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By Wendy Burnett
If you take more pain medication than your doctor has prescribed for you, on a regular basis, you have a much bigger problem than you think. Whether the doctor is under-prescribing or not, if you’re constantly calling and asking for more meds, you are labeling yourself as an addict.
Even if you legitimately need a higher dose, taking matters into your own hands will only make it harder to get. The more desperate you seem when you ask for more, the less likely your doctor is to even renew your existing prescription, let alone increase it.
The Dangers of Prescribing Opioids
Government interference is making it harder and harder to get adequate pain treatment, because the law now expects doctors to be able to tell whether someone is truly experiencing pain or just trying to get the drugs they need to feed their addiction. What’s even worse is that if doctors get it “wrong,” prosecutors can charge them with all kinds of crimes, and even if the doctor is found innocent (which is rare,) he is frequently too afraid of being charged again to treat pain patients; even if he’s managed to come through the process with his license to practice medicine.
The decision to prosecute doesn’t rest with pain management specialists who understand how pain should be treated, and what dosages are appropriate for various illnesses. That decision rests in the hands of lawyers who rarely even speak to a pain management specialist. They’re much more likely to consult an “addiction specialist” who may have no idea what is appropriate for the treatment of chronic pain, and may consider ANY long term use of pain medication as addiction. In addition, the decision to prosecute may be based on no more than the absolute number of pills prescribed, with no attempt made to determine if that number is reasonable for the patients treated or the conditions they have.
Doctors risk losing their license, losing their livelihood, and losing their freedom every time they write a prescription for a controlled medication. Can we really blame them for being careful and refusing to increase dosages, renew prescriptions, or even continue to treat us when we act like addicts?
What Can You Do as a Patient?
There are many ways that you, as a patient, can help your doctors treat your pain appropriately, while still helping them protect themselves from prosecution.
- First, you can find non-medication options that help us control pain levels and reduce your need for prescriptions. There are many things you can do for yourself; such as guided meditation, diet changes, mild exercise, etc., that can and do help.
- Second, you can be open to other treatments that can reduce pain levels without using opioid medications. There are many studies that show that for some patients; other types of medications, other combinations of treatments, and other coping strategies can reduce or eliminate the need for opioids.
- Third, you can offer to sign a “treatment contract” that sets out your responsibilities and the consequences if you violate your agreement with the doctor. The specific clauses in the contract vary depending on the circumstances; but may include things like whether you can take an extra pill without calling the doctor for approval, labs to keep track of whether you’re cheating, what you should do if another doctor prescribes pain meds, how you will protect your meds from being stolen, etc.
- Finally, you can request a referral to a pain management specialist or clinic. (Calmly! If you are telling your doctor he’s an idiot and needs to send you to someone that knows what they’re doing, you’re only going to piss him off and risk being cut loose with no treatment at all.)
Living with chronic illness or chronic pain has no easy answers and no simple cures. Finding the right combination of treatments for each patient is difficult, and requires you, as the patient, to do the necessary research to find options that may work for you. With the current “blame the doctor” mindset of the law enforcement community, it is going to become more and more difficult to find doctors willing to treat pain patients at all, and those who continue to write prescriptions for controlled medications will have to be even more careful about who they give them to.
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Related articles
What Your Doctor May Not Know About Your Pain Pills : Shots – Health Blog : NPR
- The Government’s Top Minds Are Working Hard to Make Painkillers ‘Tightly Regulated Yet Easily Available’ (reason.com)
- Prescription Drug Abuse: Who Gets Addicted? (webmd.com)
- Want pain pills? Be ready to sign a contract (msnbc.msn.com)
- Question of the Week: Got Pain Meds? (ohmyachesandpains.info)
- Law a pain for some legitimate patients (dispatch.com)
- Well: Giving Chronic Pain a Medical Platform of Its Own (well.blogs.nytimes.com)
Excellent points made; great article. Thanks for the tips.
The trouble for pain patients is going further than the use (and abuse)of opioids. As one of the recently added “side effects” of taking Lyrica (prescribed for nerve pain caused by a variety of chronic illnesses such as diabetes, shingles)is feeling happy, the government now considers it a “controlled substance” and there are restrictions on how, how much, and when it can be prescribed. For example, a prescription can no longer be phoned in by a doctor nor can a script be written for 11 refills.
As far as I can tell, Lyrica is NOT a street drug; it doesn’t work on pain like an opiod; and I’m not sure that many folks who take it feel “high.”
I wonder if folks reported feeling “happy” on Lyrica because their nerve pain had been reduced or stopped. When my face hurts less, I feel better. But certainly not “high!” (and of course, I’m never happy, LOL)
Thanks phylor – yeah, the government is getting totally STUPID about all the restrictions. “Feeling happy” is NOT a good reason to make something a controlled substance. For heaven’s sake, alcohol is abused more than anything else, and everybody knows what happened when they made THAT illegal. The same thing is happening with drugs, it just doesn’t affect everybody because not everybody is knowingly involved with people who use them. (I seem to be one of the very few that actually gets “drunk” or “high” with Lyrica, and I found it extremely unpleasant. I’ve never heard anyone else who’s taken it mention a similar reaction.)
By the gov’ts logic,anything that makes you feel happy (i.e. anti-depressants) will be a controlled substance soon….
Exactly, Kathy – next up, coffee, chocolate, and sex . . .
I would add one other thing. You can find natural remedies to control pain. I use Phenocane which I can increase or decrease as needed without addictive qualities or side affects.
(If I missed that suggestion, please forgive me. Brain is not working too well today.)
Thanks Dominique – I’ve never heard of Phenocane before, I’ll have to check that one out. . .
Nice article. It made me think of writing my doctor a thank you letter for treating my pain, but with great care and caution in regards to increasing dosage. After a bicycle accident and then a severe cut to two fingers, we had to increase the amount of pain medication I take. He asked me if I wanted to see a pain doc and I was scared b/c I’d heard such bad things. I went and he was a great doc too. He laughed and said, “Your doctor is already doing a fine job. He doesn’t need me.” My doctor wanted to make sure he was doing the best thing. He does have my best interests in mind and I sure appreciate it. He understands the level of pain I have, but at the same time, encourages the least amount of medication.
As to the politics around this, I always wonder where the patients are in the circle of people who have the power to change laws and protocols. We need a Board of Patients to offer advice on healthcare policies in general.
Thanks for the post.
Michelle – I’d bet that a thank you letter to your doc would practically send him into shock, but it sounds like a great idea. We tend to go in and bitch and moan when they do things we don’t like, but we never remember to thank them for taking good care of us.
The Board of Patients thing sounds like a brilliant idea to me . . . I wonder what it would take to get something like that started.
It is also VERY helpful to keep a pain journal/medication diary as a reference. If your medication is ordered “three times a day as needed for pain” and you’re having to take every dose and still not controlled, make a note the time & why you took it (still unable to bear weight due to back pain, etc.) Also note what you tried in addition to the medication such as heat/cold/topical rubs. A two or three line entry is sufficient. Take it to your appointment. That is a concrete tool to show your effective use of medication but still have unrelieved pain. Even if the MD doesn’t look at journal, he/she knows you’re doing your part.
Good post chick!
Great idea Sheila – this one isn’t something I’ve thought about because when I was taking pain meds my doctor knew how terrified I was of getting addicted, so she KNEW I wasn’t going to take anything unless I had to. Now that I’m handling my own pain management without drugs, I think this would be an excellent method to keep track of what works, what doesn’t work, and what activities cause which kinds of reactions . . .
Hi, This is such a HOT topic for us Painies. There are many crucial aspects when dealing with medications and physicians. It is important that the patient ensure that their prescriptions (all of them) are coming from 1 Dr. This prevents drug interaction, most importantly, and the perception of Drug Shopping. If the medications are not working at all – you may be a High Metabolizer of medications – this means you are genetically pre-disposed to require more medication than the average person. A gene test can determine this.
It is always, always important that Painies – seek ANY form of treatment that is non-medicinal. Not only because of the perception of or real addiction – but more importantly – medications can either mask important symptoms of your pain required to know for a proper diagnosis OR it can create side effects that lead away from what may be the root cause of pain.
Medication is an important factor in Painie care – but certainly not the only one. Ask for additional blood tests on Vitamin B/C/D levels, hormone levels, white blood cell counts and liver function tests. These all can be contributing factors to pain and only require simple vitamin replacements and/or hormone replacements. White blood cell counts may show infection, food intolerance and/or more severe illnesses that are masked by meds.
I am a true supporter of not being a hero when it comes to pain meds – as I think that taking more than prescribed may be an indication of tolerance (this happens naturally if meds are used for a long time) and/or increase of actual pain. All needs to be discussed rationally and calmly with your physician. However, it is not the ONLY form of care. Just like a diabetic needs insulin they ALSO need to excercise, watch their stress/sleep levels and be careful with diet. Medication is only 1 factor of a large number of factors in dealing with pain management. It is important for us Painies to understand the Dr. and for them to understand us.
Excellent info Kathleen, thank you for the additional ideas . . . I didn’t realize that the vitamin C levels could make that much of a difference, but I’ve been supplementing that one for years so I wouldn’t have noticed it on my own. (I have other reasons to need extra C.) I HAVE, however, noticed that on days when I have the money to treat myself to fresh veggies and fruits, I feel MUCH better, and I assumed that it was due to the vitamin/mineral boost.
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Really appreciate you sharing this blog post.Thanks Again. Awesome.