Letter from PCP

[Guest guest]

Sorry to post yet another depressing post, but I got a letter from my doctor

today. Not only is my PCP not willing to prescribe the methadone that he

previously agreed to prescribe (agreed to prescribe upon receiving a

recommendation from pain management), but now he has decided that he doesn't

want to prescribe ANY of my pain medications. Apparently, 300mcg/hr of

fentanyl is too much, even though I've been on it for about three months,

maybe four.

Since I'm unlucky enough to require larger than normal opioid doses to

experience any pain relief, I get screwed. Apparently, I'm supposed to get

all of my pain prescriptions from a specialist that doesn't mail

prescriptions and is just under 200 miles round-trip. He did this without

warning and I'm not scheduled to see that doctor again for months (I was

just seen by him).

I haven't even mentioned the worst part yet, my pain management doctor refuses

to have anything to do with Actiq. He refused to

even recommend a dose change, there's no way in heaven or hell that I can

convince him to prescribe it. Apparently, he will occasionally prescribe

Fentora. My insurance will not cover Actiq, Fentora, or Onsolis unless it is for

pain that is undoubtedly caused by cancer or cancer treatments.

My pain is caused by cancer and fibromyalgia, according to pain management. My

PCP believes that it is cancer pain. So, even if he prescribes Actiq ($),

Fentora ($$), or Onsolis ($$$),the insurance will refuse coverage if he even

mentions fibromyalgia.

Plus, Actiq is the only one that's generic and the cheapest, so they refuse to

cover Onsolis if Fentora or Actiq will work and they refuse to cover Fentora if

OTFC (oral transmucosal fentanyl citrate, generic Actiq) will work.

I feel really overwhelmed. I don't want pity, I just need to vent ( & ask for

a little bit of advice). Thanks for listening (reading).

IV, IM, and SubQ fentanyl citrate (generic Sublimaze), which comes in

pre-filled syringes for patient convenience, does not require prior

authorization or a cancer pain diagnosis. The problem is that too many

doctors associate needles with drug abuse or feel like it harms the patient.

If anyone has any advice on how to calm the doctor's fears, please let me know.

If anyone wants to contact me privately (off-board), please email me at

SteveMatrese@...

What really bothers me is that my PCP and I made an agreement when

he referred me to the pain doctor. I didn't want to see pain management, I

needed simple opioid therapy, which I was already receiving, without a nearly

two-hundred mile drive. I knew pain management was nothing more than my PCP's

boss wanted their 'behinds' covered. So, we made a deal, I'd see pain management

(covered PCP's liability) and he (PCP) would continue prescribing.

Most pain management offices around here don't prescribe anything, they just

make recommendations. My pain doctor does write prescriptions, so I'm forced to

get my meds from him.

I don't even have anyone to prescribe my Actiq, I'm probably going to run out,

again. He didn't even make sure there was someone lined up to prescribe the

medications. He just assumed my pain doctor would do it. I'll be lucky if he

prescribes the patches.

Is it wrong that I feel abandoned?

Current pain meds

Duragesic 300mcg/hr (q48hr)

Actiq-600 (4/day)

OxyIR 30mg (6/day)

*Methadone 10mg 2/day x7days, then 10mg 3/day [pending]

*Methadone was recommended by my pain management doctor, but not yet

prescribed

Steve M in PA, age 22

Married with 3 year old daughter