I am going to jump straight into the deep end. This is a subject that has so many variables and so many proponents and opponents. We have the federal and state governments sticking their noses into it and the DEA has decided to pile on as well. All of the above has made it a true Hell to find relief for chronic pain patients. Even those who need narcotic medication for short term use such as broken bones or after surgery care have a hard time getting the relief they deserve. Doctors are afraid of the Big Bad Wolf that the DEA has become and you can't blame them. You wouldn't want to head off to federal prison just for doing your job.
So what is someone in pain to do ? Well we can always fall back on the old standby of curling into a ball and crying. That doesn't relieve the pain and it kind of interferes with daily life when you can't get out of bed. We can head over to Costco or Sam's Club and clean out their supply of NSAIDS. These are such medications as Tylenol ( Word of warning don't take too much you will DIE ) Ibuprofen or Excedrin and Aleve. These guys work by reducing inflammation. They are pretty good for common aches and pains. You know what I mean, the pain you get because you over did it this last weekend while staining your deck. You may even have gotten a stronger version from the ER after you helped your best friend move the last time and you dropped the sleeper sofa on your foot as you were getting it through the door. They do have drawbacks. Too much can cause stomach upset, acid reflux, ulcers and Kidney damage. For me personally I can eat 20 200 mg Ibuprofen and not even burp. It will drop the pain a bit but doesn't do much beyond that. ( I don't recommend taking that many and it may just cause you to have a trip to the ER. )
Speaking of the ER, we can head over there to get some temporary relief. This works great if you don't make a habit of it. Back in the summer of 2013 I hit the ER 3 or 4 times within a month. I wasn't trying to fool the docs and I wasn't trying to break my contract with my PM clinic. I was trying to pass multiple kidney stones in the 7 to 9 mm range. They were stuck and I wound up having to have 2 surgeries to break them up. My kidneys got into the rock quarry business and have produced thousands ( No that is not hyperbole ) of these nasty little buggers. The pain was excruciating and the ER docs gave me a shot of Dilaudid. Oh boy that worked. Talk about instant pain relief. Pain went out and I promptly fell asleep. Man that was great. I hadn't been sleeping well because of the pain. I was on 20mg generic Percocet every 4 hours at the time and it did nothing whatsoever for bringing down that pain. I almost overdosed taking more to try and get the pain down before breaking down and heading for the ER. A quick comment on that PM contract. This is fairly common in PM clinics. The clause I was so worried about was getting pain relievers from any other source. I called repeatedly from the ER to tell them I was in the ER and why. I was so scared they would drop me because I was human and had to go to the ER. I also informed the ER team that I was in pain management and wasn't supposed to get pain relievers from any other source. Thankfully I was not dismissed. Getting dismissed from a PM clinic is the kiss of death. Doesn't matter the reason just about no other PM clinic will take you.
So far we have seen 2 options. Neither will do anything for chronic pain in the long term. So onto the third option. Heading off to the doctor's office. It used to be your family doctor would have handled something like this. Nowadays nope. Not going to happen. Even for short term crises your family doctor will be extremely wary of prescribing narcotic pain medication in low doses. They do not want to end up on the DEA radar. See thanks to the War on Drugs the DEA has started to practice medicine without a license. They analyze doctor's script writing practices with a magnifying glass. Too many narcotic scripts and they can expect a visit from the DEA. Even if everything is 100% above board and legal it is a royal pain in the tushie and once you are on their radar they really scrutinize your scripts and you stay there. Okay I can understand that prescription pain medication abuse is on the rise. I understand that politicians and the DEA want to stop this. The problem is they are not doctors. They do not practice medicine and they do not examine patients. They look for patterns and amounts. Once you hit their predetermined amount, bing bang boom your getting a DEA visit to go through your files. So your family physician may write 1 or 2 prescriptions for narcotic pain medication, many will not write even one. They will refer you to a pain management clinic for that. That is really scary. The DEA is in effect practicing medicine. Doctors are so afraid of the DEA they are not doing what is in the patients best interest they are doing what is in their own. They are afraid to help their patients. That s truly a sad state of affairs.
Let's head on down below the orange jungle gym to see what other options are available to those patients in chronic pain.
So here we are left with one option for chronic pain patients. The pain management clinic. I have trashed this field of medicine in multiple diaries. I know there are some doctors who really care about their patients in this field but so many more have seen the opportunity to get rich off of others suffering. I have nothing at all against a doctor making a living. I do have a bias against doctors who have set up a pain management clinic with the sole idea of getting rich. Chronic pain patients are being held hostage by these doctors and some are forced to under go unneeded procedures just to keep getting medication prescriptions.
We have explored the vegetables and now we get to the meat. Narcotic pain medication. Here we will look at it from all sides. First off let me state that these medications can be addictive. They have many side effects. Some of them are pretty bad. The most common is sleepiness and constipation. They will not give you 100% pain relief. That is a fallacy. To achieve that in most patients would be to turn them into zombies. We all want relief. Living in pain sucks but I sure do not want to be a zombie. I have a life to live but here is the problem. Pain management is under a microscope. That microscope is in the firm possession of the DEA. Pain management doctors are walking a fine line between prescribing what is needed and triggering a DEA visit to their office. Once again it is the DEA that is causing doctors to not write prescriptions that their patients need. What is even scarier is that the DEA doesn't let anyone know where the limits or trigger points are. They are capricious, changing to suit the DEA agents personal philosophy or needs. What is okay for one agent may not be okay for another. What will trigger a raid for one agent will be perfectly normal to another.
Why the hell is the DEA practicing medicine ? What gives them the right to say what is okay for a patient to take ? What medical training does a DEA agent have to make these decisions ? The answer to that last one is NONE. They are trained to look for patterns and probability. The are trained in law enforcement but not in medicine. So the patients are the ones who pay the price. They are the ones who are left in pain. All patients will build a tolerance for their medications. It is a fact. The human body is made that way. So patients will require their medications to get stronger or take them more frequently. This fact alone will show a rise in the prescriptions the DEA is on the look out for and could thus trigger a raid or investigation. Better watch Doctor A. He keeps writing stronger prescriptions. Looks like he is a pill mill.
The whole field of pain medicine is a new and growing field. Just a couple of decades ago these drugs were reserved for cancer patients in the terminal stages of their illness. There were no pain management clinics. It has been a field that needs many more in depth studies on the long term affects of pain medications on the body. Currently there are no studies on this. There are few qualatative studies on pain medicine and pain medicine practices. The field is slowly evolving. The ones who are paying the price of that evolution are those of us who suffer from chronic pain. We need more studies and of larger groups. Small studies do not give good results. We need better studies of best practices and therapies to see what will actually work and what doesn't for pain patients. We don't need more doctors making it up as they go. We don't need more therapies that don't work but the only way we can find out what does and doesn't is through large scale studies. We also need to remove the DEA from the medical field. Their too eager oversight is hurting the practice of medicine and interfering with doctors helping their patients. Yes there will be some doctors and patients who will take advantage of this and when they are found they should be prosecuted but that doesn't mean the DEA should be srutinizing the whole field.
Please take the poll and let me know what you think in the comments or even by writing your own diary for our group Pain Patient Empowerment