Clarifying Dependence, Tolerance & Addiction

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PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 6/17/2008 4:23 PM (GMT -7)   
Since this issue comes up for many of us, in many different contexts, I did a little research and found the following consensus document developed by the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine. I can't copy the article here because it is copywrited, but I think it's worthwhile reading for anyone interested in these issues. Note that these are not specific diagnostic criteria, but as someone who has been a professional in this area for many years I can tell you the diagnostic criteria for addictions are comparable to the behaviors and factors detailed in this piece. Here's the link

http://www.ampainsoc.org/advocacy/opioids2.htm

Sorry - I think you'll have to cut and paste it into your browser's window.

PaLady

Morgoth
Regular Member


Date Joined May 2008
Total Posts : 177
   Posted 6/17/2008 8:39 PM (GMT -7)   
Exactly what I needed. Now I know how the US looks at these things (or should look at them).

Thanks, PaLady

Morgoth.
To stand and be still at the Birkenhead Drill is a mighty bullet to shew.


nvrthesame98
Forum Moderator


Date Joined Jun 2008
Total Posts : 6706
   Posted 6/18/2008 2:14 AM (GMT -7)   
Thank you for taking the time to search this as this one article simply puts into context the difference that should be used but sadly isnt always the case. It is one of the best explainations I have come across and really appreciate you posting it for us.

There are times that Docs are going to have a difficult time distinguishing between the examples but if all of them would just keep in mind that any one of us CPers would try anything to stop the pain. I mean there have been times in my life when I have had uncontrolled pain as I know many of you have as well that it didnt matter if they told you swimming across Lake MI 4 times would do the trick you might just give it a shot wouldnt you? No matter how ridiculous it sounds or far fetched, one hour of relief would be worth anything to some of us. I know for me it would. If at those moments that pain gets ahold of us and we know days and weeks of neverending unchanging,debilitating pain with virtually no end in sight most of us would do or try or take anything they told us to and that marks the difference in whether or not I am addicted to opiates or addicted to living life without that pain.

That is the goal for each and every one of us isnt? I would trade just about anything I have in this life outside of my kids or their health for a normal,nothaving to go to Docs,being tested,being put thru all we have to be put thru and in the end having to base our entire existance around medicines and how well they will work today.

I get so bone weary tired of going to bed at night and not knowing in the morning when I wake if I will ever again have to be in that kind of pain (before being adjusted correctly on opiate dose of meds) The sheer thought of something happening to my Doc or meds or whatever and throwing me back into that kind of life. How can any Doc, or person or anyone else even assume that this is an addiction? Then maybe they are right! Maybe I am addicted to a better way of living,maybe I am addicted to not being in pain,maybe I am addicted to being able to get out of bed and spend time with my friends and family and do the simple things in life I use to take for granted and others do everyday. If that makes me an addict? I hold up my head and wear the stigma as well as the label proudly for I surely am just that.

Do I get upset by the labeling anymore? Not after all these years in context to myself. Do I get upset when I have a Doc trying to convince me I can live without the meds? You bet! Do I do it because I am addicted to the meds? Not on your life! as I already said I would try anything but sadly most of us have and this is only what works. I know I didnt get here in a day as I am sure most of you didnt either. Trying to figure out why any Doctor dedicated to prevent and alleve human pain and suffering would ever risk leaving a patient or person in that kind of pain for even day makes me wonder how little compassion we as human beings have left in us.

On a tangent again but for those of you who have been there I know you will understand every word I have spoken here.

Thanks again PAlady for taking the time and being concerned enough to find answers to maybe aid those questions in our minds as well as others and everyone here undertreated should take the article to their next appointment with them,maybe it wont do a bit of good,maybe it will.
NVR
 
Bilateral knee replacements,spondylosis of L-3,4,5 and S-1, osteoarthritis,premenopausal migraines.
 
Meds: Methadone,xanax,zanaflex,maxide,prempro,K+,indocin,lexapro,neurontin(coming off) lyrica(going onto)
 
 


modernartgrl
New Member


Date Joined Jun 2008
Total Posts : 14
   Posted 6/18/2008 3:37 PM (GMT -7)   
well said neverthesame98 and thank PAlady for the info and link.

ryand
Veteran Member


Date Joined Dec 2007
Total Posts : 639
   Posted 6/18/2008 4:05 PM (GMT -7)   
PALady, thanks so much for sharing this article. And Nvr, thanks to you for your words. As modern said, very well spoken!

I am, unfortunately, not yet able to say I've found a doctor who will treat me adequately to even mediate the pain. But hearing you say you have a correctly adjusted regimen gives me hope. I admire you for being able to shake off the frustration of the labeling we are subjected to. My greatest sorrow, though, is that my own friends and even family do not understand the difference in these terms. I think I may print this article out and if the time is ever right, perhaps it will help them to see a little more clearly into my world. Like you said, nvr, there is almost nothing I would stop at to find a way to ease this pain. I just pray that someday I will find the right thing.

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 6/18/2008 4:28 PM (GMT -7)   
You're all very welcome. Glad you're finding it useful. I never thought of taking it to docs & even family members, but it could be useful in a lot of situations. If you take it to your docs, be sure they don't think of it as just some newspaper article. There are three major medical associations which combined to develop this statement, two associated with pain and one with addictions. That should help it carry a little more weight.

But I also hope it helps us to clarify in our own minds that, regardless of how we're labeled by others, the overwhelming majority of CPP's are not addicts. Yes, there are abuses of the meds we take, but not usually by us. And sadly, some people who have genetic predispositions may have a higher likelihood of slipping into addiction if they have to take narcotics or other medications for pain than most of us will. There are some "red flags" that need to be respected, so that we can help pintpoint those who might be abusing, and/or who might need help for addiction as well as CPP. But that's the minority of us.

Again, glad you all appreciated it.

PaLady

BigLucy
Regular Member


Date Joined Mar 2007
Total Posts : 413
   Posted 6/18/2008 8:55 PM (GMT -7)   
Really good "article." I am going to print it out and save it for the future b/c even though I have a very good pain MD right now, who knows what the future may bring. I have had my share of doctors that have under-treated me and one memorable experience with a brand new MD who didn't say a word the whole visit other than, "IF! I decide to continue to prescribe you pain medication I will need you to sign a contract, read material about addiction and promise not to bug my staff about refills." Oh, and then she threw in that she wanted to start to taper me down and off the meds b/c she didn't believe in long-term use of pain meds--I said, great, so you've discovered a cure for my chronic illnesses, alert the press! I didn't see her a second time.

P.S. Still working FT, but tough going still--lots o' sleep required. It's why I haven't been around awhile, going through a bit of "depression" totally related to my lot in life.

Boxerlover
Regular Member


Date Joined Dec 2006
Total Posts : 274
   Posted 6/18/2008 9:11 PM (GMT -7)   

PAlady, just chiming in with everyone else to say thanks, great article.  When I first was given pain meds, I had multiple problems and at one time or another was given prescriptions for pain meds from different docs.  I knew enough that if I was going to be on them long term, I needed one doc to prescribe them for me.  I approached my primary and asked if he would be my only prescribing doc and the first question he asked me was I not worried about becoming addicted and I said compared to the pain that was the least of my problems.

I just don't get it, if the percentage of true cp patients becoming addicted is only 1-3 %, why are we all treated as if it was 75-80%.

Melissa


nvrthesame98
Forum Moderator


Date Joined Jun 2008
Total Posts : 6706
   Posted 6/19/2008 3:07 AM (GMT -7)   
Good Question Melissa! You have to wonder where and hwo they get those numbers dont ya?

RY please keep searching! There are great Docs out there and even though they are few and far between it will be well worth the searching effort when you do find one. Being controlled is one of the greatest things in life and I know this is a sad analogy of what has become important in my life but I had got to the point where the pain was all consuming and getting relief became one of the greatest moments in my life. It will be yours too!

I cant count the appointments,the Doctors,the clinics,the tests,the "sorry" I dont do pain management or I dont use narcotics for pain treatment? The times one Doc just sent me away in tears with an appointment of referral to another Doc months away yet and I the feelings of despair and the black hole I was living in that made me think horrific thoughts of ways to stop the pain myself.

I resent the years and the Docs that stole them from me simply because they couldnt see my pain or feel my pain or thought I was just another addict looking for a way to get high,they couldnt comprehend that if they had told me dog doo was the new thing in pain management I would have said "bring it on" If that is not a desperate person voice then what does it take?

I contemplated suicide several times to just end the pain but knew most likely all that would do was land me in a mental health clinic where they wouldnt even allow me to have ice or a heating pad or any other of the numerous things I was using to help some! Sad,sad,sad but so true for so many.

Even worse was the "drug wars" making it harder and harder to find Docs that were not opiate phobic as Gramps so elegantly puts it. By the way have not seen him in a few,sorry thinking out loud.

Just yesterday a Doc here where I live had his license suspended due to a patient of his ODing on methadone and xanax and I mean according to the reports he had way higher then prescribed in him but still the Doc is now temporarily unable to prescribe narcotic meds and I feel so sad for those many patients he has that are not going to be able to refill their meds this month or get them at all without finding another Doc and we all know how long that can take.

He is pending investigation so it is hard to say how long he will be suspended or even if he will ever get it lifted leaving many folks without their meds and in search of a new Doc. I kind of look for him to retire as he is one of the older Docs here that try to treat medicaid and medicare folks that cant afford the PM clinics. His health has not been good for the last few years either so he will probably throw in the towel and say forget it!

Didnt mean to take a tour here but just wanted you to Ry and others to not give up and if you can afford to travel to find a Doc try looking in nearby states if you live close to the line or larger more populated cities with more options. Word of mouth is one of the greatest ways to find a Doc as well as if you and your RPH are on a name basis and you feel comfortable asking him he is going to be a wonderful referral basis as he knows who prescribes and who isnt opiate phobic and who is.

Good luck in your search!
NVR
 
Bilateral knee replacements,spondylosis of L-3,4,5 and S-1, osteoarthritis,premenopausal migraines.
 
Meds: Methadone,xanax,zanaflex,maxide,prempro,K+,indocin,lexapro,neurontin(coming off) lyrica(going onto)
 
 


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 6/19/2008 10:25 AM (GMT -7)   
Nvr,
Your post contained so many gems I don't even know where to start. A tour but not a detour!

What touched me most is the reflection about how much of our lives get lost - lost forever - because we couldn't get good pm in a timely manner. I look at the years of my life in my rear view mirror and want to cry, and like Ry I've not yet found a good doc. Yes, I'll keep searching, but the energy to search dwindles, especially as I have to now fight the SSD battle and financial ruin. Tossed around last night not just from pain but the anxiety about what my future will or won't look like.

And searching for a doc sounds good, but you also know I'm sure the more we pain patients do that the more we look like "drug seekers". I want to find a new PCP but the city I live near is not a big one, and even though I'm part of the overall heatlh care community I sometimes think it works against me. Certainly doesn't work for me.

The other situation you described about the doc is exactly what happens all over the country, and has happened in my nearby city to the point where all the other docs are afriad to prescribe. It's not just the loss or "retirement" (can you blame the guy for wanting to get out of the business? This is part of what docs fear, and why they won't prescribe and I can't blame them for not wanting to be part of the law enforcement mess.) it's the fear that gets engendered in the remainder of the medical community as they watch just one doc go to jail, or be forced to retire, or something comparable. We had two PCP's in the local city prosecuted; one was "questionable" even from my standpoint, but the other was generally known as a good guy who was trying to help his patients and one day he's shut down, loses his license, and is faced with a looming legal process. He didn't go to jail, but lost his license; the former doc did go to jail. So when we're all looking at mess we CPP's have to face it doesn't help to always be angry at docs - and I'm not saying I don't get angry, too, but when you really take all apart you can't blame some of them.

I don't know what the answer is. Sometimes I think we need a lot of money for a huge PR campaign. You know, something that would stick with people like the 'this is your brain on drugs" commercials. Changing public opinion can change a lot but it takes creativity and some $$. To help people see the NEEDLESS suffering, the lost productivity, and lost lives in a different context. And sure, no one wants drug abuse and diversion to be ok, but most of us struggle to stay within the hoops placed out for us and in the overwhelming majority of cases we're not the ones diverting the drugs. The many get punished for the few. There has to be a better way to meet the needs of CPP's and law enforcement.

PaLady

By the way, I'm glad we're having an intelligent, reasoned discussion about this topic rather than a heated debate.

Post Edited (PAlady) : 6/19/2008 11:52:40 AM (GMT-6)


HelloKittyGirlwithFM
Regular Member


Date Joined Jun 2008
Total Posts : 27
   Posted 6/19/2008 4:50 PM (GMT -7)   
OMG, I am so mortified! I have been recently dx with fibro. I have also had cronic pain with periods and should get a hysterectomy. My gyn gives me tylenol 3 for pain and she checked the pharmacy and I have refilled sooner than my cycles and my gyn asked me if I was using her perscription for other things. I emphatically denied it, but it is true. I use it for the fibro pain because my regular dr wouldn't prescribe it. thank goodness I see the pain doctor on the 26th, but I am so embarrassed, I don't know what to tell my gyn. I have to go in to see her after I see the pain dr. Does anyone have any suggesstions? Has this happened to anyone else?

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 6/19/2008 5:07 PM (GMT -7)   
Hellokitty,
Welcome to the chronic pain forum of HW. I'm guessing that you posted to this thread because you're afraid of being perceived as an addict, or abusing your meds? I hope you read the article I referenced in the first post, as it may help you see that in all likelihood you're not an addict (unless there's a lot more you're not telling us, and I don't get that "sense").

That being said you did lie to your gyn about pain meds. and docs tend to not view that very well. If you have a good relationship with her, I'd suggest telling her honestly about the fibro, and apologize for not telling her up front. I would definitely be honest with your pain doc, because if you lie to two docs about pain meds you could get yourself into real trouble, and they may stop prescribing, plus it goes into your records and you have a difficult time ever getting pain meds. So I'd be up front with the pain management doc, and hopefully you weren't taking too many extra T3's. It's better your gyn realize you were using it for your own legitimate fibro pain then think maybe you were selling the pills or addicted. One thing is that whether you pain doc requires a pain contract or not, you want to take your meds from him/her as directed, and if you're pain's not being covered call the doc rather than try to fill something early.

Do you know what made your gyn check the pharmacy to begin with? If you have any kind of addiction history (and I'm not saying you do) then that's another story, but you'll still need to be honest.

I don't know if this helps. You may want to start a separate thread of your own and that would get your situation out to more people.

PaLady

Post Edited (PAlady) : 6/19/2008 6:10:07 PM (GMT-6)


HelloKittyGirlwithFM
Regular Member


Date Joined Jun 2008
Total Posts : 27
   Posted 6/19/2008 5:30 PM (GMT -7)   
Hi,

Thanks for answering my thread. No, I don't have an addiction history. I have cronic pain from Fibro, migraine headaches, painful periods. I think she called because I was calling so soon for medications again. Here, they will only do 2 refills on tylenol 3. So every three months, I have to call for another perscription. My perception is just that doctors are getting beat up over pain meds. She seems to be a good doctor. I just can't wait to go to the pain doctor and you are right, I need to be up front. So I think what I am going to do is go to the pain doctor and then tell her, and then she can quit writing for me. She is the only doctor that I have that issues that to me, so when I see the pain doctor, I get let her loose so to speak. I don't really care for taking the drugs, but I hate the pain! I am early on in my diagnosis, so I am still learning how to talk to doctors and find doctors that will help with pain management and rehabilitation.

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 6/19/2008 6:24 PM (GMT -7)   
Dear Kitty,
Yes, you're right docs are getting beat up and most often not with good cause. So they tend to be very watchful when it comes to pain meds, and that's not always a bad thing. I hope your pain doc is good and understanding of your situation, so you can get your pain adequately treated. You mentioned possible surgery (hysterectomy) and I don't know how much that would help your pain, and what your situation is regarding your gyn diagnosis (are the migraines related to hormones?). If you can resolve the gyn issues, maybe your overall pain levels will be reduced and you won't need so much pain medication. It is a challenge to learn how to talk to doctors - and what not to do. Being up front about your pain and other symptoms, and not underestimating or minimizing them will help so you doc gets an accurate idea of how much you're hurting. Chutz (the moderator here) recommends keeping a pain journal and that might be very helpful to do and take to your pain mangement doc. I'm not sure what thread it's on, but Chutz gave a link to a sample pain journal. You might do a search for it. That helps both you and your docs see your pain levels, how they relate to your daily activities, what helps, makes pain worse, etc. Even logging foods can help.

There's lots of good info. on this forum, so keep reading some old threads that seem relevant. You also may want to check out the fibro section.

Good luck!

PaLady

Post Edited (PAlady) : 6/19/2008 7:29:41 PM (GMT-6)


nvrthesame98
Forum Moderator


Date Joined Jun 2008
Total Posts : 6706
   Posted 6/20/2008 2:15 AM (GMT -7)   
Hello Kitty and welcome to HW.

Most likely the pharmacy notified her that you were requesting early refills as this is one of those things that look like a flag to them and to cover their own they call up and ask if the Doc is aware of.

They are a little more lenient with tylenol 3 then with other opiates in a higher class and those you couldnt have refilled before the cycle written.

Hoping your pain appointment covers the basis for you since most general Docs have heavy qualms regarding prescribing opiate meds for long term problems.

The addiction problems in this country have forced us into a state of virtually no treatment or walking such tight lines it is time consuming as well as life encompassing to get the meds and keep them as we need them.

Far too many Docs and hospital ERs are not using opiate therapy these days out of fear or just the fact that it is also time consumming for them as well with all the record keeping required and making sure they cover all the basis for the reason for prescribing meds for pain and showing they have tried other options and continue to try other things to treat your pain that the majority just dont want to be bothered with it all. That leaves many many CPers out in the cold undertreated or not treated at all.

Again welcome to the forum and I hope that you can and do find a place here where you can take what you need and add something for someone and throw the rest away.
NVR
 
Bilateral knee replacements,spondylosis of L-3,4,5 and S-1, osteoarthritis,premenopausal migraines.
 
Meds: Methadone,xanax,zanaflex,maxide,prempro,K+,indocin,lexapro,neurontin(coming off) lyrica(going onto)
 
 


bubsykitty
Regular Member


Date Joined Jul 2008
Total Posts : 23
   Posted 7/14/2008 12:47 PM (GMT -7)   
Great article!!! Thank you so much PAlady for posting the link!!
It is unfortunate for the legit CPP's that too many Dr's are fearful of Rx-ing pain meds because of the handful of bad eggs out there ....

tom inpain
Regular Member


Date Joined Jul 2008
Total Posts : 239
   Posted 7/14/2008 6:20 PM (GMT -7)   
Hi Pa Lady: you give excellent advice and i really enjoy reading Your comments and suggestions. Thank you for bringing this article to our attention. best regards, tom

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 7/14/2008 7:46 PM (GMT -7)   
Thanks bubsykitty and Tom.

And Tom, I'm not sure if I ever welcomed you, but please take this as a belated welcome. Some days I just can't keep track! I think I welcomed bubskitty!

PaLady

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 7/21/2008 5:11 PM (GMT -7)   
Some new members may find this helpful, so I'm giving it a bump.

PaLady

~Cloe~
Regular Member


Date Joined Jul 2008
Total Posts : 125
   Posted 7/21/2008 9:46 PM (GMT -7)   
nvrthesame98 said...
Thank you for taking the time to search this as this one article simply puts into context the difference that should be used but sadly isnt always the case. It is one of the best explainations I have come across and really appreciate you posting it for us.

There are times that Docs are going to have a difficult time distinguishing between the examples but if all of them would just keep in mind that any one of us CPers would try anything to stop the pain. I mean there have been times in my life when I have had uncontrolled pain as I know many of you have as well that it didnt matter if they told you swimming across Lake MI 4 times would do the trick you might just give it a shot wouldnt you? No matter how ridiculous it sounds or far fetched, one hour of relief would be worth anything to some of us. I know for me it would. If at those moments that pain gets ahold of us and we know days and weeks of neverending unchanging,debilitating pain with virtually no end in sight most of us would do or try or take anything they told us to and that marks the difference in whether or not I am addicted to opiates or addicted to living life without that pain.

That is the goal for each and every one of us isnt? I would trade just about anything I have in this life outside of my kids or their health for a normal,nothaving to go to Docs,being tested,being put thru all we have to be put thru and in the end having to base our entire existance around medicines and how well they will work today.

I get so bone weary tired of going to bed at night and not knowing in the morning when I wake if I will ever again have to be in that kind of pain (before being adjusted correctly on opiate dose of meds) The sheer thought of something happening to my Doc or meds or whatever and throwing me back into that kind of life. How can any Doc, or person or anyone else even assume that this is an addiction? Then maybe they are right! Maybe I am addicted to a better way of living,maybe I am addicted to not being in pain,maybe I am addicted to being able to get out of bed and spend time with my friends and family and do the simple things in life I use to take for granted and others do everyday. If that makes me an addict? I hold up my head and wear the stigma as well as the label proudly for I surely am just that.

Do I get upset by the labeling anymore? Not after all these years in context to myself. Do I get upset when I have a Doc trying to convince me I can live without the meds? You bet! Do I do it because I am addicted to the meds? Not on your life! as I already said I would try anything but sadly most of us have and this is only what works. I know I didnt get here in a day as I am sure most of you didnt either. Trying to figure out why any Doctor dedicated to prevent and alleve human pain and suffering would ever risk leaving a patient or person in that kind of pain for even day makes me wonder how little compassion we as human beings have left in us.

On a tangent again but for those of you who have been there I know you will understand every word I have spoken here.

Thanks again PAlady for taking the time and being concerned enough to find answers to maybe aid those questions in our minds as well as others and everyone here undertreated should take the article to their next appointment with them,maybe it wont do a bit of good,maybe it will.
 
Very good read.......... I think I found my twin....... :-) .. I have been on everything, I have tried everything... Physical therapy, therapeutic massages, epidural injections.... I was cut off of morphine in January.... I had been using opids for 5yrs........ Detox was a 21 day nightmare.. I thought I was going to die....Doctors and nurses telling me that they have back aches too..... I asked them both how the heck can you work then?  They are stronger then me, LOL....
I have been opids free for almost 7 months..... Since this change I only go out of the house for doctors appointments...
I did go to the dollar store on Saturday and about passed out at the check out.....I will never go again....... I know longer clean my house or cook and I am a neat freak.  I have been in bed for approx 7months.....I am 45yrs old... Injured at 40yrs at that time the MRI only showed bulging disc at L2......... I just had another one done in June and my DDD has worsened... Now bulging at L2-L3,L3-L4,L4-L5.  Sorry I could go on and on........ My point is I cant get any relief what so ever....  I'm not asking for sympathy just advice.....  I know longer go to the clinic that let me self detox........  If I go to another doctor they will read my medical records labeled addict......Any suggestions would be great.... I have a daughter who is getting married in Oct and I fear I wont be there....I totally agree with I we knew how to fix us we would be fixed........
TY for listening.
Cloe redface
 

ryand
Veteran Member


Date Joined Dec 2007
Total Posts : 639
   Posted 7/21/2008 11:03 PM (GMT -7)   
Cloe:

I'm sorry you are having so much pain! It sounds like you've been seeing a doctor, but why did they cut you off so suddenly? Did you say something made them suspect addiction or diversion? It seems strange they would suddenly stop like that after 5 years. What happened? Have you been treated at a pain management clinic before? Have you tried epidural injections? RF Ablation? Just some ideas...

Ry

~Cloe~
Regular Member


Date Joined Jul 2008
Total Posts : 125
   Posted 7/22/2008 6:29 AM (GMT -7)   
ryand said...
Cloe:

I'm sorry you are having so much pain! It sounds like you've been seeing a doctor, but why did they cut you off so suddenly? Did you say something made them suspect addiction or diversion? It seems strange they would suddenly stop like that after 5 years. What happened? Have you been treated at a pain management clinic before? Have you tried epidural injections? RF Ablation? Just some ideas...

Ry
yeah
Yes Ry,  I have had epidural injections while I was in the acute stages.  I was just told by a  neural surgeon that they don't work in the chronic stages.  Know one ever has suggested RF Ablation.
As for pain management clinics I have only been to two. One being I left my self and my GP doc treated me.  At first we kept me on Fentanyl patch 3.5yrs.  Then I switched to morphine, at one point my doc began lowering my doses without my knowledge.  I would pick up my scripts that were inside an envelope and my pharmacist would tell me about the change.  I voice mailed my doc's nurse 2x and never received a call back.  I started eating those pills like candy. Hence my DDD has worse from a 1 level to a five level.  After I ran out of meds my doc refused to refill it, 21 day detox.
I then started going to a new doc. who referred me to a pain clinic an hour away drive.  There I received a very low dose of methadone.
At pill count I was eight pills shy and got kicked out on the spot, that *** didn't even do it herself she had her nurse be the messenger.  So in a nut shell I am NOT an addict!  As for pain clinics I have been to two, one I left on my own for convenience reasons, the other I got kicked out of.  I know it was my medical records that put that doctors back up.  JMO
TY for reply and for listening.
Cloe :-)

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 7/22/2008 9:19 AM (GMT -7)   
Cloe,
I'm a little confused, but want to try to help if I can. First, I hope you read the article I posted the link to that started this thread (if not, please do, so we're on the same page re: dependence, tolerance and addiction).

Obviously, we all become dependent on narcotic pain medications, as well as any other substance which causes such physiology. That is different from addiction. So I'm trying to sort some of your history. Before your doctor started decreasing the morphine, did you have any indicators that you were developing a tolerance to your medication? One thing would be using more medication than prescribed. You say you were eating your pills "like candy". If you have a family history of addiction, that could mean you have a genetic predisposition, which may mean that your body may develop tolerance more quickly. So if there's any of these indicators, that may have been a reason for your doctor to initially start decreasing the morphine, although this should have been discussed with you.

Methadone actually is good for pain management, although it doesn't work for everyone, and your dose may need adjusting. My cousin's a pharmacist and she said that it's probably underused in pain management because of the stigma and because a lot of doctors don't know to use it for pain. So methadone may be your best option for pain management. I don't know if your PCP is someone you can talk with about this, but one possibility is if you have a local methadone clinic. That's not the first choice, as they may not be as trained to use it for pain management. You may need to drive, like many of us do, to at least get a therapeutic dose of methadone established, and maybe your PCP would be willing to take over prescribing at that time, but I don't know.

With the history that's now documented, you'll have a tough time with pain management clinics no matter where you go, and I know this may be tough to read but it's the truth. The thing I keep wondering is why did your doc initially start lowering the morphine? And did you switch from the patch because it stopped working?

I'm trying to put some puzzle pieces together, and I hope nothing I've said has offended you. It's not meant to.

PaLady
p.s. It's just me, but I find recopying the entire post in the response a bit confusing.

Post Edited (PAlady) : 7/22/2008 10:23:38 AM (GMT-6)


~Cloe~
Regular Member


Date Joined Jul 2008
Total Posts : 125
   Posted 7/22/2008 10:16 AM (GMT -7)   
Hi Palady,
The decrease of doses began when I was on the fentanyl patch.
I was at a doc appointment and caught the error. 
Then once on pills it began as soon as I went on disability and insurance changed to Medicare and Medicaid.  IMO they doctors become on a watch dealing with state insurance.  That is the only reason I can think of?  Once I was at the lower dose is when I started eating pills like candy.  And would run out before before the 30days.  I approached the doc and nurse about this and they both told me that they had back pain too and take nothing for it. As well I my doc felt that I was on a reasonable dose?  I don't get it.  And then I ran out again before the 30days and doc refused to refill it.  That is the self detox lasting 21 days!  By the way I will take my black berry to all doc appointment to record the consultation.  All that goes in our medical records is the notes of the doc and nurse. 
I re-doctored and was referred to a pain clinic in hour away.
That is when I started methadone that is when I realized the stigma with this med.  I asked the pharmacy if they had methadone and everyone in there turned around and looked at me, LOL.  Like a give a care at this point, it amused me.
My pharmacy didn't have it, so I had to go too another pharmacy is why I asked if they had it.  Small town.  As for family history and addiction non, my father die of cancer and didn't use anything until he went to hospices.  They btw they gave him tones of stuff, told his he is expected to pass in 10days.  He was dead in 45mins in mine my mom and sisters arms.  They killed him.  He had never take narcs before and then given too much imo.  I have no problem with this as he was so sick.  But it really makes you think about assisted death laws.
Anyway I have not yet read you link and will.  I Will say that when I was on pain meds I slept 18-20hous a day.  But at least I had 4hours of quality life.  Once I was on Methadone I was awake, I was kicked out after weekly one hour a day pill count, I was 8 pills shy and do not know why?  I will add that I know two ppl who take pain meds and are up all night cleaning.  I firmly believe that when I take pain meds, the medication goes too my brain pain receptor and then is directed to my area of pain.  I have never experienced a high from pain meds. I would assume that would be a feeling of euphoria.  Not ever.
TY for your reply I do not take offence to any of it. :-)
BTY I have an appointment with my doc on Thursday, for bladder incontinence that begin once I became bed ridden.
I also want a script for a walker and hot tub. I will ask for a referral that he suggested to me after the methadone prob.
I said no, this is went I surrender, this bored has given me a bright light and I do want to surrender any more for that I that all. I am now on a mission. devil Cloe

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 7/22/2008 10:53 AM (GMT -7)   
Cloe,
I'm still a bit confused, but then I'm confused about a lot of things! If you were sleeping so much, you may have been on too high a dose, and your doctor was trying to shift you to something that wouldn't be so sedating. Your pharmacist can probably tell you a little about what medications, and in what doses/ number of pills per month your insurances will pay for. That could have been the start of it all. And your doctors have no control over that. It's the Medicare and Medicaid regulartions, and the Medicare is a federal program, while Medicaid is a combination federal/state program. That means for Medicaid each state may have some different regulations. So find out what your insurances will and won't allow, and then you'll know what you have to work with. The truth is, we all have to work with those limits - unless you're very wealthy and can pay out of pocket for your meds. (definitely not me!).

I'm still unclear as to what doctor was prescribing the morphine and patch - your PCP or a pain management specialist? And who is prescribing the methadone - and is that what you're saying no to? These are some of the things I'm unclear about. And if you learn more about all these issues - including the importance of taking your medication (whatever it is) strictly as prescribed - you'll be better equipped to serve as your own advocate in the health care system.

PaLady
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