Help Please!!!! I screwed up with the pain mgmt doctor

[mark-Perth]

Hi Greg

Sorry to hear about your very inconsiderate pain specialist. He obviously doesnt understand the difference between abusing medication and using medication for pain. Doctors need to understand that you dont have the same pain everyday, it changes with what you do, especially if you are still working or trying to exercise.
In Aus we are lucky we dont have the contracts as they sound pretty pathetic but opiates are heavily monitored. Ive also had good docs that have allowed a regular daily dose plus about 30% extra for breakthru pain if needed. Worst case my doc also allowed me to come into his office for a morphine injection instead of going to hospital and waiting for hours. What a huge difference an understanding doctor can do though. My doc also has a big sign in his office that says no narcotics or sedatives are prescribed in this surgery! He will only do it on advice from a PS though but I have been his patient most of my life so he also knows and trusts me.

You want to read the contract you signed as well and see if there is any obligation in there for him to also help you withdrawl from the medication as regalar use does lead to physical dependance and horrible withdrawls if stopped abruptly, whether that be using Suboxone or methadone. Surely there is an ethical point that he is breaking by turning you away without any help. In Aus they have an obligation to also help you stop the medication if they start you on opiates, regardless if you abuse it or not. I would call his office and ask for an appt immediately to discuss with him helping you atleast withdrawl slowly without side effects as that is just plain cruel to just cut you off totally.

If you do have any pills left I would also start reducing them just incase you arent able to get other scripts soon. You will get the worst side effects usually after a few days without any so if you can reduce now it will be alot easier on you then.

There is also other medication that may help with any withdrawls and may be available from your local doctor or OTC hopefully like Buscopan for stomach pains(OTC). Clonidine for the leg pain. Muscle relaxants like Diazapan. Sleeping pills as sleeping is disturbed for a few days/ week. Codiene/acetaminophen tablets or tramadol for pain. I am no doctor but these medications were all given to me by a specialist who treats opiate addicts in my city several yrs ago. There was also a very small amount of naltrexone in there as well. He has actually written a book called Herion helper by Dr Neil Beck. He was treating mostly herion and alcohol addicts which is different to treating someone who uses pain medication for pain as its a sudden withdrawl his way and that shouldnt be used on pain patients. He was actually able to get around the system over here by puting in less than the full dose of each medication but then taking 2 capsules which was alittle dodgy. I never used the unlabelled capsules he gave me (I still have them) and took them to my regular doctor to show him as I didnt want to withdrawl totally but just reduce my dose prior to surgery. They were actually called Naltrexolite Plus but it looks like he has changed the ingredients slightly and also introduced a new medication for opiates called micronaltrexoneplus. He has on his website some hopefully helpful info if you are stuck with a sudden withdrawl as well as sample scripts of his medication to be written out by other doctors. This may not be available in the US but you can only try.
Products

There is also another option for opiate withdrawls that you can ask him for which is a Ketamine infusion. Ketamine infusions can rapidly withdrawl you from opiates and I have had several with great results. The effects are extremely strong as you need to have an infusion for about 4 hrs atleast at a dose strong enough to cause hullicinations. It does help though with rapid detox.

Hopefully you can find someone more sympathetic to your needs as your current PS doesnt sound very sympathetic. Im so sorry that you are going thru this and hope that you get some help before you run out of medication totally.

Good luck

Mark

[Cindylou]

I only have the 1 pain management clinic experience as well. Greg, your pain management clinic sounds as rigid as mine. I almost always get the mean nurse who first does my vitals and asks me how I am doing, but the look on her face tells me....she doesn't give a **** how I feel. The nurse practioner is better, but I still always feel like they're doing me a favor to help me, and unfortunately, it's never enough. I completely do not understand why they wouldn't give me more break through medication with the increase in the patch, especially since I have not been getting relief. My husband is always telling me to take another oxycodone because I am writhing in pain, but I say no, because I don't want to get in trouble. I am terrified of taking "1 too many." (this was when I had more than 3 left) Seems like an upside down way to operate a pain clinic. I also don't know how difficult it is to get in another clinic after you have been banned. Please keep us posted Greg on how you get this resolved. I do hate that they make it so damn rigid.

[Justin]

Hi Greg,

I hope you are doing well. Sorry for the late reply--I have been out of town for the last week.

I have only been with my pain management doctor for a month now and am new to the "pain contract." So we havent got to the point of being prescribed a medicine that helps my pain. I was told 2 weeks into a month long script that I would get switched from vidon 10-325 to percocet 10-325 once I got back from my trip for work. I travel all the time for work which isnt that good since sitting down is a huge trigger for pain. While on my trip I made the poor decision (no dr at office on Fridays to call) to double my dosage since I was getting a new script in a week. I know I shouldnt have but it is soooo hard to put on a smile for clients when Im throbbing in pain. Long story short when I went to my next appt the dr was going to switch my meds but wanted the vicodins back. I explained my story and he sympathized with me. Unfortunately, I violated my contract and was told there is NOTHING he can do for prescribing pain meds....HOW DID I GET MYSELF IN THIS SITUATION/

Greg, first of all, I am sorry that you have had such an increase in pain. I wish you weren't going through any of this. (BTW: Greg is a great guy :thumpup: and I know violating his contract was not his intention.)

OK, I'm going to go against the grain here. What I am about to write is not directed at Greg--it is a general statement regarding pain contracts. When a patient signs a pain contract with a physician, that patient must follow every letter of that contract. The pain contract is not merely a document of suggestions; it is a set a rules that patients must follow to be treated in a given clinic or to be seen by a specific provider. If a patient does not follow the established rules within the contract, then the physician has every right to fire that patient for violating the contract.

I went to go meet the surgeon today (4 hrs one way) and was told there are no trials out there I would qualify for and my insurance wont cover 2 disc ADR. Now I have no meds, no surgery coming, a whole lot of pain and no idea what I can do next.

Will my contract violation keep me from going to another pain management doctor?

No, your violation will not keep you from seeing other pain management physicians. However, physicians are not obligated to take every patient that walks through the door. Be upfront and honest about your past violation.

I have Anthem BC/BS out of Virginia. Has anyone with this ins been approved for ADR?

Personally, I have not heard anything about BC/BS of Virginia covering artificial disc replacement surgery. However, I have some medical contacts in Virginia and I will see if they have any information.

Are there any suggestions for a non-narcotic pain management device that would work for my situation?

I am so frustrated and stressed right now but I know one place I can count on is the caring people who make up this forum. Thank you to any and all with any advice. I have a herniated disc L5/S1 abutting the S1 nerves with an annual tear.....kinda the same thing on L4/L5. I have tried every conservative approach and am left with pain meds or surgery and both of those just got shot down

In terms of non-narcotic pain management devices, many here have already recommended a TENS device. You could also try some over-the-counter medications (ibuprofen, naproxen, etc.), but make sure to read the dosing instructions on the packaging.

We are here to support you, Greg. Keep your head up buddy, you have many options and we will get this figured out.

[Greg]

THANK YOU ALL for the tremendous response and care you all have put in this thread. I knew this was the place to turn to with my problems/questions What I didnt know was the amount of help I would recieve with just the answers I was looking for

Unfortunately I got so tied up at work, I lost track of the time and missed my appt with my other Dr I was fortunate to get a new appt on Tueday but it's going to be a long couple days. I will definitely be asking about some of the things you all have mentioned. I am sure I will get back on top of things but who likes having to start over.

Thank you again to everyone. I will keep you all posted as to how things go

[Justin]

Good luck on Tuesday, Greg.

[linda]

Greg,
I am so sorry for your current situation. I have same L5-S1 abutting the nerve thing that you and it is almost bone on bone. L4 only has a mild buldge but I know you are in pain. I have never been in a pain management program but am considering asking my Dr. Tues. if I can get into the one at his practice. Over the past year and a half he has screwed with my prescription, making me feel like a drug seeker. Just last week when I called in the recorded phone line he filled it but shorted me 20 and lowered the dosage to 1 -2 every six hours and in caps MUST LAST 2 WEEKS. I take short acting oxycodone. I really hate taking them too.

Is Southport near the beach? I am from Durham but live in Carrboro now.
A friend of mine messed up his contract but he was able to get back in but it was a process... This was at Duke. What town are you having to travel to?

[Greg]

Greg,
I am so sorry for your current situation. I have same L5-S1 abutting the nerve thing that you and it is almost bone on bone. L4 only has a mild buldge but I know you are in pain. I have never been in a pain management program but am considering asking my Dr. Tues. if I can get into the one at his practice. Over the past year and a half he has screwed with my prescription, making me feel like a drug seeker. Just last week when I called in the recorded phone line he filled it but shorted me 20 and lowered the dosage to 1 -2 every six hours and in caps MUST LAST 2 WEEKS. I take short acting oxycodone. I really hate taking them too.

Is Southport near the beach? I am from Durham but live in Carrboro now.
A friend of mine messed up his contract but he was able to get back in but it was a process... This was at Duke. What town are you having to travel to?

Southport is just a few minutes from Oak Island (nice beach) I was going to Supply (25 minutes) and have been searching all over the internet for another PM doctor. I think I will have to go to Wilmington (45 minutes). I dont care how far I have to travel though. With all the setbacks I have met with getting a cure for the problem, I will go as far as I need to for treatment of the symptons.

[linda]

Hey Greg,
Good luck on Tues. If this doesn't work out, surely there are some good doctors in Wilmington. I'm sorry you are going through all of this at such a young age. When I was your age my parents had a house at Topsail Island (close to Greg) and I lived there several summers while I was in college in the early 80's. The only pain I had back then was from hangovers!!!

It takes me 45 minutes to get to my doctor and driving just kills me. I just about fall out of the car when I finally get home. Your traveling job sounds painful. How far do you have to travel on these trips?
Wishing you much luck on Tues.
Linda

[Greg]

Hey Greg,
Good luck on Tues. If this doesn't work out, surely there are some good doctors in Wilmington. I'm sorry you are going through all of this at such a young age. When I was your age my parents had a house at Topsail Island (close to Greg) and I lived there several summers while I was in college in the early 80's. The only pain I had back then was from hangovers!!!

It takes me 45 minutes to get to my doctor and driving just kills me. I just about fall out of the car when I finally get home. Your traveling job sounds painful. How far do you have to travel on these trips?
Wishing you much luck on Tues.
Linda

I think Wilmington is going to be my best option. The hard part is trying to figure out which will be the best one to go to. The trips I have for work can be as close as a couple hour drive or as far as Germany...that one is only once a year! Sitting down wether a car or plane is probably the worst for my pain but if I dont go to work than I cant pay to get treated. Not like it's easy to pay for while working

I have a problem with being impatient and like to get things done right away. With doctors, it seems like everything takes so long with new appointments and the whole "come back in 3 weeks and we'll see if it worked." I have gotten my way with trying so many things in a quicker manner than normal but at the same time the bills rack up quicker. I still cant believe the discogram I had was 1,200 per disc and 1,700 for the 3 minutes I was in the room for a CT scan afterwards. Dont get me wrong, my insurance covers 80% but that's still $730 to be put in the worst pain in my life for 3 days. I will NEVER get a discogram again in my life

[linda]

Hey Greg,
Boy I know what you mean about this insurance thing. I'm still paying for my MRI from Aug. '08 at $50 a month. Our insurance used to be 80% like yours then it went to 60/40 when I had that MRI. Now it has gone up to 70\30 with a $5000 out of pocket for big stuff which is what I will have to pay for the ADR trial if I have it done. How bad is your L/4? What were the disco results. I am absolutely terrified of a disco. However, I think $5000 is a small price to pay if this adr would make me painfree. I love to hear the stories that say "all of my presurgical pain is gone" Just think how great that would be! But my negative thinking tells me with my luck I will be way worse than before, won't be able to work, go bankrupt and lose my house. Please don't let any of my negativity rub off. How is your pain today? Do you have any meds at all? Have you been taking meds a long time? Sorry for all the questions.
Linda