Re: Chronic Pain Medications

[Guest guest]

Wow.  Thanks for sharing Beth.This seems like a field ripe for some good patient centered care.

Do you feel like you are able to do a good job at the clinic you are working at?Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax: 

www.SharonMD.com

 

After working at a pain management clinic as a consulting primary care physician for the last 4 months, I have come to realize several things.

 1.     Some offices doing pain management do not explain the individuality of medications used to treat chronic pain.  Several patients come in with preconceived ideas about what medications they should be on for their pain based on what a friend or other acquaintance is receiving from their pain doctor.

 This is the text received from a patient wanting to be admitted.  The PCP physicians have to review charts before they can be accepted and treated by our clinic. 

“Hello,  my name is XXX XXX.  I have been seen by one doctor for the last three months for pain management.  He currently has me on 90  -- 30 mg. oxycodone 30 mg for breakthrough pain and that is not lasting me thru the day.  I am also on  60 mg of methadone which I feel is cancelling out the oxycodone.  My sister in law takes 240 oxycodone 30 mg for the chronic pain and 120 oxycodone 15 mg for breakthrough pain.  I would like to try this regiment. I have an MRI and the pharmacy list but I am not comfortable giving you my doctors name until I know I can be seen and prescribed as a new patient because if he is contacted then I do not get seen by yawl,  then he will drop me for looking other places, he is a very arrogant man.” 

Obviously there is so much could take issue with in this e-mail text from the patient, I will just leave it to speak for itself.

 2.    Some pain clinics are more interested in making a buck instead of properly prescribing chronic opioids and other medications for pain.  We have had several patients show up here wanting to transfer to our clinic because the one they were going to was closed down by the feds.  It is no wonder their clinic got closed down given the ridiculous amounts of pain meds they were given by their last pain doctor.  Methadone when dosed for pain should be given in small doses every 6-8 hours.  When it is dosed for addiction tx it is dosed once a day.  Patient came in today with records from their last clinic indicating that these were the meds prescribed and the instructions for taking them. 

 Methadone 10 mg  take 6 tabs at hsRoxicodone 30 mg take 7 tablets on waking; 6 tablets at 2pm and 4 tablets at hs

Roxicodone 15 mg take 1 tab q2-3 hours for breakthrough pain.  (How anyone had any break thru pain on that dose is beyond me)No other pain meds we prescribed despite patient having radiculopathy sx and chronic inflammation of her hands and ankles

 The clinics that prescribe like this have received no training on proper prescribing of pain medications, and should be treated like common drug dealers that they are.  The woman whose meds are listed above has elevated BP and elevated fasting sugars.  Her BMI is 36% and her last doctor was prescribing Adderall in addition to the other stuff she was on to help curb her appetite.  First of all this is not what Adderall is intended to be used for.  Adding it to the other controlled medications is criminal

  3.    Some patients are full of BS and show up with forged MRI’s ; Forged pharmacy records or forged medical records and get surprised when you point out the crappy job someone did forging the stuff they still have the nerve to ask why your clinic is not going to accept them as a patient.  These patients have gotten “hooked” on these meds by disreputable clinics and the behaviors they are demonstrating are no different than those demonstrated by any addict hooked on something.

 4.    On FOX news there was a story that:

According to a study on the use of opiates and pregnancy, the number of pregnant mothers using opiates increased from 1.19 to 5.63 for every 1,000 births per year.  The number of infants with born with NAS increased from 1.20 to 3.39 for every 1,000 births per year.

Meanwhile, the total hospital costs for NAS jumped from $190 million to $720 million per year from 2000 to 2009.  This amount was adjusted for inflation, the researchers said. 

The whole report can be found at: http://www.foxnews.com/health/2012/04/30/pregnant-mothers-newborns-addicted-to-opiates-increases-dramatically-over-past/#ixzz1teLmuIQh

Something needs to be done to clean up the chronic pain field; better train new physicians and retrain older ones in the safe methods for prescribing and treating pain.  A national controlled substance prescribing record needs to be implemented to prevent the common occurrence of doctor hopping needs to be implemented

 Sorry, but I just needed to vent.

 

[Guest guest]

I was literally just thinking about this yesterday...I would anticipate there will be some really neat indications for acupuncture in this space, especially NAS.From my lens, the management of chronic pain will need to take a step in the integrative direction, as the current trajectory of opioid abuse is near-parabolic.  When one starts to delve into the efficacy pathways + data surrounding opiates, you realize they're not all that effective with some opioid-induced hypersensitivity to boot.

Best,Paras_____________________Paras Mehta, MD PGY-4 PM & RPresident | CMC [House Staff]Board of Directors | Mecklenburg County Medical Society

Board of Directors | American Academy of Medical Acupunctureparas.mehta@...

 

Wow.  Thanks for sharing Beth.This seems like a field ripe for some good patient centered care.

Do you feel like you are able to do a good job at the clinic you are working at?Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax: 

www.SharonMD.com

 

After working at a pain management clinic as a consulting primary care physician for the last 4 months, I have come to realize several things.

 1.     Some offices doing pain management do not explain the individuality of medications used to treat chronic pain.  Several patients come in with preconceived ideas about what medications they should be on for their pain based on what a friend or other acquaintance is receiving from their pain doctor.

 This is the text received from a patient wanting to be admitted.  The PCP physicians have to review charts before they can be accepted and treated by our clinic. 

“Hello,  my name is XXX XXX.  I have been seen by one doctor for the last three months for pain management.  He currently has me on 90  -- 30 mg. oxycodone 30 mg for breakthrough pain and that is not lasting me thru the day.  I am also on  60 mg of methadone which I feel is cancelling out the oxycodone.  My sister in law takes 240 oxycodone 30 mg for the chronic pain and 120 oxycodone 15 mg for breakthrough pain.  I would like to try this regiment. I have an MRI and the pharmacy list but I am not comfortable giving you my doctors name until I know I can be seen and prescribed as a new patient because if he is contacted then I do not get seen by yawl,  then he will drop me for looking other places, he is a very arrogant man.” 

Obviously there is so much could take issue with in this e-mail text from the patient, I will just leave it to speak for itself.

 2.    Some pain clinics are more interested in making a buck instead of properly prescribing chronic opioids and other medications for pain.  We have had several patients show up here wanting to transfer to our clinic because the one they were going to was closed down by the feds.  It is no wonder their clinic got closed down given the ridiculous amounts of pain meds they were given by their last pain doctor.  Methadone when dosed for pain should be given in small doses every 6-8 hours.  When it is dosed for addiction tx it is dosed once a day.  Patient came in today with records from their last clinic indicating that these were the meds prescribed and the instructions for taking them. 

 Methadone 10 mg  take 6 tabs at hsRoxicodone 30 mg take 7 tablets on waking; 6 tablets at 2pm and 4 tablets at hs

Roxicodone 15 mg take 1 tab q2-3 hours for breakthrough pain.  (How anyone had any break thru pain on that dose is beyond me)No other pain meds we prescribed despite patient having radiculopathy sx and chronic inflammation of her hands and ankles

 The clinics that prescribe like this have received no training on proper prescribing of pain medications, and should be treated like common drug dealers that they are.  The woman whose meds are listed above has elevated BP and elevated fasting sugars.  Her BMI is 36% and her last doctor was prescribing Adderall in addition to the other stuff she was on to help curb her appetite.  First of all this is not what Adderall is intended to be used for.  Adding it to the other controlled medications is criminal

  3.    Some patients are full of BS and show up with forged MRI’s ; Forged pharmacy records or forged medical records and get surprised when you point out the crappy job someone did forging the stuff they still have the nerve to ask why your clinic is not going to accept them as a patient.  These patients have gotten “hooked” on these meds by disreputable clinics and the behaviors they are demonstrating are no different than those demonstrated by any addict hooked on something.

 4.    On FOX news there was a story that:

According to a study on the use of opiates and pregnancy, the number of pregnant mothers using opiates increased from 1.19 to 5.63 for every 1,000 births per year.  The number of infants with born with NAS increased from 1.20 to 3.39 for every 1,000 births per year.

Meanwhile, the total hospital costs for NAS jumped from $190 million to $720 million per year from 2000 to 2009.  This amount was adjusted for inflation, the researchers said. 

The whole report can be found at: http://www.foxnews.com/health/2012/04/30/pregnant-mothers-newborns-addicted-to-opiates-increases-dramatically-over-past/#ixzz1teLmuIQh

Something needs to be done to clean up the chronic pain field; better train new physicians and retrain older ones in the safe methods for prescribing and treating pain.  A national controlled substance prescribing record needs to be implemented to prevent the common occurrence of doctor hopping needs to be implemented

 Sorry, but I just needed to vent.

 

--

[Guest guest]

It is frustrating sometimes, but one thing I have found, is these patients are so dumbfounded that a doctor would actually sit down and carry on a conversation with them, they will usually accept when I change their meds or try to better manage their co-existing chronic medical problems. Dr. Beth Sullivan, DO From: [mailto: ] On Behalf Of Sharon McCoy Sent: Tuesday, May 01, 2012 4:45 PMTo: Subject: Re: Chronic Pain Medications Wow. Thanks for sharing Beth.This seems like a field ripe for some good patient centered care.Do you feel like you are able to do a good job at the clinic you are working at?SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com After working at a pain management clinic as a consulting primary care physician for the last 4 months, I have come to realize several things. 1. Some offices doing pain management do not explain the individuality of medications used to treat chronic pain. Several patients come in with preconceived ideas about what medications they should be on for their pain based on what a friend or other acquaintance is receiving from their pain doctor. This is the text received from a patient wanting to be admitted. The PCP physicians have to review charts before they can be accepted and treated by our clinic. “Hello, my name is XXX XXX. I have been seen by one doctor for the last three months for pain management. He currently has me on 90 -- 30 mg. oxycodone 30 mg for breakthrough pain and that is not lasting me thru the day. I am also on 60 mg of methadone which I feel is cancelling out the oxycodone. My sister in law takes 240 oxycodone 30 mg for the chronic pain and 120 oxycodone 15 mg for breakthrough pain. I would like to try this regiment. I have an MRI and the pharmacy list but I am not comfortable giving you my doctors name until I know I can be seen and prescribed as a new patient because if he is contacted then I do not get seen by yawl, then he will drop me for looking other places, he is a very arrogant man.” Obviously there is so much could take issue with in this e-mail text from the patient, I will just leave it to speak for itself. 2. Some pain clinics are more interested in making a buck instead of properly prescribing chronic opioids and other medications for pain. We have had several patients show up here wanting to transfer to our clinic because the one they were going to was closed down by the feds. It is no wonder their clinic got closed down given the ridiculous amounts of pain meds they were given by their last pain doctor. Methadone when dosed for pain should be given in small doses every 6-8 hours. When it is dosed for addiction tx it is dosed once a day. Patient came in today with records from their last clinic indicating that these were the meds prescribed and the instructions for taking them. Methadone 10 mg take 6 tabs at hsRoxicodone 30 mg take 7 tablets on waking; 6 tablets at 2pm and 4 tablets at hsRoxicodone 15 mg take 1 tab q2-3 hours for breakthrough pain. (How anyone had any break thru pain on that dose is beyond me)No other pain meds we prescribed despite patient having radiculopathy sx and chronic inflammation of her hands and ankles The clinics that prescribe like this have received no training on proper prescribing of pain medications, and should be treated like common drug dealers that they are. The woman whose meds are listed above has elevated BP and elevated fasting sugars. Her BMI is 36% and her last doctor was prescribing Adderall in addition to the other stuff she was on to help curb her appetite. First of all this is not what Adderall is intended to be used for. Adding it to the other controlled medications is criminal 3. Some patients are full of BS and show up with forged MRI’s ; Forged pharmacy records or forged medical records and get surprised when you point out the crappy job someone did forging the stuff they still have the nerve to ask why your clinic is not going to accept them as a patient. These patients have gotten “hooked” on these meds by disreputable clinics and the behaviors they are demonstrating are no different than those demonstrated by any addict hooked on something. 4. On FOX news there was a story that: According to a study on the use of opiates and pregnancy, the number of pregnant mothers using opiates increased from 1.19 to 5.63 for every 1,000 births per year. The number of infants with born with NAS increased from 1.20 to 3.39 for every 1,000 births per year. Meanwhile, the total hospital costs for NAS jumped from $190 million to $720 million per year from 2000 to 2009. This amount was adjusted for inflation, the researchers said. The whole report can be found at: http://www.foxnews.com/health/2012/04/30/pregnant-mothers-newborns-addicted-to-opiates-increases-dramatically-over-past/#ixzz1teLmuIQhSomething needs to be done to clean up the chronic pain field; better train new physicians and retrain older ones in the safe methods for prescribing and treating pain. A national controlled substance prescribing record needs to be implemented to prevent the common occurrence of doctor hopping needs to be implemented Sorry, but I just needed to vent.