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  • Ethics re PM - Please help me figure this out

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    Old 12-04-2016, 09:20 PM   #1
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    Ethics re PM - Please help me figure this out

    Hello. This is a long read. I hope someone can get through it and render some good advice.

    I am a 55 yr old grandmother and single parent to a daughter at home. I have lived my whole life with back and neck pain and no insurance. I was 51 years old when the pain finally got the best of me and I was let go from my job because I could no longer do required tasks. At that time I qualified for state insurance and I began the diagnostic process to find out why I was having such pain and weakness in my neck and back. I learned that I have scoliosis, several ruptured discs, stenosis, and degenerative disc disease. At 52 yrs old I put my trust in a surgeons hands and had fusion surgery, cervical and lumbar. I had laminectomies, discectomies. I knew pretty much immediately after the surgeries ( both done at the same time ) that something wasn't right - it felt crowed inside, felt like I'd been hit with a ball bat and then had a fist jammed up my spine. 6 months later a new MRI revealed that the discs above and below the surgery sites ( lumbar and cervical ) had crumbled under pressure from the titanium hardware inside me. I have not worked a day since February 2013 and I am on disability. My most recent MRI's look horrible. I have thorasic issues now as well as a torn miniscus in one knee. I have severe hip pain due to an undiagnosed problem. I have been on various painkillers prescribed by two different health care providers at two different times. The first provider had to shut down due to pressure from the DEA to stop prescribing pain medications. I've had my most recent doctor for the past 3 years. In that time I have not asked for early refills. I have not had to cancel or reschedule appointments. I don't owe money to my doctor. I have passed UA's and I never asked for increases in doses or stronger kinds of meds. I have walked a fine line knowing how precious pain management is to me, knowing I cannot manage my life without medication. Last month when I went in for my usual visit for refills I was UA’d. The nurse told me that the DEA had been there that day and they had to UA pain patients. The nurse whispered to me, “Dr. is needing to “lighten the load” so to speak. Too many narcotics being prescribed." My heart sank because this is how the end of my last pain management began. That health care provider was ultimately forced to shut down, under pressure from one or more government entities. I returned the UA cup with my sample and signed my name on the paperwork for the UA and it was sent off for testing. A week later I received a letter from my doctor saying that the doctor patient relationship had been breached by me and that I was being dismissed from her care and no more pain meds would be given to me. A copy of my tox report was enclosed. It said that I tested negative for two of my prescribed meds - one was a pain medication and one was a benzo for anxiety. ( I've been on this medication for 14 years ) I knew right away that it was a false negative because I had dosed at 5am that day. My appointment was at 11am. I wrote a letter to my dr., apologizing for the bad UA, asking her if we could sit down face to face and talk about why I feel it's a mistake. Then I called the office two weeks later and got a message through to her via a staff nurse, asking for an appointment. It made no difference. I was let go. She didn't even want to hear me out or work with me to correct a problem if there was one. I felt hurt, abandoned, and I felt like a loser drug addict type person because that's how you feel when this happens. It was humiliating.

    My doctor cut me off without so much as hearing me out on what’s going on with me that could cause me to fail my UA. There was no 30 days of meds or medical care to get me by until I can find another doctor. I am in the middle of diagnostics on my spine so I can see a specialist. I recently fell and now I am numb in my right foot. I am having severe symptoms of nerve damage in my neck. I need to be under a doctor’s care. I feel completely abandoned.

    Can you help me decide how to proceed?

    Thank you for your time reading this. I know it’s a long story.

    Last edited by Administrator; 02-09-2017 at 08:56 AM.

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    Old 12-05-2016, 06:38 AM   #2
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    Re: Ethics re PM - Please help me figure this out

    There is no reason why a pain patient should test negative for prescribed meds. As harsh as that may sound, it is not meant to be, just a statement of fact. Meds, taken as prescribed, should show up in a ua.
    As far as the doctor refusing to meet with you, or allowing you to explain, most pm offices send a dismissal letter and that's it. The contracts usually clearly spell out what will occur in a failed ua scenario. The doctor is not obligated, and by law can not prescribe scheduled meds to someone they suspect may be abusing them. Doctors are under no obligation to provide 30 days of meds, or time to locate a new dr.

    I learned early on, what a Dr. may do for one patient has nothing to do with me, or what they may do for me. Each patient is a seperate concern, and relationship, based on their particular situation and conditions.
    I am sorry you are in this situation, these policies have been in place for many years now, and we all have to deal with them.
    Your best option is to work with whatever doctor is diagnosing the spine issues and see if they can make a referral to a new pm. You are going to be asked about the failed test, and they will look at your prescription history, order ua's, and most likely a contract, so it would be wise to ensure you are following all the rules, and ask any questions before signing the contract.
    Good luck

    Last edited by Administrator; 02-09-2017 at 08:56 AM.

    Old 12-05-2016, 08:04 PM   #3
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    Re: Ethics re PM - Please help me figure this out

    Welcome! Sorry you are going through this mess. Unfortunately you can be let go from pain management at any time for any reason. If they wanted to get rid of you, there wouldn't be any reason for them to mix up or fake UA results, they would just say they could no longer prescribe (and possibly give you the option of staying on with the practice without opioids). It also really doesn't make any sense that a doctor would play by the rules for one patient and not another.

    I hope you can find a doctor willing to treat your pain. Any new doctor is going to request records, and that failed test will most likely be in it. If they use a GC/MS UA, the chance of error is quite low, and I think a false positive is way more likely than a false negative, but unfortunately we as patients don't have any recourse. I'd encourage you to use any meds you have left to taper down to minimize withdrawal, as even if you can find another doctor to prescribe, it wouldn't be right away, as there are waits for consults, and they typically don't prescribe on the first visit (as they wait for UA results). Things are really moving away from using opioids for chronic noncancer pain, but hopefully you can at least get a diagnosis and start working through all the other various treatment options. Best wishes.
    constant headache since 2006

    Last edited by Administrator; 02-09-2017 at 08:57 AM.

    Old 12-09-2016, 08:32 PM   #4
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    Re: Ethics re PM - Please help me figure this out

    Sorry to hear about your troubles, it can be frustrating.

    Last edited by Administrator; 02-09-2017 at 08:58 AM.

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    Old 01-24-2017, 07:21 PM   #5
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    Re: Ethics re PM - Please help me figure this out

    I'm so sorry about your situation. I would definitely contact the Doctor that is treating your spine so you can get a recommendation to another PM specialist. I agree, it's a difficult situation to be in, however it doesn't mean there isn't another PM Doctor out there.

    Once your PM made the decision to drop you as patient, there is nothing you can do, your best option is to put your energy into securing a new Pain Management Doctor, instead of focusing on the situation with woman you know, the best thing you can do is focus on your own situation. I would slowly cutback on your meds until you secure a new PM.

    Again, I'm sorry about your current situation and I hope you are able to secure a new PM physician very soon.

    ~ Fiona Jo
    080807-Cervical-Stim~071707-ACDF-C5-C7 w/instrumentation/bone graft~'07/06 Lumber instrum. removed 05/04-Fusion(DDD/Collapsed Disc L5-S1)08/99-Microdisectomy(Herniated Disc) ~Lupus/EDS,Migraine

    Old 02-08-2017, 01:03 PM   #6
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    Re: Ethics re PM - Please help me figure this out

    I am late for a response,and I sincerely hope you have found help by now.
    07/2006: A/P fusion L4-S1; DX DDD
    09/2009: started PM
    04/2011: Right rotator cuff tear
    09/2011: re-tore shoulder in PT- lost 30% function in shoulder
    06/2013: diagnosed with failure of L2-L3-L4

    Last edited by Administrator; 02-09-2017 at 08:58 AM.

    Old 02-09-2017, 07:28 AM   #7
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    Re: Ethics re PM - Please help me figure this out

    Jeepsgirl, you mentioned that you felt like your doctor treated you like an addict. I think that, when people fail those tests (test dirty or non-compliant), I would assume that probably 99% of them deny that the results are correct. Just a wild guess though. It is always someone else's fault, they swear that the methamphetamine and the equivalent of 15 Percocets in their blood must be someone else's blood.

    The demand for Pain Management seems very high now. I bet that the doctors have people lining up to take your place, Jeepsgirl. Personally, I went for an interview with PM, but I didn't like the condtions they wanted me to sign a contract for (Urinalysis every month, an appointment every month, with subsequent co-pay and deductibles, and another charge to my insurance, and being on call for random pill counts, plus the fact that the PM doctor is only in his office in our city, one day per week, and the appointments are stacked up, you basically don't get a choice to make it on your lunch hour or after work, you come when they tell you to come). As I mentioned in my PM post, I wrote a letter to my doc, explaining why I refuse to go to Pain Management (#1, I think it's a scam. Plus, I didn't request that I go to PM, last I recall, they work for me, not the other way around, jumping through hoops to get some pills is something I won't do), and if they want to cut me off, fine, I'll live. I'm not going to doctor shop. I'm not going to buy them on the street. I'm not going to try to manipulate things into my favor.

    Good Luck, Jeepsgirl.

    Last edited by Administrator; 02-09-2017 at 08:51 AM.

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