Why is getting pain meds such a problem?

[CTyankee]

I have a new surgeon who has seen me for a second incisional hernia repair operation (my other surgeon retired). We have had a consult, he has my history and he has examined me. Over the weekend I started having real discomfort and I went in to see him again this morning. He determined it is not an emergency situation and we fixed an earlier date for the surgery.

He wouldn't give me meds for my pain because his policy is to do that after the surgery. He said go back to my pcp. My pcp said no, it was the surgeon's place to do it. Waiting now for a call back from the surgeon's office.

Why the runaround? I need something stronger than Advil...possibly a lower dosage vicoden (which I tolerate well). The strongest thing I have in the house is a bottle of white wine, but I'm not interested in getting high, just pain relief...

Possible explanations, anybody?

[Vincardog]

1. The misguided "War on Drugs" has the MDs afraid to relieve real pain

[RKP5637]

2. We live in a society now paranoid about pain medications. After my recent

surgery to have my appendix removed they wanted to know if aspirin would be fine for the post operative pain. My immediate thought was WTF.

[grasswire]

5. a blood thinner, post-op??

That sounds crazy.

[RKP5637]

18. Oops, replied to myself earlier. That's what I was told. I had laparoscopic surgery, also

had some post operative problems and was in several days. Probably by then the clotting was sufficient... long story short, they gave me hydrocodone finally when released. Yes, I thought it was crazy too.

[RKP5637]

13. That's what I was told. I had laparoscopic surgery, also had some post operative problems

and was in several days. Probably by then the clotting was sufficient... long story short, they gave me hydrocodone finally when released. Yes, I thought it was crazy too.

[Taverner]

3. War on Drugs means war on pain relief

To be honest, I'm surprised Cough Syrup is still legal

Apparently getting pain meds requires the doc to sign in triplicate

Its fucked up

And as a result, more and more folks are just getting the street drugs because they're easier to get. That's what Kurt Cobain did...

[demosincebirth]

10. My daughter is on Methadone for chronic, severe back pain.

Doctor says that its either methadone, which works real good, or other less effective drugs. She knows its addictive, but what do you do if you want to live a semi-normal life

[Taverner]

12. Wow - Methadone!

Thing about methadone is that it does not get you "high" at all, but kills the pain.

Has she tried Dilaudids?

[demosincebirth]

17. No, she hasn't been on Dilaudids...

Methadone, for her, works very well. Eight years ago she was on Fentynal patches until, one time, she ran our to them over a long weekend and that really was a LONG WEEKEND.

[kimmerspixelated]

28. Maybe see a naturopath that can get to the root

of the problem instead of just treating a symptom? Just a friendly suggestion. Please don't flame.

[DebbieCDC]

4. Because you might get "addicted" -- can't have that

Better for you to be in pain than be addicted to narcotics. You wouldn't want to end up a junkie now would you? Better to suffer like a good Xtian.

That'w why it's better for terminal cancer patients in this country to die in pain rather than give them heroin. They'll feel better knowing they died on the moral high ground.

This stupid shit makes me furious.

[Jamastiene]

6. I wish this was an OP by itself, so I could K&R it.

It's so true.

[MercutioATC]

7. We've begun to feel the need to create laws to protect us from ourselves.

Seat belt laws, helmet laws, "predatory lending" regulations...

...our society has abdicated its personal responsibilities, and in doing so has sacrificed freedoms for the illusion of some degree of safety.

[paulsby]

9. begun to?

we have done so for over 100 years.

this is not a libertarian society. the govt. feels free to tell you what you can do with your body

[MercutioATC]

16. True, but the last 30-40 years has seen a distinct acceleration in acceptance of the "nanny state".

It's not just legislation like the Patriot Act. Our society has let government regulation creep into almost every facet of our lives...in fact, many invite it in.

Whether it be in 10 years or 100 years, our society has seen its heyday. We're a species in decline.

[RKP5637]

20. Quite true IMO, as you say, "...our society has seen its heyday. We're a species in decline." n/t

[RKP5637]

14. Frankly IMO the whole country is becoming delusional and pretty screwed up in many areas. n/t

[paulsby]

8. two reasons

1) your doctor sucks. my surgeon had NO problem prescribing me pain relievers (C-III) prior to surgery, and was totally open to my pain med needs post surgery. he believes (as do I) that one needs to get aggressive in this area
2) because some people are "drug seekers' and the DEA scrutinizes dr's script history, especially in regards to C-II narcotics. as far as i am concerned, it's better to let some drug seekers get their meds even if they don't need them, in order to ensure that those who DO need them, get them. and if some drug seekers overdose - that's their problem

[CTyankee]

21. I have now spoken to the surgeon's office once again to ask what I should do.

It told them that the OTC meds don't help. So now what?

BTW, I have NO history of having "too many drug prescriptions." So you can rule out me as a "drug seeker" (whatever that is).

It looks like I am in a very bad place to be. It's a long time to Dec. 29th. Maybe I should push to get this done earlier...if this pain keeps up day in and day out I'll be crazed by the 29th...

[paulsby]

30. right

i'm not saying he suspects you of being a drug seeker, it's just that because drug seekers EXIST, dr's are more hesitant to issue ANYBODY prescriptions for narcotics (and especially C-II narc's)

my surgeon rocked. post surgery, i had plenty of oxycontin (C-II) and percocet (C-III) and anti-nausea/muscle relaxers.

as a competitive athlete, i was VERY aggressive with my rehab and having effective pain relief, especially when it comes to getting enough sleep is paramount.

dr's are justifiably afraid of the federal govt. which has vastly expanded its power in all areas from drugs to domestic violence in the last several decades. if a dr has an unusual amount of C-II scripts, that alone will cause a lot of scrutiny.

but it comes down to this, you have a RIGHT to get adequate pain medication. if you have to squawk, squawk.

[CTyankee]

31. The sounds of silence.

No response. Offices closed. Everybody gone. Thank you very much.

Do I go to yet ANOTHER surgeon for a 3rd opinion? How do I find a "drug friendly" surgeon (I don't even like the sound of that). So do I go for a 3rd and he/she turnsout to be the same? It's crazy.

Tonight I'm better, thank god. I'm loosening the binder, which is a big part of the problem, but not all of it. It's also bad if I DON'T wear the binder because of the gravitational pull down of the hernia...not a great feeling.

We'll see. I do have an old pill bottle with a couple of vicodens in them. If it gets bad I can break them in half and see if they work...it's been a couple of years since I had that surgery (with the doc who retired). Of course, I'm sure the old pills are expired so I don't know what good they'll do...

If anybody has any further suggestions I'd be open for hearing about them. Spouse and I talked about it at dinner and came to no conclusion. It's funny, two people with 4 college degrees between the two of us and we can't figure out this quandary...

[paulsby]

32. i was lucky

in that i already knew my surgeon was very good, since he did my sister in law's ACL. your primary care physician, if you were still under active care for this incident , wouldn't want to issue you pain med scripts CONCURRENT with those issued by your surgeon. that smells of "dr shopping" when one has concurrent scripts for the same malady from different doctors. it's totally acceptable when the scripts are for different maladies, from different docs. like if you have a GI doc who prescribed nexium for GERD and a primary care who prescribed lipitor. generally speaking, another surgeon won't want to take over from the guy who did your surgery. it's kind of an honor among MD's kind of thang.

i would be as forceful as possible, and if he flat out refuses, get a second opinion.

i once had this issue with a doc who (imo) was prescribing the wrong (and ineffective) medication for an ailment, and just wasn't up on the current research ,etc. this was not a pain issue, fwiw. i asked for another dr. in the same clinic, and he was AWESOME and we were on the same page.

pain levels, response to pain medication, etc. varies GREATLY amongst individuals. good dr's are sensitive to this. i know people who can get relief from moderate pain with vicodin. vicodin has 5mg of hydrocodone, which gram per gram is about half as strong as oxycodone (used in percoset percodan and oxycontin). vicodin is also C-III, whereas oxycontin is C-II. vicodin is useless for me, because i have to take so much that it means i am ingesting WAY too much APAP (acetaminophen). vic's have 5/625 of hydrocodone/APAP. just as some people can get pretty drunk off two beers, and another person won't barely feel an effect, the same is true of opioids.

i'm a decent guy, and also am not particularly responsive to opioids, or analgesics in general (even my dentist gives me like twice the amount of mouth numbing meds he gives a "normal" person .), and a good doctor will recognize that people vary. dosages need to be large enough to work. sure, a larger dose is going to be more risky, and ceteris paribus, cause a more difficult withdrawal. oh well. that's the tradeoff.

[CTyankee]

33. I had the 5 50 dose of vicoden per pill. Half that dose has helped thru this thing.

I figure I have 8 such doses so I can be OK thru the worst episodes. What I'll do other wise, I don't know. I really just want to be able to DO things, not lie on my back because it hurts so much to stand up and redistribute the weight of the abdominal hernia. I need to be able to move around. It hurts to eat because digestion is interrupted and complicated, so I don't eat that much at one sitting. I'm afraid of anything that causes gas so I eliminate a lot of foods such as beans and cabbage.

I'm so hopeful that this second surgery will work but I know the odds and they are not good. With all of medical science's breakthrough's this surgery is not that great. The mesh they use is as much of a curse as it is a blessing, as I know from my own situation.

[paulsby]

34. i had an umbilical hernia fixed

and i was in EXTREME pain. in fact, when i was in the room after the surgery, as i woke up i was screaming in pain, and the doctor had to run up and jam a needle into my leg.

after the surgery, the meds my dr. prescribed simply weren't cutting it. part of the reason was that i am a strength athlete, and my abs are more developed and tighter, thus the surgery causes SIGNIFICANTLY more pain than wiht most people. the gallbladder part (they took out my glabladder as well) was fine, but pain around the umbilicus was insane. my doc doubled the meds, and i was fine after that.

simply put, you need to advocate your case strongly with your dr, and if he refuses, get a second opinion. it's just not right that you are not getting the proper medication.

[Chemisse]

29. I agree with you

1. My husband had no problem getting pain relief before and after his back surgery.

2. Drug seekers will go the illegal route whenever necessary, so the doctor's restraint is not really helping anybody.

[HuckleB]

11. It's likely that both of these docs has been burned by someone or multiple someones in the past.

Doctor shopping for pain meds may or may not be a big problem, but once a doc gets burned, he or she tends to be shy about giving out prescriptions.

[sharp_stick]

15. I think your doc is being overly cautious

perhaps he was burned in the past or possibly he's making doubly sure you aren't double dipping 2 docs and 2 scrips. It could also be that your original surgeon has gotten into trouble for funky prescriptions and all his patients are going to be looked at closely even though you will never be told this.

All of that being said though it could also be that he's just a dick. Some doctors just refuse to deal with pain properly, they're terrified of addiction and even more terrified of being associated with an addicted patient. If that's the case, I'd hunt for another surgeon this guy isn't going to get any better after the surgery than he is now.

Can you have your pcp call/email/fax the surgeons office telling him that you aren't currently getting pain meds from the pcp?

It shouldn't be too hard to get something non schedule II prescribed, especially if he knows your history.

Best of luck with the surgery.

on edit: typo

[CTyankee]

23. My pcp referred me to this surgeon and their offices are across the hall from each other.

I don't want to start a war but both of them need to know what is going on, if for no other reason than I have complained about pain and having pain is not OK. Or is it?

[grasswire]

19. the NANNY STATE

that's what we live in.

[endless october]

22. because the drug war is a war on you. nt

[Joanne98]

24. The war on drugs!

[RKP5637]

26. And it's worked so well. This country is crazy, all we do is create black markets and crime for

our supposed solutions. Abortions will be next... illegal untrained unskilled black market places to get an abortion and likely die, but we fixed it...

[notesdev]

25. Because maintaining a police state is what is really important

to the command-and-control elites in our government.

All they want is control, they show it in everything they do, every solution they propose. Your pain is absolutely and completely meaningless to them.

[RKP5637]

27. But we have a country so in control. This place is becoming sadly more

pathetic and laughable each day...

[Fire_Medic_Dave]

35. Don't you have a good friend that has some laying around?

[CTyankee]

37. Well, as I said I have a few left over from my first repair surgery last February.

Today I am OK but no one has explained WHY I was in such discomfort last week. I almost went to the ER on Saturday, but called the surgeon first to check my symptoms with him. He asked me questions about what was happening and determined that I was not in an emergent situation (i.e., incarcerated hernia which requires immediate surgery). However, my pain was real. And the presence of pain, I am told, is to tell us something is wrong...

I feel that I have done my part here, as a conscientious patient. It is infuriating...

[Fire_Medic_Dave]

41. You have reason to be frustrated. I was just trying to point out an option to relieve your pain.

Hope the surgery goes well. After surgery get bunches of painkillers even if you don't need them anymore and keep a good supply around.

[CTyankee]

42. I've learned my lesson and you are right. You never can tell what will happen.

I will just bet that docs self dose when they have the sort of pain I had. What do you think?

[Fire_Medic_Dave]

43. I can assure you they do.

I am quite good friends with my doctor and I basically have a standing prescription for hydrocodone. I usually only fill it once a year though. I have had a couple of teeth abcess on Friday afternoon and fortunately had enough Vicodin left over from a shoulder reconstruction to get by till monday. I will say though that I don't know of a single doctor that will call in a pain meds prescription there is a lot of liability in those instances. I do hope everything goes well. Take care.

David

[Lyric]

36. Try being a Medicaid patient and needing narcotic pain medicine.

More specifically, a young adult Medicaid patient with no terminal illnesses. I herniated a disc in my back so badly that I was half-paralyzed and numb in my left leg for 2 years afterward. I was in horrific, horrific pain. Yes, it IS possible to have numbness *and* blinding, searing, earth-shaking jolts of pain in the same limb. Believe me, I know. :(

They could see the herniation itself on a CT scan, but refused to just believe me about the pain. They wanted to do a 1-hour MRI to "verify" that the herniation was indeed impinging spinal nerve roots, but I couldn't lay flat on my back for that long. It would have been excruciating beyond description, and there's no WAY I could have held still for an entire hour. For me, laying flat on my back is STILL too painful to tolerate. Also, I am both overweight and claustrophobic; being stuffed (literally) inside of an MRI tube is pure torture for me, and Valium does *nothing*. I offered to try the "Open MRI" procedure instead, thinking that we could compromise, but they refused because apparently "Open MRI" is only for rich people who can pay up front, or people SO obese that they literally cannot fit into the MRI tube. Since I wasn't quite THAT obese and only had Medicaid, I wasn't allowed that option. I literally begged them, weeping, for something to kill the pain. They gave me Vioxx, which did nothing, and told me that they couldn't give me anything else without "proof"--since apparently my inability to walk, my weeping, and the obvious uncontrollable muscle spasms and nerve dysfunction in my leg weren't "proof" enough.

I suffered for the first few months with nothing but ice packs, heating pads, and WAY too much ibuprofen--so much that my stomach started bleeding from it. Without pain medication, it was torture to even get to the bathroom. My back and leg muscles weakened even further, and by the time the pain died down to a tolerable (but still awful) level 8 months later, I had to learn to walk all over again. I used a walker for the first few months. We moved in with my Mom because Rhythm's employer wouldn't give her any unpaid time off to care for our toddler during my disabled period, since I was "just" a domestic partner and not a REAL spouse. We lost everything we had, I developed severe anxiety disorder, I still suffer nightmares, and I now have a deep distrust for doctors that I've never been able to recover from.

I have severe fibromyalgia, endometriosis, PCOS, chronic severe back pain, chronic severe sciatic nerve pain, developing psoriatic arthritis in my joints, and chronic kidney stones. The ONLY time I can get a (small) pain medication prescription is when I'm "lucky" enough to have an acute kidney stone attack that can be "verified" on a CT scan--and even then, it's only for 5 mg hydrocodone. One of my well-off friends in Virginia has the same kidney stone issues, and they give HER 15 mg Percocet for her attacks. And why? I think it's because doctors assume that Medicaid patients are just looking for pills to go sell on the street. You know how those icky "poor people" can be. :eyes:

I'm a college student, I have a child to raise, a home to keep, and a life to live. I do what I have to do, whether the law likes it or not, to get through every day sane and alive. I'll leave it at that.

[CTyankee]

38. Your experience was horrible. Thank you for your story. It is maddening for me to read

what happened to you and not get outraged all over again. And yes, you are right, this WAS in large part discrimination against you as a Medicaid patient.

Another fine example of why we need universal health care RIGHT NOW. I know that Europeans are treated better vis a vis drugs than Americans are. If this had happened in France, I'll wager any amount of money there'd be those vicoden toute de suite...

[mopinko]

39. call your pcp, tell him you want some relief, and a new surgeon.

imho, a surgeon who does not care how much pain you are in is an asshole. assholes do not usually make very good docs.
this kind of pain is a drag on your health. there is no excuse for it.
if all else fails, go to the er.

feel better. rest assured that you are correct to be outraged.

[CTyankee]

40. Thank you!

The surgeon's office called back this morning and asked about the specific pain I had and I tried to describe it as best I could. Waiting now to hear back...

I have thought of getting another referral. I am researching it now, but I must tell you that I have encountered this before with the surgeon who did the first repair (now retired). I don't want to go from surgeon to surgeon looking for pain meds...it's the quality of the surgery I am looking for basically. My sense is that there are just a bunch of docs out there who have this old school and DEA fear inspired ideas about pain management. I have talked with a family friend, an anaesthesiologist, who explained it all to me. He is of the new school of docs who have more of an updated education about pain management. Unfortunately, he is not in a position to make a formal referral as he works for the VA Hospital.

I'm still thinking through this situation and what my options are...

[gkhouston]

44. +1. You're more likely to get a timely response from your PCP.

The surgeon should have written you the prescription the first time you asked. Let your PCP know you've asked and been refused, and why. The PCP can always check with the surgeon if there's a suspicion of doctor shopping (trying to get more than one prescription for pain meds).

[CTyankee]

45. My pcp's office is across the hall from the surgeon. He referred me to the surgeon.

I did call him and tell him what the surgeon said (that the pcp should give me the prescription) . So this is all taken care of. I will bet that the pcp wonders why the surgeon laid this on him but I have given up on knowing the byzantine operations of pcp's and medical specialists...