My Story:  Straight Answers from a Pain Doctor

My Story: Straight Answers from a Pain Doctor

radnovich

Dr. Richard Radnovich

Recently a reader sent an email of questions and frustrations. She brought up many issues that are common and worth addressing: doctors’ suspiciousness, that she is not an addict and, ultimately, that her doctor no longer wanted to prescribe opiates for her.  In addition to those, she was concerned about urine drug screen results, poor treatment in the ER and what is in her medical records. I will be addressing those in the coming weeks. Hopefully a doctor’s perspective and advice may be useful if any of these happen to you.

I just do NOT understand what’s going on to be treated with so much suspicion as soon as I walk into ANY doctors’ office.

You are correct, most docs, even the most caring and compassionate, are suspicious of pain patients. There are two reasons: 1) There are people coming into doctors’ offices behaving like they have pain just to get pain medications, and 2) There are law enforcement agents going into doctor’s offices posing as patients to try to trick doctors into giving them pain meds (whom they may then prosecute). http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2008.00482.x/pdf.

I have serious very painful conditions. They are all well documented by medical tests.

There are patients who have mild-looking tests or images but have terrible pain. Conversely, some patients with horrible test results have little or no pain. The tests by themselves are only partially helpful. Unfortunately, there is no medical test that specifically measures pain. Generally it is easier to get pain treatment if you have documentation of a potentially painful disease, but it does not guarantee treatment.

I do NOT have an addictive personality. Never smoked or took illegal drugs. I have a drink once in a great while.

You do not mention that you did this but stating this, without being asked, just sounds like a denial to most docs. True, addiction is actually not that common, so most docs will assume that you are not addicted. Some might assume that you are, but either way, bringing this up on your own is never a good idea. Pain docs will ask questions to determine if you might have a problem with medication addiction or abuse. Just answer the questions and let the doc draw his own conclusion that you are not addicted or abusing. By the way, addition is not so much a personality trait as it is genetic and then environmental. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715956/

My doctor said that I needed to “find someone who ‘didn’t mind’ prescribing” my pain medicine to me.

Once you hear this there may not be not much you can do. Ask for specifics – what day, what medication, how did I misuse, what did I do to damage the relationship. Ask how can you restore and maintain their trust and confidence. Don’t you deserve a second chance or a warning? Again, it may be unlikely that you will repair the relationship but you are at least hoping for a good referral – not to get dropped suddenly, and not to feel like you have been ‘blacklisted’.

This same doctor, however, prescribed Percocet along with Klonopin and trazadone to my niece, who had several suicide attempts, inpatient psych stays, drank in excess every day, smoked cigarettes and marijuana. Why is she getting all the medications that she wants?

This kind of thing does happen; ‘undeserving’ patients seem to get anything they ask for. It is understandable that you are frustrated by this, and it is tempting to mention the other patient to the doc.  Not only is it irrelevant to you getting the care you need and deserve, bringing up this kind of stuff undermines your relationship with the doctor; it is likely to make you look bad, don’t do it.

Have any of these happened to you? How did you handle it? What worked and what did not? Let us know, maybe you’ll be helping the next Chronic Pain Patient. And check back for medical records, getting mistreated in the ER and urine drug testing.

Editor’s Note: Dr. Radnovich is a well known pain physicians whose practice in Boise, Idaho is well regarded nationally as a leading clinical research site for chronic pain. His honest writing for the National Pain Report has given great energy to our effort to give our readers unique perspective.

Follow on Twitter

@DrRadnovich

@NatPainReport

Do you have an idea for topics the National Pain Report should be covering? Email us at editor@nationalpainreport.com

There are 2 comments for this article
  1. Carrie at 5:42 am

    The doc seems to be off to a good start on his advice. I have been under a pain contract successfully since 1997. I was told I would be wheel chair bound by 40. Thank God for the nerve ablation. I can’t walk far but I am keeping my range of motion (very modified yoga).While I couldn’t function without opiate therapy, I couldn’t be ANYTHING but bed bound without other means of treatment. I have DDD as ONE of many diagnosis. As I have shrunk 1.5 inches in the past few years and have bone on bone pain in back, physical therapy is a must. My first symptoms were seen on X-ray’s at 13. I just have made up my mind to keep adaptation and roll with the changes my mantras. No, I do not think that the DEA is doing right by pain patients. But we are also filling prison with addicts who need a different type of treatment. Most frightening portent of this was my Aunt, of 75, nearly blind, was told that if her UA has tested positive for the steroids she was prescribed 18 months ago, because it was 6months past “expiration date of the script ( pills were likely fine) she would have been turned into the DEA as a drug abuser. I don’t know what to make of such information. I don’t believe she misunderstood. But I wanted to know.. Is it really this extreme now?
    Thank you doctor for taking the time to help clear up what you can.

  2. Barbara Capehart at 1:47 pm

    I get what the Doc is saying. I have spent a lot of time chatting with fellow pain patients sitting in waiting rooms and have myself gotten suspicious. I have seen people throw total fits after having failed urine screens. I have also dropped a pain doctor who I felt was just writing my scripts and not giving a toss about trying to a different protocol that might help me more than just an opiate script. Just saying that if your scripts have not changed in 2 years that if I say I am not getting pain coverage anymore I probably am telling you the truth since my condition is progressive. Anyway, I see what the Doc is saying but as pain patients we have been driven to paranoia to.