When Will Doctors Speak Out for Their Pain Patients?
/By Michael Thompson, Guest Columnist
I am a retired clinical social worker and a licensed chemical dependency counselor.
I had to retire about six years ago, at age 62, when my rotator cuffs started shredding on a chronic basis. I also have osteoarthritis in both knees and peripheral neuropathy with severe pain in both feet and hands. It’s been several years since I was able to wear shoes.
I have also been diagnosed with Chronic Regional Pain Syndrome, which just means we don’t know what the problem is but were just going to call it blah, blah, blah. That’s medicine for you – an art, not a science.
I am allergic to non-steroidal anti-inflammatory pain medication. The last time I took naproxen, my blood pressure (which is normally high) dropped to 80/50. I literally saw the pearly gates. I ended up in the hospital for about a week.
To put it lightly, my genes are rotten. Everything seems to be breaking down in the latter years of my life and it all hurts.
For about six years I was on a relatively high dose of opioid pain medication. Life wasn’t great, but it was pretty good. I was able to play golf and work out three times a week in a physical therapy program. I could work in the yard and around the house. Despite all of my multiple medical problems, I had an acceptable quality of life.
MICHAEL THOMPSON
Then last year the CDC guidelines for opioid prescribing came out. My pain specialist freaked out and abruptly informed me that in order to keep the DEA from her door, she was going to have to reduce the amount of opiate medication she was prescribing for me. My dose was cut in half.
In less than a month, I cratered. I was in such intense pain 24 hours a day that I couldn’t sleep. I couldn’t function. My quality of life went from decent to nonexistent. I was no longer able to work out and gained a good deal of weight. I couldn’t walk across the room because of extreme pain. I spent my time at home waiting until it was time to take my next dose of medication.
I tried changing my schedule, so that instead of taking a pill every six hours I would take one when I really needed it for severe pain. That seemed to work better, but I wound up taking more pills than I should and came up short at the end of the month. I was left for 48 hours with no medication at all.
Even though I had never abused my medication, my pain doctor refused to help me out with an early refill, saying that it was just too bad and that the DEA would not let her write a new script even a half a day before it was due.
I was stunned, though I should have known better. For two days I thought I was going to die. It wasn’t just the withdrawal. It was the unmasked intense pain.
I worked for a time early in my career with an addiction physician who taught me that chemical dependence was a lot easier to treat than chronic pain, because of the all-consuming nature of pain. He told me that with addiction you might wish you were going to die, but with the strain that untreated pain puts on the body, you might actually die. After experiencing both, I can vouch for the truth of his words.
Needless to say, I have not made that mistake again. Since that time I have maintained a strict regimen, even if that meant that I would have to white knuckle the last few hours before the next dose is due.
When I saw my doctor last month, she told me that the DEA had instructed her that she could not prescribe more than three pills a day to any of her patients. Next time I see her, she will reduce me to four pills a day. The month after that, she will only prescribe three a day.
I don’t know what I am going to do when that happens. It terrifies me. I have never considered suicide as an option, but when a person is without hope that things will improve and they face intense grinding pain 24/7, I can understand how some people might find suicide appealing. As a therapist, I never thought that I could understand that kind of thinking, but I do.
I asked for a referral to a psychiatrist because of her suggestion that with their advanced training, they might be able to prescribe more medication or a different opiate that works better.
The psychiatrist I was referred to was the CEO of a local rehab program. When he discovered that I was retired and on Medicare, and that I didn’t have a generous insurance package for rehab, his manner changed abruptly. He treated me like I was a med seeking (which I was) and stone cold junky (which I was not).
After an extremely presumptuous and rude exchange (it was clear that he was trying to impress his two cute interns and to show them just how you handle addicts), I informed him that I just did not feel that we were a good fit and left.
It was clear that he knew nothing about my background or my history. And when he found out I didn’t have insurance money to feed his program, he lost interest in finding out anything about me. I pity his patients and his employees.
My next step was to seek a second referral. The doctor I was sent to was another pain specialist, who informed me that she was only prescribing two pills a day to her current patients, and so I should stay with my current provider.
I don’t know whether the issue has been a poor roll out of the CDC guidelines or if doctors aren’t reading them correctly and feel it’s better to be safe than sorry – even if that means leaving their suffering patients in the lurch.
Either way, it’s a hell of a way to run a railroad and a lousy way to practice the healing arts. Leaving so many people in agony is criminal. For a doctor to do this, they might as well sell insurance for all the good they are doing their patients. What happened to the Hippocratic Oath?
I have to confess. I am getting desperate. With the level of pain and stress I am under, my health is breaking down. I can understand why some might consider suicide as a real option as an alternative pain solution.
The CDC needs to consider how this will affect the aging population, for whom opiate medication may be the only path to a decent quality of life during their later years. I mean, what are they afraid of? Lines of aging junkies sitting in the gutter with a needle in their arm?
It is interesting to note that none of this is affecting the addict population, other than to increase the number of people seeking pain relief on the black market. Addicts will always find a way. Legitimate seniors with palliative and end-of-life pain concerns, and others with legitimate pain needs, have nowhere else to turn.
Medicine is failing us. This is medicine by law enforcement. Scare the doctors and the problem will go away. If the DEA is frightening doctors with the loss of their license, the CDC needs to step in and call off the dogs.
I just hope this communication to my pain doctor comes before I die from complications of intense pain. What a way to go. Death by good intentions, but poor communication.
Who speaks for us, if not the doctor?
Michael Thompson lives in the Dallas, Texas area.
Pain News Network invites other readers to share their stories with us. Send them to: editor@PainNewsNetwork.org.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.
