Unhappy with pm doc

[Guest guest]

Hello everybody I lurk a lot but have not posted in a while. My pain

management doctor has a rule that none of his patients will be

prescribed " short-acting " pain meds to deal with breakthrough pain

(i.e. Lortab, Percocet, etc.).

I am on Kadian 60 mg twice a day and have never felt that my pain was actually

controlled. I had hernaited disk surgery in December 2005 that was useless and

referred to a pain mgmt doc shortly thereafter.

There are many days that I stay in bed b/c the pain is so bad. I find myself

wondering if it would do any good to go to the ER or to call my PM doc and tell

them how much I need relief.

Of course, if I go to the ER, I'll be put on a list as a drug-seeker so that is

really not an option. If I call my PM doc, I'll go through the office people,

MAYBE get a nurse to call me back, and be told that they won't make any

medication changes.

I don't know if adding Lortab or Percocet would help at all but I wish I could

just try to see if it will help on the worst days. It just makes me so mad that

he has this blanket rule that applies to all patients.

If he looked at my case and still felt that I shouldn't add that, I would

understand but he won't even consider it. I never, ever

see him, only a nurse so everything goes through her.

I just wonder if this is typical for PM docs? Do you actually get to

see your PM doc occassionally? Does your PM doc refuse to make any

changes to your meds to try and find a comfortable level?

I want to find a new doc but, of course, I don't want to tick this guy off since

he and my surgeon are the only docs that can provide letters and support in my

SSD appeal.

I know that most of the people on this forum are in much worse

situations than me and that is why I don't post much. I think my life is close

to unbearable and I can't imagine dealing with some of the things that I read

about on here. I just want to know what your

experience is with PM docs so I know if he is really as bad as I think or am I

just being frustrated?

Thanks to everyone who make this group a source of support for the rest of us.

Please post your experience with PM docs. Thanks!

[Guest guest]

Has your doctor prescribed anything other than Kadian

for long lasting medication? MSContin, is also

morphine, but it might work for you.

There is also the Duragesic patch, that contains

Fentanyl. Methadone, lasts at least 8 hours, and is

very cheap compared to Kadian, and the other

medications I have mentioned.

It's worth a try to ask him for something different.

I'm sorry, that your doctor won't prescribe anything

that isn't long acting.

You describe your pain, how does it feel? I have

neuropathy pain, and find that Lyrica, plus Methadone

works very well. I take it three times a day, but

other people in the group, take it less often.

Doctors, of any kind, rarely come to the phone. The

nurse gets the chart out, and when the doctor has a

minute, then she can give him all the details.

Your doctor works with pain management, but might

still perform anesthesia at a hospital. If he does

procedures, he might be busy doing one of those.

Doctors, with a large practice don't always remember

each patients details. What they have taken before, if

they have any allergies, and so forth.

Last, but not least, many doctors wait until the end

of the day to review who has called them that day.

Then the nurse, will call or fax the prescriptions to

the various pharmacies their patients use.

I hope this explains why doctors rarely come to the

phone.

Kaylene

Moderator

[Guest guest]

Having a blanket policy of not prescribing short acting pain meds for

all patients for breakthrough pain sounds to me like bad medicine. I

could possibly see this as a goal for a physician who is diligently

working with a chronic pain patient and their long acting meds.

This would initially require frequent office visits to adjust dosages and/or

switching to a different long acting medication if the first one can't be

adjusted to where the patient is comfortable. Even after a patient reaches the

proper dosage level, periodic changes will need to be made. All of this

requires a physician who is willing to individualize his treatment of each

patient.

It requires open communication and trust between physician and patient. And

from your description, I don't see any of that with the clinician you are now

doctoring with.

My physician views short-acting meds as an adjunct to the long acting

meds. They're a tool that allows for further fine tuning of dosages.

They can help with exacerbations in pain levels, something the longer

acting meds cannot do. They allow for the possibility of an overall

lower dosage of the long acting meds. Instead of raising the daily

dose of long acting meds to cover an occasional increase in pain, a

lower dose can be taken daily with any pain flares covered by the

shorter acting medications.

For the most part I really believe the use of long acting and short

acting pain meds should go hand in hand. To decide against the use of the

shorter acting meds prior to even seeing the patient makes for, in my opinion, a

bad physician.

Good luck in finding someone new.

Kathy in AZ

" painstinks " wrote:

> Hello everybody I lurk a lot but have not posted in a while. My pain

management doctor has a rule that none of his patients will be

prescribed " short-acting " pain meds to deal with breakthrough pain

(i.e. Lortab, Percocet, etc.).

[Guest guest]

Thanks for the great feedback. I just don't understand why he would

make a blanket decision for all patients. I never see him, always

the nurse and she just says there is no point in asking for short

acting b/c he won't approve it for anyone.

She even told me about an 81 year old patient that sat in the room crying b/c

her pain was so bad and he wouldn't change his mind. Ridiculous! At 81, what's

she going to do, sell it?

Here's an even more frustrating thing. I called another pain clinic

and asked if I could set up a consultation with a doc. I want to

discuss his treatment ideas and find out if he/she would be right for

me before I make a big change.

Nope! Can't talk to a new doc unless my existing pain doc gives me a referral.

My insurance company doesn't require a referral, the pain doc requires a

referral. No, can't make an exception for a one time conversation.

We are really discriminated against. I am a 37 year old female,

married 19 years, 3 young children. I held a professional position

in one job for 15 years until I had to quit.

Now, I am fighting with my disability insurance company and SSD so we don't go

bankrupt. Who would quit a fabulous (cushy government job, I might add, that

paid much more than I ever dreamed I would make)so they could live in poverty

waiting for the disability income that might never come? And why on Earth would

I want to abuse medication when I have a wonderful family and no history of ever

abusing anything?

I wish they would just believe us until we give them reason to think

we are lying. I am so embarrassed to be in pain and docs like this

make me feel even worse.

I really need to get a new doc but I'm afraid it will be hard.

Thanks everbody, at least this group understands and somehow that

helps.

--- kathy wrote:

>

> Having a blanket policy of not prescribing short acting pain meds

for all patients for breakthrough pain sounds to me like bad medicine. I could

possibly see this as a goal for a physician who is diligently working with a

chronic pain patient and their long acting meds.

[Guest guest]

painstinks wrote:

> Nope! Can't talk to a new doc unless my existing pain doc gives me a

referral. My insurance company doesn't require a referral, the pain doc

requires a referral. No, can't make an exception for a one time conversation.

I'd be checking out someone else. I wouldn't mention it to my current pain

doctor, nor would I mention my current doctor while making an appointment with

someone else..

You're hiring them, they're not hiring you.

--

Lyndi