pain with opiates and has a couple hundred or more patients he's doing the same for. They need to be able to show they have tried other methods to manage someones pain by using tools like injections, relaxation techniques, PT etc. They ned to show they are trying to deter drug abuse and diversion byusing ools like UA's, contracts and psych evals. The more alternative methods you have tried and failed, the more comfortably the doc can prescribe the meds you say you do need to function.
If every patient that ever had back surgery went to PM and claimed to have life altering pain and needed OxyC or MSContin or even the muscle relaxers that have streetvalue, the number of opiate scripts would increase 10 fold and the streets would be flooded with prescription drugs. Having been DX with failed back surgey is just the start, it doesn't gaurentee pain meds and doesn't mean you won't be trying other methods to manage your pain. Lots of folks have back surgery and move along with life, It's a small percentage who's lives have been permanently changed and left in a state where they can't functon without meds.
There are hoops to jump through, tests to pass, even psych evals. You can expect anything, from a compassionate doc to one that tells you in the first 2 minutes he doesn't use opiates to treat pain. I've met a dozen PM docs who don't use opiates at all, regardless of your DX or condition. You are just getting the real scoop, nobody is implying you shouldn't be treated, but when asking what to expect, every doc has their own opinion even in the PM field, and no doc is obliged to prescribe pain meds to anyone. Regardless of their DX, what their taking now or number of failed surgeries.
The docs that have some common sense and know they are being scrutinized, do their best to cover their back side and use tools like UA's to ensure the meds are being used corectly and as prescribed, "not sold" and to ensure illegal meds are not being used.
Nobody meant any offense, but I would expect a UA if I changed docs, I did a UA yesterday at the PM doc I have been seeing for 5 years and that manages my intrathecal pump. It's just the way it is, because of people that do abuse the docs, the system and the drugs. It sucks, but it's the reality of being in CP and finding relief.
Good luck, Dave
Many PM docs do UA's prior to beginning treatment and random UA's durng treatment. This shows the"DEA" each doc is making their best effort to stop diversion. They do randoms for several reasons, 1, to ensure a patient is not abusing illegal drugs. and 2 even more important, The drugs prescribed to a patient are actually in the patients system. If your prescribed MSContin they want to find the morphine mtabolite. Try explaining why a sn easy drug to detect can't be foound when you were given 180 morphin tablets just 3 weeks ago? I'm sure he meant no offense, but to expect to have to sign a contract explaining the docs policies and need for absolute compliance. If a patient can't function without these meds, compliance really isn't hard. I wouldn't risk filling a script early and getting discharged over taking an extra pill every now and then. Every PM doc has already heard every excuse for running out early that you could possibly think of. So if they really do fall into the toilet, the contract tells you not to even bother to call and ask for more medication as this call alone may end oyour relationship with your PM doc. What to expect was asked, and the answer is absolute compliance. If your dsose is not working, allow your doc to adjust it, don't take it upon yourself or go to your GP to fix what your PM doc is or isn't doing.
If your GP is presently prescribing, I serriously doubt you have a contract or have random UA's. A PM doc that is prescribing class 11 meds to hundreds if not thousands of patients draws the most attn from the DEA. These PM docs must comply with every wish of the DEA or risk being investigated. A simple compliance investigation will shut a PM doc down for weeks because he can't prescribe if the DEA has hauled every chart out of your PM docs office to do an audit.
This is something I doubt your GP or surgeon will ever have to worry about unless he happens to be the towns soft touch for weight looss pills, pain meds and tranqualizers. GP's do get into trouble, but are not under the same scrutiny a PM doc that uses the most potent opiates every day is. SO whatever word was left out of the UA explanation, I'm sure that's all it was.
You want your doc to demand compliance, to take steps that ensure he will still be in practice next month when you show up for your apt. IF he's prescribing opiates, even 10 mg percs, you do become dependent. If your PM doc gets busted or investigated for his prescribing methods, you and every legitimate patient gets left out in the cold and gets a good taste of withdrawal. Simply being a patient of a doc who gets busted throughs red flags up when you look for a new doc. Many of the patients of a doc that gets busted will have a very hard time finding a new doc without intense scrutiny from other docs.
Unfortuntely legitmate CP patients pay the price for people that take advanatage of PM docs willing to believe in your pain that can't be seen and prescribe opiates to treat pain. This draws addicts and people looking to make money on meds with extremely high street value. That script for 90 10 mg perc is worth between 450 and 900 bucks on the street. So it draws the local dealers and if they happen to have medicaid paying for their meds, IT means every pill is pure profit.
Most likely big brother is watching, It's not paranoiya when The DEA does have your PM doc under a microscope, simply because he treats pain with opiates and has a couple hundred or more patients he's doing the same for. They need to be able to show they have tried other methods to manage someones pain by using tools like injections, relaxation techniques, PT etc. They ned to show they are trying to deter drug abuse and diversion byusing ools like UA's, contracts and psych evals. The more alternative methods you have tried and failed, the more comfortably the doc can prescribe the meds you say you do need to function.
If every patient that ever had back surgery went to PM and claimed to have life altering pain and needed OxyC or MSContin or even the muscle relaxers that have streetvalue, the number of opiate scripts would increase 10 fold and the streets would be flooded with prescription drugs. Having been DX with failed back surgey is just the start, it doesn't gaurentee pain meds and doesn't mean you won't be trying other methods to manage your pain. Lots of folks have back surgery and move along with life, It's a small percentage who's lives have been permanently changed and left in a state where they can't functon without meds.
There are hoops to jump through, tests to pass, even psych evals. You can expect anything, from a compassionate doc to one that tells you in the first 2 minutes he doesn't use opiates to treat pain. I've met a dozen PM docs who don't use opiates at all, regardless of your DX or condition. You are just getting the real scoop, nobody is implying you shouldn't be treated, but when asking what to expect, every doc has their own opinion even in the PM field, and no doc is obliged to prescribe pain meds to anyone. Regardless of their DX, what their taking now or number of failed surgeries.
The docs that have some common sense and know they are being scrutinized, do their best to cover their back side and use tools like UA's to ensure the meds are being used corectly and as prescribed, "not sold" and to ensure illegal meds are not being used.
Nobody meant any offense, but I would expect a UA if I changed docs, I did a UA yesterday at the PM doc I have been seeing for 5 years and that manages my intrathecal pump. It's just the way it is, because of people that do abuse the docs, the system and the drugs. It sucks, but it's the reality of being in CP and finding relief.
Good luck, Dave
IngyW68
12-31-2005, 05:55 PM
Hi there,
Just a few tips from someone who just a horrible experience with a PM doctor.
Make SURE that the PM doctor requires a signature and photo ID for picking up prescriptions later on and that maybe your spouse is the only person on file to pick this up. My PM didn't require and of this and when my husband went to pick up a prescription for Percocet for me, the receptionist swore that I had already picked it up a few days ealier. Well, I had been in NC at that time and even though I provided written letters from my dad who I visited and other friends, they labeled me as questionable since they thought I was really trying to scam another prescription. Well, I would have been saved if they required a signature and photo ID.
Then, I just had second surgery for a failed cervical fusion and my surgeon and PM are friends and my surgeon mistakenly told my PM that he gave me a prescription that should have lasted for 10 days but it was only 20 pills of Percocet 7.5/750 to be taken every 4-8 hours as needed and I took them every 4,5, or 6 hours depending on my pain level and called my PM after I ran out and because my surgeon swore it was 10 days worth, when I walked in to my PM they told me, in the waiting room, that I was kicked out for taking medicine wrongly. I showed them a copy of the Sam's club Pharmacy that proved the amount and dosage but they STILL didn't believe me I guess because of the "label" I had for their mistake about the missing prescription.
So, needless to say that I am going to report this to the medical board since they denied me treatment and left me with nothing 5 days after surgery, slandered my name to my PCP telling them about these incidents and even with all the proof I have, they refuse to acknowledge this and clear my name, and also never diagnosed my shoulder/scapula pain that I have to now go to an ortho for next week. THey also never offered any other form of treatment for me from day one back in June.
My suggestion is keeping records from your pharmacy every few months or so about your prescriptions for any descrepency, requesting copies of your records every few months, (maybe just your diagnosis pages and anything you are not getting treated for, etc.) and even if they don't request signatures, I would ask to sign your chart every time you or your spouse picks something up to save any mistakes on their part. I truly believe that they are hiding something like someone is taking prescriptions in their office or they know they are wrong not to ask for signatures, and that my PM and Surgeon were friends that they wanted me out of their hair and that if they talked to my PCP that my doctor would believe them over me... So, even with all the proof to discredit every words they have said, it seems too late since I am "labeled".
I truly hope that you and others can learn from what happened to me because I think if I had been any more down or depressed about this long road of chronic pain and having them do this two days before Christmas, it could cause someone else to commit suicide to be left in the cold with so much pain and to have everyone calling you a liar when you have proof in your hands and they dismiss you in front of a waiting room of people!!
Gee, you can't tell I am a little upset about this can ya? I am just praying that God will work it all out in the end and that people who do such awful things will get their punishment some way, some how and if I can help others from this happening to them.
I pray that you will find a compassionate and trustworthy PM to help you live a life that is productive and joyful despite your pain and who wants to not just have you suffer because they are so scared of covering their own """"""
Hugs,
Ingy
Just a few tips from someone who just a horrible experience with a PM doctor.
Make SURE that the PM doctor requires a signature and photo ID for picking up prescriptions later on and that maybe your spouse is the only person on file to pick this up. My PM didn't require and of this and when my husband went to pick up a prescription for Percocet for me, the receptionist swore that I had already picked it up a few days ealier. Well, I had been in NC at that time and even though I provided written letters from my dad who I visited and other friends, they labeled me as questionable since they thought I was really trying to scam another prescription. Well, I would have been saved if they required a signature and photo ID.
Then, I just had second surgery for a failed cervical fusion and my surgeon and PM are friends and my surgeon mistakenly told my PM that he gave me a prescription that should have lasted for 10 days but it was only 20 pills of Percocet 7.5/750 to be taken every 4-8 hours as needed and I took them every 4,5, or 6 hours depending on my pain level and called my PM after I ran out and because my surgeon swore it was 10 days worth, when I walked in to my PM they told me, in the waiting room, that I was kicked out for taking medicine wrongly. I showed them a copy of the Sam's club Pharmacy that proved the amount and dosage but they STILL didn't believe me I guess because of the "label" I had for their mistake about the missing prescription.
So, needless to say that I am going to report this to the medical board since they denied me treatment and left me with nothing 5 days after surgery, slandered my name to my PCP telling them about these incidents and even with all the proof I have, they refuse to acknowledge this and clear my name, and also never diagnosed my shoulder/scapula pain that I have to now go to an ortho for next week. THey also never offered any other form of treatment for me from day one back in June.
My suggestion is keeping records from your pharmacy every few months or so about your prescriptions for any descrepency, requesting copies of your records every few months, (maybe just your diagnosis pages and anything you are not getting treated for, etc.) and even if they don't request signatures, I would ask to sign your chart every time you or your spouse picks something up to save any mistakes on their part. I truly believe that they are hiding something like someone is taking prescriptions in their office or they know they are wrong not to ask for signatures, and that my PM and Surgeon were friends that they wanted me out of their hair and that if they talked to my PCP that my doctor would believe them over me... So, even with all the proof to discredit every words they have said, it seems too late since I am "labeled".
I truly hope that you and others can learn from what happened to me because I think if I had been any more down or depressed about this long road of chronic pain and having them do this two days before Christmas, it could cause someone else to commit suicide to be left in the cold with so much pain and to have everyone calling you a liar when you have proof in your hands and they dismiss you in front of a waiting room of people!!
Gee, you can't tell I am a little upset about this can ya? I am just praying that God will work it all out in the end and that people who do such awful things will get their punishment some way, some how and if I can help others from this happening to them.
I pray that you will find a compassionate and trustworthy PM to help you live a life that is productive and joyful despite your pain and who wants to not just have you suffer because they are so scared of covering their own """"""
Hugs,
Ingy