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5 years ago  ::  Jul 15, 2009 - 4:13AM #1
inthemidstwest
Posts: 136

Hi, everybody.


 


I've posted before on this board, but really haven't felt the need to post in quite some time.


HOWEVER...since I am again still AWAKE at 3AM... I have to wonder.


 


How do you get physicans to take you seriously about recurring, shooting pain that seriously prevents you from getting sleep. Even while taking painkillers, neuropathy meds, and getting cortisone injections???


In the past few weeks, I have been experiencing brutal shooting pain in my right leg.  To complicate matters more, both my anesthesiologist AND general MD are on vacation until the 20th.  Swell, eh?


Oh and then there's all of the hype since the death of Michael Jackson and Anna Nicole Smith.


How is the average patient (not celebrity pill popper) supposed to get real treatment for pain while the same profession enables celebrity junkies?


Rush Limbaugh, Heath Ledger, Anna Nicole...the list is endless.


Frankly, I find it sickening and disheartening.  If the Inspector General would arrest and charge the individual physicians with manslaughter, or a similar charge, revoke their licenses nationwide,  wouldn't it be of service to all pain patients who truly have to suffer due to others negligience/greed?


I realize individuals can develop addiction with certain medications. But it is becoming nearly impossible for the average American to get treatment without declaring full disability, just due to the endless MRIs, CTs, Neuro Consultations and such. Even with insurance, the overall cost of various meds keeps skyrocketing.  When I hear in media about Michael Jackson's 40,000 dollar pharmacy bill, it makes me want to vomit.


 


Maybe I'm just overly sensitive because I am in pain, and it is late.  But does anyone else see the hypocrisy with the overall management of pain treatment?


 

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5 years ago  ::  Jul 21, 2009 - 1:27AM #2
Dreamweever2
Posts: 733

I'm afraid that instead of getting any better, it's most likely only going to get worse for people in chronic pain. The doctors will become more and more afraid to prescribe for chronic pain with so many people becoming addicted, and celebrities over dosing. What we need severely is more research into more effective types of pain treatment. Too many doctors get defensive and frustrated, and it becomes easier to blame the patient. I think the sad truth is that they are very limited in what they can do to help, and their egos get bruised when their attempts don't work. Again, it becomes easier to blame the patient. I wonder how they would feel if they had to go around for a period of time in our bodies. Maybe then they could learn a little compassion, but then again, I doubt it because they would know that they would eventually to escape what we cannot. I don't know what the answer is. I just went through what I'm afraid was a failed attempt to control my pain. Since the procedure I had on Thursday, here it is Monday night, and I'm in worse shape than before. More pain, and able to do less. I don't like to be taking pain meds. It's something I try real hard to avoid. This procedure was one in which they burned the sensory nerves that are feeling the pain, in an attempt to interrupt the pain impulse flow to my brain. In the past, it worked for about 6-7 months, but this time, I'm actually in worse shape. The only alternatives left for me now are even more invasive, and involve implants, which I want no part of. I don't know what the answer is. It's a pretty frightening situation to be in. I think one of the worst parts about it is that there is no real way to prove the pain. It's very easy for doctors to deny it exists, or say it's all in your head, or look for another alterior motive that doesn't exist. Blame the patient seems to be the best solution for them. It gets them off of the hook, and very very few of them will admit if they can see, or know that something has been done wrong or mishandled by one of their colleagues. They cover for each other, part of the good ole boys club. Call the patient crazy, lazy, attention starved, whatever it takes, but cover each others butts at all costs. I wish I could say that I thought it would get better, but in all honesty, I can't.

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5 years ago  ::  Jul 21, 2009 - 2:03AM #3
Gracious_mystery
Posts: 7

I have chronic back and neck pain. I really know how you feel.


The only advice I really have is as a patient you are paying this doctor to help you manage your pain to your satisfaction. If you are really convinced (and be honest with yourself) that your Dr. is not giving you enough meds to fit your needs, and you have repeatedly told them this you need to find another Dr. if you can.


You have rights as a human being with a chronic pain condition.

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5 years ago  ::  Jul 30, 2009 - 12:39PM #4
MysticWanderer
Posts: 1,328

Graciousmystic and dreamweaver are both correct.  Unfortunately chronic pain control seems to be on a pendulum n medicine today.  When I first went into practice there was much medical board oversight concerning the over prescription of pain relievers.  Then the chronic pain bandwagon came through and there were actual sanctions for inadequately treating pain.  Then there were celebrity addicts and overdoses and once again the boards were down our throats about over-prescribing.  It is a fine line and frankly takes a competent, caring physician in a long term relationship with his patient to achieve good chronic pain control.  Acute care centers are reluctant to prescribe additional pain meds for fear of enabling addicts.  Your situation is truly a conundrum but these physicians should have others covering their practices and you should be abe to get some relief.  Again if you feel that your pan is not being taken seriously or not being appreciated by your current providers then by all means shop around!

"Not all who wander are lost" J.R.R.Tolkein
You can safely assume that you've created God in your own image when it turns out that God hates all the same people you do. ~Anne Lamott
"Against stupidity the gods themselves contend in vain."
Friedrich von Schiller
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5 years ago  ::  Jul 30, 2009 - 1:58PM #5
REteach
Posts: 15,016

I'm glad you have an anesthesiologist, too bad he is on vacation.


Your description sounds like neuropathic pain, and narcotics are not usually the best way to treat that--Neurontin is not something that is addictive and that does treat neuropathic pain.  Elavil is an antidepressant that helps with sleep and chronic pain as well, and is not addictive.  Cymbalta is another nonaddicting med that works well with pain. 


I think that part of the problem gets to be that even some pain meds take a while to build up to full dose, and narcotics are not the best pain pills for all kinds of pain.  Likewise, some problems do get better with time.


People also underestimate Tylenol and Ibuprofen, at least in larger scheduled doses.  Ibuprofen 800 mg three times a day over several days on schedule, not just when you hurt bad, can help.


I agree, though, that it is hard to get pain control sometimes.  One of my pet peeves is stuff like Lortab, that combine a narcotic and acetaminophen or ibuprofen.  When you combine them, you run the risk of underdosing or overdosing the acetaminophen or ibuprofen.  I prefer the NSAID on a regular schedule, then a separate narcotic on a regular schedule with a breakthrough dose.


 The sad thing is that trying to "tough it out" can actually increase sensitivity to pain.

I know you believe you understand what you think I said, but I am not sure you realize what you heard was not what I meant...
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5 years ago  ::  Jul 30, 2009 - 2:04PM #6
REteach
Posts: 15,016

On the flip side,


I spent an hour on the phone with a patient with chronic pain.  I set her up with a sports medicine doc to develop an exercise program, PT to help with exercise and pain, and OT to work out alternative ways to get things done.  I also set up a sleep clinic visit to try to help her sleep.  I recommended she contact her pain clinic and ask to see a pain psychologist.  She cancelled everything--and lost of lot of sympathy on my part.  Lots of pain cannot be controlled by meds alone--it requires a multimodal approach.  If she refuses, there ain't much I can do to help her.  There is no magic pill that prescribers are hogging to ourselves. And for some things, fibromyalgia being one of them, a slowly increasing exercise program is one of the most effective ways of helping oneself. 

I know you believe you understand what you think I said, but I am not sure you realize what you heard was not what I meant...
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5 years ago  ::  Jul 30, 2009 - 10:06PM #7
inthemidstwest
Posts: 136

That's unfortunate for the patient, unless they have already received all of these treatments with no overall improvement and/or no longer have insurance.


 


It just seems like the institution parody of pain management being effective when most doctors place true chronic pain patients on a 'how bad are you really in pain' category.


*on a scale from 1 -10, evaluate your pain.  *use either slashes, dashes or dots to indicate on the diagram severeness of pain.  Sound familiar?


 


After 10 years, EMGs, EKGs, MRI's, CT's, thousands of dollars in PT, OT. and acute care, nope, the pain isn't getting any better.  And ironically, I'm the same patient that refused high dosages of narcotic painkillers on the onset.  So maybe I shot myself in the foot?


Nonetheless, this pain patient is fully for the DEA to create a national database for narcotic pain management.  It seems silly there is none.  You can't even buy more than 2 bottles of cold medicine at your local Walgreens during cold and flu season without presenting ID.


Why not a national database???  Wouldn't it serve all well?


 


 

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5 years ago  ::  Jul 31, 2009 - 8:22AM #8
REteach
Posts: 15,016

Have you seen this:  pain-topics.org/  You could share it with your primary care provider.


I have seen methadone work well, but you really need someone who knows how to use it. 


The purpose of "how bad is your pain" is actually to try to make it better.  It provides an objective measure of "it was at 7, and now we have it down to 5" or "now it is up to 8--guess that didn't work."  It is called the "5th vital sign".  Generally, the goal is less than 3. 

I know you believe you understand what you think I said, but I am not sure you realize what you heard was not what I meant...
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5 years ago  ::  Jul 31, 2009 - 6:26PM #9
inthemidstwest
Posts: 136

Jul 31, 2009 -- 8:22AM, REteach wrote:


Have you seen this:  pain-topics.org/  You could share it with your primary care provider.


I have seen methadone work well, but you really need someone who knows how to use it. 


The purpose of "how bad is your pain" is actually to try to make it better.  It provides an objective measure of "it was at 7, and now we have it down to 5" or "now it is up to 8--guess that didn't work."  It is called the "5th vital sign".  Generally, the goal is less than 3. 




Thank you for the link....no MD has EVER mentioned the goal of pain management being at below a three. And I've never marked it at below a six.  There hasn't been one day in 10 years I haven't dealt with pain, either shooting pain or dull pain.  It's just been a matter of my assesment on a numeric scale.  Actually, I was thinking about checking into Zazen yoga classes, if there are different positions that can be acheived lying down. I also take omega-3 and an herbal supplement to help with inflammation, in addition to the Rxs.  My ultimate goal would be to manage chronic pain without having to rely on ANY medications, but that may be too high of a goal with my spine in the condition it is in. 


 


I was in an auto accident ten years ago and was diagnosed with spina bifida in my cervical and lumbar spine, even though I had never experienced any pain issues before.  At the time, oxycontin was being prescribed as a cure-all for pain management.  After taking 12hr release for two days, I flushed the rest.  It did absolutely nothing for pain but made me feel really off center.


 


I just started receiving cortisone injections with a block in the past six months...this seems to last for only a few weeks at best. Am now taking 4 assorted meds for neuropathy and breakthrough pain, in addition to 800mg ibuprofen.  It sounds like this is as good as it gets.


Very frustrating to say the least.  So thank you again for the link!


 


As a healthcare professional, how do you feel about there being a national database to manage prescribed narcotic medications in patients?  Pro or con?


 


~itm


 

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5 years ago  ::  Aug 01, 2009 - 8:52PM #10
REteach
Posts: 15,016

Pro.  It might help some people feel more comfortable with prescribing them.  Most people do not abuse them.  


The thing I like about that link is that it is multimodal.  Unfortunately, for some people, there is no med that will take the pain away.  I just gave some lidoderm and Efector patches to someone, and they took the edge off, but she needs some non-med stuff.  PT can often use deep heat.  Hot and cold are underestimated.  Acupuncture, particularly with some electrical stimulation can help.  So can TENS. Reiki and massage. Some people find that memory foam mattresses can help.  Sleep is critical--perhaps a sleep clinic can help too.  Seriously, a good pain psychologist can often help as well.  They understand the pain is real, but things like guided imagery and relaxation, with the other stuff, can really help too.  Exercise can really help, too, for those who are deconditioned or have problems like fibromyalgia and Ehlers-Danlos.  Pain is depressing and some anti-depressants really are helpful in dealing with chronic pain.


Again, narcotics really are not the answer to all types of pain, particularly neuropathic pain.  

I know you believe you understand what you think I said, but I am not sure you realize what you heard was not what I meant...
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