Drug Contracts

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Rhaevin
Regular Member


Date Joined Jan 2011
Total Posts : 230
   Posted 3/11/2011 2:16 AM (GMT -6)   
Evening my dearest family,
 
I have a question, and I'm unsure how to approach it. I guess my Pain Management Doctor (the only doctor I really see) has finally found a surgeon who is qualified, and willing, to do my Spinal Cord Stimulator Implant. I did my trial back in Feburary with great success, but because my Doc wants to use the paddles for my implant (they afford better control and coverage then the standard leads) and the process for this requires a Lamectomy, /and/ the fact that in the last year 3 seperate surgeons have ended up with their patients suffering some form of paralysis, most Doctor's are not willing to do this procedure anymore. Also because of where my CRPS affects me I will need to have the leads "sutured" into place in my neck, up by C2.
 
Now as we all know any time you do surgery on the back it's risky, and especially the neck because of the size of the area. I'm in a debate on whether or not to do the procedure simply because of this risk; I'm not sure I want to saddle my family, especially my 8 year old son, with the responsibility of having to take care of me for the rest of my days. But I have tried to put this outta my mind until I talk to the surgeon and talk about the odds, his successes with this procedure, how many he's done, etc. Yah, I'm a logical numbers kinda person.
 
So I got the paperwork from surgeon the other day; my appointment isn't until the 24th of March. In this packet of paperwork that I have to fill out (read that my mother will be filling out as that much writing will put my arm outta comission as my pain levels have already been holding at a steady 9 on a pain scale) one of the documents is a Drug Contract.
 
I have heard good and bad things about drug contracts. I understand it means I can't seek other doctor's for pain meds, not even the ER. It means all refills are handled by this surgeon's office, I have to have the pharmacy I use contact them no less then 5 days in advance. It means I must use the meds as dictated, "or else". Now I can understand, especially with as tight a rein as they've put on narcotics, why doctor's do this, but to date I've /never/ had ANY of my doctor's have this sort of contract. I'm not sure if it means he'll be taking over my pain meds from my Pain Management Doc or not. I've got such a good relationship with my PM doc, and I trust him implicitly. If this is the surgeon I think it is I've met him once before two years ago back before I had a diagnosis. He was way behind schedule, and when he finally got to me he gave me such a look of disdain and made me feel like I was wasting his time. "There's nothing wrong with your x-rays. I'm a bone specialist. Why are you here to see me?" It was said in such a tone, as if I were a small child bugging him and taking up his valuable time. Now I'm not sure it's the same guy, I won't know till I see him.
 
So my question is this: What do you think of Drug Contracts? Is tying my hands with a guy who's office is an hour away worth it if it's the only way I can possibly get my surgery done? My PM doc has been with me for a year and a half now ... I hope you can understand my reluctance to turn my care over to someone I only want to see for a surgical procedure. I'd like to hear your thoughts if you were in my shoes.
 
Thank you all for your time.
 
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

flower123
Veteran Member


Date Joined Apr 2009
Total Posts : 856
   Posted 3/11/2011 4:27 AM (GMT -6)   
I would talk to your PM doctor about it. My opinion....is that I think that it's probably a standard form for the surgeon. I would call/make an appt. to see your PM doctor, and discuss who will be handling your meds. after surgery. It sounds like you have a great relationship with your PM.

I would find out if your PM can prescribe the pain medication you will need after the procedure. That is what I have done when I have had surgery, but I have never had a surgeon have me sign a contract. Contracts can be tricky, so it's good that you posted. I hope that others will be around with more advice, as I'm not so sure about this one.

Hugs,
Flower

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1753
   Posted 3/11/2011 6:30 AM (GMT -6)   
Wow, you are right to be so concerned. I'm like you in that I'm not sure the risks outweigh the possible benefits. That withstanding....don't sign anything you are not 100% comfortable with...it can really be a problem for you later.

After making up my mind about the procedure, assumunig you decide to go ahead, I would then talk to the PM and get something from them in writing saying they will take you back as a patient when released from the PM provided by your surgeon. It could be really sticky if things aren't done correctly and you don't want to end up without PM becuase of some clerical error. Word of mouth is good, but doesn't stand up in any court that I've ever been in.

Good luck!
Failed fusion L5-S1, Pituatary damage, HGH Def, Fibro, Bladder surgery failure, Nissen Failure, GERD, OCPD, GAD, MDD, CTS (Bilateral Surgery completed), CFS, TMJ, Migraines, Vit D, A, Magnesium deficiency, Pre-glaucomic (sp?), HBP, Idiopatic Reactive Hypoglycemia, Edema, too many Drug/Food allergies, sensitivites, and current meds to list.

CRPSpatient
Veteran Member


Date Joined Mar 2011
Total Posts : 1276
   Posted 3/11/2011 7:28 AM (GMT -6)   
Wow. Drug contracts are a completely foreign concept to me, so I'm not sure how to comment on that part of it - is this a US thing? The fact that you are not even allowed to seek pain medication from an ER concerns me. What happens, for example, if you go into a flare in the middle of the night, on a public holiday, or some other time when your doctor can't be reached?

The surgery itself - as you know well by now, I'm in a similar situation. I had a discussion about paddle leads a couple of years ago and I refused because I felt the risks of a laminectomy with CRPS were far too high. I guess that you have to talk with your PM doctor and the surgeon - are they anywhere near each other? Are they in close discussion with each other over this?

Wishing you all the best.

Laura
CRPS since 1999, diagnosed in 2005 and since spread to full body, spasms, dystonia & contractures, gastroparesis, orthostatic hypotension.

On Oxycontin/Endone, Topamax, Mobic, Magnesium, Florinef, Somac, Cipramil. Have a spinal cord stimulator, intrathecal pump with baclofen & bupivacaine and doing physio.

Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 3/11/2011 8:20 AM (GMT -6)   
Quite frankly I would not sign it until you have all of the facts.

I would want to know if this is for a indefinite period of time, or is it finite. I would also want to know does it mean the surgeon is taking over your pain management, what you are suppose to do if your pain overwhelms your medications and the stimulator, etc.

Also read the contract carefully. Please do not assume it is a "standard" one.

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 5012
   Posted 3/11/2011 8:42 AM (GMT -6)   
I agree with all the above! If this surgeon wants to handle all meds forever more I would be looking for another surgeon.
Alcie
 
 

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1235
   Posted 3/11/2011 9:43 AM (GMT -6)   
Most typically, after surgery, the surgeon prescribes medications for the immediate post op period. This usually means 1-3 months depending on the type of surgery. You do have a couple of options, if your PM doctor is willing to handle the post op prescribing, then you can simply explain to the surgeon that your PM doctor will handle the medications in conjunction with the surgeon.
You can ask the surgeon to only prescribe during the immediate post op period, with your PM doctors permission.
Or you can simply sign the form after you have seen the surgeon and see what he says.
I would talk to your PM doctor first and see what he would like for you to do.
Sandi

desert
Regular Member


Date Joined Feb 2011
Total Posts : 93
   Posted 3/11/2011 9:54 AM (GMT -6)   
I would also guess that this is one of your surgeon's standard forms anytime he has a patient that will receive narcotics. I don't know, but I imagine he is thinking you'll need some pain killers simply for the recovery after the surgery, and that is why you ended up with this contract in your lap. Talk with the surgeon. You may be able to just handle it over the phone, but if he doesn't seem to understand your point of view right away, then do it in person. If he's thinking he will be taking over all of your pain management, I'm not sure you want an overly busy and rather rude surgeon taking care of that. Have him talk with your pain doctor and work out how he can treat your recovery safely while your pain management doctor retains control of your case as a whole and will manage your day to day medication needs once the surgery is complete. You need someone who knows you, and isn't too busy or too far to help you out when you need it. I do not think it would be wise to sign something that does not fit with the way your care will actually be carried out. Standard form or no. The doctor has this form because he expects it to be seriously upheld for his patients, so just saying it doesn't mean anything for you doesn't really make sense.

Best of luck Rhaevin! I know you've been waiting to find a surgeon for a while. I hope everything goes perfectly for you and you can enjoy relief better even than your trial unit. Keep us up to date on both this contract issue and your surgery. You'll have all my best wishes and hopes with you.

-Jeff

momtofourangels
Veteran Member


Date Joined Apr 2010
Total Posts : 2261
   Posted 3/11/2011 8:51 PM (GMT -6)   
Hi Rhaevin. I wouldn't be signing that if I were you until I talked to the surgeon and my PM dr. about it. I would make sure that the surgeon knew that he wasn't taking over my PM care permanently or watever. I would tell him you already have a PM dr. that you're happy with and you would only need the immediate post op time taken care of. Just my opinion. I haven't had surgery of this kind, so I don't know what happens after back surgery, but that's what I would do if it were me.

love and hugs
Loretta
Dx: osteoarthritis, bursitis in left hip, Osteoarthrits in right hip, compression fracture in thoracic spine due to falling on frozen ground March 2001 , ddd, spinal stenosis, bone spurs, osteoarthritis in spine, osteoarthritis in both knees

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16416
   Posted 3/11/2011 10:28 PM (GMT -6)   
The question I have is who is going to be handling your SCS Unit, the surgeon or your current pain mgt dr. I am not sure why there is a Contract in his paperwork unless he plans on being the one handling you from here on out and taking over your complete care, including pain mgt. As one of the others mentioned, it is not uncommon for your current PM dr to take care of your meds post op, he can work with the surgeon on that. You need to talk to both drs to get all of this settled so there are no surprises later on down the road.

Take care.
Moderator Chronic Pain Forum

Rhaevin
Regular Member


Date Joined Jan 2011
Total Posts : 230
   Posted 3/12/2011 1:54 AM (GMT -6)   
Thank you everyone for all your wise words, comments, questions, and loving concern. You have no idea how much all of you mean to me.
 
Thankfully I already had an appointment in place to see my PM doc on Monday; time for the monthly renewal, talk about anti-depressants, and now this paperwork. After reading the contract again with my Mom because of how it's worded I shouldn't have to much trouble retaining my PM doc as head of my pain meds.
 
I'm definately /not/ signing the contract, I've come to tha conclussion without a shadow of a doubt. If it's just for post-op meds, that's fine, he can handle that, otherwise he and my PM doc can coordinate things. If not signing the contract means no surgeon, then so be it. That is one of my questions for my own PM doc as this is the surgeon he referred, and I know he's worked hard to find someone that would take my case; I don't want to offend him over what some would consider a trivial piece of paper.
 
It does at least turn out that this is not the same guy I saw two years ago, so that's reassuring. Also, and I think I mentioned this, my friend with the SCS across the street knows one of the other surgeons in thie group of Head/Spine specialists. As far as I know this surgeon is strictly to handle the implanting of my unit. I think after that everything else my PM can handle given he did my trial for me. Also I'm hoping I'll have the same Rep from Boston Scientific that I had during my trial, as I really feel I made a connection with her, and felt comfortable with her. Her and her team (I saw one of her associates for a minor adjustement during my trial) are really nice people and very fast at getting things taken care of.
You have all raised some wonderful points, and I will be jotting alot of this down in my notebook I take with me to appointments; my portable memory device as I call it. That way I get everything covered and asked that needs to be.
 
Laura -- Some of those questions, about the lamenectomy are questions I'm reserving strictly for the surgeon; they will be the make it or break it questions that will lead me to decide whether or not I'll have it done. You and I have talked alot about this recently I know. It looks like currently my CRPS is trying to spread to my neck now. Having alot of neck issues, and I know especially my jaw and neck are starting to pop alot, much like my wrist and shoulder do. Who'd have ever thought we'd be so "musical" at our age. Keep me informed about what sort of progress your doctor there is making about doing the paddle leads without the lamectomy as I would hope it wouldn't be long till they got that sort of ability in the states. I wish they didn't have to go into my neck, but with my arm being the issue I don't have alot of options. I wore my TENS unit today and I gotta say, after having the SCS it's like the difference between a Rottweiler barking at you, and then a Chiuaua's bark. But for the first time last night I was in so much pain that I actually had to grab my feather pillow to prop my arm on; it was the only way I could get it comfortable enough so I could eventually get some sleep.
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

CRPSpatient
Veteran Member


Date Joined Mar 2011
Total Posts : 1276
   Posted 3/12/2011 5:00 AM (GMT -6)   
Sure will do Rhaevin - I'm not seeing my doctor to talk it over for a few weeks yet, but going to have my tech here pretty soon I think - he reprogrammed the other week to get me some coverage from my functional lead but even with max intensity I can barely feel it now. I'm going to ask him if he has any papers or any other information he can give me as all I can find online is the patent info I posted recently.

I'm so sorry that it seems to be 'trying' to spread as you put it...I know that feeling so well, and just how scary it is :(

For what it's worth, I think you've made the right choice *hugs*
CRPS since 1999, diagnosed in 2005 and since spread to full body, spasms, dystonia & contractures, gastroparesis, orthostatic hypotension.

On Oxycontin/Endone, Topamax, Mobic, Magnesium, Florinef, Somac, Cipramil. Have a spinal cord stimulator, intrathecal pump with baclofen & bupivacaine and doing physio.

uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 3/12/2011 10:41 PM (GMT -6)   
Well, Most, if not all of us that see a PM Dr. are under contracts...that's what we have to do. I assume it's the same thing. All it does is make sure you aren't abusing your meds. or puting your life at risk...and covering the Dr.'s ASS. Signing a contract is pretty self-explanitory. I hope you have great results with your surgery....

Rhonda

Chutz
Veteran Member


Date Joined Jan 2005
Total Posts : 9090
   Posted 3/13/2011 1:43 AM (GMT -6)   
Hi~

There was a post recently about new laws coming into effect soon that will regulate (maybe over-regulate) the use of pain med's on non-cancer pain patients. The timing is not definite yet but it appears that everyone taking above a certain amount of medication will have to be under contract, submit to regular testing, and on and on. I live in Washington state an we have a new law that will be effective mid-year and is more strict than the proposed federal form. I did talk to my doc about this...who is my PCP...and he confirmed what I had read.

Thanks to Ides who discovered this information and provided the link. Here is a paragraph and the link to the article if you are interested. I'm sure more information will be coming out as the year progresses.

FWIW...
Chutz

Legislative and regulatory responses to opioid prescribing are on the horizon. The FDA has proposed a new Risk Evaluation and Management Strategy (REMS) for opioids, but the REMS has not been approved yet, because an FDA committee wants stronger requirements, including mandatory physician education programs. And, in Washington State, a new law that takes effect in mid-2011 will require documented evaluations (diagnosis, treatment plan, and objectives) before physicians initiate long-acting opioid therapy.1 The law also will require written agreements signed by patients, periodic review of patients' progress, continuing education for physicians who prescribe long-acting opioids, and mandatory consultation with pain management specialists when physicians prescribe morphine equivalent doses exceeding 120 mg daily. Notably, the law does not apply to patients who have chronic pain caused by cancer, or acute pain caused by injury or surgery, or who are receiving hospice or end-of-life medical care.

general-medicine.jwatch.org/cgi/content/full/2011/113/1?q=etoc_jwgastro
Moderator on the Fibromyalgia and Chronic Pain forums
~*~*~*~*~*~*~
Daily Donnybrook: Fibromyalgia, Insulin Dependent Diabetes. Ulcerative Colitis, Rare form of Dermatitis, Collapsed Disk, Osteoarthritis (especially in right hand and neck) and a couple of other adjunct agitations.

"Gravitation is not responsible for people falling in love." Albert Einstein

momtofourangels
Veteran Member


Date Joined Apr 2010
Total Posts : 2261
   Posted 3/13/2011 2:19 AM (GMT -6)   
I have a contract with my pcp which is the one that prescribes my pain meds. I just had to sign it when she started prescribing them a few months ago. I didn't have to sign one when i was with the pm dr. that she referred me to or the one i saw about 2 or 3 years ago. But it's pretty simple. I wish you luck with your surgery and everything.

love and hugs
Loretta
Dx: osteoarthritis, bursitis in left hip, Osteoarthrits in right hip, compression fracture in thoracic spine due to falling on frozen ground March 2001 , ddd, spinal stenosis, bone spurs, osteoarthritis in spine, osteoarthritis in both knees

CRPSpatient
Veteran Member


Date Joined Mar 2011
Total Posts : 1276
   Posted 3/13/2011 3:01 AM (GMT -6)   
Rhonda - and others... are drug contracts largely a North American thing? Most of my contact to date has been with other CRPS sufferers in Australia - I've never really chatted to any o/s CP patients before and I've never heard of drug contracts before. I can see the merits in them, I guess, but personally very glad I don't have to deal with them.
CRPS since 1999, diagnosed in 2005 and since spread to full body, spasms, dystonia & contractures, gastroparesis, orthostatic hypotension.

On Oxycontin/Endone, Topamax, Mobic, Magnesium, Florinef, Somac, Cipramil. Have a spinal cord stimulator, intrathecal pump with baclofen & bupivacaine and doing physio.

uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 3/13/2011 8:51 AM (GMT -6)   
CRPS, It's undeerstandable that the DR.'s want to ensure their patients safety by having them sign and follow a Pain Contract...and I understand the need to cover themselves....I do hate having the "Pill counts", and unending UA's...I wish I was there with you....LOL

Rhonda
Spinal Stenosis, DDD, DJD, HBP, Type 2 Diabetes

Methadone 120 mg. X daily
Oxycodone 30 mg. 5 X daily
Lisinopril HCTZ 10/12.5 2 X daily
Novolin 70/30 insulin 75 units 3Xdaily
Novolin R insulin 1Xdaily
Novolin R 0-50-0-0

That's all....but OMG!! isn't that enough?

grainofsalt
Regular Member


Date Joined Aug 2010
Total Posts : 215
   Posted 3/13/2011 9:11 AM (GMT -6)   
To Rha.

I am currently on a drug contract, but mine is relatively relaxed. I think the contracts might depend on things like state laws and whether the doctor is independent or part of a larger medical community like a hospital.

For my contract, it simply means:

1. Take the medicine as prescribed and that I understand I can not get new prescriptions should I run out early, unless my doctor gave permission to use additional medication for breakthrough pain.
2. Consent to drug test. This protects you as well and lets your doctor know you've been telling the truth. Its completely random and only you PM sees the results (well and the techs/nurse). They also test for illegal drugs to ensure the medication you are on will not have a dangerous reaction with illicit substances.
2a. Also, being on other controlled but non Opioid substances with a primary care docs prescription is fine and you are not penalized for it provided you reveal what you are prescribed at the time of testing.
3. I can get my script filled at ANY pharmacy. There is no restrictions there.
4. I can receive Narcotics from an urgent care or ER center. I do not need to notify my PM immediately, simply I must inform him within 24 hours of receiving the medication. I also am required to let the UC/ER doctor know that I am already on pain medication so that he or she can determine whether a stronger or different drug is temporarily needed. Narcotics filled from other doctors are for short term use only. Also, Narcotics from other doctors must be an urgent care situation, so a primary care doctor could not prescribe them.
MRI revealed disc bulge and test injections revealed RA. Radio Freq procedures have decreased the severity of pain by about 1/3rd. currently on 75 mgs of Nucynta (tapentadol) 3 time per day. Works as well as 10 mgs of hydrocodone, less addictive, no tylenol, but schedule II. Also take Alieve OFTEN, much better than Ibu.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16416
   Posted 3/13/2011 10:25 AM (GMT -6)   
CRPS, pretty much all pain mgt drs have some sort of a Contract in use. Now, that REMS has been involved all pain mgt drs will have to have their patients sign one. GrainofSalt has a very liberal Contract, most of them are very restrictive. I really don't think its a big deal, if a patient is doing what they are suppose to be doing then there is not a problem.
Moderator Chronic Pain Forum

Rhaevin
Regular Member


Date Joined Jan 2011
Total Posts : 230
   Posted 3/15/2011 1:41 AM (GMT -6)   
Chutz  -- Thanks for the heads up! I'm not currently signed to a contract with my PM doctor, but if that has to change, so be it.
 
GrainOfSalt -- The one I recieved is a bit more strict then that. One of the things that worried me was that if I had a flare up at night or on a weekend I wasn't allowed to go to the ER for any sort of pain drugs related to my issue. However if you read on you'll see this won't be an issue.
 
So I saw my PM doctor today. I showed him the contract and he waived it away; he'll still be handling my pain management medication, so I've no worries about the surgeon's contract. Whew! I was a bubble-head though and totally forgot to ask him about anti-depressants.
 
The good news is that the surgeon I'm seeing is one of the best neck surgeon's in the area. He's with the Spine and Brain institute out in Las Vegas. While he may not do many SCS unit implants he does excel in neck surgeries, and given the risk of my surgery mainly comes from the need for the lamectomy in my neck, it sounds like I'll be in excellent hands. My doctor has made me feel very optimistic about all of this. Like I told him "I know you weren't just opening the medical white pages and just calling down the list of surgeon's till you found someone that would say yes. If you're refering me to him it's for obvious reasons; you feel that he will be my best option, the best qualified, to do my surgery with minimal worry about nasty consequences or outcome." So I am very much looking forward to next week and meeting this surgeon. My boyfriend has offered to go with me for multiple reasons, and I'm grateful for his support in all of this, and his positive attitude; I think he's more optimistic then I am, but there's nothing wrong with that!
 
Had a really bad night over the weekend. I can't remember the last time my pain got so bad it curled me into a little ball and actually woke me up in the middle of the night. It was such a bad flare it actually woke my boyfriend as well, who could do nothing more but hold me gently and stroke my back, trying to find some way to get my muscles and nerves to calm back down.. murmuring to me softly to try and focus on my breathing, slow it down, focus on relaxing, stroking my hair, rubbing my back. It actually worked, and after murmuring and apology to him, I was able to drift back off to sleep.
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
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