Thursday, December 2, 2010
Are You Annoyed With Your Pain Doctor?
When does the communication between the chronic pain patient and their pain physician break down? You may have experienced this too. Your physician is extremely caring and you are involved in the treatment plan, but then suddenly you start to feel that your physician is not listening to you or worse, something else is now in the driver’s seat that is not explained to you.
My first physician became interested in Botox’s cosmetic advantages and started a cosmetic clinic. As a pain patient, I felt discouraged sitting in a waiting room with patients who were full of hope and animation as they talked about all the benefits of their cosmetic treatments while I sat there in pain. I was desperately trying to be full of hope too; hope that the next treatment would work and decrease my pain.
The effects of Botox only lasted for about 3 months. Repeated Botox treatments started a cycle similar to being on roller coaster; ups and downs of pain levels that were too extreme. But my physician insisted that I continue even though the results were unsatisfactory. That’s when I started to wonder what was happening to the left over medication from my Botox treatments. Was it being used for cosmetic patients to pad the pockets of a greedy physician? I never dreamed I would get a straight answer, but I did.
“I use the prescribed amount for your treatment. The left over portion is already reconstituted and can not be saved for your next treatment. Botox is not only expensive, but it is in demand. I do not feel comfortable wasting it, so I have devised a system to use the Botox by scheduling a cosmetic patient after a pain patient. That way everyone benefits.” Really? It was time to find a new physician.
My consult with physician number two was promising. On my third appointment I was introduced to the physician assistant or PA. The patients in this practice were only seen by the physician for changes in treatment regimen, otherwise they were seen by the PA. I hung in there until the PA made his first medication error. As a former healthcare administrator, I understand the business of medicine, but it must be run with quality care and satisfactory outcomes. I was politely told that the physician was too busy to see the patients because he had just started a spa with weight control and cosmetics. Time to change again!
That brings me to my present physician who is caring, experienced, and has always taken the time to listen to my concerns. He treats the patient as a whole person and together we work towards controlling my chronic pain. One of our goals has been to reduce my pain medication when I respond favorably to treatments and I have had some positive success with it until recently. After attempting to reduce my medication again, I found myself having an extremely difficult time and I went back in to see my physician. He said that he wanted me to stay on the lower dosage for 2 more weeks and “tough it out.”
He explained that chronic pain patients develop more pain receptors than normal people so that their pain is experienced at higher levels. Something that would not even bother him would be perceived by a pain patient as significant. He continued to explain that he knew this was true about me because I had “yelped” during my recent transforaminal steroid epidural injection.
I reminded him that I had declined the MAC anesthesia and had done the procedure under a local. When the steroid was introduced, it caused considerable pain down my leg for just a minute and yes, he did have to wait for it to subside. He then said that most of the patients used the MAC anesthesia because this injection can be very uncomfortable.
This left me confused. Was he telling me I a wimp or not? I wanted to reduce my medication dosage and eventually discontinue usage if possible, but I didn’t want to live in bone searing pain and “tough it out” either. My physician looked at my prescription bottle and said, “I see that this lower dosage was filled a week and a half ago, so I do think the best option is to try this for another week. If you just can’t stand the pain, come back in. I will have another prescription available for you.”
He then spent 20 minutes telling me about his trials with patients who are attempting to obtain Oxycontin, Vicodin, and Percocet. He told me about the time consuming new regulations and because the DEA was cracking down on pain physicians, it was more difficult to order narcotics. Unfortunately our county had become noticed in national media for excessive narcotic prescriptions usage with escalating overdose statistics.
According to the American Pain Foundation, legitimate patients are having far greater trouble than before in gaining access to pain medication. Some patients have to visit several pharmacies before locating one that can fill their prescription. Due to the growing number of abuses and regulatory hurdles, many physicians are once again “under-prescribing” or ordering smaller quantities of medication at a higher cost to the patient. Dr. Edward Michna, director of the pain center at Brigham and Women’s Hospital says that doctors fear legal problems, citing arrests of physicians in prescribing cases. He believes that more doctors are becoming “phobic” about ordering narcotics.
Obviously, the system is broken again! The DEA and local authorities should be able to distinguish between a legitimate pain management physician, who is board certified in Pain and Rehabilitation, and the physician who sets up a “pain clinic” with cash paying customers who line up around the building to purchase their prescriptions. Many of these docs have patients who have been hospitalized for overdoses and yet they return to the clinic and easily secure more narcotics. And what makes matters worse is once these so called pain docs have been identified, they typically take the shingle down, close the door, and reopen for business in the next county or state. What is it going to take before they actually lose their medical licenses?
I left the office with my prescription bottle in my hand and I sighed. Pain specialists seem to be falling into a few categories. There are the ones who are using cosmetic Botox and weight control medications to tap into the growing population of baby boomers who do not wish to age gracefully. There are the ones who have become the equivalent of a 21st century pusher while practicing under the umbrella of pain management. And that leaves the physicians who are desperately trying to treat the more than 70 million Americans who suffer from chronic pain while complying with all the regulations, and trying to avoid becoming an enabler to a ballooning population of prescription abusers. I am beginning to fear what the future holds for us.