My Doctor is Afraid to Prescribe Narcotics!
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TJ713 posted:
I am a male nurse and have been working hellish med/surg/telemetry floors in various hospitals for 13 years. Usually the only male on the unit, all of the other nurses often called me to help them lift or turn heavy patients.

Finally, 2 years ago, my back went out...a herniated disc in L5-S1. I though I knew what pain felt like before this, but I really hadn't had a clue! With an invisible sword impaled into my right buttock and an invisible fire in my right foot, all I could do is squeal in pain until surgery was done.

During my nursing career I had seen many control battles between other nurses and supposed "drug seeker" patients. I always left it up to the doctor to decide whether or not to order pain meds for those who claimed to hurt. If it was ordered and the patient asked for it, I gave it!

Now that I am suffering intensely with permanent nerve pain (sciatica), I went to see my pcp after 2 surgeries and multiple procedures. She is TERRIFIED to prescribe narcotics because the feds have cracked down on pain control, stripping doctors of their licenses and imprisoning some of them.

So I have started a petition on the White House website. Please sign it and maybe we can bring pain management back to hurting patients. The website is: https://petitions.whitehouse.gov/petition/allow-physicians-prescribe-pain-medications-their-discretion-without-scrutiny-federal-government/P75db5z1

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bj1208 responded:
Hi TJ and welcome to the support group -

I know that it's frustrating when we are in pain and one of our doc's won't prescribe meds.

Just to let you know - most Primary Care Physicians will not prescribe narcotics of any kind as they would be watched for one and would need to submit documentation of why they are prescribing narcotics. There are even some pain clinics that will not prescribe anything higher than hydrocodone 7.5/500 - I've been there and done that.

The best Pain Management I've found is a PHYSIATRIST PAIN SPECIALIST -

http://www.spineuniverse.com/treatments/what-physiatrist

they go deeper into pain management by treating from the pain up and not just the symptoms. They have the resources to treat patients with any and all types of treatment plans. I'm not saying that they are good for prescribing narcotics but depending on the diagnosis, past treatments and outcome of those treatments will determine how they handle chronic pains.

Please do a search for pain management clinics and see if any are a PHYSIATRIST Pain Specialist - see if this would benefit you for treatments and what needs to be done. They also have great Spine Specialist they work closely with, sometimes both Orthopedic Spine Specialist and Neurosurgeon Spine Specialist.

Hope this helps - keep us posted what you find out~~
~~ Click on my name or picture and read my story ~~

Take care ~~ God Bless ~~

~~ Joy ~~
 
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trs1960 responded:
So your calling the fox union to complain about problems with the hen house!
As Joy stated the problem is the fed. The DEA makes doctors risk their license to prescribe you opiads. Yet by law they have to treat your pain.

This is one of the reasons pain managment specialists have become so previlent. Primary care docs also (typically) can't disable you. They can write you off for a week or so, but beyond that is another hurdle of beurocracy.

With your medical background I have to wonder if you can find a good pain managment doc or clinic? As you are probably aware, Pain docs come from multiple disciplines and each has merit.

Since you're post op, your surgeon should be able to refer you to a pain doc. Most or anethesialogist that use their pharmacological knowledge to manage long term opiad treatment. Joy metioned a physiatrist. I just ran in to a friend of mine last night who is a physiatrist. They specilaize in orthopedic rehabilitation without a knife. They are extremely knowledgable about the body and can often prevent surgery from being needed. Some also venture off and get certified for pain managment which is a great background to leap from. Some PHDs also get in to pain managment. Another great background for pain.

It really comes down to how you get along with the pain doc. There has to be mutual respect in the working relationship. As you now know, the patient knows things the doctor can only guess at. As you know there are god docs and not so good docs. Keep your radar up.

There is a book you might enjoy authored by an orthopedic surgeon that blew out his back and found himself in the same scenario you describe...the inside looking out!
The book is called the Art of Healing Back Pain Naturally: Art Brownstein MD.

My last advice is to not fight pain, you will lose. Throw yourself at the DEA and maybe you'll help all of us, but the pain you feel you must learn about to prevent it from taking its own course. Pain is where the brain and body meet and all of us men know what happens when we let our anatomy run the show!!

Best of luck

Tim
 
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TJ713 replied to bj1208's response:
Joy, thanks for the great info. I was brief in the description of what I've been through, but I have truly been to nearly every kind of specialist and the only treatment options left for me are risky (like cutting the nerves that cause the pain, which the surgeon told me has an 85% failure rate). All the "pain clinics" here in Houston were shut down by the DEA. I haven't tried the physiatrist thing yet, but will check it out and let you know what happens. Thanks again. T.J.
 
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TJ713 replied to trs1960's response:
Tim, thanks for all the advice. God Bless. T.J.
 
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trs1960 replied to TJ713's response:
Are you talking about RF ablation or physically cutting nerves? If the procedure your talking about cuts the nerves you need to read up as that has been proven disastrous. Pain will recede for awhile and then often returns worse than before with no remedy.

Do you have any friends with inside knowledge? If the issue is bad enough to discuss cutting nerves you need to do everything possible to find another path. If your talking about RF ablation then it's a burning of the nerve ganglion. An RF tip is used under fluoroscopy and the ganglion is burned. First you'll have to undergoe a test procedure using an analgesic on the same nerves. If that gives you relief they will move forward to the RF. success rate of RF is more like 50/50 with results lasting from months to years. I've had it done 4-5 times now with about the same 50% success rate.
 
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TJ713 replied to trs1960's response:
As you know, medicine is extremely specialized now and my specialty was not neurology...so forgive me for mixing it up. My surgeon mentioned RF ablation briefly, but said the success rate is not good and the pain could end up being worse than now. I honestly thought he was referring to cutting the nerves and did not research it because anything that could end up worse than this is not an option for me.

You've had RF ablation 4-5 times? When it failed, did it hurt much worse than it was before the procedure? Did they use at least conscious sedation before doing it? Please tell me more. I feel something I haven't felt for awhile...hope!
 
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trs1960 replied to TJ713's response:
When it failed it just didn't do anything.
 
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TJ713 replied to trs1960's response:
TRS, this gives me GREAT HOPE! After my second surgery, I got a nerve block shot (Lydocaine and Steroids) into my nerve canal and was able to function for MONTHS with little pain.

When I went for another shot, the doctor found that scar tissue had sealed up my nerve canal to such an extent that the medication would not go in. He did a procedure to scrape away all of the scar tissue and made 2more attempts. But the nerve canal is completely sealed and there's no chance of any more shots.

Would this stop the procedure you're telling me about? I assume they shoot this acid into the nerve canal. Is that correct?
 
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trs1960 replied to TJ713's response:
You need a good pain doc to answer your questions. As you can appreciate, we have to be careful about what we say as we could steer you the wrong way as we try to help.

I will tell you what happened to me: The first RF didn't work as he couldn't get the probe to the ganglion. This is near T8 where my vertebrae are crushed together. Procedure was performed under fluoroscopy with IV sedation (fentanyl and versed as I recall.) very little pain.

Attempt #2 started the same, but the probe hit home and when he turned it on it hurt like hell. The pain went away as soon as the probe was turned off and the sedation turned it into a distant memory. This worked like magic and 7 years later still provides relief. I had one more attempt up in the thoracic, but there's just too much damage.

Recently I had two more done at L2-L3 bilaterally. They helped, but not as great as #2.

The important note: If my doctor told me he wanted to try it again I would take his advice. This is a doctor I have seen for years and we would discuss it at length. I trust him tremendously.

Hope that helps

Tim
 
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TJ713 replied to trs1960's response:
Thanks for the info Tim. I have one more question for you, if you don't mind. I experience 3 sensations...annoying numbness, FIRE burning, and a SHARP sword. What sensations were you experiencing before the procedure and what did they change into after #2 worked?
 
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trs1960 replied to TJ713's response:
Boy...I get similar sensations. Nerve pain seems to be the fire or extremely sharp and pointed. The sword or sometimes I describe it as a vice that is continulually tightened until it becomes pointed, but starts as muscle tension and cramps. Numbness on me seems to be from cutting through all the tissue nerves during surgeries.

Now here's the kicker. The body does some strange things when it comes to pain. It seems to me that a disc pain can cause nerve pain and then morph out to muscular cramping pain or referred pain.

The only thing that remains constant for me is the numbness, but as we've discussed many times, we're all unique. Despite the severity of my skelotel injury I am lucky to have avoided spinal or CNS nerve damage. So all my nerve pain has either been referred or peripheral nerves.

I also feel a distinct difference between muscular pain to the left side of my thoracic spine starting under my scapula. This is the vice ever tightening until it feels like a piercing sword. My lumbar gets a sharp pain emanating right from the spine. I think this may be disc pain or nerve impingement ?

Epidural s and RF have helped the lumbar, but not the thoracic. I believe this is because the skelotel damage in the thoracic have the muscles and bones in a permanent battle to correct the curve of my back. It's 3 inches shorter in that area so the muscles and vertebrae don't really agree on where they should be.

Hope that makes sense. I don't want to describe something in me that may cause you to think a treatment won't work for you. Sharing knowledge is great though
 
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1q2w3e responded:
I have had a kidney stone for about 2 weeks now and Friday I had a lithotripsy. I am now in more pain and can't seem to get pain meds. Friday night the pain was so bad I went back to Parkridge hosp. in Chattanooga where I had the treatment done and I was treated like someone that was drug shopping. Earlier that day I was given Percocet 5/325 but it was not taking the edge off the pain. The doctor in the E.R. Thats the strongest they could give. After about 4 hours the E.R. Doctor told me I had a choice I could be prescribed Dilaudid 2mg. or be admitted for pain management but I had to go to a different hospital. I choose The meds. not wanting to have to start all over at another hospital. The other meds. were not any better. I have had kidney stones in the past and have never had problems with pain management.
 
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bj1208 replied to 1q2w3e's response:
Hi 1Q2W3E - welcome to the support group -

I think what I would do is call your primary care doc and/or the physician that did the procedure in the morning stressing everything that has happened and the amount of pain you are in.

Most times hospitals do not like to prescribe pain meds as most will only write a script for the hydrocodones 5/325 and only will give enough to last til you can get to your primary doc or surgeon where they can evaluate and monitor your pain levels.

please get ahold of them and let us know what you find out
~~ Click on my name or picture and read my story ~~

Take care ~~ God Bless ~~

~~ Joy ~~