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Did I do something wrong? (and pain med contract questions)

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Old 07-20-2010, 07:07 AM   #1
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steve63 HB Usersteve63 HB User
Question Did I do something wrong? (and pain med contract questions)

Hi Guys,
I had a few questions about pain management doctors and pain med contracts. After years of chronic pain, my GP finally referred me to a pain management doctor. I'm going through a series of injections now, and the pain doctor said he would take over prescribing the medications my GP had been giving me (Tramadol and occasionally some Percocet for bad flares only). On my first visit, the Pain Doc asked me if I needed any meds filled. It had been over six months since my last Percocet was filled by my GP (30 pills) and I was out of them so I asked him to fill it. He said sure and gave me a script for 30 pills to take as needed. About six weeks later I went for my next injection. At the end of the appointment he asked again if I needed any meds filled. I said no that I was all set for meds since I hadn't been taking too many Percocets over the prior six weeks. After the second injection I had a very bad flare up (including fever & spinal headache) so I ended up using half of my 30 Percocets within a week. Well anyway, six weeks later I went back for my follow up. By then I only had a few Percocets left. When the appointment was over, he didn't ask me like he usually did whether I needed any meds filled. So as he was leaving the room I asked him if he could refill the Percocet because I was getting low. He looked at me kind of suspiciously and asked me if I had gotten any Percocet recently from one of my other docs (of course I had not). I told him no and then he said "Well if you want more Percocet you'll need to sign a pain med contract". I was taken aback since I thought pain contracts were only for patients who were prescribed opioids on a regular basis rather than as needed. Am I wrong about that? Is it normal for docs to make you sign a pain contract even if you are only taking pain meds as needed? The contract talked about being willing to submit to drug tests. I asked the office nurse why I would ever need to be drug tested since I was not going to be taking the Percocets regularly. Aren't drug tests to prove you actually are taking a drug rather than diverting it somewhere else? It didn't make sense to me, but I signed the contract anyway and he gave me a script, but I left the office feeling a bit unsettled. On the first two visits he is the one who offered me more Percocet which I refused the second time. He never said anything about a pain contract. Then on the third visit I asked for a refill only because he didn't ask me his usual "do you need any refills" and I assumed he was just rushed and forgot. Did I do something wrong? Are you not supposed to ask for a refill from a pain managment doctor unless he offers it? Is that why he asked me to sign a contract, because I asked for meds rather than waiting for him to offer them? I read the contract rather quickly and being a little unsettled I'm not sure I remember everything I read. I know one thing said that I could only get pain meds from that Pain doctor. I have no problem with that in general. My only concern though is that I do get recurring kidney stones. Every couple of years I end up in the ER on IV pain meds (it always seems to happen on the weekends). Anyway, now that I've signed a contract, if I were to go to the ER on a weekend for a kidney stone, do I have to refuse any IV pain meds they offer me because of the pain contract? This whole thing really has me a bit unsettled. I have never have nor would I ever abuse meds. I just don't understand why all of a sudden out of the blue they asked me to sign a contract. Everything seems more complicated now. All of a sudden I feel very guilty. I almost feel like I should just stop asking for any more Percocet and deal with the flareups as best I can. Is what happened to me normal, or do you think I must have done something wrong to make this pain doctor suspicious and make me sign a contract?


Last edited by steve63; 07-20-2010 at 07:09 AM.

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Old 07-20-2010, 08:45 AM   #2
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Re: Did I do something wrong? (and pain med contract questions)

DON'T feel guilty. Don't feel like you did anything wrong. It is totally normal that he had you sign a contract. Maybe he thought that "as needed" meant less than you thought. Don't worry about it. Please! It's totally normal to have to sign a contract. Don't worry about getting a urine test, either. If you get one, he knows you may not have it in your system because you take it as needed.

Do you see him every month?

Okay, so also...if you do go to the ER for a shot, then I would call your doctor first, to get his approval. Does he know that you get kidney stones? If he doesn't know, then I would bring it up at your next appointment.

Like I said, PLEASE Don't worry. He sounds like a nice doctor. It is so normal to have to sign a contract these days. Really! It sounds like he is a straight shooter, so maybe you misread him when you thought that he was suspicious. Maybe he was just thinking. Sometimes, I give people funny looks accident.


Old 07-20-2010, 09:27 AM   #3
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Re: Did I do something wrong? (and pain med contract questions)

They are very suspicious dont be nieve, With the overwelming drug missuse the pain managment persciber has to be very careful, thats the reason for the contract. It helps protect the persciber and You, if you fail to follow any of the guidlines he will drop you as a paitent. and No you did nothing wrong by asking for pain meds. Iv been seeing a pain managment perscriber for over 2 years same meds for the last 3 years and drug testing every 2 weeks and still get the same LOOKS and comments that make you feel like you did something wrong. Its terrible that people who really need the pain medicatins have to put up with the stigma of opiods because of drug abusers.

Old 07-20-2010, 09:35 AM   #4
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Re: Did I do something wrong? (and pain med contract questions)

PM docs are VERY suspicious. You have to follow that contract to a tee which (if your contract is like mine) means:

1)submitting to urine tests at any time and possibly blood tests

2)pill counts

3)don't cancel or change your appointments

4)don't up your dose on your own

5)if you have a flare-up, call your doctor--but try to get through it on your own (well, that's what I do by using heat/ice, etc.)

6)don't ask for early refills

7)try other things to help your pain like exercises if you're allowed, yoga, heat/ice, the list goes on...

Just my opinion here... PM docs are under a lot of scrutiny and have to be very careful with prescribing medications...

Last edited by Administrator; 07-24-2010 at 03:38 PM.

Old 07-20-2010, 10:24 AM   #5
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Re: Did I do something wrong? (and pain med contract questions)

Thanks for the advice Reallywant (and you too Kevin). I feel a little better now. I thought contracts were just for those on heavy doses. The 12 weeks between my last two Percocet refills was the quickest I ever went through almost 30 pills and that was only because of the spinal headache I had for several days. But it still only averages out to be a little over 2 pills per week. I just didn't think such a small amount was a big enough deal to require a contract.

How does a pill count work? Do they call you up at random and ask you to bring in your pills at any moment? I assume they are making sure you don't have less than the # of days that have passed would allow? That's makes me nervous because I had a prescription stolen from my house by a "friend" a few years ago. I didn't report it to my GP for fear he'd think I was making up the story to get more drugs. Thankfully I was doing pretty good at the time and didn't need the meds that bad. I guess I'd better find a safer place to keep my meds because right now they are just sitting in the medicine cabinet where any visitor could open up and see them. I've never been overly worried about theft figuring that if someone did steal them I'd survive until my next appointment. But if theft could cause me to lose my doctor that would really stink. This is what I mean when I say it's getting really complicated now with a contract. They just don't make it easy for you...but I guess it's more the government than the I guess I have to deal with it.

Last edited by steve63; 07-20-2010 at 10:30 AM.

Old 07-20-2010, 10:27 AM   #6
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Re: Did I do something wrong? (and pain med contract questions)

I bought a safe to keep my pain meds in. I too am in Pain Management and don't want a "friend" to help themselves. Plus I won't have to worry about the questions that go along with someone being nosy about WHY I have those meds etc

Old 07-24-2010, 01:00 PM   #7
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Re: Did I do something wrong? (and pain med contract questions)

At the PM clinic I go to we take all our meds to every apt. Honestly they only count the controlled meds, mainly opiates. But they want the ability to see if your taking more or less than they prescribe. Every script I pick up has a fill on or after date on it, So it's not even possible to fill a script before day 30. I do about one UA a year at one of my regular apts, although my contracts say I am willing to come in within 24 hours notice and submit to a completely random test. Every doc is differewnt though.

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