I cannot say that my pathway with my medical providers vis-a-vis Palliative Care is easy. It’s not. I jump through many of the same hurdles (comprehensive urine drug screens; pre-authorization for opiate prescript
ions over 90 mg morphine equivalency; ongoing documentation that substantiates a medical need for ongoing opiate therapy; state reporting database of my opiate prescript
But I have escaped the need to sit in a pain management office and the climate that looked at me as a “criminal” for having a failing body and needing a measure of pain control. I do empathize that the experience at a pain management practice can seem draconian.
I have had the misfortune of misdiagnoses and grossly incompetent medical care. I am distrustful of medical care. It has not been all rainbows and unicorns. In Palliative Care I have found an inherently caring and supportive climate of clinical providers - which has been a god send. But you do not get to receive Palliative Care unless one’s situation is grim. It is a sad reality to have to qualify with a serious/life threatening condition to find compassionate care through Palliative Care.
I agree with Susie that the best/most wise approach is to “ride the wave.” That is, be knowledgeable of your health conditions and accepted best practices regarding treatment options. Do not
openly challenge a prescribing dosage of opiates. You may end up with nothing.
I am cognizant of having a tool box of ideas/strategies that I self employ to reduce my pain. Yoga is a key component of my self-care. You do not need to be a human pretzel to benefit from gentle yoga. I also use warm buckwheat packs, practice relaxation techniques, use diversion (crossword puzzles; NetFlix movies; cuddles with my puppy); TNS unit; swimming with a kickboard and range of motion while in the water.
I recognize that I will never be pain free. A 50% reduction of my baseline pain level is what I have come to accept. Some days are better than others. I take a “good day” as a blessing.
In my case, my underlying conditions are not expected to improve with prescript
ion opiates. Documentation does need to show that I am able to achieve a higher level of function with activities of daily living with prescript
ion opiates. This is where the two functional assessment surveys serve as objective quantifiers. One assessment reports my functional level (ease climbing a set of stairs, ease of getting dressed, etc) without access to opiate medication. One assessment reports my function on the same key indicators with access to opiate medication. A similar assessment is available on the PainNetwork internet site.
Bottom Line: Documentation must support that I am more functionally capable with prescribed opiates. My physician will also ask me questions each session about
my function and quality of life. Ex. Am I able to prepare a simple meal or does pain preclude my ability to maintain nutrition? Ex. Have I been able to participate in a community activity or does pain keep me home and isolated?
My medical team also reduces my prescript
ion opiates every 3 to 4 months for a one month period. This is a purposeful reduction in order to tame growing physiological dependency. Ex. Reduction in duragesic patch from 50 mcg to 25 mcg. I understand that an ever increasing opiate dosage over time is to be avoided, unless my underlying conditions worsen to warrant a change. Does that mean I am comfortable every day? Nope. Pain is not a constant. Some days are more difficult with an uptick in pain.
Like everyone here, I do the best that I can to make the best of a less than ideal situation.
Post Edited ((Seashell)) : 7/9/2018 4:45:15 PM (GMT-6)