Would you try a treatment that you think is just a doctors band-aid?

[FauxLiz]

As I have discussed with several time on this forum I struggle with chronic daily migraines. I have tried countless specialists, well intentioned GP's, a bevy of alternative and holistic medicines, treatments and at one pointed added a pain psychologist in addition to my current T and Pdoc. The referral is to a doctor with a ridiculously high negative review rating across multiple sights. Just reading his private clinic website you recognize that he has three treatment modalities: Subox, Subutex, and 12 step programs. I won't deny that there are times that i abuse my pain medication (take more often than prescribed) but I do so as it is really the only way I can continue to function at my job and stay employed. (I am actually right now considering whether working is better or worse for my health both with the PTSD and the Pain.

I have agreed to meet with this so called Dr (who by the way is a recovering prescription drug addict and doesn't fill me confidence.) I am at a point that I truly feel all my doctors specialists included have hit a brick wall and are just turfing my of on this guy so rather than calling me a chronic pain sufferer they can call me a drug seeking drug addict, which is funny as I have never filled a prescription early, if I take extra to get through one day I grit my teeth and bear it with the lower dosages the next day. The only true pain med that I take is not even a schedule 2 med it is a schedule 4 and considered safe during pregnancy. I have also been on this medication since I was 28 (20 years) and in all that time have asked for one increase in dosage per month and that was at the point where I couldn't function without it and was about to lose my job due to the amount of time I had taken off because I either couldn't drive to work, got there and couldn't read a computer screen and had to be picked up to go home.

So my question is would you try to go in with an open mind, would you be skeptical or would you just simply say i am not putting myself through this?

 

[Deadman]

I'm not clear from what you wrote as to the purpose of the referral. Is it to get better pain management or to wean you off your current meds?

 

[FauxLiz]

@Deadman sorry for taking so long to respond. The purpose of referral is to see if I am a candidate for one of the long acting "opiate" meds to provide a solution to my headaches. The thing is I don't currently take opiates daily and don't want and will not allow another doctor that is too lazy to figure out what is causing the chronic pain and just presume like so many that I am faking it because "its just a headache.

One major thing that I left out of my earlier post is that I don't take my pain meds every day. Though I have the headaches 20-25 days a month in excess of 20 hours per day I have what I consider base line meds when the pain is a 2-4 those include increase fluids, anti nausea meds, benedryl, increase in my daily magnesium and extra sleep. I will not do this regime for more than 2 days in a row. The second level of meds used to be triptan abortives, I had to eliminate those after a mini stroke last summer so now I alternate ibuprofen and tylenol. This I will try for headaches from 3-6 for up to 3 days. My last resort or for headaches that begin at an 8 I have my rescue med which few doctors use anymore but that was popular in the 90's is a schedule 4 low dose opiate nasal inhaler I get 1 spray every 3-4 hours with not more than 3 doses a day. While I could go crazy and I have abused this med taking extra doses to get through a day because some of my work days exceed 16 hours in the office and I don't have the option to do what I want which is go home, crawl into bed in a dark room and hope when I wake up I will feel better I don't however use these rescue meds more than 3 days in a row. So yes depending upon how my migraines cycle there are days when I am struggling with pain that I just plain don't take any meds because I don't want to become dependent on any of them nor do I want to run the risk of a common condition called Medication Overuse Headache.

"At XXXXXXXX, our goal is to offer those who have been suffering from chronic pain and opioid addiction the opportunity to lead fulfilling lives, free from many of the restraints both physical and mental that their conditions impose." This is a direct quote from the Drs practice homepage. That in mind I very little confidence that he ever looks at patients with chronic pain as anything but addicts.

 

[Deadman]

Chronic pain is such a difficult topic these days. Where I live we are having an opioid overdose epidemic. Many people want a crackdown on opioid prescriptions but some doctors worry that their legitimate chronic pain patients will be left in the cold. Chronic pain is no joke but neither is the addiction potential of opioids, especially if you are inclined that way to begin with.

I'll try to quote the best medical I ever received from a doc back when I was a medic. "If your pain is preventing you from living your life then take the meds/get the surgery. Otherwise use lifestyle management and lots of ice. All medical intervention carries risk. You may end up worse off."

When he told that to me we were discussing the constant pain in my knees but I still use that guideline for all my medical choices. Can I live with it? If yes 'ice' and lifestyle. If no, take the pill.

 

[FauxLiz]

@Deadman that is what I have done in my life. The pain does prevent me from living my life. I miss concerts that my children are/were in. I have been forced to reschedule trips, needed more assistance getting around at my mother's funeral than her 99 Year old mother did and many more things than I can recount. I take the meds, I try every treatment thrown at me and continue to do so with the least amount of regularly administered medications. I went so far as to agree to brain surgery hoping that fixing a known birth defect would resolve the issue. What frustrates me so much in all this is I am not a drug seeker nor am I an addict but I am terrified I guess that just agreeing to be seen by this physician with his known prevalence for presuming that everyone is an addict frustrates me.

 

[Nessa7]

Is there any chance that it is a formality of their chronic pain program? My psychiatrist, dentist, and gynecologist are all part of the same health network, and they are now required to make all of their patients go through some kind of program before they are prescribed opiates for chronic pain. They have posters about it hung up on what seems like every wall in the building.

 

[FauxLiz]

@Nessa7 I wondered that as well and found out it is only part of the protocols for their head pain patients. This is a University specialty clinic that sees spinal, neck and headache patients. The headache patients are only those that have been refereed as chronic intractable from their overall neurology/neurosurgery department.

I guess that is why to me it is insulting they aren't worried that patients with spine or neck injuries/issues may develop an addiction but presume that those of us with headaches they haven't been able to resolve are addicts and that is after the first sentence when you meet a new physician, NP, PA, nurse, desk clerk, etc anywhere that I have been so far is "we don't prescribe narcotics for headaches so if that is why you are here you might as well leave. Not sure which is more insulting, that statement, the 18 months I waited for an appointment with the miraculous neurologist that wants me to see the addiction guy or the ER resident that told me he could fix my problem with amputation.

 

[joeylittle]

@FauxLiz - this is not really relevant to your question - but have you tried amitryptaline?

 

[Nessa7]

That is terrible. In my health network, I think it would at least be a consolation that it is happening to everyone and might be helping to prevent dangerous or frightening behavior in a different office.

You had to wait 18 months to see the neurologist that gave you this referral? That is such a waste of your time. Are you at least able to get on the schedule of the doctor that you actually want to see when you're done seeing the guy they're forcing you to go to?

 

[Friday]

chronic pain and opioid addiction the opportunity to lead fulfilling lives, free from many of the restraints both physical and mental that their conditions impose." This is a direct quote from the Drs practice homepage. That in mind I very little confidence that he ever looks at patients with chronic pain as anything but addicts

He wouldn't have any reason to look at patients as anything but addicts... As he specializes in treating addicts.

 

[tontoe]

have you tried amitryptaline?

A friend of mine had some success with low-dose amytryptyline. It's often prescribed "off-label" here in the UK for what docs call "neuropathic pain" [i.e. pain for which the medics can't seem to isolate a cause]

 

[joeylittle]

@tontoe - I've known people in the US respond to it well for migraines, also.