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When your doctor won't prescribe narcotics: Tips for getting the pain relief you need
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jrae922 posted:
Great article, really puts things in perspective.
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Wolfsong452 replied to NeNe_11's response:
I am going to a pain management doctor, I'm to the point I feel why bother going? doesn't seem to help.; Yes, they give me some pain meds. but I only have enough to last 56 days, so, some days I can only take one pill, or if I take more than one, then there will be days where I can't take any!

pain meds. don't really seem to help, yet I've gone without, then decided well, guess they do help a bit. Same thing with the anti-deppression medicine. Was going great, then had a crash, haven't been back to great yet.

so, it's to the point what do I expect? I know I will always be in pain, thinking the doctor doens't have anything else they can do.

Yet, I have not her issues, knees, shoulder, weight problems etc.

so, maybe if and when I get some of these taken care of, I might be in less pain.
 
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forgetful88 replied to Wolfsong452's response:
Regular PCP are becoming more & more reluctant to prescribe pain killers & it is due to the hassel of it all due to government & war on drugs.

Alot of people make it impossible for those really & truly suffering in chronic pain.

I have a hard time getting my ambien due to insurance arguing that it is not medication to help me live....Now they have no problem for my thyroid medicationi because I need it to live. (Don't have a thyroid).

My regular dr. is only allowed to give 2 refills & then he has to re fill out the paperwork again for another 2 refills.

I mean I understand the whole drug addiction to pain killers & stuff, but you will find more PCP sending their patients to Pain Centers.

I refuse to go that route so I am good on Advil/Ibuprofen 800.

I have more health issues, but who doesn't...So as long as I am still above ground can't complain...
 
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HDienst responded:
I am a physician and felt the need to chime in here.

Realize first that none of us go into medicine to deny help to those who need it. Over the years, however, there have been a number of "distractions" that have begun requiring lots of physician time that could be spent taking care of people. Pain medicine is one of those big ones.

Most docs have no issue with giving narcotics for acute pain. It is chronic pain that remains the problem. Patient's often don't realize that pain medication is not a good long term solution. If you use it for many weeks to months, tolerance builds requiring the need for more. This cycle will never end. To top if off, if you stop you go into withdrawal. Which muddies the waters for doctors a bit - is the patient truly in pain or are they "addicts".

If you add to the problem the amount of diversion, lies, deception that we encounter on a daily basis, I think you begin to understand the problem. On top of this, we are watched very closely by the authorities on our prescribing habits. I regularly get reports on patient's using my DEA number fraudulently or lying to me about there seeing other doctors. To tell you the truth, I did not get into medicine for this. I feel like I have to be a babysitter.

Because of all of the above issues, I have adopted a policy of no chronic pain medicine for all but a select few who sign pain agreements with me. For most people, this is two scripts and you are done. If you want more you need to find a pain doctor who will do it. I take care of a lot of very sick people and the countless hours, lies told, and arguments sickens me.

I don't expect you all to completely understand, but I do want you all to at least try and realize that this is a BIG problem in medicine, so don't expect anyone to hand out narcotics easily unless they are unethical.

Here are some tips though to get your doctor to help you. Offer to sign a pain agreement with them. This just states you will only go to him/her for ALL your pain medicine needs. No exceptions. Also you agree to go to one pharmacy only. You agree to random urine drug screens to insure you are taking the medication (and not selling it) and not taking other illicit drugs (abusing one increases risk of abusing another). Finally, take all meds as directed only. And last but not least, don't ask for increase frequently. This one is the one we fear the most when chronic pain patients come in.

Typically, with pain agreements, you will be expected to come in monthly as well. Nothing is more annoying for doctors is for patients to complain about coming in. Realize that doctors make no revenue when people don't come in. They make nothing for the phone calls, looking at labs, making referrals, and reviewing and signing scripts. I recommend you go in promptly with a smile. Someone has to pay for the lights, the nurses, the equipment. We are not just there to provide scripts to people.

Your doctor will be especially impressed and more likely to prescribe meds if you are doing other things to help as well. Active participation in physical therapy, psychotherapy, hypnotism, injections, other non narcotic medicines, exercise, eating right, and making sure the other aspects of your health are maintained. There is nothing worse a patient who always complains about their pain but does nothing about their diabetes, hypertension, cholesterol. Or never gets regular physicals.

Hopefully, this will be helpful to you all if you are frustrated with your current interactions with your doctor about pain medicine.

A little understanding, honesty, and cooperation will go a long way towards helping you reach your goals.

A wish you all luck!
 
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HDienst replied to HDienst's response:
Let me add a few answers to some other questions as well.

Does your doctor HAVE to provide pain medicine.
No. There is no requirement that doctors provide pain meds. If a doctor has agreed to accept you (yes they have that right), then they are expected to provide standard of care to the patient in that area. Typically, this does not include pain medicine as pain itself is a manifestation and not itself harmful. Nor is withdrawal from narcotics.

About fibromyagia. No one understands it. There are few medicines for it. It is often misdiagnosed.as well. I think that is the reason one encounters problems with using the "fibro" word. My recommendation is to find a rheumatologist who likes to treat fibromyalgia. They are out there. Until you do, it will be a constant struggle.

Your doctor is not your enemy. Adversarial patients who complain about all their other doctors will not build trust with your doctor. Do all of the things your doctor ask such as lose weight, exercise, use good sleep hygeine, take meds as directed, and continue to be a productive member of society (I mean continue to contribute by working or helping others). These are the kinds of patients that doctors want to help.
 
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rickylee04 replied to Leb12970's response:
Hey Leb, srry for your problems. The best thing you can do is to search out a good primary doctor then build a good relationship with her or him. Next you need to research rheumy's in your area, personally I choose young females because females are more nurturing, and sympathetic in my opinion, and younger doctors have yet to peak out and start down the slope. Once you find one you think will serve your needs go to your primary and ask her to give you a referral. She should appreciate the fact that you found your own, and she may use this new found rheumy for other referrals. If your not comfortable with your new rheumy right off, start the process again. Remember, a relationship with a primary and a rheumy is for life. You wouldn't marry a person for life if you were not happy with them. The process is hard but worth the trouble. My primary is a 37 year old female, and my rheumy is a 39 year old female. It took a lot of work but I get whatever I need, and I think they are treating me as well as anyone could. Good Luck, I wish you well.
 
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tamsenj replied to HDienst's response:
This helps. Thank you for taking the time to explain your perspective. I understand a bit more. I wish you didn't have to do this as it takes time away from the reason you probably chose medicine.
 
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jamesndebmoore replied to Leb12970's response:
It is time to talk to an attorney. Without stepping you down from narcotics it is possible that you could have all kinds of problems. Heart attack for one. Good luck. I've been fighting with drs since 98 and it is hell. I don't have a life. I still can't believe doctors can treat us this way and call themselves doctors.
 
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An_249546 replied to HDienst's response:
Ok, I am a Software Engineer, and I need to chime in here. You may notice that I have a bit of angst against doctors, but I believe it's righteously placed. And just to spell out my vitriol, I do not think you're as smart as you think you are.

In response to "Realize first that none of us go into medicine to deny help to those who need it." While that may be true, the number one reason is money. When you ask a child who wants to be a doctor why he wants to be one, he almost always says "to make lots of money". I never hear "to help people".


In response to "Most docs have no issue with giving narcotics for acute pain. It is chronic pain that remains the problem.", my statement is "so?" I have a painful condition that will never go away and I need to mask it so I can live normally. If that involves me taking pain pills for the rest of my life, why is that a problem?


In response to "is the patient truly in pain or are they 'addicts'. ", I need to say that reports of people addicted to mild narcotics is severely overblown. These 30 mg of codeine pills that you guard like gold are the kid's toys of narcotics. I doubt you really know what an addict truly is.


Your statement "Realize that doctors make no revenue when people don't come in. They make nothing for the phone calls, looking at labs, making referrals, and reviewing and signing scripts. I recommend you go in promptly with a smile. Someone has to pay for the lights, the nurses, the equipment. We are not just there to provide scripts to people." enrages me. You can complain about not making enough money when you aren't driving the latest model of Mercedes. When your salary is less than six figures a year (which I believe it should be), then you can cry me a river.


Other countries allow their people to treat their pain - such as Canada. They offer OTC codeine. Why in this country do we have to cater to your whims for the slightest bit of relief? It's absurd and ridiculous. It's gotten to the point where I'm willing to pay $400 for a box of something from a foreign pharmacy online because you and your kind are worried that someone might become "addicted". Is that fair to me? I want relief from severe pain, you want relief from paperwork.





 
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jharmon replied to An_249546's response:
Wow, I think the doc hit a nerve with you.

I think what the doctor is trying to say is you can do what you want, but if you want "better results" in your interactions with your doctor then maybe cooperation and understanding might go along way.

I have a wonderful doctor who truly cares and I for one, don't happen to agree with your generalizations and stereotypes. Nor you anger about how much money they make. I think it is obvious you have a "chip" on your shoulder. You sound a bit like you are entitled.

Just my two cents!
 
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jharmon replied to An_249546's response:
You talk about "other countries". Well, in most other industrialized countries with socialized medicine, you don't have a choice of a doctor. You get who they give you. And what the doctor says is final.

I think you better be careful what you wish for. You may get it with the latest flavor of Obamacare.

Just my three cents!
 
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Getoverit replied to chronicpaingirlie1's response:
I'm assuming you also drive your 2 1/2 year old son around in the car while taking OxyContin....or just Lortab. You might not think you are high but chemically your driving and judgement is impaired. People don't understand that these medications are not for everyday use and need to be used as a last resort. They are very addictive and have a lot of side effects. Prescription drug abuse is a major problem in the US right now. Everyone thinks they can just take a pill to fix everything instead of taking. He time and effort to help themselves. If you NEED them to function day to day then chances are you need to seek help elsewhere. Many people now days have chronic pain because they don't take the time to exercise their joints and muscles. I do understand that some people really do need medication and that is fine, but taking narcotics everyday for chronic pain (unless you are dying!) is not anyway to solve a problem.
 
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An_249929 replied to An_249546's response:
Spoken like a true addict. If you want relief try psychotherapy, physical therapy, dieting, excercise. Pain medications only mask a problem with your body. Fix the problem and you fix the pain....
 
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Getoverit replied to HDienst's response:
Very well stated. I couldn't agree more.
 
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An_249929 replied to Wolfsong452's response:
The weight is the problem. If you put the effort in to help yourself lose the weight, I guarantee you will be in less pain. Pain medication only masks the actual problem. Fix the weight and your body will thank you. And you will feel so much better after!
 
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manoncampus replied to chronicpaingirlie1's response:
These Doctors are scared and they will loose their business anyway they carve it.
We are in legitimate pain, and I was on a steady dose of
meds, MSContin 2- 60 mg a day and 4 10 mg methadone.
The doctor discharged me because I could not fill my methadone anywhere and asked for Norco-hydro lesser drug.
He forced me to find a stranger that took 2-3 hours each visit, and gave me half my dose.
I ran out and found a doctor who wouldn't help till he got my history. By then, in pain and in 3rd day of withdrawl. Sick, shaking blood pressure up to 150 over 130.
Finally I got a two week script, we will see next visit.
I am hoping he is watching me every two weeks.
IT is getting BAD out there!
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