Jan 4, 2010

Pills and Suspicions (Controlled Drugs)

A question Doctor D gets asked a lot:

Why are doctors so stingy with medicines that make me feel better?
Yeah, I have to admit doctors are totally difficult when it comes to certain pain and anxiety medicines. You show up in a doctor's office and request a medicine that has worked for you in the past and suddenly you get read the riot act and treated like a criminal. Weird isn't it?

Doctor D admits that he does this too. It's not because he doesn't care. D went into medicine because he cares. He has just learned to be cautious over the years.

These medicines are very powerful. Some people really do require them when other meds just won't work, but they can also get you high or even make you stop breathing. Every MD has seen these medicines destroy people's lives.

Heath Ledger and Michael Jackson kicked the bucket because of medicines like this, and Doctor D can guess what's probably gonna show up in Brittney Murphy's toxicology report.

But forget about celebrities, these medicines harm regular folks every day. There was the young mother that broke down in Doctor D's office saying she can't make it though a day without buying pills off the street, and the high school freshman that died of an overdose after spending her birthday money on pills to party with her friends. You don't forget patients like those.

It's one thing to see somebody hopelessly addicted to alcohol or die of a cocaine overdose. It is really sad.

But with prescription drugs it's different. I'm the supplier of drugs that are killing local kids and ruining families. You can see why I get nervous about every prescription for a controlled substance I write.

I totally want to help people in pain. Unfortunately that compassion makes me a sucker for manipulative people. I wish that I could believe what every patient says they need, but if I gave everything that was requested of me I would most certainly end up killing someone. Therefore Doctor D uses very conservative prescribing practices to make sure he has obvious medical reasons for every prescription he writes.

This sucks for patients with legitimate needs who use these medicines responsibly. The behavior of the bad apples causes good people with real needs to be treated like criminals.

Sorry! Doctors hate to act like cops, too, but the very serious drug problem puts us all in positions we don't like.

Please be patient with us. Doctors really want to help people, so if you are honest, patient, straightforward, and work with the system you will usually be taken care of. But doctors are edgy about these meds so please don't react with anger or game the system. I understand your frustration, but acting out won't help you. It will send up red flags that may get you banned from every getting strong medicines.
What do you think? Are doctors too hard on patients who need controlled drugs, or do you find the restrictions reasonable? Have you ever been mistreated when you asked for medicines? ...or known someone who was addicted to pills? Doctor D would love to hear your thoughts in the comments!

40 comments:

Old MD Girl said...

I got grilled by a nurse practitioner when I requested Valtrex for my oral cold sores that kept recurring. It was extremely unpleasant, and it took 30 minutes of convincing her that I knew what I was getting into in requesting such a "dangerous" medication (sarcasm intended). In the end the nurse practitioner said, "Well, it's not as though you're asking for a controlled substance!" and wrote the damn script.

Ha. Ha. Ha.

I don't think that interrogating the patient is the best way to go about building the doctor patient relationship. How would you like to be that cancer/lupus/whatever patient sitting there, being accused of drug seeking? Surely there must be a better way to do this.

A Doc 2 Be said...

I get grilled for Concerta the first time I request from new doc... after that, it is a routine script writing exercise. My head is all over the place without it - ooh, a butterfly flying to the bird feeder on its way to the mall! haha Makes perfect sense to me, not so much to people listening to me.

What I saw from a rural family practice doc is monitoring. How often do meds go missing? How often is the script asked for?

OMDG, I think at some point the physician/patient relationship is severed because of the drugs - has to be that way. Sort of letting the patient hit rock bottom until he/she well understands there is no route but addiction treatment. Some patients, of course, never do hit rock bottom.

Doctor D said...

I should clarify: I don't tie patients to a chair under a heat lamp and grill them until they confess.

I do ask a lot of questions in a friendly way and do a full and careful exam while getting as many records as I can. I listen and look very carefully and only prescribe if I find a compelling reason to do so. I realize this level of caution screens out some legitimate people, so if I say "no" I do so in a polite way. I explain that I don't disbelieve them, but I don't find something than meets my criteria for writing this particular medicine. They are welcome to get a second opinion or see a pain clinic if they don't agree.

Most patients respond well to this. The ones that nut up and scream at me are the ones I suspect were trying to pull something over on me anyway.

Dani said...

I think it is fair for the most part. I only worked in a doctor's office for a few weeks last summer and most of the patients who asked for drugs were probably abusing them. I just found it really sad. It is unfortunate for those who really needs them though.

WarmSocks said...

I describe symptoms and let the doctor make decisions about what's appropriate. I don't ask for pain meds - and usually decline when they're prescribed.

Your approach sounds reasonable. I wonder if it would work to treat this problem like parents can answer toddlers - with little kids, it's possible to say "yes" while meaning "no" and they take it so much better.

Dragonfly said...

Good post!

Josiah O. Morris said...

Having held a position in which I had a similar, yet vastly less serious responsibility, I'm somewhat accustomed to dealing with the tactics of those who are trying to pull one over on someone. I got burned a few times by being a bit too trusting when I first took the job, but became extraordinarily cautious after dealing with a repeat offender. I'm sure that, somewhere along the line, I turned away more than a few people whose intentions were pure. Unfortunately, I didn't have the flexibility to refer them to someone else...mine was the last word.

After I made the decision to become a doctor, desperate drug-seekers came to mind and I worried about how I might handle those folks. Are these kinds of difficult situations dealt with in medical school, or do you just pick it up along the way in residency and so on?

Another thing that concerns me is my...um, propensity for laughter at the most inopportune times. I've nearly lost it while shadowing doctors before and I can't offer an explanation as to how I managed to hold it together. How do you, and other doctors, do it?

Lindsay Ash said...

I am on a ton of potassium, i mean a lot. 120 MEQ's a day. i just saw a new doctor who wanted to take me off of it to see what happened, she told me she thought i was addicted to the potassium.
I was like you really don't want to do that, not unless you would like to see me with a K of about 1.8 in a few weeks.
I mean jeez potassium. Who gets addicted to potassium?? Is that even possible?

Doctor D said...

Wow, Lindsay, 120 meq daily! That is a lot of potassium. Has anyone ever tried to figure out why it drops so low?

Josiah, there were a few lectures in medical school and residency about controlled drugs but they weren't much good.

The med school lectures on narcotics seemed to be more moral than medical. Either the lecturer felt narcotic were evil and there is never an excuse to prescribe them, or that narcotics were wonderful and any attempt to control or limit their use was intolerable cruelty.

Doctors have a hard time discussing narcotics rationally (for understandable reasons). It is Doctor D's view that no pill is inherently good or evil. They are medicines with risks and benefits that should be weighed carefully.

Helen said...

I'm wary of narcotics and other painkillers because I don't want to mask my symptoms and end up ignoring disease activity. I'd rather be fully aware of the state of my illness. That said, I know there are people who genuinely do need stronger painkillers, and I did take them for a week or so after my surgery.

My Mom works in a pharmacy, and I know she spends a lot of time dealing with people who will do anything to get narcotics - fake prescriptions, make up stories, even attempt to steal drugs. It must be difficult for you to have to decide who these drugs will help and who they will hurt.

Anonymous said...

As the daughter of an addict, I wish that doctors would be more restrictive about what they prescribe. After a car accident about 10 years ago, my mother discovered that pain meds were a more socially appropriate method of self-medication than alcohol. After trying numerous types, she decided she liked percocet best, so convinced her doc that it was the only one that works for her and has been on the maximum dose for years. She takes them 24 hours a day, and chews them when she needs a high. When she came to visit us in Australia, she brought a massive bottle (because you can't get them here) - my partner got her to give him one (very reluctantly), and he said it was like a mild form of ecstasy.

We know she's an addict - should we have said anything to her doc about it? What would your reaction as a doctor have been if we came in and asked you not to prescribe them?

Doctor D said...

Thanks, Anonymous.

Yes, family often knows things that doctors do not. I have often had family call and tell me that so-and-so is using their pills to get high or selling them on the corner. I really appreciate this input.

It is important to note, however, that I won't just cut off someone's meds based on a tip. It makes me more suspicious and I begin looking into such concerns on my own. Unfortunately there are enough crazy families out there that some people might call in tips on innocent patients as a form of revenge or manipulation. So we have to look into each allegation individually.

That being said, I appreciate someone that cares enough to call. Even better is discussing it with your mother and her doctor together. I have had family members come in with patients and we have a frank discussion of addiction together.

This often allows patients to open up and make a plan to get off meds that have been hurting them.

Lindsay said...

Doctor D
There are some suggested causes, a few known, no one knows why i need more and more potassium just to keep it slightly normal though, and know one knows why it drops so quickly.
this is the most i have been on.
Suggestions?

Doctor D said...

Sorry Lindsey, I promised myself when I started this blog that I won't give any diagnosis or treatment advice.

Still that's pretty wild! Worth discussing with your MD.

betty said...

Having chronic pain for 20 years plus and finally getting a diagnosis of Ehlers Danlos IV only 2 years ago,I understand the dilemma of pain medication use for the pt. and the doctor.I did not want to rely on pain meds or become addicted so I found myself acting tougher in front of the doctor,dismissing the pain, only to suffer in silence.However, I have learned through an amazing Dr.,a practicing physiatrist, that chronic pain is a symptom that must be treated no differently as if the pt.was a diabetic and required insulin.I am still resistant to stronger narcotics but HEED the NEED to suffer silently now.I would suggest if you feel uncomfortable managing and treating a person who has chronic long standing pain that a referral to a Physiatrist may be at hand, they are very good at weeding out the drug seekers.

rheumablog said...

A good post, Dr. D, and a difficult one. RA can be excruciating; there have been times in the past when narcotic pain meds were the only things that dulled the pain for me, even a little. Fortunately, the pain is usually bearable (if not pleasant), and like Helen, I'd rather not mask the pain for fear of injuring already inflamed joints. But at the same time, I also understand the other side of the argument. There have been times when I've felt humiliated when I've had to ask for pain meds and got that "look" from the doc. It has only happened a few times over many, many years, but perhaps it was all the more humbling to me because of the infrequence of my asking. It's too bad that the only drugs that truly deal with severe, disabling pain are the ones that are so often abused.

Sounds like you approach the whole problem in a compassionate and pragmatic way. I'm glad you didn't make this a sarcastic post about stupid, selfish "seekers."
-Wren

brilliantmindbrokenbody said...

Controlled substances are definitely tough. The trouble is that it's very hard to tell the difference between a desperate person in pain and a person who is addicted.

People trying to avoid giving controlled substances resulted in a nurse practitioner trying to convince me that tylenol would help with my pain when vicodin wasn't strong enough.

I think this is a place where pain management specialists are useful. When you're dealing with chronic pain, if there is a good pain specialist - one of the variety that believes in treating pain holistically, not just through psych methods - that may be your best bet in getting a patient appropriate treatment. And I'd expect them to be particularly familiar with signs of drug-seeking behavior and addiction.

~Kali
www.brilliantmindbrokenbody.wordpress.com

MLee said...

I think that treating chronic pain is very different than treating acute pain. Pain tolerance is different for everyone. I see many friends, patients, and myself, who have had pain for years and are able to get to their comfort level with NSAIDS, such as celebrex, I personally loved Vioxx and about went manic when it was pulled:). However, some that do not have pain everyday, and those of us that do have chronic pain need something stronger sometimes. I think that the best option is others have said, explain your symptoms, what makes it better, what makes it worst, and then let the doctor decided and offer what he/ she feels best. If you think they are wrong, ask them why do you think that is my best choice and/or treatment options. It is surprising at what an open discussion between patient and doctor can accomplish. Yet, there are many who go from doctor to doctor and seek till they find what they want. I wouldnt want to be the doctor who wrote a script that a person overdosed on. Ethical practice and moral desicions can be hard when it comes to scripts.

femail doc said...

Colorado maintains a web-site that includes information on all controlled substances rx'd to patients including who rx'd, quantity, pharmacy, and how the pt. paid for the rx (credit vs. cash). Very illuminating.

Anonymous said...

I've had horribly disabling menstrual cramps from endometriosis for years and could never seem to persuade doctors to prescribe effective pain control. I was unaware of the phenomenon of the "drug-seeking patient" until recently and, looking back, I wonder if those doctors put me in that category or were merely indifferent to pelvic pain. I resorted to taking truly massive doses of ibuprofen. My gyns said not to take so much, but the risk of kidney damage seemed remote compared to my immediate pain.

I've had several open abdominal surgeries and other allegedly painful procedures since then, and every time doctors expressed surprise that I didn't complain of pain and used very little pain medication. But I'd always be thinking, "Gee, this isn't anywhere near as bad as having a period!"

Doctors by now have given me enough narcotics to last until the end of time, and I've tossed away most of it except for what I can use for cramps. I sometimes wish I could go back to my former gyns and tell them how bad my periods feel, using a surgical comparison that will be more meaningful to them than whatever I said in the past. I do understand that they can't tell just by looking at someone who will or won't become addicted, and it's a pretty awful thing to risk. Still, in my case, what a lot of pointless agony and tear-filled days. . . .

HugeMD said...

Here's my 2 cents on how to get your chronic pain properly treated. Obviously this is a huge topic and this is just couple paragraphs, but it's a start. Find one primary care doc to coordinate your care. Make sure they have all your records from all your specialists. Make sure any narcotics are from one doctor or that all doctors prescribing narcotics know what you're getting from everybody. Follow through on recommended NON-narcotic treatments and tests and recommendations--these things often work. Narcotics frequently lead to tolerance and often don't work all that well in the long run. Understand that often being pain-FREE may not be a realistic goal, unfortunately. Making pain manageable and learning skills to cope are often more realistic goals.

Don't go to ERs and urgent cares for narcotics for your chronic pain. Getting narcotics at multiple places from multiple doctors is dangerous, bad medical care, and will quite honestly probably result in your being seen as a "drug seeker". Contact your doctor. If you're using your narcotics as prescribed, your doctor is likely to be able to help you.

I agree with Dr. D. I don't want to police the prescription of narcotics. But I'm also not going to treat chronic pain in urgent care and risk contributing to addiction and overdose. And I'm certainly not handing out Percocets like candy to people who are blatantly lying in order to get them. I'm going to give people the benefit of the doubt, but I'm going to be smart about it. I'd LOVE to be in a state where I had a registry of all narcotic prescriptions. At least that would give me one more resource to try to figure out who's lying and who's not.

I agree with Dragonfly. Great post!

radioactive girl said...

I have found in my case, having had cancer and then rheumatoid arthritis/sjogrens that my doctors almost want to hand it out like candy. Not really of course but since it is offered to me(and refused) quite often I'm pretty sure I could get pain relief if I needed it. I wish there was some kind of magic sensor that said "drug seeker" or "genuine pain" so people in real pain don't have to get "the look" if they ask for something.

tracy said...

My only comment concerns psychiatric medications. i mean no offense by this, Dr. D, but it seems best, especially if the person is taking more than one and has a psychiatric disorder, that they be perscribed by a psychiatrist, in most situations. i kbow of at least 3 family members who could be helped sooo much if they would just get a consult and get on the correct medication...

Maha said...

A very relevant post Dr. D. When I had my wisdom teeth removed, the orthodontist didn't offer much in the way of patient education. He told me that plain tylenol would be sufficient for pain control. It wasn't.

I unfortunately had to travel to another province for an interview and the pain worsened. My family got sick of my chubby cheeks and teary eyes and took me to their local ER. The amount of cut eye that I got from the staff was unbelievable. At the time I was 18 and wasn't really aware of the drug seeker phenomenon. Three different nurses talked to me (probably to see if I had a gap in my story), blood work was done (I'm sure a tox screen was probably added as well), then the doc came to see me. She grilled me for a good 20 minutes and finally let me have 1/2 a percocet which was a lot better than taking a plain tylenol. I probably made the mistake of asking for a script because I was out of province and couldn't handle the flight back. Finally the doctors were switching shifts and I got another doctor who got me to try PO toradol which worked wonders. She wrote me a script and sent me on my way.

Point of this long story - even though as a nurse, I don't prescribe, I feel that my judgment of pain is probably quite tainted by my former experience in an ER which leads me to advocate more strongly for timely pain control. Unless of course I get the patient who himself told me that he sells a tablet of percocet for $80 on the street.

Anonymous said...

I have Crohn's, my guts are full of ulcers and some days my joints, including sacroiliitis, hurt too bad to walk on stairs in my house.

GI tells me that the best way to treat the pain is to treat the disease and to go take some OTC tylenol. I've always had blind faith that there must be some really good reason why I can't have something stronger and must stay in pain.

Doctor D said...

Anonymous, perhaps when your GI doc said that Tylenol is the "best" way to treat pain he meant the safest, which is often the case. Certainly some people with your condition don't need more, but if you are always in severe pain then it may be worth asking your GI doc to refer you to a Pain Management Specialist.

drottematic said...

there's a great paper on opiods and related mortality in the CMAJ (before the intro of oxycontin)

http://www.cmaj.ca/cgi/content/full/181/12/891

Grumpy, M.D. said...

It's a tough issue, D. All off this deal with this one. I try to use the narcs sparingly in my practice, yet still use them for those who need them. None of us want to be seen as running a junkie store, nor do we want to be seen as causing needless suffering.

On a semi-related note, I'm not sure trash like Embeda (and it's coming cousins) are going to change this either way, and will only end up costing the people who really do need them a lot more money.

Michael Guzzo said...

Good post doc. Since we're always next in the abuse chain, pharmacists appreciate the cautious docs.

Like you wrote, it's unfortunate that the legitimate patients suffer because of the abusers, but prescription drug abuse is becoming so prevalent and widespread that caution should be standard practice.

Here's a fact sheet from the DEA concerning prescription drug abuse. More people now abuse prescription drugs than cocaine, heroin, hallucinogens, Ecstasy, and inhalants, combined. There are more deaths, illness, and disabilities from substance abuse than from any other preventable health condition. It more serious that many non-healthcare people are aware.

Not only this, but doctors (and other prescribers) are being watched more closely, and being held more accountable, for carelessly (and sometimes not carelessly) over-prescribing controlled substances.

So, all you legitimate patients please understand the reasons for any restrictions and delays when it comes to getting pain relief, and go easy on your doctors and pharmacists.

Anonymous said...

WAY more people get injured and killed because these substances ARE CONTROLLED !! Think gangs, robberies, etc, etc...There are Law Enforcement professionals who know this for a fact. LEAP is one such org of law enforcement against. Stop enabling the drug dealers and fleecing the people who need these medications !! Paying $60 for an office visit per month for a $10 script is just plain wrong. http://www.leap.cc

Anonymous said...

...and doctors, please understand the reasons for any expressions of outrage from a patient in dire need of pain relief that is more potent than most of the OTC "white bread" headache pills. And please...if there is potential for a procedure (ie. medical abortion) to cause severe (labor) pains, be honest in explaining this to the patient...and provide or prescribe strong enough medication to provide relief, with instructions to begin taking it before the pain starts. AND please leave the term "drug-seeking" out the discussion. Then, maybe, the patient will be more understanding and it won't have to hurt you so much.

Have Myelin? said...

I have MS, colitis and right now...a dental abscess. I am always in pain for MS or colitis.

I find medical mj works. Since I live in Colorado where it is legal at least on the State level, I can get it free from my caregiver. I can't afford to buy it from the dispensaries and he is kind enough to simply give it to me.

I wonder how many Vicoden users would give up their stash (LOL) free to someone in pain. I have some for the dental abscess but it is not working as well as medical mj. Interesting...

The other point I'd like to make regarding medical mj is my neurologist said he never saw a patient go to ER for medical mj symptoms (unless it was laced with PCP or something) but it is common to see patients with prescription drug side effects in ER.

I wish they would legalize medical mj on the Federal level and then leave it alone. It isn't something that can be "dosed". It really works best when the patient has full control. A smart patient does not smoke it, instead they use a vaporizer.

I've said enough LOL! =)

Anonymous said...

Can a person actually get "banned" from certain pills?
If a pill is addictive, and a patient is prescribed it, then
monitor them before a problem arises.
I have been prescribed percocet, clonazepam, propranolol, and prescription strength ibuprofen all in a matter of a couple months, then sent on my merry way...no one asked me any questions.
I realized on my own the potential problem in front of me and had the pharmacist discard the meds I no longer needed.
I also went through pretty nasty withdrawal from the clonazepam after only one week of use, all on my own.
Not one of my doctors was looking out for me.
By the way, I was given 7 refills of clonazepam, 60 pills each bottle, maybe the doctor needs to shoulder some of the responsibility for this kind of problem.
If I were to be banned because this looks suspicious, that would be a kick in the pants by an idiot doctor.

Anonymous said...

I'm sorry but the "please understand that we're cautious because of the abuse out there so if you have legitimate chronic pain, tough luck because of the bad apples." You are doctors, do your damn job, treat patients. I recently moved to another state for a new job, insurance does not kick in for a few weeks, NO ONE will treat me or take on a new patient even though I have years of records from my previous doctor, X rays, MRIs, etc. I'm just plain sick of this. I've worked in pharma sales so I understand the whole FDA controlled substances caution but when you refuse to treat a legitimate patient in chronic pain, you are jeopardinzing their quality of life let alone their job and what happens then is if someone is in that much pain, they get desperate and what happens when they do turn to the street and something happens to them? That is on all of the doctors who said no to treating a legitimate patient. This very moment, I am almost out of my meds which I'll be on for life, I've called every doctor's office under the sun, no one wants to take on a new patient, especially on pain meds and because my insurance does not kick in for weeks, paying cash puts up a red flag as well. So you tell me, MDs, why shouldn't I be irate with you? You are not doing your job. What would you suggest I do or where should I go? Seriously, if anyone can actually answer that, it would be a revolution. The few places who are willing to see me can't get me in for weeks and that won't work right now since I'll be out tomorrow. I haven't waited until the last minute, I've been trying to get a "primary care" office since I've moved and with a new job that's 12 hours a day as an executive, I rarely have the opportunity to even research and call until I'm done and then places are closed. I've tried urgent care facilities, no luck (not sure what they are "urgen care" considering they say urgent and my case is urgent). Don't tell me that an irate patient is a red flag. It's pure bullshit. I'm at the point where I'm exhausted trying to look for someone to help me so I have every right to be irate. The medical community is a joke and is now incapable of treating patients. Money is the bottom line or they are cowards and just don't want to deal with the crap that goes with prescribing pain meds. So if you MDs are so smart, you tell me, what should I do in the next 12-24 hours?

Anonymous said...

Amen. Why shouldn't people be irate? Some of us are tired of suffering because of the bad apples. If people are abusing prescription drugs, they are hurting themselves. Doctors who react to that by refusing to treat people with legitimate pain are hurting people with legitimate pain.

People need to take responsibility for their own actions, and doctors need to make sure everyone understands that, rather than hurting more people that don't deserve it.

Anonymous said...

I have been getting valium for a few months from a group of doctors and they also were giving me tramadol and wellburtin without telling me the dangers of seizures wt these two together is so much higher. well I had two seizures in one night thank god my husband was home. then I went in and said that my back is stiff it hurts I can't breathe and I have three kids under eight and can't just sit down crying all day I have responsibilities. I signed a agreement that I thought don't go sale them don't go give them away. and I didn'thhe gave me nyctna or whatever and then two months later I had surgery and found a lot of endometriosis and he gave me a few hydrocodone but it was just for that time and obviously the other meds were not working for that just made my back feel better.now that I had surgery he just took me off wt out warning now I'm cold turkey. I am going to a new doc and a pain clinic but I am scared that now I won't get the help that I have been thru so many ppl that my bills are ridiculous I already know what I have and afraid I'm going to have to deal and its not fair. what to do?

Anonymous said...

I sit here at 12:35 a.m. in some of the most excruciating pain I've ever had googling nearby Emergency Rooms. Why? Because an overly cautious "Urgent Care" doctor refused to prescribe anything stronger than 800 mg Ibuprofen for an infected tooth abscess. I've been through this once before on the same tooth and the dentist prescribed antibiotic and vicaprofin (sp?). I told "Urgent Care" I had been taking 800mg ibuprofen with no relief. This guy today would hear none of it and prescribed an antibiotic and the ibuprofen. I asked how long before I saw some pain relief. He said 48 hours. Well, as I said, that Urgent Care visit wasn't even 12 hours ago. I have already fainted once since then due to pain, which makes me reluctant to go the ER. I'm no pain pill addict but I'm paying the price for those who are.

Anonymous said...

I too had no Idea of pain pill shoppers. 2yrs ago I was involved in a head on collison which dam near ended my life. But since have been on pain killers for my busted body. My pain clinic also treats me like a criminal. Not the doc though but his staff. Last trip for refills I got raked over the coals for using more than 1 phamacy. I said well if you would see me in the same dam office instead of in 2 different towns maybe I would. And this random drug test bull@#$t random my ass every time I go I take one. Test me all you want but thats a charge of 3100 to my ins, 150 if self paid. What the hell does random mean? I am a auto mechanic what if I charged my customers 3 different prices? Ya know its shit like that that got the GOVT involved in health care now were all screwed. Atleast my doc understands I CAN NOT do my job with out meds. Doc I can tell you this if a 25+yr auto tech coplains of back pain he ain't kiddin ya. just go watch him do his job, ya know the job he HAS to do everyday to feed his family. That would help you be 100% sure he really is in pain.

Anonymous said...

People say drug seeker and pain pill shopper but its not that simple I had my labrum repaired rotator cuff repaired and bicep reattached 4 months ago and have been in pt since. The pphysical therapy got so painful I had to stop bc Tylenol or voltaren wasnt helping and now my shoulder is dislocating again and ny orto/surgeon not only refuses to help with the pain but to even to work me in sooner bc my next appt isnt for two weeks so point being some people are forced to go "shop" around just for a little pain relief... I cant understand how any person could argue that narcotic pain neds are not needed after a surgery of that kind with 3 anchors in my shoulder to fix its dislocatting and instability since it is now having the same problem as before surgery and is very painful yet I can not get sny help with the pain itd sad hard and makes you just want to give up

Anonymous said...

Pain is essential in the healing process. It exposes dysfunctions within the body, and hopefully, deters further injury of oneself. Without pain, one may never know the culprit which hinders the process towards homeostasis.
Persuading was your intentions, so persuaded we are.

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