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    Old 12-15-2006, 08:30 PM   #1
    ejreiss
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    requirements for opiod treatment

    I was wondering if there are any requirement protocol or standards which have to be met in order to be prescribed long acting pain meds. My problem is that I am perm disabled due to failed back surgeries and work comp ins will not send me to another pain man doctor to get second opinion. I have to try and get treating doctor to prescribe what I need to function and no matter how much I ask he refuses. Why is it that some people who have a fraction of the problems I have can be prescribed just about anything they ask for and others with real serious pain issues can't get what they need. Isn't there some kind of standards or written procedures to follow to determine if you should be prescribed pain meds. It aggravates the hell out of me because I suffer 24/7 and can't get relief, yet I hear about others who abuse the hell out of their meds and show serious signs of addiction yet they still come out of the doctors office with another prescription. Maybe this is partly the reason why opiods are so questionable and controversial. It's a sad thing if this is solely based on a doctors opinion, because this is why some people are addicts and others in real pain can't get relief.

     
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    Old 12-15-2006, 08:47 PM   #2
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    Re: requirements for opiod treatment

    Hi Ej,
    I understand your frusteration with the situation, But in truth most of the people on this board have been in pain management for years and when they started, they went through the same things and worse, because long acting meds didnt exist and most doctors would not treat anyone that wasnt terminal or hospitalized with anything stronger than tylenol with codeine.
    I myself went through tens units, bio~feed back, hydrotheraphy, accupuncture, injections, you name it, for a long time before I was put on a opiate regimine.
    Those people you mention that seem to always have meds that they abuse, don't last long in PM. If they are seeing a doctor that is irresponsible, it is only a matter of time until he is shut down and his patients thrown into withdrawal. If they do manage to find a legit doctor, they have to follow the rules or they will be cut off, plain and simple.
    I agree that people like that make it harder for the rest of us, but a lot of the people who seem to 'get anything they want' have really been through years of suffering and trial and error and years of proving they can manage their pain medications responsibly to get where they have some quality of life.
    Please don't give up, you will find a doctor that you can communicate well with and that will be willing to prescribe in a responsible manner, always having your best interests in mind.
    For most people, total pain control would mean they had very little quality of life, and a good doctor will NOT shoot for 100% pain control, 100% of the time, but rather a balance of pain management that enables you to have the best possible life and activity level.
    I do understand how frusterating it can be, and I look forward to reading more posts and getting to know you better.
    Your Friend, Fabby

     
    Old 12-15-2006, 09:50 PM   #3
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    Re: requirements for opiod treatment

    I would add that the more you ask for specific treatment, the less likely you are to get it. So rather than specifically asking for an opioid for pain relief, phrase your request differently. Instead say something along the lines of "I'm miserable all the time doctor, my pain is never less than 7 on a scale of 1-10. My sleep is disturbed as I hurt too much to fall asleep easily, and once I'm asleep I wake up in severe pain within a few hours. I can't enjoy even simple activities that I once looked forward to, and my personal relationships are suffering because I'm in too much pain to enjoy interacting with family and friends. What can we try next to try to get me some relief? I can't go on living my life like this!" He has to respond to a question like that, but he may not respond with what you have decided you think is the right answer for you. No matter, whatever he says would be next in line for a course of treatment give it a try with an open mind. If it helps, great!! If it doesn't then make an appointment after giving it a good try and go back and tell him the new treatment isn't working. Again state the level and consequences of your pain, and ask him what you can try next. Rinse and repeat until you and your doctor finally find the answer that works for you.

    Many doctors will not tolerate being asked directly for pain meds and will automatically say no. And there is a hierarchy of treatments to move through before a doctor will prescribe pain meds. Just keep seeking the next step in treatment until you finally feel better. Always ask what comes next, never tell the doctor what you want next. You and your doctor may just find an effective treatment for you that doesn't require narcotic pain meds! Just let the doctor make the plan, and keep giving him feedback if the plan isn't working. That is where alot of people drop the ball. They don't go back and tell the doctor that the plan isn't working. They just feel like they were given 1 option, and it didn't work, so they are stuck. You may want to consider keeping a pain journal with ratings of your pain, what you were doing at the time you noted the pain, what action you took to relieve it, and what relief if any you found.

    For example:
    12/15/06 I spent 15 minutes loading the dishwasher and sweeping the kitchen floor. My back pain spiked from its usual 7 to 9 with severe burning sensations in my lower back and radiating down my left leg. I took 2 OTC ibuprofen and laid down with a heating pad for 20 min. 1 hour later the pain was down to 8. I then did the gentle stretching I learned in PT and the pain returned to its usual 7.

    The more concrete information you can give the doctor the better. Good luck finding some relief!

     
    Old 12-15-2006, 10:02 PM   #4
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    Re: requirements for opiod treatment

    Fabby is quite right. I have waited many years to finally get accepted on to a PM docotrs schedule. Dr's must be very careful who they prescribe drugs too. They are watched very close for triplicate (scipts for class or schedule II controlled sub) druf prescriptions. They can;t just write a class II drug for every one. I am sure as you say, that you are in pain. Unfortunately, the world of opiate treatment is one of the most complex. Everyone will insist you get surgery or some sort of procedure to correct the situation. In some cases there is no procedure to help (that is were I am). Also, the world of PM docs is quite complex. It took many years to find the right doc for me.

    I am very happy now and could not be more thankful. I did have to go through many trials and tribulations first. Don't give up. You will find many friends on this board.

    I find that you will most likely not find the addicts looking for a fix on this board, but mostly people that are legit. The ones you speak of go to sneaky docs and hose docs get arrested. There is a webpage run by the d.e.a. that shows all the cases of Dr they have cases with and the reason. It is very interesting. it is amazing to see how many cases of Dr fraud is going on right now.

    Good luck

    California Chris

    Last edited by moderator2; 12-16-2006 at 08:21 PM.

     
    Old 12-15-2006, 10:02 PM   #5
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    Re: requirements for opiod treatment

    Dear Ejreiss,

    Fabby is right. Most of us have gone through every type of so-called treatment before finding the right doctor who is willing to listen and prescribe appropriately. It is not an easy process!

    I am on Social Security Disability due to the Lupus I have. My medical records are ridiculously thick. And, I am so, so fortunate to have the doctor I see. My Internal Medicine doctor Rx's my PM medication. She has realized that--in our area, at least--the Pain Management situation is not successful when it comes to getting this runaround that often seems rampant.

    After reading and re-reading your post, I can't understand why you aren't allowed a 2nd opinion. Because we understand the pain concept on this board, I believe that most of us would consider the lack of relief your doctor "provides" to be absolutely cruel.

    Please, please don't take what I'm about to ask the wrong way, because I am in your court! You said that no matter how much you ask, this doctor refuses. Does he see you as a "drug seeker"? I have been accused of this before, so I know that it is completely insulting--especially when you have proof (like your failed back surgeries). Some of the procedures that I endured prior to my opiod therapy should have been followed up by legal action.

    Finally, I had a set of circumstances that allowed me to be blessed with all of the right situations occurring at the exactly right time. My religious faith was enhanced by leaps and bounds when I found the right physician.

    I don't know how to go about saying it, but is there any possibility that you could ask the work comp people if inadequate care (often called "cruelty") is part of the treatment process? This just rubs me the wrong way.

    Please keep us posted on your situation like Fabby said. We want to get to know you better, and we want you to feel better!

    Sincerely,
    Jon (Conductor)

     
    Old 12-16-2006, 01:38 AM   #6
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    Re: requirements for opiod treatment

    thank you everyone for your reply,
    Although I am relatively new to this board I am not new to pain and I am subject to the wonderful wold of work comp. I am not a drug seeker but when I leave the doctors office he makes me feel like one because he refuses to help. I've been having problems for a long time and my first back surgery was way back in 1999, 2nd in 2001, and my 3rd in 2003. I've been under pain man since 2001 but never asked for any pain medicines. I consider myself to have a very high tolerance for pain and have dealt with this for a long time without asking for any pain medication. I don't know if you read any of my other posts but work comp considers me to have already seen three pm doctors for this. They are playing their games and the truth is I've seen the first one because he is the one over the course of the years who they sent me to for about ten different epidural type injections. When I was done with the injections I was done with him. The second was a pm doc that they sent me to have a independant med exam which was nescassary as a testimony on behalf of work com in order to settle my work comp case. the third doc i am seeing now and he is the only that has treeted me for long term management. He has given me perc 7.5 for about two years now and I have not been seeking more than that from him at all up until about three months ago. I am finding out that short acting meds are in no way suppose to be the only meds used for chronic pain. I am just at a point where I am realizing that I have had no life for a long time now and no matter what I try I can't seem to function and at this point it is my last resort. I also have always had a high tollerence to any medicine even if I have never taken it before. He prescribes me 60 percs a month and since I have a high tolerance to begin with my tolerance from taken it for two years has also grown and I get about two hours of successful relief each dose. So my problem is to decide if I would like to sleep for a couple of hours or get some relief during the day in order to go to the store or do something like that. I would like to be able to just try something long acting and see if that works. He won't even try any other medications as I am finding out there is a lot out there for nerve damage. His only choice seems to be the same every month with no trial of anything. I've obviously not asked for pain medicine until about three months ago however the doctor knows about my pain and problems since the beginning of treatment. I've only asked recently specifically for long acting opiods because I am tired of dealing with this with no success. I am also on ss but due to failed back syndrome, proven nerve damage, and proven scar tissue due to multiple surgeries. I am no fake and am sick of being treeted like one. And as in my original question I am still wondering if there is some kind of standard or protocol they follow or if they just make their own decision.

     
    Old 12-16-2006, 01:43 AM   #7
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    Re: requirements for opiod treatment

    p.s.
    obiously you can see my dilema. If I didn't have a problem I would be sleeping right now. It is about 4:40 am and still not able to get to sleep due to the pain I am in. This sucks.

     
    Old 12-16-2006, 03:42 AM   #8
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    Re: requirements for opiod treatment

    Hi again,
    I am so sorry you are suffering. I can suggest that since workmans comp is not being helpful in finding you a pain management doctor that is willing to listen to your concerns, You might want to try looking for an internist or GP that is willing to treat chronic pain as part of your overall care.
    I use my internist as my PM doc, and so do quite a few others on this board.
    Remember that it is in workman comps best interest for doctors to tell you theres nothing more they can do, you cost them less if that happens and so they want to limit you to the doctors that will give and outcome they desire.
    Maybe you could ask around, or get on the phone and see if you can find a regular doctor willing to take you on as a pain patient.
    Do you have friends or family that have ever had a bad accident or illness, if so ask them who they saw and what was done for them, they might be able to recommend someone.
    During the course of your surgeries, did you ever come across a doctor that seemed to be someone you could communicate well with? maybe an ER doctor or something? if so you could check to see if they also have a private practice you could get into.
    Your pain sounds just awful, I am so sorry you are suffering like this.
    ~Fabby

     
    Old 12-16-2006, 09:24 PM   #9
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    Re: requirements for opiod treatment

    thanx fabby for your reply and your consideration. Unfortunately my destiny is controlled by work comp and as I have stated earlier "the only doctor that w.c. is willing to send me to is the one that is treating me now". I wish I could go to other doctors and find someone that is going to treat me like a human being. He only sees me for 5 minutes once a month and refuses to try other methods to see what works for me. Then after 5 minutes he probably forgets all about me and I suffer all day long every day. The only way I could go to another doctor would be to pay for it out of my own pocket and then if I find one that is willing to try different medications I just wouldn't be able to pay for them on my own. Injuries like this not only results in a lot of pain and suffering but it also hurts financially and I couldn't afford to pay for it. It is work comps liability and they try everything they can to get off cheap. At this point I am just trying to figure out how to get this doctor to try any other methods. I was hoping you people could give me something to go into my next visit with. Maybe some info that will persuade him to try something else. If this fails to produce any other results then I will probably have to wait several months more to go in front of a judge and try and get him to order a second opinion.

     
    Old 12-16-2006, 11:51 PM   #10
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    Re: requirements for opiod treatment

    Do you live here in the states? Are you working? and finally it sound like you have no insurance plan?

    If you are not working, you may want to try and get some kind of financial aid or insurance coverage like medicare or her in California medical. Then you can possibly see some other kind of doctor.

    I don't see you going into the comp doc you have now and somehow telling him how to prescribe you drugs. If he is writing for perc, then he is writing some pretty strong narcs. Most of the meds that are long acting are the same drug that is percocet. I can't see why he would not want to give you a long acting since you have been on them for 2 yrs. Obviously it's not a short term injury, so why just give you short term meds? If he thinks you are going to continue to need the pain meds, then he should make life a little easier on you and give you Long acting meds.

    I would maybe go in with a question like "Doc, what is my outcome? How long do you think I will be in pain, and how long do you think I will be in your care?" Then maybe tell him that since this is a long acting injury, you want a long acting drug. You may even act dumb and say, "Hey doc, I have done a little research and found that I can take one pill every 12 hrs instead of every 3-4 and it has the same ingredients as what I am taking. It would sure help me and my life style not to have to take pills every 3-4 hrs. Can you please make my life easier and give me a script for these, so I can free up some of my time and my pain"

    just my thoughts

    California Chris

     
    Old 12-17-2006, 02:38 AM   #11
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    Re: requirements for opiod treatment

    Hey Ej, Actually there are guidelins for proper prescring for almost every state. You can check out your own state at this *** web site, Just point and click on your state and then read all the guidlines involved.

    [url]http://www.medsch.wisc.***/painpolicy/matrix.htm[/url]


    Those are just state guidlines, there are also fed guidlines and then you have the unwriten and every changing guyidlines of the DEA. DEA guidelines are made up as they go and those change from year to year and don't even require legislature to enforce their new idea of how PM should be managed. They dececided a few years back that everyone taking LA opiates would have to be seen monthly, regardless of how stable the patient was. You could be in a wheel chair and on the same dose for years and have never asked for an increase and they still wanted you seen every month to be reavaluated. There is no law that says patients have to be seen monthly to recieve contiued medical care, However once the DEA involves themself, the mere threat of an investigation means they can come in, seize all the records for reveiw and take no other action. The doc can't prescribe without a patients record so they have been shut down before even stepping into court or a charge being filed.

    Having the records available is part of the fed and state laws for prescribing opiates. So you have to play ball by the DEA rules. How long can a doc hold out when the dea has seized his patients records simply for reveiw. This isn't for the reveiw of your records by some outside doc,the review is done by over zealous law enforcement. You can't apply standards of law enforcement to the practice of medicine. Yet they have this unchecked power to change what they require of docs every year to allow them to practice without fear of being prosecuted. If they say every patient must have a urinalysis every 3 months,and be seen by a psychologist for an eval every year, if the doc doesn't play ball, they can effectively shut them down without ever filing a charge.

    Thier licences aren't suspended, but a doc can't prescribe to a patient if the patients chart is sitting in a pile of other charts in a DEA office pending review. So the fear of prosecution and the need to work within DEA guidlines whatever they may be is pretty much manadatory.

    I have yet to read of a doc clearing themself entirely once the DEA sets their eyes on them for their prescribing. Even if the doc wins a long case like Dr Horowitz in the late 90's, Once he was allowed to practice again, he was back under the scrutiny of the DEA and more charges were filed and records seized again. The first time they shut hime down, 16 patients commited suicide. How do you fight a govt aganecy like the DEA that has unlimited recources and doesn't require legislature to enact or make policy changes from one year to the next.

    So even if the doc follows every state and federal law that allows the prescribing of opiates, If the DEA decides you have too many patients recieving excessive doses, it will be a constant battle. What exactly is an excessive dose for the management of pain and how many patients is too many? Those things aren't spelled out in the laws and are left to interpretation of a govenrmant office who's job is to prevent drug abuse and diversion. Is law enforcement trained or capable of making those medical decsions? They aren't docs but they are capable of dragging a doc through the mud, suspending his dea #'s that allows prescribing and simply making practicing impossible by a mere investigation if patient records are seized.

    So who knows when they will step in and audit or shut a doc down. PM docs have the choice of complying with every whim of the DEA or not taking any chance and simply not use opiates or limit it to the bare minimum that ensures they won't be investigated. PM docs are putting 10+ years of training and hundreds of thousands of dollars in school loans and the future of their own practice, family and livelyhood on the line and in the hands of a DEA agent with nothing more than an acounting degree or a criminal justice degree.

    How does an acountant or CJ grad know what's needed by someone like you or me? Even with advanced screening methods and drug testing and psych testing, some patients will still abuse meds, doc shop or sell meds they claim they need. So no doc is really entirely safe unles he doesn't prescribe the meds the DEA feels shouldn't be available to those that don't have cancer and aren't dying.

    The actual laws are just one portion of what docs have to deal with as far as ensuring they stay in practice. Just because there are laws in place that say it's OK to prescribe meds if the doc has tried X, Y and Z unsecesfully, doesn't gaurentee a doc will be willing to put hislivelyhod on the line . Those laws don't protect them from DEA scrutiny or harassment. Yes they may win their case a couple years down the line and be ableto practice again, but how long can you expect a doc to live with no income to pay their mortgage and childrens college expenses. There human too and at the mercy of the DEA the same way we at at the mercy of the docs..

    Obviously comp is an entirely different can of worms. Your settlement gaurenettees treatment, but it doesn't gaurentee your satisfaction with the treatment your provided. Fortunately you have the option of apealing and requesting a hearing. You will likley win the right to get another opinion, but they don't make it easy. The more docs you see, the more tests they run, the more meds you take, the more it costs the insurance company. If comp docs don't look out for the interest of the insurance company paying them, they won't retain those lucrative comp contracts that ensures a flow of paying patients and the anual fee to simply be available for comp patients.

    A friend of mine is a doc and his first HMO contract out of his residency was for over a million dollars a year. That's just to be available to the patients that belong to that one HMO. In exchange for that million, He agrees to accept the HMO payment schedule and be avaiklable for those patients. If he actually sees a member of that HMO or performs a procedure he's paid for that individual service and he's just a general surgeon. Comp works the same way. They accept money up front to be available to workers covered by the comp carrier and they are expected to work for comp at controlling the expenses or they loose their contract and that anual fee that may be worth millions.

    Sorry if I'm rambling, It's 5 am here, I've been up all night. It's been 7 years since my last surgery and I haven't slept more than 3 hours straight since.
    Back to bed for a couple more hours, I hope

    Good luck, Dave.

    Last edited by Shoreline; 12-17-2006 at 02:44 AM.

     
    Old 12-17-2006, 12:12 PM   #12
    ejreiss
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    Re: requirements for opiod treatment

    djemcee- I live in new jersey Iam not working and I am permenantly disabled.
    I already have medicare but that was made clear to me that I can't use that for any back related medical issues at all. I have to use work comp and go to the doctors they are willing to send me to. I currently get prescribed perc only 2/day. My problem is I have constant pain and he is prescribing me short acting perc which gives me about two hours of help. He is prescribing it as if it is a long acting med which lasts for twelve hours.

    Shoreline- I understand where your coming from as far as the doctors losing their livelyhood, but the only ones that are suffering from all of this is people like me who have exhausted all other medical means and are told to suffer and take it like a man. I'm just wondering why its ok for some doctors to overprescribe patients until they are like a zombie and other people like me get stuck with a doctor that fears the dea so much that he dosn't even want to try to see if there is something else out there that will work for me. So why did this doctor even go into pain management if he is unwilling to help. Yeah he may risk losing his livlyhood but at least I wouldn't be loosing my whole life.

     
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