Re: Pain meds and contracts

[Guest guest]

This conversation has got me to wondering: Has anyone else's doctor,

when putting them on a pain medication regimen, discussed with them

the differece between ADDICTION and DEPENDENCE? (sorry to yell those

words, but it seems many doctors don't think about the differences

when dealing with pain patients!)

My husband and I have the same doctor, and he had this conversation

with us both when putting us on opiod meds. He explained the

difference between being dependent, which we were choosing to enter

into by taking the meds, and being addicted. He made sure that we

understood this before he would allow us to put pen to paper on our

pain management contracts, and reviews it each time we change dosages

or which medications we take. And he's not even a pain specialist!

It seems that, if doctors are going to risk putting us on these

drugs, that they'd at least want a basic understanding of these two

concepts.

I agree: you should find a new doctor quickly.

in Oregon

--- Robyn Montgomery wrote:

> If you have chronic pain then what good will it do to reduce or

take away your meds?  That just going to make you miserable.  I would

find another doctor, as Kaylene said, and I'd do it today!

>> Kris wrote:

I have been too afraid to call the Dr., because he has capitalized

the fact that I am an addict and that they want to get me off the

meds altogether (which is a joke since my condition is chronic

> and degenerative and is not going to get better on it's own.)

[Guest guest]

Well, I was forced to sign a contract before they even discussed what meds they

were going to put me on.

They said " Well, we want to get you off the meds you are currently on, but if

what we give you doesn't work, we will switch you back. Here, you have to sign

this before we will treat you. Oh, by the way, here's what we are putting you

on, you have to live with that. You are not allowed to take any other controlled

substances, see any other doctors for treatment of this condition, or go to the

hospital for treatment of this condition without consulting us first, or you

will be blacklisted. "

That was pretty much it, they screwed me over big time, never kept their

original promise, and have been giving me lower and lower doses of meds every

time I tell them the ones I am on aren't enough. They are forcing me to live in

severe pain.

I am going to discuss with my primary doc if he won't take over my pain

management then I want a different referral to another pain doc that will give a

crap about how much pain I am in and not just how they might somehow be sued if

I am on too high a dose or something.

~*Kris

wrote:

This conversation has got me to wondering: Has anyone else's doctor,

when putting them on a pain medication regimen, discussed with them

the differece between ADDICTION and DEPENDENCE?

[Guest guest]

wrote:

> This conversation has got me to wondering: Has anyone else's doctor,

> when putting them on a pain medication regimen, discussed with them

> the differece between ADDICTION and DEPENDENCE? (sorry to yell those

> words, but it seems many doctors don't think about the differences

> when dealing with pain patients!)

,

Yes, matter of fact the pain specialist I went to gave me an intractable pain

certification

letter. He advocates for pain patients also and runs a pain foundation. He is

the one

that told me about The Survival Guide for Intractable Pain Patients, by Dr

Forest Tenent which discusses this in depth.

He referred taking opoids as a heart patient being dependent on their heart

medicine,

the diabetic needing insulin, the blood pressure patient needing blood pressure

medicine,

telling the side effects and dosages.

He also said anytime that I had to go to the ER or have a problem to have the

doctor

call him and he would verify my pain condition and pain therapy to make sure

that I

got adequate pain relief if I had to have surgery, tests, or procedures

requiring other

pain medication because of tolerance.

This doctor, and I agree, states that pain patients do not get high on

their pain medications as addicts seek the euphoria, we seek pain relief. Pain

patients may

get sedated but there is no euphoria as some doctors think there is.

He said that the doctors coming through medicine school are still naive about

this

and much still needs to be done.

He said that a pain patient worries more about the amount they take than an

addict

as an addict takes as much as he can to get high.

He prefers using the word dependence instead of addiction, medication

instead of drugs, and staying away from anything that might reflect an addict

and I

agree. This is a topic we have mentioned before.

He is the only one in the five pain management doctors (second opinions

included) and

the contracts really don't address the differences just what is expected of both

the

doctor and patient.

My current contract states that the opiates can be addicting, my other stated

that you could be become dependent and discussed the withdrawals and titering.

The doctor I see now will not put a couple on opoids if he is seeing both of

them. I was talking to a couple in the waiting room and they said it was bad as

one of them has to take anti inflammatories and the other gets to take the

opoids.

It really bothers me but I guess they are concerned about their practice. They

also

do urine testing but haven't asked me to count my pills as I hear some do.

That is my experience. I hope it remains positive as I just started going to

this pain specialist three months ago. We will see. Bennie

[Guest guest]

Kris wrote:

> Well, I was forced to sign a contract before they even

> discussed what meds they were going to put me on.

Kris, that is standard practice with pain management doctors. It is

geared to weed out those, who want medications for something other than

pain relief. It protects both the doctor and the patient.

Considering how young you are, it is very understandable why the doctor

is leery of giving you more medication. I am many years your senior and

have had chronic pain most of my life. My doctor would never give me a

dosage as high as you're taking now.

Instead, I do physical therapy exercises every day. I do not stay in

bed, no matter how much I hurt - unless I have a knock out migraine.

But, with body pain, I get up and move. I also make sure my mental

health is good. I keep my weight down to where it should be too.

It's not easy to do those things, but because I have done them for the

last 40 years, I have managed to keep my mobility. It's not great and I

fall over frequently, but exercise and good nutrition are vital for

people in chronic pain.

Please don't depend on pain medication as your main source of relief.

You need to use a combination of therapies - physical and emotional.

Some folks also feel that spiritual is important to their well being too.

Please talk with your doctor about these things. You may have a good 50

- 70 years of life ahead of you. Grab hold of it.

--

Lyndi

[Guest guest]

>

> Kris wrote:

> > Well, I was forced to sign a contract before they even

> > discussed what meds they were going to put me on.

My doc, who's not a pain management specialist but a regular GP,

settles my dose and/or drug before doing a contract. Maybe he's just

trying to cut down on paperwork?

in Oregon

[Guest guest]

My Pain Dr. made me sign the form before we even talked at all. I

thought that was very strange, like he knew he was going to give me

pain meds before even seeing me. I think Dr. that do this tend to be a

little more unstable (not sure if that is correct way to put it) than

ones that actually talk to you and go through the pain contract with

you.

What do you all do when it says to not get pain meds from any other Dr.

and you have to go to the hospital or emergency room? Does the hospital

Dr. have to get a hold of the Pain Dr. before you can get any meds?

I was driving the other day and thought what if I was in a wreck? Or

had some other kind of emergency? Is my pain dr the ONLY dr I can get

pain meds from ever again? Just wondering how that works.

Caitlin

> > Well, I was forced to sign a contract before they even

> > discussed what meds they were going to put me on.

[Guest guest]

I think it depends on the doctor. 

When I had a pain doctor I liked and talked to this happened to me.  I was a

paitent of his however my neck locked up.  I couldn't move it at all and the

pain was a 9.5.  I went to the er.  I mentioned to the er that I had a signed

contract.  They gave me pain meds anyway. 

When I went to the pain doctor a week or so later, I told him about it and he

said that was fine.  He said that ER docs and surgeon's don't count in the

contract.  No where in the contract did it say that though, so I think it might

be up to the doctor and your relationship with him. 

I am sure that if I was going to the ER weekly and getting pain meds there as

well as from the pain doc, he would of had a diffrent response.

 

Jess

[Guest guest]

Hi Caitlin:

First of all, a comment and then the answer to your question.

You feel that docs who make you sign the pain contract before talking to you are

a bit more " unstable " than those who do not. As someone who is in the medical

profession, I'm sorry, but I have to respectfully disagree.

While I certainly agree that they should talk to you and discuss the pain

contract with you in detail before you are asked to sign it, I do not agree that

this should be brought up only after the patient and doc have discussed narcotic

medications for the relief of the patient's pain.

If I were a doctor, I would certainly discuss it first. I would state that this

was my policy, here are the rules, here are your responsibilities, my

responsibilities and the consequences should the agreement not be met. Then,

and *only then*, would I discuss narcotic medications. This is how my doctor

did things and I found it very professional. I also found him to be completely

stable.

The answer to your question about obtaining pain meds from another doc is a bit

complex. It depends on your pain doc's definition of " obtain " . My contract

specifically states that I will not obtain pain medications from another doctor

unless it is an emergency. " Emergency " according to my doc, also includes

" flares " , " pain crisis " , " pain emergency " and other such terminology. In other

words, if I end up in an ER, I am within the bounds of my contract to receive a

shot and even a prescription if needed.

It also helps that I tell both the ER doc about my pain doc and the other way

around. If I go to the ER, I tell my pain doc. I tell him exactly what was

said, what was given, etc. I want him to know so that there are no surprises.

I am also happy to give the ER doc my doc's number so that if he has any

questions about my treatment, (nine schedule II opioids), he can call my doc and

ask.

Now, some docs do not allow their patient's such lattitude. I think the

appropriate thing for you to do in this situation, if you are concerned, is to

simply ask. Explain how you were wondering about it and ask what your doc would

want you to do should an emergency ever come up...

Hope this helps,

--

Dodge

Read my blog at:

http://jumpthis.wordpress.com

http://www.yahoogroups.com/groups/a_different_reality

---- Caitlin Kennedy wrote:

=============

My Pain Dr. made me sign the form before we even talked at all. I

thought that was very strange, like he knew he was going to give me

pain meds before even seeing me. I think Dr. that do this tend to be a

little more unstable (not sure if that is correct way to put it) than

ones that actually talk to you and go through the pain contract with

you.

[Guest guest]

No, I told them the first few times I needed a shot, then I didn't bother, I

just tell them afterwords, when I go to my next appt. They sometimes ask me if I

had any accidents or went to the ER.

~*Kris

Caitlin wrote:

What do you all do when it says to not get pain meds from any other Dr.

and you have to go to the hospital or emergency room? Does the hospital

Dr. have to get a hold of the Pain Dr. before you can get any meds?

[Guest guest]

--- Caitlin wrote:

> > What do you all do when it says to not get pain meds from any

other Dr.

> and you have to go to the hospital or emergency room? Does the

hospital

> Dr. have to get a hold of the Pain Dr. before you can get any meds?

You need to talk to your doctor with the contract and ask these kinds

of questions BEFORE this happens, so you will know what to do. Every

doctor could be different - don't trust what someone else's doctor

agrees to!

Ask not only about emergencies, but also ask how they want you to

handle any scheduled surgery postoperative pain meds (which the

surgeon usually writes, but your pain doctor may want to handle), and

ask what to do if your pharmacy is out of your meds if the contract

specifies only one pharmacy.

(My pharmacy is out of stock of my meds about every other month! And

schedule II opiates can take a week or more for the pharmacy to get

more in stock - far too long to wait. So I had it written into my

agreement that I could use a specific second pharmacy in this

situation as long as my regular pharmacist called ahead to the second

pharmacy and records it in my record.)

You doctor's office should be happy to answer all your questions in

advance, so that there are no problems when an emergency does happen.

Cheryl in AZ

Moderator

[Guest guest]

Cheryl,

Thank you so much. My pharmacy is out of meds quite often too, so that is a

GREAT point to bring up. I'm fairly new at all this, so I'm still learning. My

Dr. has been evasive when I talk about emergencies. Basically, that we will

cross that bridge when it comes, but I want definitive answers and am going to

keep pushing. Sometimes I think they think I'm trying to be sneaky by asking

these questions to see what I can get away with. Now that I am actually

dependent on a med is scares me to think of all the ways I could not be able to

get them. Sheesh.

Caitlin

Ask not only about emergencies, but also ask how they want you to

handle any scheduled surgery postoperative pain meds (which the

surgeon usually writes, but your pain doctor may want to handle), and

ask what to do if your pharmacy is out of your meds if the contract

specifies only one pharmacy.

(My pharmacy is out of stock of my meds about every other month! And

schedule II opiates can take a week or more for the pharmacy to get

more in stock - far too long to wait. So I had it written into my

agreement that I could use a specific second pharmacy in this

situation as long as my regular pharmacist called ahead to the second

pharmacy and records it in my record.)

You doctor's office should be happy to answer all your questions in

advance, so that there are no problems when an emergency does happen.

Cheryl in AZ

Moderator

[Guest guest]

Tell them you are asking because you don't want any surprises when the time

comes. Explain to the doctor that you are active in a chronic pain group and

this is one of the questions that comes up a lot, which it is. Tell him you

have concerns about how to handle things and he needs to let you know what

the guidelines are so that you aren't left guessing.

" Sweet Goat Mama "

Carolyn Eddy

www.goattracksmagazine.com