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Dr doesn't want to prescribe pain meds


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Old 10-27-2005, 04:51 PM   #1
JeanneO
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Dr doesn't want to prescribe pain meds

Hello...I'm new to the board (1st post)

I'm frustrated with my Dr because he doesn't want to prescribe pain meds for a bone spur in my shoulder. I am scheduled for surgery on 11/15. When I called to schedule the surgery I asked the nurse for something to ease the pain because OC medications weren't helping. She got my pharmacy info and said that they would call something in. She then called me back and said that the Dr didn't want to call in a narcotic because it was 4 weeks until surgery, even though that didn't make sense to me I accepted it. My feeling was that she implied that the Dr didn't think that it should hurt that bad. I stewed on this over the weekend and really felt like my pain was being dismissed. So I wrote a letter to the Dr expressing my concerns and how I was feeling and faxed it on the next Monday. I didn't hear back from him so I re-faxed the letter on Wednesday thinking that maybe the first one didn't go through. I still have not heard from the Dr. I called last Monday just to make sure that they had recieved the fax and the nurse told me that they had and that my chart was on the Dr's desk and that she thought he was going to either call me or write me a letter. She even said that she was surprised that the Dr didn't call in a prescription. It's now Thursday - a week and a half since I first faxed the letter and still not a word.

I still have pain, burning in between my shoulder blades, down my left arm and up into neck. I feel like I've been completely ignored. My first visits with the Dr didn't leave me feeling this way. I felt that he had compassion and understanding but now that he hasn't responded to my letter I'm not having the same feeling.

I've been in pain (progressive) in my shoulder for almost a year now. I thought (or hoped) that my cervical discectomy done 2/16/05 (C5-C6 was herniated) would make this pain go away but of course it's 2 different issues. It just feels like I've been in pain for a very long time.

My question is whether I should call again or if I should just let it go and suffer through the next 2 weeks until my surgery. Or if I should even try to find another Dr that won't ignore me. I've never been treated this way by anyone in the medical field, everyone I've dealt with has been kind and responsive. The truth is that I don't really want to go through the trouble of finding another Orthopedic Surgeon, I really just want to get this over with. I don't want to be a pain in the neck (or shoulder) lol kind of patient, but it worries me that he won't be sensitive to my pain after surgery as well.


Any suggestions would be very much appreciated.

Jeanne

 
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Old 10-27-2005, 06:55 PM   #2
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Re: Dr doesn't want to prescribe pain meds

Jeanne:
Hi & Welcome
I'm sorry to hear about your pain and the trouble your having with your doctor.
I guess every doc has their own philosophy on pain meds, however, I would be very concerned with his neglecting your letter for this long. I, truly do understand how you feel about wanting pain relief and many people take narcotics up till the day of their surgeries, so I can't understand your doc's refusal for meds due to your up-coming surgery.
The greatest concern for me is what happens if your in pain after your surgery? Is the doc going to relieve your pain with narcotics? Also, if God forbid, something unexpected happens and your pain is worse after surgery, will the doc ignore your pleas for help like he has ignored your letter?
Those questions should be answered and you should feel confident with your doc's surgical ability along with his willingness to respond to your pain needs in a timely manner.
Good Luck

 
Old 10-28-2005, 07:22 AM   #3
tina76
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Re: Dr doesn't want to prescribe pain meds

I wouldn't wait any longer for him to call you back. I would call HIM back and leave a message for his nurse that if he is NOT going to call in a prescription, then you want to talk to him TODAY! Demand it. It is completely ridiculous for him to be ignoring you this way. Especially when you have a legitimate reason for having the pain. They wouldn't be doing surgery if this wasn't a problem for you! Call them right away. Let us know what happens! Good luck!

 
Old 10-28-2005, 09:39 AM   #4
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Re: Dr doesn't want to prescribe pain meds

Hi Jeanne, I agree with Samme, If h's comletely dismisive of your pain now, who's to say he won't be just as ismissive pst op.

I imagine his thinking is the less you take priot to surgery the less he will have to prescribe pos op and the more effectiveit willbe. But that doesn't mean you need to suffer. Even if he gave yo ultram or vicodin, percocet would likely manage your post op pain.

There may be something in your file your not awatre of. If you took mes longer tat your last ortho felt was neccesarry after the cervical surgery, h may have noted thathe sus[ected you have a drug problem. That notation will follow you every where you go. It would be sent back to the referring prmama care doc to expresss hs concerns and part of the comunication bewteen PCP and the shoulder surgeon. If you have a been abeled a drug seker or potential addict or that's tough to get away from regardless of whether it's true. THere are still pleny of opiate phobic dcs that completely disagree with pain mnagement and the use of opiates for any lngewr than absolutely neccesary. It's unlikely your going to chnage his mind by complaining or faxng or arguing. It would deeply concern e to place my post op care in his handfs when it's was so inadaquatelymanaged prir to surgery. You do have the right to another opinion, you may have to wait an extra wek or two to get a surgery date but at least you pain culd be managed untill you have surgery and properly managed post op.

I think my next dsiscusion with this doc is that his reluctance to even attempt to offer you any type of relief leaves you greatly concerned about psoit op pain and ending up in woa wosrse position with a frozen shoulder due to his unsubstantiated fear of treating pain. F you thnk you hurt know imagine having surgery and given ultram for post op pain. Frozen shoulders are almost alway caused by pain and the increased pain caused by mvement. THe only contrl he's giving yu is to imobolize te shoulder cmpletly to prevent pain and to risk your stomach liver and kidneys with whatevr you can find OTC. 16-17k perople die every year trying to manage pain with OTCmedication, that's staright from the ZCDC. If he wuld rather a patient de from a gastric beleed from too much Ibuprofen or have liver failure from too much tylenl, You have to wonder how he's going to manage you post op pain or will he simply leave yu in the same position saying he's fixed your problem so you should be in less pain now than prior to surgery, you managed to get through the month prior to surgery with a spur, why can't you get through a few weks of post op pain once the spur s removed.
A singl patent sn't going to change his ideology on using pan meds and you are likely ging to fid ut the hard way what his true ideas regarding pain mnagement are. Your fixed, so you shouldn't need any meds.

There is such wide varety of theories invlving pain tratment and you ghave an obviously oiate phobic doc who believes pain meds are an abslute road to addiction. They togt ths in med school up untill 10 years ago, butthen they do internships with docs that were tought the same thing.
I remeber seeing an eppsisde of Trauma in tyhe ER on fiscovery, a 2nd year intern was quated as saying she would much rather see a MVA come in than another addict looking for narctics to trat ther headache. Where does a second year intern get this type of opiat phobic thinking if mnnnnnnot from the docs she's being supervised by and the education she received durng med school. It realy was sickening to see such a young uintern with such an ugly attitude towards someone she culd easily elp Vs a patient that she wuld rather be in the role of playing god where life and death is tested by her knowledge and skill. @nd year residence are a bit premematre having a god complex and having such engrained attitudes regarding treating pain.

However they do see peopecome in with shatered liand crushed limbs and pain contrl is not partt of the ABC, air wa, breathing and cardio suport. Use of opiates supresses respirtory problems and giving opiates to someone with a colapsed lung ould be fatal. So pain and screaming through Diagnosis and testing while they stabalize a patient is something the become very acustomed too. These patient don't die due to la ck of pain control so pain control isn't seen as a life or death emergency in an ER. where every intern takes a roatation though emergency medecine. That's the bginningof a docs foolish ideas regarding pain. But they aren't the ones left to clean up themesses caused by poor pain treatment like patient tat develop RSD or cronic regional pain syndrome because their pain was porrly managed. If you want to take the risk of developing CRPS bewhen you know this doc has no empethy for pain, it's would be hard to totally blame the doc when you had a very good clue of what is in stoore come ost op time. CP is hard enogh to deal with but when you know you made a choicethat caused this problem is makes it that much harder.

The self doubt, the decsaion you made to tought it out as not to prolong the surgicl time, but if your pain was managed even partially the extra few weeks to find a compassionate doc would have taken care of and prevented a problem like chronic pain or a frozen shoulder that leaves you disabled or greatly impaired.

Find a new doc, and get a copy of you med records just to see if there was comunciation bettwen you last surgeon and tour GP egarding opiat use. If yo find that's the caasse, it's time to change GP's or PCP's. With a note like that in your file you could go to your GP doubled over and puking from a kidney stone and leave with instructions to take Tylenol because surgeon # 1 clabeled you as a drug addict because you exceeded his comfort level or expected time you would need opiate pain meds.

If one doc labels you an addict, it is against the law to give those same drugs to a patient with a history of addcition or abuse.It's possible your GP may manage your pre op pain but that may just confirm the docs suspision that you will find the drugs he thinks you want, one way or another.

Ditch this doc and find one with a grain of compassion and at least a basic understanding for the need to control pain to prevent acute pain from turning to chronic pain. It shouldn't be that hard to find a doc with a basic understanding of pain management aside from opiates causing physical dependence after long term use.

Dependnece doesn't equate to addiction so his assumption is based on misinformation spread by docs trained that these meds should be reserved for patients dieing from cancer or the most extreme cases.

Good luck, sucking it up to let hm cut on you and possibly not treat that pain either is setting yourself up for misery and doesn't make sense. I would fire him and explain exactly why. If he has no empathy for the pain you have now, why would you think he would manage your post op pain effectively.
Take care, Dave

 
Old 10-28-2005, 10:05 AM   #5
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Re: Dr doesn't want to prescribe pain meds

I agree with Dave (Shoreline) completely. My best friend is having surgery today and has been on pain meds for the condition that needs the surgery since they diagnosed it 3 weeks ago. I have had several surgeries and was always treated prior as well even though it's been a few years... I can see this doc giving you a script of 15 vicodin after your surgery and saying "good luck" which wouldn't even be enough for someone who'd never touched a pain pill, let alone someone who probably has at least some sort of a tolerance. My goodness, if I had to have surgery now, I don't even knwo WHAT they would give me to manage the pain after! You need to figure this out quick. I am worried that you will go into this surgery and come out in an even worse and more painful situation after! Give a new doctor some thought! If that is not an option on short notice, at least try and talk to this doc directly and find out exactly what the problem is with the meds. Get an idea of what he is going to give you post op. Don't just go thru the nurse. Sometimes things get mixed up that way. Good luck!!! Let me know how you are doing! - Tina

 
Old 10-28-2005, 11:25 AM   #6
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Re: Dr doesn't want to prescribe pain meds

Thank you all for your responses.

In all honesty I don't really think that there could or should be anything in my records regarding addiction. Before I had my cervical disc surgery, I was on pain meds for approx 3 months, and after surgery I had the original prescription and 1 refill. Should I ask the nurse or Dr when they call if there is something like that in my file?

I called the nurse and left a voicemail this morning. I did ask them to call in a prescription and if not please tell me why....that's one of the things that's really bothering me, that they didn't give me a reason why...just said to take Tylenol and Tylenol PM to help me sleep. This does make me want to look for another surgeon, I just didn't want to postpone the surgery but I also don't want to be treated by an uncaring Dr.

I'm not in extreme pain every day all day and some movements and activity do make it worse and cause me instant pain, but days like today are particularly bad and that's when I'd like to have something to ease it.

Thanks again everyone....it helps to get opinions and suggestions.

Jeanne

 
Old 10-28-2005, 12:01 PM   #7
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Re: Dr doesn't want to prescribe pain meds

When you had your cervical disc surgery was it by a different doctor?

I would tell them about your previous surgery, that your pre-surgery pain was treated up until the surgery and that you want to know why the same thing is not being done in this situation when your pain is just as bad if not worse.

 
Old 10-28-2005, 12:49 PM   #8
JeanneO
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Re: Dr doesn't want to prescribe pain meds

I had a different Dr - a nuero surgeon for my neck surgery. This Dr is a orthopedic surgeon. To be real honest this isn't as painful as that, but the really bad thing is that in conjunction with the neck pain I did have this shoulder pain, but I had hoped that this would go away with the neck surgery but it's not related at all. So I've been in pain for a little over a year now. The shoulder pain I was living with because it wasn't really bad until recently...it's gotten worse over the last couple of months. I'm not even 100% sure that this will take care of my problems, I still have tighness and pain between my shoulder blades and in my neck, but one of the problems there is that because my shoulder hurts I can't increase my level of activity in my neck, (stretching and building the surrounding muscles.) without having it flare up.

 
Old 10-28-2005, 12:55 PM   #9
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Re: Dr doesn't want to prescribe pain meds

Well, even if it doesn't hurt as bad as teh neck did, it still hurts enough to hinder your life. Therefore, it should be treated. If the pain is bad enough for this doctor to decide to cut you open to fix it, it would be logical to think that it would also be bad enough to prescribe soem meds for in the interim. I just can't believe that he hasn't... When do you expect to hear back from them? What time is it where you are? You should call them back again before the end of teh day. And tell them you need to hear back from them TODAY. Don't let them ignore you. Have you thought about going into the ER over the weekend? Tell them what is going on. That your doc is ignoring you etc... and that the pain is bad, daily,and hindering ability to function on certain things. They might prescribe somethign there, and/or be able to advise you on what to do. It's possible the ER might be familiar with this doc too, possibly it isn't just you? Maybe he is notorious for this sort of thing.

Last edited by tina76; 10-28-2005 at 12:55 PM.

 
Old 10-28-2005, 01:22 PM   #10
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Re: Dr doesn't want to prescribe pain meds

It's just about noon here, so I thought I would call back around 2 if I didn't hear from them.

When I called on Monday the nurse called me right away. Within a couple of hours but she called to tell me that the dr wasn't in and that my chart was on his desk wting to send me a letter or for him to call me.

I just get more frustrated by the minute.

My husband thought that I should call my GP when the dr first said no pain meds. But I thought that wasn't really right, I thought I would see if I could handle it and deal directly with the ortho surgeon but it certainly doesn't seem to be getting me very far.

 
Old 10-28-2005, 01:38 PM   #11
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Re: Dr doesn't want to prescribe pain meds

Definitely call you GP! I had to do the same with my chronic pain issue when I switched insurance. For years I had a doctor I loved then I switched jobs and had to get a new gyno. She decided she didn't want to prescribe pain meds. Which was ridiculous because I have a legitimate condition that the only way to cure is a radical hysterectomy. Which I am too young for. So I went to my new GP who is awesome and he took over the pain meds etc... He is wonderful. Call the GP today!

 
Old 10-28-2005, 03:07 PM   #12
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Re: Dr doesn't want to prescribe pain meds

Here is the handwritten letter dated today that I received via fax from the DR.

Thanks for your note of 10/17. It helps to have a more detailed description of the symptoms as you have provided. I think the oral antiinflamatory medicines, either short or long term can help with the shoulder condition, as well as a local injection as you received. Surgical care might also help, and I believe we are scheduled. On the other hand, I've not been treating this type of condition with pain medicines, other than in the immediate post-op time frame. I don't think it's the appropiate use of them and not good practice. That's been my feeling over the past 22 years in this office. I hope this helps to clarify.
Best Regards


As if I would just go in and say please cut my shoulder up because it doesn't really hurt that bad and boy would I like to be in pain right now.

 
Old 10-28-2005, 03:14 PM   #13
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Re: Dr doesn't want to prescribe pain meds

Call you GP now. Tell him what this doc said. Tell him the anti-inflammatories are NOT working and that you are in a lot of pain and that You do NOT agree with this doc. Not to mention... he coudn't CALL YOU??? I have never heard of a doc that writes a letter rather than calling a patient. How impersonal! I just can't get over that. Wow. I am just baffled. He obviously doesn't believe in pain meds. You are going to have a hard time after surgery as well. Call the GP and tell them you want a second opinion on your condition before your surgery, have them recommend someone, and that you would like the pain to be treated in the meantime. This is just ridiculous. A letter!!!??? I just can't believe it...

 
Old 10-28-2005, 03:28 PM   #14
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Re: Dr doesn't want to prescribe pain meds

Oh boy. Aren't orthos famous for this kind of thing? I thought I'd read that in other posts, that orthos tend to be opio-phobic.

Please call your GP, and if all else fails there's always the ER.

You know when I had back surgery, the surgeon (neuro) did not give me any pain meds either prior to surgery, and the doctors who did the rounds at the hospital sent me home with #30 regular-strength vicodin. UNBELIEVABLE! I was taking more than (the equiv. of) 30 vicodin a day because I'd been living in agony for 2 years before the surgery. Oh there's so much more, but I'll stop there.

Wren

 
Old 10-28-2005, 03:37 PM   #15
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Re: Dr doesn't want to prescribe pain meds

Hey JeanneO: Tina is right, that was the most impersonal communication from a doctor that I have ever seen or read. All of that, when it's much easier and more personal to just pick up the phone. What a jerk!

I really don't mean to tell you what to do, but if I were set to have surgery and I got that type of treatment pre-op, I would do some serious thinking about what it's going to be like post-op! If I had to make a guess, I would say you will be very seriously under medicated and there won't be a thing you can do, unless you Primary Care doc is a very unederstanding guy.

Bottom line, I would very seriously think of finding another surgeon as quick as you can! Good luck to you.

Last edited by Rrector; 10-28-2005 at 03:37 PM.

 
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