I hate doctors who think we should limit pain medications

[TravelingChris]

I just watched today a doctor on tv talking about how too many pain medication prescriptions are given out. He seemed to think that only cancer patients need them- or at least that was the impression I got. He also said everybody who uses them is an addict and needs more. Totally and completely wrong. Less than 5% of people who take narcotic pain killers become addicts which is less than the amount of people who take a drink and then become alcoholics. Many of us don't need increasing amounts of medicine. Are there people who misuse the drugs- certainly. I had a BIL who downed pills in a quantity that would kill either myself or even my dh who was closer to his size. OTOH, I have arthritis and have had it for over 15 years. I can't take NSAIDS but do need pain relief. I would like to personally find that doctor and take a vicegrip to his joints one by one so he could feel why I need pain pills. I am certain that Imp needs her pain pills too. He seemed to pooh-pooh chronic pain. If you have a chronic condition which comes with pain, like RA or RSD, you will have chronic pain.

[kiana]

What a jackass.

[ma23peas]

. Less than 5% of people who take narcotic pain killers become addicts which is less than the amount of people who take a drink and then become alcoholics. .

 

I agree with him that there are alternatives to try before just prescribing, I worked in pharmaceutical sales for almost 10 years, sold Duragesic pain patches..I know a great deal about chronic pain and its reality. Absolutely, there are patients who need it...but that 5% who you say are addicted account for a far greater percentage of the amount of pain killers used due to their addiction. It's kind of like welfare, there are certainly those that need it, but unless education and regulations in place, abuse will become rampant (which we are very closely nearing). You go to any family practice or internal medicine/urgent care clinic/ER clinic...the vast majority of those seeking pain meds are those 5%...so when those 5% come into their offices, call after hours and represent more than 50% of the patient visits seeking pain meds..you might be able to understand their perspective. Luckily, I have only had to have pain meds (outside of labor) once in my life...I was in the ER and in debilitating back pain (flares up from a 6 car pile up I was in in college)...I could not sit on the hospital bed but had to stay in one position, he gave me a localized 'shot' and said that would take care of it...it took care of it for 5 minutes and he looked at me like I was an idiot for not walking..he quickly suggested that the ER was not a place to seek pain meds...my husband was with me and about went off on him...I just needed something to help me be able to sit or lay down without screaming! So, I see your frustration but you need to look at both sides of the coin.

 

Oh, and drug abusers are highly creative, one of our biggest selling points with Duragesic is the low risk for abuse against Oxycontin....but within 2 years the need for the abuse escalated and people were cutting the patches into little squares and selling them..fentanyl is 100x more powerful than morphine...taking it by mouth even in a 1cm square can be lethal..other patients would put a blow dryer to the patch to increase the rate of absorption, others just stole the drug and slapped 20 patches on their skin...it's a horrible addiction.

[TravelingChris]

I have no problems in punishing doctors who prescribe totally unreasonable amounts to people with no physical ailments. I understand that there are unscrupulous doctors who prescribe to anyone willing to pay. I am totally against drug addicts getting drugs but I also know that methampthamines are much more dangerous for the public as well as the users than narcotics.

 

I did see a pharmacy doing the right thing last week. They said they were out of stock of Sudafed or other generics last week when a scruffy looking suspicious character came in. (I was there waiting for my antibiotic at that time).

[Carrie12345]

I have no problems in punishing doctors who prescribe totally unreasonable amounts to people with no physical ailments. I understand that there are unscrupulous doctors who prescribe to anyone willing to pay. I am totally against drug addicts getting drugs but I also know that methampthamines are much more dangerous for the public as well as the users than narcotics.

 

I did see a pharmacy doing the right thing last week. They said they were out of stock of Sudafed or other generics last week when a scruffy looking suspicious character came in. (I was there waiting for my antibiotic at that time).

 

Well that's quite hypocritical, don't you think?

:confused:

[Kathleen in VA]

I have no problems in punishing doctors who prescribe totally unreasonable amounts to people with no physical ailments. I understand that there are unscrupulous doctors who prescribe to anyone willing to pay. I am totally against drug addicts getting drugs but I also know that methampthamines are much more dangerous for the public as well as the users than narcotics.

 

I did see a pharmacy doing the right thing last week. They said they were out of stock of Sudafed or other generics last week when a scruffy looking suspicious character came in. (I was there waiting for my antibiotic at that time).

 

Here in Virginia you are only allowed so many sudafed/generic sudafeds per month anyway. That scruffy person would have to show his driver's license to prove he hadn't exceeded his limit so I'm not sure they were judging his character by his looks - it wouldn't have been necessary.

[TravelingChris]

I don't know if they were really out or not. But we have a huge problem with meth in this area, he didn't look like the typical customer for this store, he didn't have a local driver's license ( I heard his conversation with the clerk), and I can see why they didn't sell him any.

 

I don't think it is hypocritical at all. I don't have issues with cracking down on illegal drug trade. I do have issues with ranting about physicians giving out any pain medication prescriptions. That was what the doctor on the news channel was doing. He seemed to think that the way Russia does it which is totally forbid pain medication is fine except that cancer patients suffer. I say that a lot more than cancer patients must suffer since on pain rating scales, there are a number of conditions, including RA and nerve pain syndromes that are considered more painful than cancer.

[Carrie12345]

I don't know if they were really out or not. But we have a huge problem with meth in this area, he didn't look like the typical customer for this store, he didn't have a local driver's license ( I heard his conversation with the clerk), and I can see why they didn't sell him any.

 

I don't think it is hypocritical at all. I don't have issues with cracking down on illegal drug trade. I do have issues with ranting about physicians giving out any pain medication prescriptions. That was what the doctor on the news channel was doing. He seemed to think that the way Russia does it which is totally forbid pain medication is fine except that cancer patients suffer. I say that a lot more than cancer patients must suffer since on pain rating scales, there are a number of conditions, including RA and nerve pain syndromes that are considered more painful than cancer.

 

My point was more on the judgement side. I have two chronic pain conditions. 95% of the time, I appear perfectly healthy. Should I be denied medication because I don't look sick?

Well, neither should someone who looks scruffy.

(Particularly when there's already a controlled system in place!)

[Kathleen in VA]

I don't know if they were really out or not. But we have a huge problem with meth in this area, he didn't look like the typical customer for this store, he didn't have a local driver's license ( I heard his conversation with the clerk), and I can see why they didn't sell him any.

 

I don't think it is hypocritical at all. I don't have issues with cracking down on illegal drug trade. I do have issues with ranting about physicians giving out any pain medication prescriptions. That was what the doctor on the news channel was doing. He seemed to think that the way Russia does it which is totally forbid pain medication is fine except that cancer patients suffer. I say that a lot more than cancer patients must suffer since on pain rating scales, there are a number of conditions, including RA and nerve pain syndromes that are considered more painful than cancer.

 

Oh, I see - a little more to the story. That makes more sense.

 

I hear you about pain meds not being just for those with cancer. I haven't had a narcotic prescription filled for about 3 years, but with my back issues it is nice to know that if I really needed more relief than I'm getting from ibuprofen I could ask my doctor and she would write me an Rx. There have been two or three times in those three years that I've thought how wonderful it would be to have the bigger guns - those times when I waaaaay overdid it and paid for it big time. Thankfully, bedrest put me back to "normal" and I endured it, but if it had been there I would have been thankful as well.:) I can't imagine living with extreme chronic pain not relieved by bedrest and not being able to take anything stronger than Tylenol - that would be a nightmare.

[kiana]

Yep. My SO has a serious autoimmune arthritis. When it flares up, he will quite literally wake up in the morning, take a painkiller and wait for it to work before he can go to the bathroom to urinate.

 

If he couldn't take anything stronger than Tylenol or Ibuprofen, he'd need a full-time carer.

[Carrie12345]

By no means would I ever want pain meds OUTLAWED, but I have got to say that I've been overprescribed many, many times, even before my chronic issues. And not just pain pills. My primary will give me as much amphetimine as I want. If I had no moral code, or maybe if I were just in dire straights, I could have made a pretty penny.

[Veritaserum]

What a jerk. :glare: Who is he to decide who has enough pain to need relief? I get migraines. Most of the time my migraine medication works to take them away. Rarely it doesn't. The only other thing that works is Lortab. When I get a migraine during pregnancy, I can't take my migraine meds, but I can take Lortab. I actually hate the way narcotics make me feel, but 3-4 days of agonizing, debilitating pain is far worse than taking one or two Lortabs and sleeping the migraine away.

 

I am glad that my doctor prescribes effective pain relief when I need it. It's unethical not to!

[WeeBeaks]

I came up against this too with migraines. I got a new doctor after the one I had told me to just take Tylenol and I would be fine. I wasn't fine. I was in the ER repeatedly vomiting every 5 minutes for 6 and 7 hours on end in extreme pain. I now take a specific migraine med (Maxalt) and also a narcotic (1st and 2nd line depending on the migraine). It keeps me from extreme pain necessitating an ER visit every single time.

 

I have heard doctors saying too they are cracking down on pain med prescriptions. I think it is the wrong tactic frankly. I think we need an overhaul of the medical system whereby the physician actually knows his patient in more than 3 minute office visits. I used to work in the med field too. I don't think the majority (exceptions of course) of pain pill addicts are getting their pills from one primary doctor, who they have a relationship with. They are going from doc to doc, and not having a good history with any doc. Not taking chronic pain seriously is completely the wrong thing to do. Nobody should live in pain if there is treatment available.

[Unicorn.]

What a jackass.

 

:iagree::iagree::iagree:

[Amber in AUS]

OK, I don't think that pain meds should be withheld for people who need them, but i do think that people need more thorough evaluations to determine if they really need them at the prescribed rate, and if it is increasing why. My SIL has been on continuing to increase doses of pain meds for the last 10 years, they finally put in a morphine pump last year, she is 38. She's had many problems, back, knee etc and had more surgeries than i can count, often with the 'we can't find anything wrong' response. What she really needed was some psychological intervention 10 years ago, because her pain started when she fell out with her DH's family. It's a very sad story and i have no doubt she will die from a pain med overdose because Dr's continue to prescribe to her instead of treating the root problem. And no, i'm not saying all pain is psychological just saying we need to take bigger measures for long term pain med people.

[sewingmama]

OK, I don't think that pain meds should be withheld for people who need them, but i do think that people need more thorough evaluations to determine if they really need them at the prescribed rate, and if it is increasing why. My SIL has been on continuing to increase doses of pain meds for the last 10 years, they finally put in a morphine pump last year, she is 38. She's had many problems, back, knee etc and had more surgeries than i can count, often with the 'we can't find anything wrong' response. What she really needed was some psychological intervention 10 years ago, because her pain started when she fell out with her DH's family. It's a very sad story and i have no doubt she will die from a pain med overdose because Dr's continue to prescribe to her instead of treating the root problem. And no, i'm not saying all pain is psychological just saying we need to take bigger measures for long term pain med people.

 

 

Gosh I can't believe she could find a DR in Aus that would prescribe this easily. I literally have to be half dead before a DR here will give me antibiotics let alone pain pills. The last time I tried to get pain pills because I was literally immobalised with pain the only thing they would give me was Panamax :glare: Yeah thanks guys - I'll just chew my arm off instead because that would help the pain more.:glare:

[Amber in AUS]

Gosh I can't believe she could find a DR in Aus that would prescribe this easily. I literally have to be half dead before a DR here will give me antibiotics let alone pain pills. The last time I tried to get pain pills because I was literally immobalised with pain the only thing they would give me was Panamax :glare: Yeah thanks guys - I'll just chew my arm off instead because that would help the pain more.:glare:

 

Maybe it's the private specialists who she's seen for her back and knee? I don't really know. I know she was listed as an addict at 2 public hospitals and would refuse to go there. I do know she had has some genuine pain over the year, but man, a morphine pump at 38! I thought they saved those for cancer people who were near the end.

 

I think the worst part for me is that no one is the family (except me) thought anything of it until the morphine pump when it, then it was too late. In a way by not encouraging her to get off the pills they were enabling her. Crazy!

[ChristineW]

I recently saw statistics that more people die from an overdose on legal prescribed medicines than die from overdoses of illegal drugs. From a public health standpoint, it makes sense to reconsider how painkillers are prescribed.

 

If you are in chronic pain, I can see how a doctor advocating reducing the types of conditions which painkillers are prescribed would be upsetting. :grouphug:

 

Christine

[Myeightkiddies]

I have Rheumatoid Arthritis (not like grandma's arthritis; it destroys joints and affects many organs. It is progressive and can result in death), Sjogren's, and FMS. Currently, I choose not to be medicated. It's a personal decision.

 

I am in pain, not discomfort but pain, every minute of every day. Most nights I cannot sleep (which is why I post here in the middle of the night, sometimes). When I do sleep it is due to exhaustion, and I wake-up every few minutes. I know ladies with this same disease who take a wide-array of pain medication. I don't blame them at all. It's not just cancer patients who need pain medication on a regular basis.

[WeeBeaks]

I recently saw statistics that more people die from an overdose on legal prescribed medicines than die from overdoses of illegal drugs. From a public health standpoint, it makes sense to reconsider how painkillers are prescribed.

 

 

Was this overdoses by the person prescribed the meds?

 

In the articles I have seen, it is typically kids or others who were not prescribed the meds who then fish through mom's/dad's/grandma's medicine cabinet and take the pills to get high. Those articles were reminders for all of us to keep a close eye on meds, and weed through the medicine cabinet regularly and toss things not needed (old prescriptions, old this and that) that can be dangerous or tempting to kids.

[Harriet Vane]

What a jackass.

 

:iagree:

[Farrar]

I recently saw statistics that more people die from an overdose on legal prescribed medicines than die from overdoses of illegal drugs. From a public health standpoint, it makes sense to reconsider how painkillers are prescribed.

 

If you are in chronic pain, I can see how a doctor advocating reducing the types of conditions which painkillers are prescribed would be upsetting. :grouphug:

 

Christine

 

And I heard a recent story talking about how we're now coming to new understandings of the detrimental health effects of long term painkiller use. Plus, I heard another story about how the more you use, the more desensitized you become and therefore the more you need for pain relief. They were talking about how we needed to re-evaluate the way we advise people about pain relief and respond to it.

 

But that doesn't mean we should be callus, as that doctor sounded. Or act like people don't need it or are abusers or addicts when they're just in chronic pain.

[kalanamak]

In my state there has been a HUGE uptick in chronic pain med related deaths, due to inadvertent build up of breakdown products and people dying in their sleep.

 

I have to 2 Jan 2012 to complete a huge PITA education course if I want to be able to prescribe the equivalent of 120mg/24hours of morphine chronically. Many docs are not happy about all this and chronic pain patients will be DUMPED. We have gone from a message of "your pain will be 'believed and relieved' " to "forgodsake stop killing your patients" in one year. We will be reviewed, we will be overseen, we will be sniffed over and have to double document and .... I can't go on. It is too horrible.

 

The last crackdown patients were dumped by anyone who has a waiting list for new patients. I met many, who tearfully told me they'd never lost a single script and their doctor of X years sent them a letter of termination.

 

I see this, in my state, as the typical swerve from ditch to ditch. One extreme to another. I am dreading it, but will have to do it, even though my patients are incarcerated, have their meds doled out carefully by licensed nurses, and who are constantly watched for signs of oversedation. I'm talking every 15 minutes checks, round the clock.

 

The world would run differently if I were dictator, but I am but a licensed cog in the wheel, that that license means I am a very scrutinized cog. I'm sure there are irresponsible docs out there, but I think many were doing just fine until there was a big push to make everybody pain-free. Sometimes you can't. Sometimes it is just making it tolerable.

 

AHHHHHHHHHHHHHHHHHHHHHHHHHHHH! In the last 18 months I've clocked 430 hours of studying to keep up with my credentials and state education requirements. I am so looking forward to another two modules to do on line for the holidays.

[elizabeth]

I just watched today a doctor on tv talking about how too many pain medication prescriptions are given out. He seemed to think that only cancer patients need them- or at least that was the impression I got. He also said everybody who uses them is an addict and needs more. Totally and completely wrong. Less than 5% of people who take narcotic pain killers become addicts which is less than the amount of people who take a drink and then become alcoholics. Many of us don't need increasing amounts of medicine. Are there people who misuse the drugs- certainly. I had a BIL who downed pills in a quantity that would kill either myself or even my dh who was closer to his size. OTOH, I have arthritis and have had it for over 15 years. I can't take NSAIDS but do need pain relief. I would like to personally find that doctor and take a vicegrip to his joints one by one so he could feel why I need pain pills. I am certain that Imp needs her pain pills too. He seemed to pooh-pooh chronic pain. If you have a chronic condition which comes with pain, like RA or RSD, you will have chronic pain.

 

This RA sufferer agrees with you wholeheartedly. I cannot take NSAIDS as I get upper GI bleeds with them and have to drink a lidocaine cocktail to get relief. The only point I disagree with is the vicegrip to his joints...I can think of a far better place to bring the issue downhome to him. What a privilege he has to be so ignorant of what chronic pain is to live with day and night. I am on my second round of high level steroid therapy this month and still need my gabapentin and valium. Think he would like to trade places with either of us??? I bet not.

[Scarymelon]

I completely understand where he is coming from. I practice in a community that is being devastated by abuse of chronic narcotics and I am very, very gun shy of prescribing because of misuse. I have had four patients die in the past year because of narcotics prescribed to other friends/family members that they started taking. Large numbers of high school kids in our area are also addicted and are starting to turn to heroin The only time I feel comfortable prescribing narcotics is when I have a stable long term relationship with a person and I still do drug screens constantly. I agree that there are certain chronic conditions where narcotic pain medications is appropriate; but it is not appropriate for DAILY use for someone with a vague musculoskeletal problem or generalized adult pain. It is good to be reminded that some people are helped with narcotics and use them appropriately, but I would put this at about 5% of my patients that seek them out.

[Lizzie in Ma]

I just watched today a doctor on tv talking about how too many pain medication prescriptions are given out. He seemed to think that only cancer patients need them- or at least that was the impression I got. He also said everybody who uses them is an addict and needs more. Totally and completely wrong. Less than 5% of people who take narcotic pain killers become addicts which is less than the amount of people who take a drink and then become alcoholics. Many of us don't need increasing amounts of medicine. Are there people who misuse the drugs- certainly. I had a BIL who downed pills in a quantity that would kill either myself or even my dh who was closer to his size. OTOH, I have arthritis and have had it for over 15 years. I can't take NSAIDS but do need pain relief. I would like to personally find that doctor and take a vicegrip to his joints one by one so he could feel why I need pain pills. I am certain that Imp needs her pain pills too. He seemed to pooh-pooh chronic pain. If you have a chronic condition which comes with pain, like RA or RSD, you will have chronic pain.

 

What....An....Ass

Probably still thinks infants don't need anesthetic too the troglodyte.

[Catherine]

is a daily part of medical practice.

 

There is no reliable way for a doctor to determine whether a patient is lying, in the vast majority of cases. There is no way to see or confirm what they are feeling. Drug addicts are notoriously adept manipulators and liars.

 

Within the past month, I've seen a healthy young woman in her early 20's, with her life in front of her, die of a "recreational" OD of oxycontin. She had a bag of pills in her pocket when the paramedics cut her clothes off.

 

And I can promise you that "nice" people are drug addicts. Grandmothers and Moms. Police officers and prominent people, people with regular jobs and families. I've seen dozens. Drug addicts don't all advertise themselves with tattoos and pierced noses-and plenty of perfectly normal people have tattoos and pierced noses now anyway. And the stories about cutting up fentanyl patches?? I could tell some tales about the gross, disgusting, truly bizarre and unbelievable things I've known addicts to do to pursue their goals.

 

By way of education: chronic pain is long-lasting, by definition. Long term, regular (daily-at least) use of narcotic pain meds will produce tolerance, meaning higher doses will be needed to achieve the same pain-relieving benefit. Tolerance has nothing to do with the realness of the pain or the motivations of the taker. It's a physiological phenomenon, pure and simple.

 

It is also true, unfortunately, that chronic pain cannot be completely relieved or controlled. For those of us afflicted, it is going to be a feature of daily life, which seems horribly cruel and unfair. Knowing this reality, it makes sense to develop an arsenal of pain-relieving techniques\meds\approaches, so that one is not totally dependent on one, and only one, med for relief.

[Alessandra]

I would like to personally find that doctor and take a vicegrip to his joints one by one so he could feel why I need pain pills.

 

What a jerk. :glare: Who is he to decide who has enough pain to need relief?

I am glad that my doctor prescribes effective pain relief when I need it. It's unethical not to!

 

This thread reminds me a a dentist I had. This was an oral surgeon who could have prescribed painkillers. After a root canal, he told me to call him if I needed a prescription. I lived way out in the country and got ferocious pain on a Saturday at midnight. And I thought sadists wanted to see the pain they caused.

 

The next time I went to an oral surgeon, I found a different one. He gave me codeine and told me to take it as a preventative for a few days, even if I was not in pain. He also gave me percodan 'just in case.' I never needed the percodan, but it was nice to know that the dentist realized that pain could strike at unpredictable times.