pain management problems

[Guest guest]

Hi all:

I need some advice on pain management issues.

I have a " pain management " specialist (I use that word lightly) He

has been giving me Buprenex IM which is on the lowest class of pain

drugs but it is injectable. They don't use it in this country as a

sublingual pill except to use it for some other things.

Because of the problems I have had my docs (as usual) are trying

their best to keep me out of the hospital. I have no venous access,

central line, PICC line, port or otherwise. Long story abut much

damage and destruction of the venous system. Good point to try and

keep me out.

My pain doc has prescribed my meds for every 8 hours prn if needed.

I don't always use pain meds etc. And if I have to I use it more

than 8 hours.

Well, I asked my PCP for some kind of breakthrough med by mouth that

he could give me. He said that since I had a PM specialist he

couldn't give me anything and to explain the situation to the pain

management doc and see if he would give me a scrip.

Now mind you my pain management specialist only gives me 60 doses

for 90 days so you can see where one would get into trouble quickly

if things were bad. Since last June I have been in the hospital 8

times and actually had to dig into my " stash " and finally wound up

running out of meds.

I went to the PM doc today and told him the situation, would he give

me something for break-through pain at my family physician's request.

He proceeded to get all huffy and mean and said no. If the family

doc wanted me to have something then he could give it to me and take

over my pain management care altogether. Very on the defensive a

real jerk. So he wrote the same scrip for the IM pain med and to

come back in 60 days. Now, I already know that my family doc WILL

NOT manage pain meds. So I am between a rock and a hard place. As

long as I don't run out of this stuff I am fine OR if the pain

doesn't get so bad that this won't work. I feel that something in

between by mouth that is a little stronger, could possibly keep me

out of the hospital the next time. It is well known and documented

in my records that it is safer for me to be home than in there. It

is a nightmare.........a venous nightmare I must say. The only pain

management docs on my insurance are the one I am going to and the

one that is not taking any patients but his P.A. is. I am confused

about that one. P.A. taking patients on their own? They still have

to have physician supervision. I am at my wits end.

The only ray of light in this whole situation is that finally I have

a nurse case manager who is basically an advocate for the patient

and does what she can. She has even consented to go with me to the

doctors appointments! Can you believe that. It is a godsend.

Problem is, I cannot get into my family physician office until the

end of April of all things to see him. Long time when you are

dealing with pancreatitis. I have told my PCP what a " quack " this

guy is but that I had to do what I had to do when looking for a pain

management doc. When I found him, he was new in town and would take

patient's on self-referral. I had to convince him that I was not

a " nut case " and we went back and forth, but really he is

not " managing " anything, he is just writing scrips (or should I say

his PA is). THis is the 6th PA he has had since I starteda nd that

has been two years.

I feel like I am back at square one. I don't always take meds but I

know when the pain is there, how it feels when it is time to go to

the hospital and something stronger by mouth would be a Godsend to

be able to try. Also, this pain management doc is putting the wrong

diagnosis on my chart, he has low back pain and neuralgia! Don't

know why, pancreatitis is a very legit disease for crying out loud.

The way it stands is after I see the family doc in a month, then he

will have to try and get me an appoinment with a " pain management "

doc and that could take months. I am fed up. Anybody got any ideas

of a pain management doc with compassion, etc. The one I wanted to

go to who is not taking patients and use have to be on a waiting

list for his PA is very good. We have a couple out of network in

this area but one of them has opened so many offices and been in so

much trouble, there is no way I want to go to him.

Someone suggested I ask Dr. Cotton if he would make a suggestion to

my doc about pain management. I may try that. Problem is again, my

doc does not feel comfortable giving pain meds and I don't think he

will do it. There are three offices in my doc group and at one

office one of the Nurse Practitioners had no problem when I was in

the hospital writing me a scrip for the injectable stuff. She use

to be a surgical nurse and knows all about the drug. She made the

statement that my doc was probably too young. Well he is 40. He is

not that young!

I guess I am just blowing off steam but this is ridiculous. I need

a plan! Hopefully with the help of the case manager who has offered

to go to my docs with me, she and the docs can come up with a pain

plan.

Any suggestions would sure help.

Kaye..........NC

[Guest guest]

Hi Kaye,

It sure sounds like you are in beteween a rock and a hard place.

But your PCP sounds like there may be a path of relief there if you can get

to see him. And the case nurse sounds like they could be very helpful, maybe

the case nurse could get you in to see your PCP sooner.

If your veins are so bad why is your PM Dr. still recommending injectible

opiates? Why is the written diagnosis for the wrong condition? These might be

good questions for your PCP and your case nurse.

Please pardon my inexpert opinion but your condition sounds like a

opportunity to try Oxy and loritab for breakthru conditions.

I firmly believe that a " chronic condition patient " must have doctors that

are competent, and caring, and resourceful to have at least a chance to be

treated as well as possible. And, the patient must have faith in the Dr. and

their

care and their recommendations. Maybe it doesn't always happen to turn out

well but it should at least be possibly attainable.

Another possible source might be assistance from your insurance (Yes, I would

rather eat a dead rat than try to deal with an insurance carriers

representive of " no-service " ) carrier. If explained to them they may have a

suggestion, a

back up PM source that could be seen, even a call to the Dr.

I hope maybe others might have other suggestions.

Best Wishes, Poncho - GA

PS Don't forget to rebuild " stash "

[Guest guest]

Kaye,

I am so sorry to hear about your pain problems. When I was in the hospital

this week the nursed were really careful with my veins. I have wonderful veins

thank goodness! They said that with people with chronic diseases like ours

that alot of the meds they give us are horrible on the veins. They said one of

the worse was phenergan. They don't give it all now in the IV. They also diluted

all of the meds they gave me with saline and flushed my iv really well every

time they gave me anything. That is the first time any hospital has done that.

I thought it was interesting. I have never had nurses so concerned over my

veins, because mine are so good.

I definetely think you should see an new PM doc. Maybe Dr. Cotton can

recommend someone and get you in with someone else close to you. The only PM

docs we

have in my hometown are in a small group and it is just 2 in there. I have

not tried them yet but after I go to ton I hope they will help me to get

in to them. My PCP and GI docs want me to wait until I go to ton and

see Dr. Hawes before they go further with my treatment.

Take care and keep fighting for what you know is right for you!

Angie in SC

" The happiest of people don't necessarily have the

best of everything; they just make the best of everything that comes along

their way. "

[Guest guest]

Kaye,

What a predicament this is....it's crazy. I have a doctor who is ln Georgia,

licensed in that state, as was my PM doctor, but I CAN and do fill all their

narcotic scripts in South Carolina. So I do believe that if Cotton will write

you

a BT script, you can fill it at home. Call your pharmacist to double-check, but

you CAN fill an out of state script in SC, so maybe NC's the same.

With love, hope and prayers,

Heidi

Heidi H. Griffeth

hhessgriffeth@...

SC & SE Regional Rep., P.A.I.

www.pancassociation.org/anthology#Heidi.html

Note: All comments or advice are personal opinion only, and should not be

substituted for professional medical consultation.

Kaye wrote:

> Dr. Cotton is five hours away and you can't fill a prescription for narcotics

in

another state....at least that I know of.