How can being a CP patient be a strike agaist you in the hunt for a new doctor

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Jim1969
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Date Joined Jul 2009
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   Posted 3/4/2011 11:28 AM (GMT -6)   
In another thread some one commented

Somebody said...
I can not fathom how being a CP patient on narcotics is a strike. After all, a majority of CP patients are on narcotics; I am on that list.


and I felt this was a very important topic in its own right to be discussed.

If you are looking for a primary to look after your general health needs then finding a new doctor is usually not to difficult for CP patients, but when you are needing/wanting a primary to also manage your pain management it becomes a lot more difficult. A lot of PCP are very uncomfortable prescribing narcotics, especially for long term use. Between the way the government looks upon long term opiod use, those who abuse the system (patient and so called doctors), and a fear of losing either their licenses to prescribe medication or to practice medicine in general it is something many just do not want to get into.

Sure, if you have a doctor with whom you have a long term relationship with before getting CP s/he may treat you, but their attitude changes dramatically when they consider taking on a person's case who already has it and does not have another doctor who is handling the pain management aspect.

So why don't CP patients have a PMD handle their pain meds? The answer there is two fold. The first is that there really are not that many pain management doctors to begin with and second the largest percentage of those that are only do procedures. They do not or rather will not prescribe pain meds. (In my area for example, 60 mile radius) I know of at least 8 pain clincis and a over 15 PMD's. Out of that I only know 2 who will prescribe narcotics and one of those I know for certain will only do it after you have tried EVERY other solution which can take years in some cases.)

straydog
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Date Joined Feb 2003
Total Posts : 16765
   Posted 3/4/2011 1:51 PM (GMT -6)   
Jim good topic. My PCP told me the reason they do not write scripts for anything stronger than vicodin and its for 10 days only, no matter what the problem is, they do not have the time it takes to spend with a CP patient, (they are double booked at 15 minute increments w/patients) there is too many hassles and too many problems with patients and medications, meaning who is real and who is a drug seeker, messing with the random UA's, having to retrain an entire office into pain mgt type setting to keep the DEA off of your back and they do not want to be bogged down in the red tape, its not worth the hassle was the bottom line.

My gi dr is the same, very rarely will he offer a patient vicodin and if he does its a week's worth and do not ask for a refill. He will tell his patients to either go to their PCP or find a PM dr. My PCP that told me nothing stronger than vicodin, was the dr that started me on Fentanyl patches. I had an appt coming up with a PM dr and he did this because I was in severe pain and and cannot take things like vicodin and NSAIDS. I looked 'at him and said but you just said you did not write scripts for this kind of pain medication. He said with you being a patient here for over 10 years and not once have you ever asked for pain medication except for your migraines, I am quite comfortable doing it this one time since you have a pending appt with a PM dr. I was truly shocked that he did this.

I have also seen the downside to a PCP rxing pain meds and the person ended up dead from overdosing, due to the dr not knowing enough about pain meds.
Moderator Chronic Pain Forum

mrsm123
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Date Joined Dec 2007
Total Posts : 1235
   Posted 3/5/2011 1:14 AM (GMT -6)   
Most PCP only recieve an overview of pain treatment ( acute mostly and a bit of information about chronic pain) in medical school and we all know that there are so many variables in treating chronic pain, the medications, dosing , conversion formulas, etc that on top of there not being a big paycheck, there are too many regulations and too many potential problems with staying on top of the new and ever changing DEA regulations to make it feasible both financially and professionally. There is also the problem of doing it for one patient who then recommends this PCP to his friend, who recommends him to another and so on and so on, until he has new patients, not for the general scope of his practice but seeking pain medications and then he opens himself up to a whole new slew of potential problems, so most will not do it. My PCP has been mine for 18 years, I have never asked him for pain medications, even when I fractured and displaced my tailbone and while I know that he probably would write my scripts for me, I won't ask....I don't want to put him in an uncomfortable position and honestly, while he is a great GP , and he was the former director of the ED at our largest hospital, I don't feel that he knows enough about the treatments of chronic pain and it's complications that I just am not willing to take any chances, for him or for myself.
Sandi

MIKEL99
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Date Joined Feb 2010
Total Posts : 914
   Posted 3/5/2011 7:22 AM (GMT -6)   
I think thats right on Jim , I am very hesitant to change doctors because the one I have knows my history and the meds I've tried and that I'm for real . I've heard a lot of stories from other people in pain about how hard it is to get their doctor to prescribe pain meds for them , these doctors don't want to touch it generally . Because of issues like phony pain clinics that are really just drug dealerships in disguise its made it difficult for legitimate sufferers to get what they require to function without disabling pain .Consequently when you get a doctor who does understand and is willing to help you, you hold on to them , but sometimes they are difficult to find in the first place , thats for sure . Mikel
HIV+. meds - epzicom, Kaletra . oxycontin as needed , Hip replacement has been a total sucess , I feel blessed and thankful and happy most of the time . Everyone in the CP Forum shares in my sucess , thank you all !!

Davy Navy
New Member


Date Joined Mar 2011
Total Posts : 3
   Posted 3/6/2011 4:17 AM (GMT -6)   
Man, if that isn't the truth about new Doc's and CRPS/Neuropathies...BTW, howdy to all from a newbie to the forum; a sufferer of CP/spreading neuropathies since late 2009 when i was involved in a Motorcycle accident (got smacked by a kamakazi deer on an Interstate, and was shoveled off the road...lol. Actually not funny, but I live in reality). My wife and me had just moved to another State...we figured it would be difficult, but WOW!
 
What I have found that really makes it rough are the 'junkies', the ones who Doctor-shop, the ones who flat out lie...the ones who 'walk' in and laugh it up in the waiting room...then stagger in with their 'walkers' and say they are a "10" and cry once in the office (I have seen this), then grumble and gripe in the parking lot when they are told what we are told and given a scrip for motrin. (haha)
 
I feel like slapping them in the mouth...And I have relatives who are junkie-scammers. We had to keep our meds under lock and key...and still watch them closely!
 
CP sufferers, even with records, x-rays, body-scan results and Dr recommondations from prior Pain-Clinics in hand are just not believed! (and I don't even compute my own as a "10"..."7-8" on a bad day) Complete new tests are ordered, while the new patient suffers and hopes their last scrip carries them through...to the point of halving them to make sure!
 
The junkies are clever...and were the ones who got obscene amounts of meds...which made it onto the streets for a nice profit. And the sad thing is...their 'best' customers are, you guessed it; CP patients who can't get meds!!!
 
Is it time for legit CP patients (who can prove it) to get loud and not shut up? or is it already too late?
 
 
 
fentanyl patch/100mcg/hr
percocet 10/325
neurontin 2400mg
celebrex 100mg
wellbuterin 200mg
prozac 60mg

Post Edited (Davy Navy) : 3/6/2011 2:22:36 AM (GMT-7)


CRPSpatient
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Date Joined Mar 2011
Total Posts : 1276
   Posted 3/6/2011 4:56 AM (GMT -6)   
Good topic, though I actually seem to be a little different from the norm here. My primary pain med is Oxycontin ER, and I take the IR form for breakthrough pain as I need to. My day-to-day pain needs are managed by my GP and have been for quite some time now. There are a few reasons for this - I have multiple specialists - PM, GI and cardio, so my GP acts as a central point for everyone's information and communications, and makes sure everyone stays informed. He is also five minutes down the road, instead of over an hour's drive away. I have an excellent relationship with him (actually - with all my doctors) and he is happy to prescribe what I need. If I require a change in dose, he also manages that; it's only if I am changing to a new medication that my PM steps in to establish and stabilise it, then my GP takes over again. It may be because I see or at least speak to him very regularly (every 2-3 weeks at the outside), but he also consults with the other doctors at our local clinic so that he can write me authority scripts with no problem. This means that I can get a month's supply of oxycontin on a single script, rather than the usual 10 days.

Davy Navy
New Member


Date Joined Mar 2011
Total Posts : 3
   Posted 3/6/2011 5:43 AM (GMT -6)   
I hear you on that...My G.P is my clearinghouse as well...PT, Neurology, Pain-Clinic, which ever other little 'lovely' that comes along. Anymore, you have to see the G.P, who sends you to a Pain Clinc...that sends you back to G.P to write scrips. 
 
Isn't it insane?
 
Somehow I wonder if I am being punished for the sins of my youth?
 
Naw, no one would go NEAR those...lol
 
 
--------------------------------------------------------------------------------------------
 
Getting spread down a highway near you!!

Post Edited (Davy Navy) : 3/6/2011 3:50:48 AM (GMT-7)


uniquelyme
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Date Joined Nov 2008
Total Posts : 1037
   Posted 3/6/2011 7:56 PM (GMT -6)   

I know that when I had to find a PCP and they read that I went to a PM I felt like I was under a microscope...and every visit the nurse and the Dr. always asked the same thing..."Are you still taking the pain meds? and why are you still needing them" ? This Dr. was the one that finally DX'ed me with Type 2 Diabetes so I had to see him about every 2 weeks anyway, but it never failed....and he would always bring up that these pain meds will make me become addicted...and I will eventually have to stop taking them...NO, not in this life.

But when I first went in to see him one of the first things he told me was "There is no way in hell I will give you these meds." I didn't even bring this up and he had to get smart with me....I think they are more worried about losing their license to practice then taking care of patients....Too Bad, it would make things a lot less difficult if they would do it...

Rhonda

Rhaevin
Regular Member


Date Joined Jan 2011
Total Posts : 230
   Posted 3/7/2011 1:33 AM (GMT -6)   
Jim, that was my comment.

I guess alot of my inability to grasp this is because CP patients are typicially perscribed, at least by PM doc's, narcotics. Personally my PM seems opits as the devil's candy, but also understands that sometimes they are the only thing that works... if you can call what they do working.

Oddly enough it was my Physicians Assistant, the very one who saw me the day after my accident that spawned my CRPS, that was my greatest ally in my combat against my pain. PA Tarrant understood my condition, though at the time he only suspected CRPS, and he was the one to eventually write the referal to my current PM doctor. When I was in a rock and hard spot and had no insurance, Tarrant was who I saw. Against the law he understood that it was costing me $50/visit to come and see him, and another $80/script to get my generic pain meds. So he would write my script and then give me two refills as well. Technically this is a big no-no, and I'm not sure how he got around it. When Tarrant had to go on permanent medical leave (he was diagnosed with terminal cancer and given 6 months saddly) I started seeing Dr Bady. Not a bad man, though after 6 months, every month I saw him he would look at me. "Why are you here?" To get my script refilled. "Why again are you taking Loritab?" Um... hello, file in your hand, diagnosed CRPS stage 2.

Now with insurance I am back to seeing my pain Doctor again. And from what I hear from my friend, her PM doc is just as wonderful as mine. He is generous with his scripts, they can be refilled when ever needed for his established clients, etc. In some ways he makes pain management easier then my doc does, and it's tempting to switch, but aside from the pharmasutical bennefits I see no logical reason to leave a doctor who is treating me well, has my best interests at heart, and has been trusted repeatedly with my life in his hands.

I suppose I could understand how seeking just a generic practioner could pose a problem as a CP on narcotics. I guess it was a missunderstanding of apples and oranges. I hope though Jim that you find that Tarrant... that doctor who knows, cares, and takes good care of you without making you feel like you're being ignored, that you're not important... none of that.
Originally injured 10/26/2007 - Initial diagnosis; Tendonitis
Spent next year seeing specialist after specialist; Bone, Muscle, Hand, Neurologist, Chriopractor, Physical Therapist...
Went through a battery of tests, multiple MRI's
11/16/09 I was finally diagnosed CRPS - Stage 2
Permanently disabled, on Percoset.
February 2011 successful SCSU trial
No surgeon willing to do my SCSU Implant

bsjaguar
Veteran Member


Date Joined Jun 2009
Total Posts : 974
   Posted 3/7/2011 7:50 AM (GMT -6)   
Jim, I know where you are coming from even though I am no longer using narcotics for pain relief.  I haven't been to my PM doc in quite some time because I am sick of having injections that don't last and not being on narcotics I see no reason to have to drive all that way.  Anyway, my tramadol (non-narcotic pain med) was going to run out so I asked my PCP for a refill.  He asked me why I didn't get them from my PM doc, I asked him why I should pay a $40 co-pay and drive 2.5 hrs for tramadol?  He wrote out the script.  Then after reading good things about baclofen, other muscle relaxers always knocked me out, I asked my rheumatologist if I could try them.  He asked me why I didn't get them from my PM doc.  He did write me a script and I do like the baclofen.
 
The point being is once you've been to a PM clinic, doctors don't want to treat your chronic pain even when you aren't requesting narcotics.  With me not working it also got too expensive going every month to PM docs, rheumatologist for PMR, and then add in the MRI's and injections.  The co-pays were killing us.
 
How's you SSDI claim coming.  I'm still waiting to see the ALJ. 
---Jag---
 
DDD, osteoarthritis, facet syndrome, fusion surgeries C-5/7 & L-4/5 both in 2006, torn meniscus surgeries left knee 2000 & 2002, buldging disc L-2/3, fibromyalgia, polymyalgia rheumatica

Mrs. Dani
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Date Joined Jun 2009
Total Posts : 2787
   Posted 3/7/2011 12:57 PM (GMT -6)   

  

    When I first came here I didn't understand. I was na├»ve, I suppose. The stories, the realities I read just shocked and horrified me.

    Once I became sick my doctors created a web of particular specialists that all care for me and communicate regularly with one another. Occasionally they would bring in outside specialists for different aspects of my care that came up along the way. Even when my insurance changed and technically I could no longer see them... I was charged bare minimum and was still allowed to continue my care. Even when all my teeth crumbled out of my mouth in just a few short months. I didn't realize at the time what they were doing for me and to what extent. I soon learned as the bills came pouring in. Many were donating their time.

     It is easy for me to say "Hey! You shouldn't be treated like that!" But in all reality the few medical professionals that treated me badly were removed from my care, never to be seen again. My other doctors took care of those problems. One even apologized while I was being wheeled in for procedure. I forgive him, but he treated me badly. Even see him to this day and he is always concerned and wanting to know how I am doing.

    In other words, I have been seeing my GP since my only concerns were moderate acne and birth control. Many many years. He brought in a few specialist when I became sick who have looked over me constantly from day one. I have no clue what would happen to me if I was faced with needing new doctors. How would I be treated? I don't know. My spine is progressing no matter what doctor I see. Would I be treated with care and understanding like I am now? Maybe not. Would my pain be a strike against me? Gosh, I just don't know. Back to the original thought.. my spine is progressing anyway.

    The truth is, I have never had anyone question my pain. One specialist early on (the one that is very sorry and I run into at the hospital often) and a couple of nurses who didn't see what I was hiding under my unusually long sweaters. They are all very sorry now. But I have no doubt that if it were not for my deformities I would be treated very poorly by any "new" doctors.

  smhair   The medical community can be cruel to "us". In short we hate to know that any of "us" are being treated badly. Sadly, there is little we can do about it in this day and age.

*hugg*
  dani


TWO roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood

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