Let's cut right to the chase: if you are unwilling to accept some risk of a positive drug test, then you should not use any CBD oil product. That may sound extreme . Some days he seems better than others, clearer, looks us in the eyes. We are loving him as he is right now. He is thinking about his future, but not ready for a lot. Your only job right now is to be a parent to your son. A parent If not, take him for a physical exam and let a doctor do a drug test. Most times.
a positive of chase: risk if you accept Let’s the then test, are cut to unwilling to right some drug
I truly know myself inside and out; like you said the mind has no choice but to transcend the body to survive, and when you reach for the light in those darkest of places you know you have the strength to deal with whatever life can throw at you. I pity people who make such comments, ignorance and arrogance are worse vices than any drug known to humans. Yes, this group is very informative and supportive.
Comments like yours have no place here. You speak of middle schoolers and then leave an uneducated and childish response.
You speak of studies yet list no references, I suspect because you are just regurgitating general knowledge to people who already know about addiction. We know because the only way we can live our lives to any degree of comfort are with drugs that are highly addictive and we have to be so careful. If you truly know anything about what you are talking about, I should not have to tell you that there is a difference between drug dependence and drug abuse. Clearly the people here do not fall in to the latter category, we are dependnet on the drug because we are using it for what it is intended.
None of us would choose to pay that much money long term, or endure the side effects of taking such meds long term if the other options we had tried had worked. However Idk why I even try to explain; I would never wish such a thing on anyone, but statistically you or someone you love will be affected in some way by chronic pain due to illness, and or injury.
I have a feeling your ideals will not hold up so well then. Excuse me, a pain patient who never smoked pot as a teen, nor did drugs. Why not say, Whatever and get it very with. Do you also preach taking your meds on time as prescribed or no?
I note you said: This is stupid behaviour. It is not working out! Why are you suffering like this? Complain or find another Dr. Hi Doc, your long glib suggestions of a variety of treatment modalities to try, is an insult to patients suffering from severe, chronic daily pain.
I am a medical doctor; I am no longer able to work; I have among other conditions severe spinal stenosis, prolapses in the cervical spine, lumbar spine, two subdural-bleeding in the brain from falling ; I am wheelchair bound; stay awake at night with severe pain; been shot in the chest and leg; have accelerated osteo-arthritis, brittle bone disease and pituitary infarct; what infuriates me is when I ask my Physician for pain prescription and he says: Doctors are morons if they treat genuine pain sufferers with the same paint brush as recreational drug abusers.
I am not a recreational drug abuser: I am in PAIN. For those Doctors who do not have the compassion regarding pain, let me remind you about the Oath that we both took: I curse every medical practitioner who makes a joke out of a patients suffering and insults a person in genuine pain; I hope your kids suffer from non-ending pain and you look on in misery knowing that you cannot do anything for them.
Dr Ahmed Adam, South Africa. I am very sorry for your pain. I have no children by choice So unlikely that my children will suffer non-ending pain I chose not to have children so I could care for others.
Keep up the good work and may all that is good for you come to you in great abundance, best regards, Dr Adam, South Africa. I completely agree with every single statement you made. I feel as though that ought to be emblazoned in bold on every single text book, chanted as an incantation at least daily all throughout medical school, and stamped on every official piece of documentation from all medical boards because it is just that important.
You come across as an astute, compassionate physician, which unfortunately seems to be a minority these days. Every time a statistic is quoted which states that there have been so many prescription related drug overdose deaths, the second half of the equation is never publicized. There is never any information shared on how many patients take their own lives because they have had their medications reduced or withheld. And the stories like Leila happen very often all across the country and have been happening for many years.
First I agree with Ahmed Adam exactly and thanks Dr. Wible for the contact and support here. If taken appropriately opioids work in the long term for me over 18 years while working full-time and make life tolerable. The data posted to sites such as the CDC and a current negative Consumer Reports article are complete nonsense and easy to rebut — too easy actually. The data is seriously flawed, easily refuted, and totally biased toward a negative outcome. Needless to say things in our area are getting worse not better and I really empathize with anyone in this situation.
Hopefully more to say later. Adam First Id like to say that I never post on these forums at all but I felt compelled to after reading your post. I have multiple Sclerosis, multi-level ddd, spinal stenosis, fibromyalgia, carpal tunnel syndrome, bulging and herniated discs with tears, tibial tendonitis in both legs, have went paralyzed 3 times, once from the neck down for about 24 hours in January or , then in June of my left arm for 5 months and when that got better in February of my right arm went paralyzed for about 6 weeks.
I went into the ER one night back in April of in excruciating pain and it was a pain I had never had before. He did not care and sent me out of there knowing how painful shingles is, I was in a fetal position crying in pain like I have not done since giving natural birth.
Sorry for the long post and the. Is a new phone. And I am so sorry for you. And what you are going through. Also my husband reminded me that he also sent me home with a blood pressure of over Trika, I too have been mistreated too many times to count.
Endometriosis, ovarian cysts, bad gallbladder, unknown internal bleeding where I would vomit blood and need transfusions.. I was put in pain management after about 10 er visits and no one could find out what was wrong with me.
Well after trying surgery after surgery things got worse in a few cases. After a lapor I had worse pain than when u went in. Wound up in the er over and over and the drs would not treat my pain.. Turned out the surgeon while closing me up entrapped a major nerve. So finally had that removed with another surgery. The Dr still discharged new after not going to the bathroom once in 2 days.
I went right down to the er after I was discharged. That er Dr just said I wanted iv pain meds and nothing was wrong with me. So as they were shoving me out the doors my labs came back showing my kidneys were shutting down..
Yup I had a perpherated bladder. And no one believed me till it was almost too late. Than the same with my gallbladder. Than finally after 6 months if dealing with the bad gallbladder my husband convinced a Dr to take it out. By that time it was grey and infected.. Than shortly aft er that surgery I started vomiting blood everyday…no answers for a year. I was hospitalized for 4 months needing blood transfusions weekly, unknown number of endoscopies, transferred to 3 hospitals with no answers.
So I had a sitter for a week. Finally I was down to 80lbs and had gotten 3 staf infections from the picc lines so my husband was going take me out bc no one was doing anything for me. Best day of my life. It was the most severe rare case of HHT he had ever seen. So I was put on the correct meds and got better.
But to this day the HHT caused most of my organs to bleed so I had a full hysterectomy too. But there are a few who still just refuse to control my pain..
Seratonin syndrone, throat closed and more bleeding. And still those few drs knowing everything I have been thru is legit still believe I am just addicted to them. So I now take my struggles and experiences and help others.
Your life should be lived to the fullest! It took me traveling all around the states to find my drs. I probably saw plus drs. And to be honest not even a quarter of them truly listened to me. So keep searching friends. Good luck and many prayers! Oh and I did try every possible thing before pain meds. But now having a great Dr he explained everything so much more clearly for me to understand the meds. Pretty much every pain doctor in this country requires their patients to sign a contract that they will not get meds from any other doctor.
Did you call your doctor? I am so sorry Doctor for you. I agree with you about the other diseases and the other issue is the cost. Why does it cost 2. I love my country. We have some issues I would like to see dealt with before I check out of here to make what I have gone through mean something more to me than meaningless, mind-numbing agony, depression and torture.
I feel for you!! Every adult has pain and you have trust sometime the patient just knows what will work in his own body. I have Fibromyalgia along with thousands of others who struggle every day for a pain free day. All the thing you suggested ,we are doing to get a hours worth of freedom from our pain.
There is a big problem with pain clinics making addicts of people because they give too much and want it taken every few hours every day. I have been seeing a pain doctor for 7 years and we have an honor system. He gives me 10 hydromophone 2mg a month and I show him 2 or 3 of them when I got back. I take it when I need it most.
I know this method will not work with every one , but it will with some. Most people with fibromyalgia die by their own hand because the pain becomes too much. I believe the medical field needs to do more to understand the mind set of the patient. We are not all looking for a pill, we just want relief. Turmeric work good for me with the every day pain. I have Chronic Primary Erythromelalgia on b other hands, both feet.
Tha t s a start of a list. Severed tendons, scar tissue. Was in 3 fires, hit by 4 cars, went o very a bridge in one. Have, because of the irresponsible Doctors I meet monthly.
Any thoughts other than statistics and things that do not apply to me? Geuss especially at my habits, shame perhaps. Tool so often used to treat pain…. I read your ideas.
Mine are Long Acting Opiates are good medication. Like a gun is good at killing. You have nine cats in your home. You and your husband smoke and you notice the cats are developing breathing problems and then one is diagnosed with and dies of lung cancer. What would you do now to make your home a healthier place? The other day I read an article in USA Today discussing the fact that married couples lived longer healthier lives than single individuals their age.
What led me to write this is not any problem or disagreement with the results of marriage but the conclusion the doctor reporting it came up with: They are healthier because they have someone who cares about them telling them what to do. Yes, my wife tells me to drive carefully and I do because I love her but once I walk out the door how I drive, what I eat, exercise and more are not because she is watching me and instructing me.
Married men also have a lower incidence of lung cancer than single men who smoke the same amount. Women with malignant melanomas of same site and stage as a comparable male group had better survival statistics than the men. The conclusion by the doctor blew my mind. Estrogen and progesterone must be protecting the women. What do we conclude now based upon all these closed minded medical conclusions that do not relate to people but attempt to be scientific?
Our conclusion based upon their wisdom: If estrogen and progesterone was the reason women with melanomas had a better survival rate than men then sleeping with estrogen and progesterone must be what is protecting men who smoke from lung cancer and heart attacks.
And the reason living with dogs increased survival statistics must be related to the fact that when their owners did unhealthy things like eating fatty foods and not exercising they growled and threatened to bite them. I hope you are smiling because I am kidding and it is not because of mechanical causes that these statistics are revealed. When the instructions to take care of yourself come from someone you know loves you it can and does make a difference, because they are not criticizing you they are educating you, but first we need to feel loved and cared for and about before we take their words seriously.
Relationships are what it is about. Men are human doings while women are human beings. I am constantly trying to get the men to become aware of the importance of relationships with pets and people and life and women to see that they need to relate to themselves also and not just live a role, such as Momma, which leads to their demise when the kids leave home.
So develop a relationship with yourself and work with your new self and love and care for that new self as if you were your own child too. So when the kids leave home there will still be reasons to survive for the wage earner and mother.
In a sense it is about hormones because our internal chemistry is altered by our relationships. Growing up with love is a major factor in health. Not because your parents are telling you what to do every day but because their words are hypnotic and they remain within you and when they are therapeutic also you are constantly hearing them in your subconscious, as well as, conscious mind and making healthy choices.
Self-love coming from being loved leads to self-care and a healthy life. The effect of a lack of relationships is not understood by many doctors but is by the poets and song writers. I have mentioned W. Childless women get it and men when they retire. Now to get to the question I began this column with. What do you think the woman who wrote about her experience and her husband did?
And what would you and your husband do when you realize you are killing your cats due to your smoking in the house? This story comes from a full page letter to Cat Fancy Magazine, written several years ago, detailing the emotional impact the death of her cat had on the couple. Here is their solution: We love our cats more than the convenience of smoking indoors. We are not killing our cats anymore.
We hope you are not killing yours. So the relationship is therapeutic but how about getting to know yourself and having a relationship you can enjoy with yourself. When you do you will find you are never lonely, even when alone. Not to mention that there is also another level of relationship that is always there to support you when it is a healthy relationship and not about guilt but related in a therapeutic way to your spiritual connections and faith. What I have learned and what all health care practitioners and people in general need to know is what Jung had to say and psychology knows.
There is an unconscious psychic reality which demonstrably influences consciousness and its contents. All this is known, but no practical conclusions have been drawn from it. As we have become more empowered over nature the mind has become more prominent and the head dominates.
But we must remember there is a unity of psyche and soma within us and they must both be paid attention to. So we and our health care practitioners must treat both our intellect and our experience; our psyche and soma. Our duplex must be accepted and acknowledged as part of what we are living. The seat of faith is not consciousness but spontaneous religious experience. When you have a relationship with God it keeps you from dissolving away in the crowd.
What struck me is how few men and doctors are aware of this and make it part of their lives and professions. When you ask men to draw a picture of themselves many just draw their head.
Yes, some women are thinkers and draw a large head too attached to their body. When medical students are asked to draw themselves working as doctors the majority draw themselves sitting behind a desk with a diploma on the wall behind them. That is why I started to write this article. So folks wake up to your multiple personalities and that your mind, body and spirit are all within the unified creation which you are. In a sense you are like the planet earth with many components, residents and environmental factors which all have an effect on the health and wellness of the entire planet.
Just like global warming cannot be treated in a simplistic one solution way because every part of the body earth is showing symptoms of the change so our bodies manifest what changes are going on within our duplex make up and unconscious mind. Pay attention to what lies within you and respond to it so you live your healthiest life and develop relationships which enhance your life and give it meaning.
Happiness is not in strength, or wealth, or power, or all three. It lies within ourselves. If your main issue driving the smoking habit is anxiety then treat that first. A good therapist or even a meditation program can help. Vipassana centers often offer a free 7-day silent retreat. Pamela, I know of far too many people who have experienced pain and have been receiving inadequate treatment for it. This is a tiny minority. Only once have I ever had drugs stolen from me, decades ago, and very few pills were taken.
I have learned to take precautions since then. Even those in dire poverty with kids to feed understand that to sell drugs to someone means that stranger could be harmed by those drugs. Most people are morally together enough not to go the drug dealer route. In this way, people are brushed aside. Do these doctors have any conscience at all? I had no idea so many patients were diverting prescription drugs.
I try to err on the side of trusting what patients say — even though I have been lied to, manipulated, and even had prescriptions forged.
Still I want to wake up every day and believe that I am sitting next to a patient who really does want a long-term relationship with a family doctor built on trust and respect. I do have priorities. Prescribing chronic opioids to patients with difficult-to-verify diagnoses increases my risk of all of those problems I hope to avoid.
Do you really think that there is so much more pain today than there was 30 years ago when opioid prescribing rates were very low? I do think that many doctors hand out opioids like candy, and this is contributing to the addiction, diversion and overdose deaths. I realize that doctors have a broad range of opinions regarding opioids from chronic, non-malignant pain. I happen to be one who feels that opioids are rarely appropriate in this situation, despite the aggressive lobbying by Purdue Pharma and others during the 90s.
This is a very good point made by Dr. I, as a pharmacy professional, can completely sympathize with everything this doctor is saying. I can also see things from the perspective of a Chronic, Non-Cancer Pain patient, too.
I promise you, this is not the case, and we are not all addicts! I used to take Neurontin gabapentin and Zanaflex tizanadine and the combination of these, helped for a few years.
However, I was switched to Lyrica pregabalin when it first came out, and had to switch back to Neurontin when I had lost insurance and could no longer afford the Lyrica. The following years resulted in doctors swapping back and forth between Neurontin and Lyrica, based on preference and my ability to afford the medications, but for the last 4 years, I have not been able to take either, due to me becoming chemically sensitive to this class of medications, to include having an extremely severe reaction to Topamax topiramate.
The ER doc wrote me off as a drug addict before ever meeting me, and discharged me with only a referral to a drug treatment program. This was one of the biggest insults the medical community has ever given me. This is not the only medication that I have grown sensitive to.
I have become sensitive to almost everything I am given, and in most cases, the side effect are far worse or I have some of the worst, rare or almost unheard of side effects of the given medication. I have also had the problem of running into doctors that see the medications I take, and automatically reserve themselves to not wanting to actually give me a diagnosis. I have had rhuematologists say I have textbook presentations of either Rheumatoid or Psoriatic Arthritis, or Systemic Lupus.
Yet with all the documentation of these, I can get no doctor to take me seriously or give me a confirmation. My point is, if anything else worked for me, I would gladly NOT take the opiates! I wish there was a magic drug that would work that was not an opiate. Opiates are all the work for me. NSAID make me vomit blood, steriods make me hurt worse in the long run.
I can still fell where the needle went in me with the steriods and that was 10 yrs ago. Until then give me pain meds please! WTF Nothing is said that we could not get our prescriptions filled that we have been taking for some time while at the same time doing random urine testing!
Over the bridge i go. I found a good doctor but have often found that doctors would trivialize my physical problems. They would give me a medication for depression or anxiety and basically leave me to deal with the physical problem. It is not only opiates that patients get dependent on. In my many many years living with traumatic brain injury I have seen many many other patients and many doctors who readily prescribe or take psychiatric meds for symptoms of brain injuries.
We are often treated as if we are mentally ill, which in fact we can become when our needs are ignored and we are not able to care for ourselves. Advocacy is difficult to find and there is not enough rehabilitation for us. Bottomline, people know 4 types of answers to there pain problems: I use clinical reasoning and acumen to assess every pain encounter. I even rx some kumbayh methods. I hear you Leslie. And TBI like many other issues is impossible to handle in a minute office visit. My doctor friend says it is worse than drive-through medicine.
Sometimes it feels like vending-machine medicine. I have not worked in an emergency room and I can only imagine what happens there. No happy dancing bunnies. They come to my office. I do think that good patients who follow the rules are clueless about the real problems in the ED. I do not doubt you for a minute Renaldo. Sorry, Doctor, but you just made my head explode! They ask me how long I have taken morphine but no one ever asks me about the 10 years in which my doctor and I tried every conceivable drug and treatment OTHER than morphine.
Dependence does not equal addiction. I face ugly discrimination and bias on a daily basis because of a drug I need. What no one considers is that morphine is just one part in my daily routine to control my pain. They do not see that morphine was my absolute last resort. Prior to introducing morphine into my regimen, I could not walk unassisted and I frequently needed a wheelchair.
Yet, because I take this one drug, I am branded a threat, a nuisance, a time-waster, etc. I was a highly paid, well-respected intelligence analyst and top cybersecurity advisor for our government. I always dress nicely. I always address the medical professionals with respect. All these doctors and nurses would have to do is call my doctor or pharmacist. I have overheard medical staff whispering about my doctor and they further spread their nastiness by implying that my doctor must be a Candy Man.
Every guideline says I must be treated with respect and that my request for help should be given all consideration. Perform a complete pain assessment and review the recent analgesic history. Pseudoaddiction improves with the provision of adequate analgesia, including opioids. In contrast, associated with a substance abuse disorder will not change.
I am so sorry this has happened to you Sonder. If doctors had more time and energy to truly care for their patients, we could avert these misunderstandings. We all absolutely need a trusted doctor who can oversee our treatments and make certain patients are not suffering needlessly.
Unfortunately, as my next blog indicates, many doctors are at a breaking point with despair, depression, and suicide: For many, it is hard not to become jaded. The good news is many physicians are breaking away from abusive employers, contracts, working conditions and choosing to start ideal medical clinics so they can really be doctors again.
You do know all we ever wanted to do was help people. You have gone above and beyond what most people do and the fact that you are educating yourself is impressive. Maybe the professionals, doctors and pharmacists, who disrespect you should walk in your shoes to see what your quality of life is without that medication.
I see that this post was written several months ago — but am hoping you might see this anyway. I want to say a million thanks to you for this. I am having a really bad week dealing with my chronic pain issues — — I am 48 years old and have been dealing with chronic pain issues since I was 17, at which time I was diagnosed with Chronic Interstitial Cystitis.
I have been very depressed lately as I have felt like I am also treated like an addict much of the time when I do seek pain medication. I have 30 years worth of stories to tell — detailing every treatment I have tried -and feel my history is completely dismissed and that I am disrespected so often — and especially by pharmacists , ER physicians and nurses.
I have never abused any of my pain medication in any way yet feel as if that is how I am viewed as doing. To be honest, the treatment I have received by these so called professionals has caused my depression to worsen much more than the actual disease and pain itself.
These last few weeks in particular have been hard as I have had to make several ER visits due to kidney stones — I have passed one, had one surgically removed and am getting ready to have a third surgery next week.
Anyway — as I am being treated by a pain clinic for my IC — each time I have gone to the er for kidney stone pain I was sent home. No diagnostics were done to determine what was going on. They just assumed I was drug seeking after hearing my history and sent me home on three different occasions … I finally went to a different ER — they diagnosed the stones — referred me to a urologist who did my surgery and is getting ready to do another as I said , one stone I passed on my own.
Anyway — this was just one in a very long line of stories- same song different verse. It has affected my self esteem and made me feel so worthless. At one time during the last few weeks — I had taken a prescription for an opiate to the pharmacy — it was stronger and the frequency increased above what I normally take as it was temporary and was going to be used until I could get my stone surgically removed. I just drove away and took it elsewhere — and cried for hours. And I am not a crier normally.
Anyway — I will stop my blubbering now. I feel so bad for you and for all the others on this thread who suffer from any type of chronic pain — and who have to deal with being treated with such a lack of respect. I am sending out prayers , positive thoughts and much love to everyone. And thank you Sonder Twyful for sharing your story … And for all others on this thread who have taken time to share their stories.
Oh, and PS … those of us who truly experience chronic pain know that we will never, ever, ever be free of pain. I was told this was to protect the patient in case a new physician attempted to change things. While marijuana is legal,chronic pain pts are being treated less than dogs. I had part of my nose and lip cut out and soft tissue in between removed. I was sent home without any pain killers. I jammed my arm into my rotator cuff, and I was sent home without any pain-killer, etc.
I ask for one 10 mg codeine to get me through the first night, and they call me a dope addict. I miss the s, where they gave me codeine. I have to sit up slowly. I have to turn my head slowly.
Hang onto a wall or person when I try to walk. And not be able to suck anything from a straw, because part of that muscle was cut out? Pain management is an area where the collapse of personal medicine becomes most evident. I would expect that it would be hard to fool a long-term physician, and most patients would be ashamed of themselves.
Today, in most practices, 3 years is a lifer. Chronic pain, like depression, often causes a systemic impediment of many routine activities, and impairs the patient in ways that are not always obvious.
I find that drug-seekers talk about drugs, and people with chronic pain talk about pain. We set goals not measured in degree of pain alleviation, but restoration of function.
Those with chronic pain KNOW that it cannot be taken away, but it can be minimized in significance. As medicine becomes dehumanized, the type of suffering which is most exquisitely felt by humans becomes trivialized. If you are not human, you do not have a right to claim human problems. Suck it up, says the system. Sufferers are merely discards waiting to be processed.
Are we proud of this? I like the way you ask for a solution. By asking everyone maybe someone will have a good idea. The only idea I have is to redirect addicts to a special clinic where well trained therapists can tell the difference between a drug addict and a patient in dire need of pain medication.
Another idea is to have a webs site database where patients with a true need to use opiates are registered after going through some kind of evaluation. Then in the emergency room if they are already registered they can be given pain meds. We do have a drug monitoring program where pharmacists and other medical providers can check to see if a patient is getting multiple narcs from multiple docs doctor shopping drug seekers and that does help.
So please explain to me why i still have my prescription for my fentanyl patch in my purse and can find no pharmacist that will fill it! I am too embarrassed to tell you how many times and for how long I have gone without my medications since the first of the year! I am working on an exit plan! It is bad enough to suffer from pain but when you have a doctor that gives you a prescription and pharmacists playing god ….
Please explain for my children deserve that much! Pam, For me, it takes time, relationship, an ability to trust my own gut, and an acceptance that all humans are capable of all behavior given the right circumstances. The most important of these for me is still time, intentionally designing my practice to allow time to hear out the source of the pain; time to explain the options and their responsibilities including an up front conversion how we can establish trust; time to assess response and adjust.
The astounding increase in all prescribing is inversely proportional to the shrinking amount of time the system allows prescribers to spend with their patients. Unfortunately, the easiest way to satisfy those needs in the typical 7. The associated personal, financial, and spiritual costs are crippling, no matter what drug we are talking about.
Docs, especially primary care docs, I gotta tell ya … hold the line. Reclaim your time with your patients. Give up cursing the system and find a way. The sky is always falling. We did it with my bricks and mortar practice by starting very small without debt, with an exam table and computer. We intentionally watch our overhead like hawks, so that catering to the overhead does not drive our clinical decisions.
Overhead, like debt, limits us all and turns our patients into a means to an end instead of our soul-enriching mission. Stop running to catch up. If you stay with insurance companies as your primary payers , never outsource your billing.
But most importantly, link arms with your patients. Tell them you need them, because you do! Primary care docs get out of bed because relationship matters to us. Keep going back to the patient-doctor relationship as the source of your work-life strength and joy and make your decisions accordingly. The world would definitely be a better place. There should be more medical professionals that feel this way. Allergic reaction or just over stressed at work but they came on fast so it scared me.
The ER doc kept asking what drugs I took. I had taken NO drugs! Benadryl finally stopped the hives. It was after my stoke. The doctors did 3 different drug screens. I was furious that they did them without asking and then charged me for them. So it was odd to me that 20 years ago and then again 2 years ago someone would look at me and think drug user. I think the crux of the current opiate problem is that very few doctors have actually received the appropriate level of education on the subject, but they still accept people with chronic pain as patients.
These type of patients are tough to treat and they require a lot of time and attention from the doctor. The doctors who accept such patients, who are not aware of this fact, soon become overwhelmed with the required work. Those doctors are very quick to blame the patient and are too quick to label a difficult case as an addict. Even though that doctor is not a pain specialist, his word will be accepted as if he were an expert — simply because he is a doctor. While I sympathize with doctors who have to deal with this dilemma, guidelines DO exist, but few doctors or nurses follow them.
First of all, if the patient says he is experiencing more pain than he can handle and that he needs a higher dose, he has a right to be believed. Secondly, do another physically examination of the patient. You should always check for changes in physical condition. What else could be wrong? If his opioid addiction risks are low, why would he lie?
Working with pain patients involves a good risk management. Do a risk assessment how likely is the patient to be an addict or become an addict? Then you create a Risk Management plan with appropriate goals and actions of of both you and the patient.
Require urine tests and a pain contract. The only way to completely avoid failure is to never accept patients with chronic pain. You honestly cannot do this on just a gut feeling. And, if you find that a patient has become addicted, the LAST thing you should do is to turf him out on the pavement with a kick in the pants and a surly grunt. You are a physician and your first action should be to offer help. If the patient refuses help, then you can make plans for termination at a set date.
These are not my ideas. These are the guideline from the American Medical Association. Again, I am really sorry that the state of things has become so stressful that both honest patients and honest doctors suffer. Personally, I think the current attitude is nothing short of hysteria. While addiction is a huge problem, I would like you to consider the following numbers.
Thanks and I apologise for taking up so much commenting space on your blog. As you can see, this topic is a hot button for me. Thanks Chey — Appreciate your thorough research and comments. Time consuming in an assembly-line office, but doable with the right tools in place. No one seems to agree on a number. The most reliable statistic I could find without spending days looking for a trusted source is 16, per year. Lower numbers are right around deaths annually, but that official stat is almost 15 years old.
I had been under care for a few years with the same dr. I have been choric ill, following what I felt was a viral infection, I have severe spine issues and a nerve damage…. I have been thru a number of treatments that did more harm than good, trying to manage symptoms.
I went from riding my bicycle miles in a summer a couple of years ago to now some days not being able to walk well. While not finding a cure at least some of my painful symptoms were managed. I never found a need for more, more , more… followed all instructions. I was on contolled medication for a couple years.
I was abandoned by this dr. I live in a rural area. After a month of trying to get treatment I finally get a letter back dated a month saying I had 30 days , ample time to find a physician. He sent me the letter after the 30 days had gone by.
I had done nothing wrong but am forced to stopp cold my medication and suffer more… Trying to get my records… nightmare. I turned to my neurologist who was currently working with me. He would not help and I was not allowed to even make an appt. The office manager, his wife, came out and told me that if she had known I would ever say my pcp abandoned me…. I dont get to see my neuro again for about 5 months after telling office manager I was going to use urgent care.
You couldnt believe the things she said to me…. My neurologist has fired me now to. I tried one thing. When I look at my records from a couple of months ago I had many treatment plans for his multiple sclerosis diagnoses. I have worsening symptoms and suffer. They ingnore my suffering. At the time of my last visit he got much information incorrect as to pcp name, and he in my progress report states incorrect information about medications.
He kited this report to my other doctors who are not even involved in this care. I have done nothing wrong. I have nothing to hide. Cold stopping medication dangerous. Medication would be welcome. A plan would have been welcome.
I have had no help sense last fall. I have been labeled. But, you learn over time who is trying to seek an extra high for the night or for funds to pay for another habit. I remember as a teen, I got a severe sunburn on my back. I went to the ED and the nurse told me to go away and take motrin.
I cried for 2 days until a 6 pack took the edge off. My name was on one of the many pill bottles he collected around the state. And get this this, I gave him something legit that would have controlled his pain in the first place.
I never carried a weapon with me before that, now I do. So, yea, the people I see may be on one side of the bell curve, but many are not. But can the bleeding hearts blame us for being suspicious, and for doing the things we do? Ellos saben que me importa. Unfortunately, when it comes to chronic pain management one bad apple does spoil the whole bunch. Unfortunately, according to the Oregon Medical Board one is required to treat pain so there is an obvious contradiction which has been sharply underlined by the fact that the Oregon Medical Board has essentially been on a witch hunt against pain management providers in I am on the neglected patient side of the fence.
It has very little to do with the criminal activity of others. As someone else said, the criminals are the minority, and is more anecdotal evidence than actual fact. Sure, you can find multiples of addicts and dealers in any given state, but there is no way to measure the statistics due to the hidden nature of criminal activity.
I suffer a life-threatening illness and have lived with chronic pain for most of my life. I have always been treated fairly and promptly by medical professionals until my insurance changed under the Affordable Care Act and I was forced onto Medicaid.
Since then, I am treated as almost sub-human and am constantly denied narcotic medication. To note, I have chosen a pain management regimen without narcotics only because I believe they are band aids for open wounds, often causing more problems.
They mask the symptoms short term but fail to treat the underlying illness and still, are often over-prescribed, which leads to dependence and ultimately, addiction. With that said, sometimes the pain gets the best of me and because it is worse at night, I have no choice but to visit the ER. With Medicaid, I might be given mg of Tramadol orally. I was thoroughly evaluated, examined, complete with lab workups, and was kept for hours for all of this to happen.
Now, I am not even given a gown, there are no exams or labs, and I am released within an hour or two, and most of that time is spent in my room alone. Prior to, the nurses stayed with me as their time allowed or were checking on me throughout the night. I am still in pain when I am released. Before, that was unheard of! The tone of their voice, body language, obvious disdain in my direction, etc. There are exceptions, of course, but for the most part I am treated as if I am there to get high.
I could be crying, at my last visit I was literally screaming! And my vitals backed me up; it was very obvious that the pain was legit and I was not faking.
That was -one- symptom, which was a migraine and side-effect from a new medication. The statement and tone confused me because I had never had a doctor talk to me that way, it was extremely disrespectful and he made it very obvious that he thought of me as an addict there to get drugs.
Where is the logic in that? It is most fascinating and reveals a darker side of medical practice in which patients are treated according to their financial means. Still, I would hope that doctors and nurses would treat everyone as individuals deserving care and respect no matter what their social class.
By the way, I choose to accept any patient regardless of their insurance, BUT I do not accept all insurance because I refuse to be abused and undervalued.
I would rather see patients for free than be disrespected by these onerous and low-paying third parties. All this abuse from third parties just trickles down to patients.
Please watch this video: Took it down, but this blog has the basic content: Adrienne, I can relate. One doctor offered treatment of symptoms with low doses of oxycodone. Yet I have a terrible fear of throwing up. I had seen House and heard horror stories about quitting cold turkey, so I asked for help in tapering down.
I was just scared to death of throwing up. Chronic pain is awful. I believe a patient should be offered treatment if they want it. Quality of life and ability to function should matter more than how many idiots will overdose and die because they took too many of the drugs they lied to get. I recently experienced my first migraine. I hid under a blanket for 4 days and wanted to die! I sympathize with anyone who suffers these regularly! Mine was a side effect of the fancy epidural steroid injections.
Every fiber of my being was screaming no, but I had no choice. In order to see a surgeon, I had to have the injections. I was desperate for relief anyway, so I figured if they helped even a little, maybe it would be worth it. Injection itself was fine, but the week that followed of nausea and a migraine, no, never. On the insurance note, I have experience from both extremes. When we had plenty of money and I had a 6ct diamond solitaire on my finger and the best of insurance, I was still treated like crap.
They were in on my drug seeking scheme! Having no insurance I got treated like total crap still. After a suspected stroke, which prompted a full chopper ride to the nearest hospital, they did nothing upon my arrival in the ER.
Medics and flight crew said cerebral vascular event. My daughter also recalls hearing someone say my pupils were unequal and sluggish. They told my husband that it must have been a drug interaction.
He asked how my mg of ibuprofen could interact with itself, they had no answers for that, but assured him I was fine. Yes, he wanted to punch all of them in the face. I had Medicaid long ago. Much to my surprise, I was actually treated with dignity then. I mean, sure, maybe other people would be, but I had always been terrified to take them, goes back to my fear of throwing up.
At that point in my life, I had never had them and was afraid of them. I know that being female has something to do with it.
Estrogen induced exaggeration of symptoms. Truth be told, I hate the pills. Sorry about your experiences. I know how you feel. All of the abusers whine about it to any camera in sight, victim this and victim that. People like you are the victims of the misguided effort to control liars and criminals. People like you need to be heard.
Thank you for speaking your truth. Curious if you are treated differently by male vs. A diagnosis of estrogen-induced exaggeration of symptoms may be more likely to happen with male docs? I also have a theory on why you may have received better treatment on Medicaid. May be that you had a new doc fresh out of training who was more idealistic and loving by nature and not burned out.
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I would advise any parent of teens, if you are beginning to suspect a Telling your child you love them unconditionally is always right. Always let them know you believe they have the ability to recover. They drug test us and after a few years the juice he would use to hide the She's just not ready. If you are the mother of an adult child who is making poor choices, this can be a heavier burden than any of the earlier ones you carried when your child was younger. Other parents fall into a trap of accepting the blame that some misbehaving Interventions can be effective when you let your child know that their bad. If the pain is still a problem, then selected patients may consider a trial of Some doctors are acting out of fear that they could face disciplinary action daniel, you are absolutely right, i am with you on this, lets get I have never failed a monthly drug screen and I have never missed another pill count.