Important! FDA proposed regulations re: pain meds.

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PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 2/12/2009 5:56 PM (GMT -7)   
First, a shout out to Orlo on the fibro forum who posted the link to this article. I strongly encourage everyone to read it:

http://www.nytimes.com/2009/02/10/health/policy/10fda.html?em

This is a New York Tiimes article from just a couple of days ago which begins to detail new regulations the FDA is proposing in order for a physician to be able to prescribe a number of pain medications - mostly extended release forms such as oxycontin, fentynal patches, opana, kadian & others. There is a link in the article that I'd suggest you click on to the FDA list of medications affected.

It appears the FDA wants to make it more difficult for doctors who are not somehow specially trained or certified in pain management to prescribe any of these drugs. That would mean any of us who obtain such medications from, say, our PCP could no longer do so. Now before you go off on a rant (and I believe we'll have many rants on this, mine included) my opinion is it's also VERY important for us to remember to THINK. To learn about the particulars, and what we may be able to do.

The article says the first hearing would occur in March. Doesn't give details. But a hearing means the FDA will be taking in information about these proposed regulations, and how they should be designed and/or implemented. There is a place on the FDA website (fda.gov) that teaches consumers how to give input about these types of things. Also, I think it's important to look at professional organizations of Pain Management physicians and see if they are doing anything at these hearings. If anyone wants to help do research to find the appropriate links to places where we could help, give input, etc., I think that would be great...

BUT one of the rules of this website is that it's not for advocacy. I would hope the moderators and administrator would allow us to post links to places where we COULD do advocacy, but that's not my call. I do want to be respectful of the rules here, though.

I'll be waiting to hear what others know, are thinking about all this, etc. I also wonder (03Mach??) if this has anything to do with shifts in the types of drugs being prescribed already (for example, PCP's switching from longer acting meds) thus leading to some shortages, but that's only a hunch on my part.

To me the critical aspect of this is that those of us who may have PCP's who prescribe our pain meds., and maybe those of us who live a distance from pain management docs, could be affected enormously. It seems there MAY be some training that non pm docs could get so they could prescribe, but why would they want to take on that burden? That's already why many of them are reluctant.

Ok, I'm done for now! shakehead

PaLady

Post Edited (PAlady) : 2/12/2009 10:27:53 PM (GMT-7)


deb in indiana
Regular Member


Date Joined Aug 2005
Total Posts : 387
   Posted 2/12/2009 6:06 PM (GMT -7)   
My regular dr.won't give out these meds he makes you go to pain management.My pain dr.you have to see him monthly to get your meds so every month you pay office call.The sad part of it all is the kids are getting these meds and are selling off the street one girl sold 2 oxy's to under cover cops for 80.00 a felony 1000 feet from a park but she was 23years old pills were in her name on the pill bottle

Chartreux
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Date Joined Aug 2006
Total Posts : 9622
   Posted 2/12/2009 8:03 PM (GMT -7)   
Thank you PAlady for posting about this article, that said, I've read it
and will have to think what I might say as I'm not certain yet how these meds
will be restricted.
Was interesting and Thank you for keeping us informed PAlady...
soft hugz to you...
**********************************************
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******** "We could never learn to be brave and patient if there were only joy in the world" from Helen Keller *********

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kttn251977
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Date Joined Jul 2007
Total Posts : 554
   Posted 2/12/2009 11:14 PM (GMT -7)   
great post, my PCP said in the beginning he could not treat me for CP.... he sent me to a PM dr and I am happy...... I like knowing that they will not "over-prescribe" because they know me..... well, i don't think over prescribing would ever be an issue for me. lol. great post, i fee that peeps with CP need to see a specialist. PLEASE don't everyone get mad at me, you guys know I love you all......... I just know my PM has procedures that a normal dr can't do. (nerve blocks, spinal blocks, etc) Be vigilant & get the care you DESERVE!!!! you are worth it!!! love to all.... hope no one is affected by this. but my PCP will not prescribe anything stronger than percs. its going to happen. i used to know a dr when i lived in ga who prescribed anything to anyone.... i had pneumonia once at 18 & you should have seen the meds he had me on..... i admit i was almost addicted to the cough syrup cause I was on it for 6 months, this is why there needs to be specialists. good luck to all on this very tough issue.
RX's: Oxycontin 80mg 2x's daily; Oxycodone 30mg 5xs daily; Zanaflex 4mg 3x's daily; Restoril 15mg 1x; Soma 3x's daily; Lyrica 100mg 3x's daily (pain & fibro.); Phenergan 25mg (as needed); Amitriptyline 25mg 1x (chronic pain); Cymbalta 60mg 2x's daily (pain from fibro); Abilify 5mgs at bedtime (depression); Metoclopram (as needed) & Senokot (as needed).
"The most critical choice you'll ever make is the one you make about what you're going to do with this. The past is over. The future hasn't happened yet. The only time is now."
- Dr. Phil


Scarred_for_life
Veteran Member


Date Joined Jul 2008
Total Posts : 1559
   Posted 2/13/2009 2:02 AM (GMT -7)   
OMG! I saw this entire post PA then went to the site and read....about went into a deep depression. It would figure that this would happen. One bad apple spoils the entire barrel ya know? There are so many junkies out there that we that are legt. pain patients are forced to jump through so many hoops to get our meds and then try and explain to our doctors that we really are in pain so many times its horrible. I don't know how many times I have gotten that look from my doctor that told me "are you really in pain or is this just a scam to get pain medications" then have to spend the next few months trying to prove the fact that I really am in pain. It's crazy!

Anyway...another thing for us CPers to worry about right?

Scarred
What doesn't kill us only makes us fight back harder! :P


shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 2/13/2009 5:14 AM (GMT -7)   
Hi all, i guess i am sorta "for" this....I think if everyone had to see a pain specialist, it would make it harder for the drug seekers to get their drug, hence, taking less pressure off of us.

Scarred, i really feel for those of you who have had to deal with doctors who make you feel like you have to beg for your meds. I wish everyone could come see my doctor! One visit with him yesterday to go over the post hysterectomy pain, and he was very willing to figure out how to help me...without being the kind of doctor who just passes out meds to just anyone.

I will be interested to read everyone's opinions on this.....
Jan. 2009, complete hysterectomy, diagnosed stage 4 endometriosis & adenomyosis (age 36)
2003, dx moderate UC
2000, dx selective IGA deficiency w/ anti IGA antibodies
2000, dx Antipholipid Antibody Syndrome
1999-2009, chronic hemmoragic ovarian cysts, w/ partial ovary removal
1977, complete reconstruction of foot after lawnmower accident (chronic pain)
 
Meds
6mp 75mg, prednisone 40mg (just starting meds again)
percocet 5mg 3x day
potassium 3x day
 


Pamela Neckpain
Veteran Member


Date Joined May 2008
Total Posts : 1821
   Posted 2/13/2009 6:07 AM (GMT -7)   
I haven't read the article yet. It's 5 AM and I've been awake for an hour.
I'll start easy here, what's a PCP?
Thank you, PaL. I will read by the morning's light.
Pamela

shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 2/13/2009 6:20 AM (GMT -7)   
PCP= primary care provider, usually a general doctor, or an internist
Jan. 2009, complete hysterectomy, diagnosed stage 4 endometriosis & adenomyosis (age 36)
2003, dx moderate UC
2000, dx selective IGA deficiency w/ anti IGA antibodies
2000, dx Antipholipid Antibody Syndrome
1999-2009, chronic hemmoragic ovarian cysts, w/ partial ovary removal
1977, complete reconstruction of foot after lawnmower accident (chronic pain)
 
Meds
6mp 75mg, prednisone 40mg (just starting meds again)
percocet 5mg 3x day
potassium 3x day
 


Pamela Neckpain
Veteran Member


Date Joined May 2008
Total Posts : 1821
   Posted 2/13/2009 6:24 AM (GMT -7)   
Thank you, Shannon. That was quick! I'm just preparing myself to read
PaLady's article.
Now ... Does anyone know where my glasses could be?
Pamela

shannon?

AndreaRN
Regular Member


Date Joined Mar 2007
Total Posts : 91
   Posted 2/13/2009 10:44 AM (GMT -7)   
Thanks for the heads up PAlady. Will read it today.

I use a PCP and happy with him. He recently put me on Vit D to help with the bone pain. Truthfully, can you imagine a pain management doctor suggesting Vit D? From what I hear they like money making procedures. Could be wrong.

Andrea
Women who behave don't make History!

C3-4 herniation
C4-5 disectomy & fusion (anterior)
C6-7 & C7-8 L laminectomies (posterior) (need R)
Partial removal of supporting Cervical Posterior Ligament
Constant shoulder pain & tightness.intermittent neck pain
bulged discs at C6-7 & C7-8

Vicodin 7.5 for pain
Atarax 50mg q 6 hours for pain
soft collar and heating pad best friends


VIEW IMAGE


jenpen400
Regular Member


Date Joined Apr 2007
Total Posts : 117
   Posted 2/13/2009 12:39 PM (GMT -7)   
I think this may effect pain patients negativly. My PCP was specialized in pain management and now he has gone to family practice. I think this will chase more Dr.s out of this specialty. I hope I'm wrong.

jennifer
Chronic pain, anxiety, PTSD, and Depression. Norco Soma Ambien Xanax Tramadol and Prozac.


shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 2/13/2009 12:56 PM (GMT -7)   
HA, Pamela, did u check the top of your head?, maybe in your hands?
Jan. 2009, complete hysterectomy, diagnosed stage 4 endometriosis & adenomyosis (age 36)
2003, dx moderate UC
2000, dx selective IGA deficiency w/ anti IGA antibodies
2000, dx Antipholipid Antibody Syndrome
1999-2009, chronic hemmoragic ovarian cysts, w/ partial ovary removal
1977, complete reconstruction of foot after lawnmower accident (chronic pain)
 
Meds
6mp 75mg, prednisone 40mg (just starting meds again)
percocet 5mg 3x day
potassium 3x day
 


Tony McGuire
Regular Member


Date Joined Feb 2009
Total Posts : 483
   Posted 2/13/2009 12:56 PM (GMT -7)   
Andrea,

Funny you mention the Vitamin D. I was on 50,000iu/day for 2 weeks, now once a week. Yes, for something to do with pain management. Whodathunk?
Wife: Liz
Dogs: Koshka & Chomp


Tony McGuire
Regular Member


Date Joined Feb 2009
Total Posts : 483
   Posted 2/13/2009 1:00 PM (GMT -7)   
As to the new bill, and attitude toward pain meds.

My pain management doctor believes he will be VERY busy in the short term. I asked if doctors wouldn't be switching to the specialty and he was pretty emphatic in saying no, he didn't believe so.

No one wants the liability for a very specific and narrow specialty. So, in his opinion, pain management will be a situation of getting appointments a long way out.

Fun for us all; something to do with our spare time.
Wife: Liz
Dogs: Koshka & Chomp


QTKaren
Veteran Member


Date Joined Apr 2008
Total Posts : 605
   Posted 2/13/2009 1:07 PM (GMT -7)   
I would not have a problem seeing a pain doctor if there were any that would take me!!!! I am on SSI and have medicaid for my medical and in a 75 mile radius have not found one pain clinic that would take medicaid anymore. They have all gone to private insurance around here. And at some of the hospitals if they will see me in thier clinics they are very much against narcotic pain meds. They are more into needles and therapy which I have already been through and thats what brought me to the narcotics and some relief. But I have been on the same doses for over 5 years now and need them upped but my primary can only write me what a pain doctor has already set up. Where does that leave me? screwed and in lots of pain since there have been several chronic pain things happen to me since those meds were set up.
Karen
 
Mom of one gramma to 4 lover to One
 
Fibromyalgia,IBS,Stroke x2,endometriosis,Diabetes type 2,neuropathic pain,nerve damage due to tailbone removel,nerve damage due to fractured back,deppresion,high blood pressure,severe nausea,atrophy,chronic pain,nerve damage due to botched bladder surgery,torn hip joint,hypoglycymic
 
Norco(double strength vicodin) 80 to 100 mg @ day
Ms Contin(morphine) 45 mg @ day,Lyrica 600mg @ day
 
 
 


PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 2/13/2009 2:16 PM (GMT -7)   
I'm glad there's a good discussion going on here. I would say that in theory, it would be nice if we all had access to pain management specialists who did the entire range of pain management - from the injections and pumps and stims but also to medications. BUT as we all know from reading on this site (and on this very thread) having "access" means a lot of things. QT brings up the issue of doctors not accepting Medicaid, and I myself may be on that soon. Many specialists don't accept it, so if you're lucky enough to get a PCP who will prescribe opiods for long term pain relief, you may be out of luck. TonyMcGuire mentions the wait that could be possible. Or perhaps the distance we may need to travel. There is only one pain management specialist in my area who still prescribes, and he's in the process of building a big clinic so he can do all the high tech stuff in his own office. I wonder once that's done if he'll still write scripts. Many people on this forum work with their PCP's who do a great job with pain management, or maybe only see their pm specialist a couple of times a year, and then their PCP writes the scripts. PCP's will likely stop doing that now, unless they receive specialized training, which will cost them money. Which will add another layer to their practice such as pain contracts and urine screens and such. Most PCP's won't want that liability, as Tony says.

This isn't a bill in Congress. These are proposed regulations from the FDA. Regulations are different from a bill. They have not yet been finalized or implemented, as I said earlier. Anyone who finds info. on groups doing advocacy on this issue, I hope you'll post the link here because I for one would like to add my 2 cents (more than that, really) to this. I don't really disagree with those of you who are saying that we should see pm specialists, or that docs should have specialized training, but when I read the article it seems to me the training is more about identifying criminals or those with addictive potential. That's not reallly about helping US get good pain management. That's about helping law enforcement. Assessing for addictive background can be done easily - with a questionnairre. And most of us know our docs are already on the lookout for this. And docs who are going to be giving out meds illegallly are generally going to be caught - and they can be PCP or pm specialists. That has nothing to do with their training, it has to do with whether they're going to obey the law. The one doc that got prosecuted locally here (and is in jail) was a pm specialist. But that is part of what has made ALL doctors reluctant to prescribe meds. I think it's part of why many pm docs go into the high tech stuff - they don't have to worry about abuse, diversion, etc. Yes, they may make money, but they also don't risk having the DEA over their shoulder.

Sorry for going on about this, but I just think this could make it even more difficult for all of us to have our pain treated - even as TonyMc says having longer waits for the pm specialists in our area.

PaLady

Post Edited (PAlady) : 2/13/2009 2:38:56 PM (GMT-7)


skeye
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Date Joined Mar 2008
Total Posts : 2976
   Posted 2/13/2009 8:08 PM (GMT -7)   
I feel like this is one of those "punish the many for the wrongs of the few" circumstances. My pcp is the one who is currently handling my pain management. I did see a pm for a while, but he ran out of procedures to do on me & medications to try other than pain meds. He got me started with things, but I transitioned to my pcp, as I was already seeing him regularly for other related things & he offered to take over my pain management too. I love him to death & he seems to be very knowledgeable about pain as well. When we are adjusting doses or switching meds, he has me talk to him every few days, as well as see him every other week, so I'd say he is pretty careful.

Skeye

PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 2/13/2009 8:46 PM (GMT -7)   
Skeye,
Yours is one example of how I think this could be harmful. I wonder what your PCP thinks of all this.

PaLady

Tony McGuire
Regular Member


Date Joined Feb 2009
Total Posts : 483
   Posted 2/14/2009 2:51 AM (GMT -7)   
PAlady, as far as 'here', I am in the Salt Lake City area of Utah.

My PMS (Pain Management Specialist) told me of another PMS in the area who just got thrown in jail here. Wrote something like 5,000 scripts (in a year if memory serves) for anything people wanted. Wallk in, ask, walk out with the script. At $80/mg here (my PCP states) that PMS was making sure several dealers made a bunch of money.

My Primary Care Physician is willing to work with me however best suits, as is my PMS.

My PCP took me through several meds, and was heading for more (Oxycontin was next up) when he suggested a PMS. His 'referral' program was to hand me the book of doctors for my insurance company and say 'pick one'. He had no suggestion, since he had just moved into the area. I got SUPER lucky in picking he one I did.

I had heard about the FDA maneuver through a couple of stories in the local newspaper online edition. Then I brought it up to my PMS and talked it over with him. He is partners with another guy in one of those fancy clinics; they do all kinds of nerve blocks and stuff for all types of pain. He tried it with me, and of the 3 blocks for my legs & feet, not one of them made the slightest difference.

While my PCP hadn't gone the route of Methadone, the PMS wasn't shy about it. And I thank my lucky stars because it was what I needed. And while it scares me silly due to the stories I heard from the 70s and 80s of it being a substitute for heroin addiction, the PMS explained that it wasn't addictive TO ME, with his managing it. (Yes, more involved than that but important part is it smoothed my fears of Methadone.)

So, I think I am one of the very very lucky ones. My opioid needs have been identified, and my PCP can prescribe if something goes wonky with the PMS. And the PCP isn't worried about prescribing them if it comes to that.

As the search for me progressed with the PCP, Oxycodone was one of those I tried. It not only killed 100% of the pain, but I felt REALLY good too. Probably a good thing I didn't go the Oxycontin route with the PCP, as I understand it is just a longterm version of Oxycodone. We aren't supposed to feel THAT good taking painkillers, are we? And isn't that how addicts are started? Neither Methadone nor Morphine seems to be 'feel good' stuff for me, but somewhere in the combination much of my pain is killed. I can't feel any change in how I feel even when I take 2x30mg of Morphine; until I add the Methadone and then the pain starts receding within a few minutes. Kinda like magic.

As to the FDA, I sure wish their resources went to finding those abusing medications, and leave the honest people in pain alone. I guess the problem is figuring out who is which.

I hope my PMS was wrong in his predictions of the results of the FDA messing with us. When you MUST physically appear before the doctor before he/she can give you a prescription, it sure makes it obvious that there will be longer lines for PM clinics if the FDA does what it appears they are heading for. I didn't even know the deal with PM clinics until December when I started.

I've always tried to put away a few doses for 'just in case' situations. But it doesn't look like that is in the cards in this situation. Anyone got any suggestions on how to manage that? Do you just skip a dose or two and deal with it, in order to have an emergency dose?
With the meds I'm taking, plus age, I'm a bit forgetful. Couple that with a PMS (whole clinic) that isn't open on Fridays, and I've already run into situations where I ran completely out on Saturday morning, with no relief until after 9am on Monday. I was literally crying from the pain by Sunday afternoon, and I'm a 53 yo man who hadn't cried for 30+ years other than when this all started for the same level of pain.

I'll stop now so those reading right after I post can get some sleep this weekend.
Wife: Liz
Dogs: Koshka & Chomp
Heart: Lisinopril
Brain Zaps: Gabitril
Kidney: Simvastatin
Diabetes: Metformin, Insulin
Pain: Avinza, Morphine IR, Methadone, Cymbalta, Lyrica


Pamela Neckpain
Veteran Member


Date Joined May 2008
Total Posts : 1821
   Posted 2/14/2009 3:31 AM (GMT -7)   
My attention span is short. I hate that about my brain and my meds.

I gotta start figuring out what's going on before my Pain Management Doctor
leaves. I can't find a PCP so there's no problem there.

Pamela

Shannon: My glasses were NOT on the top of my head. They were on my round
table which I call the "Clear Vision Center" On that table are:

A crystal ball: To see the future
Opera glasses: Just in case I should EVER need them. Also you can see far.
A magnifying glasse: So you can see close
And there amongst all those treasures ... My GLASSES

Now it's 2:35 AM. My pain has set in. I can't read long things. I should though.

But anyhoo, Shannon. TY

Post Edited (Pamela Neckpain) : 2/14/2009 3:37:24 AM (GMT-7)


straydog
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Date Joined Feb 2003
Total Posts : 13455
   Posted 2/14/2009 9:27 AM (GMT -7)   

I had an interesting talk with my dr yesterday about drs not being knowledgable in pain medications. Somehow we need for these pain mgt drs to have their ducks in line if they are going to treat people. Too many are sitting half on the fence in prescribing pain medication. By that she is talking about the ones that will only prescribe certain meds and never go beyond that realm because they don't want the DEA snooping around. The patient seeing this kind of a dr is the one paying the price and their pain is not being handled properly. She was last visited 4 yrs ago and she says the DEA is not what most people think. She said they can be very helpful to a dr in their practice with tons of tips on how to make their practice run smoothly. She went on to say that if a dr is that fearful of the DEA coming in, then that dr is doing something wrong and knows it. She says the DEA is a piece of cake compared to being chastised by the medical board because they are ruthless.

I really don't see our PCP running out to get more training, I am not sure what to think of this. Susie



Tirzah
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Date Joined Jul 2008
Total Posts : 2280
   Posted 2/14/2009 12:26 PM (GMT -7)   
This is already the route my insurance company has chosen to gone -- no coverage at all for narcotic scripts unless they are written by either a PM or an oncologist. I have been looking for new insurance & have discovered that many, many other private insurers in IL have chosen to go that same route.

Unfortunately, a new breed of doctors has emerged in my area b/c of this trend. They are the pseudo-pain-specialists. Nothing against physiologists in general, but it seems that a whole boat load of them suddenly arrived in my city after the insurers started this rule & though they claim to be "pain specialists" all they really do is write orders for PT, and an occasional script for tramadol. The "real" pain doctors only accept medicare/medicaid unless you want to drive an hour away (which I gladly do). Unfortunately, in IL you all you need to open a "pain clinic" is some sort of medical degree & plenty of malpractice insurance. So physiologists hang a sign out front & in no time can start charging more money for the same service. To call these places "pain clinics" is a farce. They have almost no training evaluating pain so for the most part they end up under-prescribing meds & offering no adjunct treatments like surgery or injections, but at least that's better than the ones at the other end of the spectrum who don't know what the heck they're doing and end up overdosing their patients. Those poor souls end up in the hospital or worse & all that does is further feed the fear that narcs kill & ruin lives.

I will say that there are some docs who have taken advantage of the loophole & done so to their patients' benefit. My osteopath, for example, is a family doc but he got his practice qualified as a pain clinic. Mostly he does physicals & writes for anti-biotics and such, but when needed he can give a trigger point injection, write for narcs, or, my favorite, provide OMT treatments. He knows his limitations & spends free time studying, observing & practicing under supervision how to use narcotics & injections carefully to manage pain. I'm very glad to be able to go to the PM I have b/c he is the best there is in his field, IMO, but I know people who can't afford a specialist & going to their family doctor is a good option as long as they're okay with having more limited treatment options.

In any case, I do think that all docs ought to be required to earn some CME credits in pain management. I think it would go a long way towards better understanding on all parts. I do with there were more highly-qualified PM's here & everywhere else, but if that's coming at all I think it's quite a ways down the road. :(

peace,
frances

PAlady
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Date Joined Nov 2007
Total Posts : 6795
   Posted 2/14/2009 2:30 PM (GMT -7)   
This thread is turning out to be really informative and thought-provoking, IMHO.

Maybe part of the answer is what you're suggesting, Frances, in requiring all doctors to get enough CME training in pain management to NOT be afraid of prescribing at least the shorter acting narcotics. But that does require making adjustments to their practices and that's what I don't think they'll want - pain contracts and such.

I don't have a problem with physiatrists but I think they're possibly not being used at the right point in the process. They are specialists in Physical Medicine. Many doctors don't understand physical therapy and related modalities very well, either, so they'll just write a script for PT and you get what you get. And I've learned that makes huge difference, too. So if you had a physiatrist early in the process he/she could prescribe more precise modailities re: PT, etc. When those things faiiled, then the next level should be used. Maybe surgeon, stronger meds, whatever.

But I don't want to sidetrack myself here! Frances you mention your insurance company will only allow specialists to write for narcotics - including short acting ones? What then happens to those of us who might not have insurance???? Or like QT, have no choice but to be on government plans.

And Tony, I sure can see those waits - which here are long enough anyway - for getting an appointment with a PM speciaist growing. Lines around the block! I can sympathize with you re: limited availability as the hospital host policy I have is now requiring all of us to use their hospital pharmacy, which is only open M-F, 7am-4:pm. I've already had to stretch out my percocets one week a month ago as I was waiting for the script in the mail and it came late Friday afternoon.

I don't know. This just seems very scary to me. Going to make a bad situation even worse for those of us with legitimate pain. I agree totally with you, Tony, and just wish the FDA would use their resources in another way to try to curtail abuse. And perhaps let the professional associations decide which doctors are or aren't qualified to prescribe these medications. Many pm specialists already know pain is generally undertreated, at least in the U.S


PaLady shakehead

Post Edited (PAlady) : 2/14/2009 3:27:49 PM (GMT-7)


Tirzah
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Date Joined Jul 2008
Total Posts : 2280
   Posted 2/14/2009 3:56 PM (GMT -7)   
Sorry, I think it's only for C2's that you can't ever get a script from a non PM/oncologist. Shorter acting does not mean less addictive, though. Often the shorter acting ones create addiction the quickest (take fentanyl for example, which is ultra-short acting). They do cover up to a month or so of Vicoden and for about 6 months of Ultram before you're off to the PM's office, but yeah, basically everything will eventually land you in the PM's office. Our local hospitals now have PM's on staff to write for post-op meds when a C2 is needed b/c some of the insurance companies won't even cover those without a script from a PM (i.e., percocets must be written by a PM or at least an anesthesiologist, even if it's post-op -- NS's scripts are not always covered). Some people go to see a PM pre-op so there can be a paper script waiting for them to pick-up at the hospital after surgery. The PM's are happy to oblige, but I guarantee you that this would not have been their first choice on how cover getting scripts for pain meds.

Obviously the possible FDA rule would start affecting those who don't have insurance or who have medicare/medicaid. Right now in IL, those people have their choice of where they go to be treated. Honestly, some crazy fools are jealous of the Medi patients b/c of that. I think that's nuts. Medi is the worst b/c then people only get to see their PM once a month no matter how horrible condition they are in. I can't figure how I would have gotten through some of the really tough times if I wouldn't have been able to go in for extra injections mid-month. Unfortunately, our pain does not follow a 30-day calendar, it just invites itself over whenever it darn well pleases. tongue lol Next time I will stamp it with a forwarding address of the FDA so it can go & bother them for a change. (jk, mostly I like the FDA they save us from evil peanuts & spinach and such, but it does seem this particular regulation would pose an extreme hardship on people like you)

I know it will be tough for a lot of people, including you, PA if this goes through. Please don't think I am against PCP's or such writing for narcs as long as they do so responsibly. The PM's (not the pseudo-PMs, the real ones :) in my area have really rallied as late, but until recently the PCP's and specialists didn't really consider them much more than glorified drug dealers & they definitely would not write scripts for much of anything. The PM's have been great about putting on lectures & classes and such about how to identify addiction and as a result have been exposed to a lot of questions from the rest of the medical community. The best thing to come out of it is that now regular docs are starting to see pain control as a medical treatment. No one would ever say that a patient should be denied narcs during major surgery b/c it would be both cruel & dangerous. And yet somehow they fail to translate that the same benefits (controlling heart rate, bp, breathing rate, etc.) apply to people in severe chronic pain. I've been really glad to see that some of the PCP's & ER people & the like are starting to defer to PM's on issues of pain control whenever they themselves don't feel comfortable enough treating. My PCP has started actually looking at vitals both on & off narcs and can see that there is a measurable benefit to my overall health to be on these medications. And for that I'm really glad. I know I wouldn't trust my own PCP to handle writing narcs for me even if insurance covered it & she was agreeable b/c she doesn't understand conversions, standard titrations or typical dosing for a given size & weight. But I certainly don't take any issue with non-PM docs who know what they're doing writing legitimate scripts for their pain patients. If I can help in your battle, I will gladly join-up.

But I fear that like what often happens that our voices will go unheard in favor of some uninformed neurotic with a loud voice. We have hands-free cell laws here in Chicago now even though every international study ever done (& there have been many) has shown that it makes the roads less safe b/c it gives people a false sense of safety. The insurance companies even lobbied against it b/c it is talking, not holding the phone that causes accidents. Nonetheless, some poor uninformed soul who, tragically, lost his daughter in an auto accident by someone holding a cell phone told the legislators that this was going to save countless lives & thus was able to get the law on the books. It is situations like that where some influential person tells some tragic story about someone dying that end up creating laws that negatively impact us all. That is why I think that education is the key. Properly prescribed narcs save far more lives than they destroy.

But perhaps we should follow others' lead and write our own sob stories (has anyone lost a family member due to not being able to take them to their local doctor's office for treatment/pain meds?). The sorrier the better. And make sure you mention anything that would involve endangerment of life or limb. Barring that, I think it will actually take a lost life in order to prompt people to do the right thing. So sad, but that's just the way things go these days. :(

let me know if you find out about those hearings!
frances

PS-- What doctor would be against pain contracts? We already have to sign a basic contract with them stating we won't be late, will pay our bills, will take meds as prescribed, etc. What's the harm in adding a few lines about not selling scripts, abusing meds or doctor shopping?

Scarred_for_life
Veteran Member


Date Joined Jul 2008
Total Posts : 1559
   Posted 2/14/2009 4:07 PM (GMT -7)   
Frances; My pain contract included those things selling my scripts abusing my meds and that I will not see any other doctor for pain meds. Yours didn't?

Hugs

Scarred
What doesn't kill us only makes us fight back harder! :P

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