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Old 05-08-2008, 09:03 PM   #1
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Chronic Pain and Demographics

Time Magazine ran a story on Friday May 2nd about chronic pain and demographics. Specifically, they talked about how the working class and poor have less access to both PM and meds....That many pharmacies in working class sections don't carry any pain meds. Apparently, both care and access to meds can vary greatly according to zip code. The article also discussed how estimates are that up to 15% of Americans are besieged by pain and that it's become a major health care crisis.

Does anyone else feel that pain discriminates by social class, gender, or other demographics? At my pain clinic, there seems to be many, many working class patients and it seems that for the most part, they are routinely complaining (in the waiting room) about their care. I have heard many say that people don't believe them. I just listen because I don't want to be associated or thought of as a complainer, which I'm not. Some of these patients are more vocal / outspoken than others.

Conversely, I've never had a problem with being taken seriously...I'm not upper class by any means, but would consider myself in at least the upper half of the US social class system. I did have a very interesting situation once though.....I had a problem with a UA a couple of years ago, and it was quickly resolved with a re-test (lab error). One of my meds came up missing in a UA, but showed up on a re-test of the exact same UA sample...Lab error. But before it was resolved, there were a few tense moments and @ one point, the Doc told me "you don't look like a diverter"....Whatever that means. Didn't really think of it @ the time, but have since then.

I'm wondering if one's appearance, education level, perceived income, and even gender has anything to do with PM care? I would hope not, but conventional wisdom tells me otherwise.

Curious what your thoughts are on the issue, or if anyone had experienced a issue with their care in relation to the concept?

Regards,

Ex

 
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Old 05-09-2008, 06:38 AM   #2
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Re: Chronic Pain and Demographics

This can be a touchy topic Ex. I believe if one is in a certain social class there is a tendency to judge according to the typical perception of that class. It's like a teenage driver is assumed to be a rotten driver because so many of them are. So when a cop sees a young driver he will watch him closer than he would someone my age[56]. Like it or not if you are a young driver you are being watched and you will get a ticket for things that a cop wouldn't even see me doing. The same type of thing must go on in other areas. Like pain management doctors. If someone who is obviously from the bottom end of the social/economic scale comes to get treatment for a pain problem the doctors are going to suspect drug abuse more often than if that person is from the upper half. He will base that suspicion on the fact that statisticly more people in the former have problems with abuse. Is it fair? No but it's reallity. It's the same way with certain minority groups. The number of abusers per one thousand members of the group is higher than in other groups of people. All that is looked at are the cold hard numbers not the reasons for the problems. The only thing we can do about it is try to keep our lives clean and police are brothers and sisters so they do the same.
Sorry about the long post and if I stepped on any toes.
Fred

 
Old 05-09-2008, 07:43 AM   #3
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Re: Chronic Pain and Demographics

Hey Fred.....I think what you're saying makes perfect sense. Not sure there is an answer.

Ex

 
Old 05-09-2008, 08:01 AM   #4
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Re: Chronic Pain and Demographics

Sadly, descrimination does exist. It shouldn't. And I am appalled by it. There is so little humanity left in the medical profession. I worked in the health insurance industry for many years. Quite a bit of it in HMO's. I had several opportunities to observe the ignorance of some physicians, their office support and administration.

To judge a person, solely on their income bracket, especially in terms of quality medical care, is unconscionable. You can never truly gage a person's integrity by sight alone. Income or class, should never be a consideration. I think people would be flabbergasted and outraged to know how many "so called" medical professionals have abused narcotic medications and have walked away, unscathed, with their liscences, practices and reputations intact.

I won't say much more, because I would probably end up writing a post of epic proportion. (Not to mention, jeopardize my good standing on these boards.) All I can say, is that all people deserve to be treated with equal compassion, dignity and respect; regardless of race, age, sex, income or education. Powerful and informative thread, Ex. Peace to all, cmp

 
Old 05-09-2008, 08:11 AM   #5
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Re: Chronic Pain and Demographics

There was a series on our local news last year about all the suburban housewives being addicted to Vicodin...how they were filling multiple prescriptions at multiple pharmacies, even forging scripts, buying it on the street, etc. These were women typically in their mid 30-s, stay-at-home types (husbands who make really good salaries) who got addicted.

The result for me has been a pronounced reluctance on the part of my physicians to prescribe these types of painkillers. So far, they've given me things that just don't do squat to help with my pain, or they irritated my insomnia, or both. I got a script for Vicodin back in December for pain after my cervical injections, but I tried not to take them, and so I have a few left that I've been taking now for my FM and tendonitis pain (which is surprisingly bad). I am trying to convince my OS/PM to give me some, but my internist has already said no.

I don't quite fit the demographic of the mid-30's housewife (I'm about 15 years older), and I do have legitimate CP issues which need to be addressed. If I can't get something soon to help with my pain, I will have to find another PM doctor who will.

It's very frustrating. The pain is really wearing me down, but there is a tremendous drug problem in most of the local area schools, and then the housewives....so the doctors have been really clamping down. I hope I can find a doctor who can help me before I get to the point of deep depression.

So, after that rant, I would say, yes, demographics (addicted rich housewives) have impacted drug scripts here in North Texas. Just not the type of demographics you might expect.

Tex

 
Old 05-09-2008, 09:45 AM   #6
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Re: Chronic Pain and Demographics

I think it may have a lot to do with communication skills.

Like practically anyone else, I show up at the ER in sweats or worse and clearly not in the best frame of mind. I'm sure my appearance doesn't help. In fact, I probably look like white trash first blush. But as soon as I open my mouth and explain the situation the atmosphere changes. What may have started out as suspicion or an "on alert" type expectation changes to a discussion of the best treatment.

I work in research and development of aircraft and spacecraft. That experience has given me the opportunity to learn how to work with people and be persuasive. I run with a crowd of similar minded folks for the most part. Like most others here, I am by no means wealthy. And I am insured through an HMO. My life experiences have taught me how to make sense with folks of all ilk, rich, poor, minority or not, white and blue collar, or no collar, etc.

From everything I've witnessed, those that communicate well, show respect and know how to stick up for themselves tend to get better treatment than those who do not or can not. And this seems to be true regardless of color or address.

Sure, there are exceptions. But for the most part I find communication skills serve as a tie breaker almost every time.

steve

Last edited by forginon; 05-09-2008 at 09:47 AM.

 
Old 05-09-2008, 05:24 PM   #7
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Re: Chronic Pain and Demographics

I know for a fact that many many people are discriminated against and it usually is based on race, age, and income level. Of course addiction does not discriminate on any of these factors. I can tell you that I have seen people from every demographic that IS an ADDICT and was truly an eye opener. I first went into drug treatment and I was completely blown away at the diversity of the people there.

I can tell you that I did not hold much hope when I went to my current doctor that I would get treated with any narcotic medications. However, he definitely believed me that I wasn't using anymore and that I did have chronic pain. He was willing to help me when many other doctors would not have treated me, especially with any opiate/opiod medications. The one thing that I will admit to is that I always dressed in business casual clothes and avoided going in dressed down in jeans. I was worried that it might look bad and that he might have a "different attitude" of me. Ultimately it may not make a difference but who knows. I tend to have "odd" thinking

brian

p.s. the one thing is that I was completely honest and upfront with my doctor, that I was a recovering addict, that I had tried this list of medications that were not helping, and that I was truly suffering. I went in with a prescription list of the last 6 months and agreed to radom UA and blood testing. I tried to communicate to him effectively that I had a true need for help with my chronic pain. I also had ALL of my medical records transferred to him. The only thing he did was wait until he received ALL of my medical records before prescribing the fentanyl patch. After he did, then he was willing to let me try it and it has helped tremendously.

Last edited by brianpain33; 05-09-2008 at 05:28 PM.

 
Old 05-09-2008, 06:00 PM   #8
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Re: Chronic Pain and Demographics

Quote:
Originally Posted by TexMom85 View Post
It's very frustrating. The pain is really wearing me down, but there is a tremendous drug problem in most of the local area schools, and then the housewives....so the doctors have been really clamping down. I hope I can find a doctor who can help me before I get to the point of deep depression.
Yes, you are the crowning example of what happens in cases like this. Even though you aren't involved, you happen to fit the "profile" of what's going on in your area, thus, it directly effects your care. No different than minorities who are pulled over for drug suspicion and etc.

I feel bad for you! Please hang in there best you can.

Ex

 
Old 05-10-2008, 07:44 AM   #9
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Re: Chronic Pain and Demographics

I think Steve hit on something that is very relevent to this topic. Communication skills. The problem, as I see it, is that the physicians or clinicians who treat most of us, have absolutely no desire to effectively communicate to their patients, just what is wrong and how to treat it.

Most doctors, especially specialists like surgeons and ortho docs, do not take the time to explain to their patients that they will more than likely have pain issues, that may last indefinitely. They go in and treat the injury or condition, initially......then leave the patient to figure out what to do next. It's like "I did my part, now you're on your own". And sadly, most people turn to their primary docs, who in turn tend to want to refer the patient back to the specialist. It's like a vicious cycle. And the patient is the one caught in the middle.

How is anyone, regardless of intellect or education, expected to know what it takes most physicians a decade to learn? I've known some very well educated and financially "stable" people, who have been "left hanging" by a physician, who couldn't be bothered to take the time to actually explain, even the most basic aspects of medical care to their patients. If I hadn't worked so long in health care, and hadn't had the experience of taking care of my parent's when they were ill and near the end of their lives, I wouldn't have known half of what I knew, when I began my own journey with chronic pain.

I'm not saying that this is all there is to the descrimination that occurs, but I feel it is a very big part of why it happens to so many. Just my humble opinion...........

 
Old 05-10-2008, 10:20 AM   #10
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Re: Chronic Pain and Demographics

Cmp, Steve, Ex

You said it all better than I could have. It is the sad truth about many doctor-patient relationships these days.

Tex

Last edited by TexMom85; 05-10-2008 at 10:20 AM. Reason: spelling

 
Old 05-10-2008, 10:54 AM   #11
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Re: Chronic Pain and Demographics

I'll take this concept one step further....I'm convinced that some areas of the country have been wrongly stereotyped, and thus EVERYONE in those areas can't get proper access to PM....Areas such as WVA, SWVA, KY, & etc. where OC abuse has gotten some publicity.

A real shame..........

Ex

 
Old 05-10-2008, 11:26 AM   #12
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Re: Chronic Pain and Demographics

I agree Ex and I'm continuously asked if I am employed or not - if I were unemployed, would they deny me service? I have insurance.

I've been reading a great deal on this board and I'm just amazed at how hard it is to get good care and for those who keep plodding on, dodging bullets, kudo's to you all.

I had no idea about the housewife thing - interesting. Next time I'll turn up at my doctor's dressed up as a librarian!

 
Old 05-10-2008, 02:21 PM   #13
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Re: Chronic Pain and Demographics

It's very clear that there's no black and white when it comes to getting decent pain management. I had posted that I felt it boiled down to communication skills most of the time. But that there were exceptions.

However, it seems the exceptions are the rule more often than not. Too many of us with just fine communication skills are denied proper care. Too often the opportunity to communicate anything is stopped short by health care providers with too little time or caring to even listen.

I don't live in a part of the country scandalized by the OxyContin conspiracy theory. Thank God. Color means much less here (Silicon Valley) than in other parts of the country as whites are in the minority. And the majority is composed of Blacks, Hispanics and Asians. So the criteria here for getting or not getting good care is much harder to discern. The most obvious discriminator here is blue vs white collar, but the industry is predominantly electronics regardless of occupation. So, around here, communication skills are still critical in getting attention regardless of the need. But elsewhere it's clearly less obvious.

I wonder how much luck has to do with it. Right place at the right time. Location, location, location. Being seen right on the heels of a confrontation with a diverter.

We stand at a crossroads, where the old school docs, those who were not trained at all in PM in med school, and were "raised" to believe that narcotics were essentially evil are on the way out. There's a new generation of docs coming who has less bias regarding classes of drugs, who are more open to advancements in pharmaceuticals. JCAHO standards have included pain as the sixth vital sign, and hospitals refusing to accept this cannot get certification. It is now illegal to under-medicate patients in pain, especially the terminally ill, in more and more states. Most states now have a pain patients bill of rights, and a state-wide position on care for non-cancer chronic pain. But, there are negatives as well. "Managed Care" is on the rise with insurance companies more often making the medical decisions for patients. And the DEA has put fear into the hearts of well-meaning docs who care about the QOL of pain patients.

I don't know where we go from here, but it's all too clear that there's no formula for how to go about getting one's daily severe pain relieved. To be treated fairly w/o being tagged as a drug seeker or worse. To be believed when reporting pain. Why do I get such a good PM doc and such a wonderful PCP, while the next guy can't get past the receptionist's desk. I thought I knew, but it's clear I don't.

If anyone does figure this out please let us all know.

steve

Last edited by forginon; 05-10-2008 at 02:30 PM.

 
Old 05-10-2008, 11:30 PM   #14
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Re: Chronic Pain and Demographics

Steve, it is.....Unfortunately......

I think you're right about persistence.....We can add that to the list. Sometimes, persistence gets patients labeled as "drug seekers" though because they build a file or history of many Docs. It's a fine line, I know.

I guess when I say "luck", I mean stumbling upon that great Doc......Whether it's by referral, by accident, persistence, or whatever....Just "lucky" to have found that person, however that may be. Or, as you say, "lucky" to be located in an area not known for abuse...Or happen to be located in an area known for progressive medical care and philosophies....Makes a difference, I think.

At the end of the day, I think there is a huge variation in PM Docs, dependent upon these many input variables.

Good night.

Ex

Last edited by Executor; 05-10-2008 at 11:38 PM.

 
Old 05-11-2008, 02:01 PM   #15
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Re: Chronic Pain and Demographics

Hi everyone! This is a very interesting thread!

Some of you have said you try to dress better when going to see the doctor for pain. "no jeans" or "business casual". I fear that if I look nice, and put my makeup on, that no one will take my pain seriously. I even make the effort to dress down completely and remove my makeup before I see a doctor for pain. AND...I am a "girly girl" who does not like to leave the house without my full regalia of hair, makeup and wardrobe.

What's the right thing to do? Have any of you struggled with this?

Stephanie

PS: I hope this wasn't a shallow addition to such a deep thread!

 
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