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Falling through the cracks
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JennSeattle posted:
I am an uninsured sick person. I utilize the "charity program" at a local teaching hospital. For a year now my pain issues have increased and the help given by my doctors has hit a wall. She actually said "There's not much more we can do." Pain management won't take me due to being uninsured. I am also an addict in recovery so opiads are kinda off the table. I have to admit I am getting further depressed and desperate. Not sure how much longer I can hang on....I'm stuck. I can't work to afford doctors and the doctors I need don't see charity care patients. I've tried holistic stuff. ANy sugestions?
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TDXSP08 responded:
There are certain narcotics that are used for addicts with Pain issues if try to get high off them you will send yourself into a bad withdrawal if you use them correctly you can recover from your addiction and have your Pain treated at the same time i'm sure Harborview has a Psychiatrist that is an addictiton pain management doc that works with the uninsured you just have to be persistent and find S/he to address your dual issues.Or King county Mental health has got to have one on staff at their county Drug and alcohol rehab because that issue comes up frequently.
i have no small step for man, but i have 6 tires for mankind,Watch your Toes!
 
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JennSeattle replied to TDXSP08's response:
what is this drug you speak of in first part of you note - and thanks for the reply. Harborview is strongly encouraging me to get community care through the state (in process).
 
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TDXSP08 replied to JennSeattle's response:
Buprenorphine Hydrochloride Sold under Trade names as Subutex and Suboxone and they can be prescribed to people who previously had Drug addiction but also are dealing with issues of chronic pain now of course I am not a doctor and i can not say that your doctor when you find s/he will want to utilize these medications but at least you know they exist and if the doctor says i don't know what to do for you, you can bring up these medications and ask about using one of these .but only if they are stumped as to a treatment because as a rule you should never ask for a certain Medication from a Doctor.

Good Luck let us know how you are doing
i have no small step for man, but i have 6 tires for mankind,Watch your Toes!
 
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JennSeattle replied to TDXSP08's response:
Yes I know this drug. I will ask about it - I understand it to be very expensive. I'll know more tomorrow about getting community health care. I'll keep you updated.
 
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Peter Abaci, MD responded:
Jenn,

I think it is a big challenge for anyone to manage a chronic medical problem, whether we are talking about chronic pain, diabetes, or hypertension, without insurance or good medical resources. Many times public resources are overwhelmed and are forced to focus more on acute health problems as opposed to treating chronic diseases in a more comprehensive fashion. Despite this challenge, I want to give you some food for thought:

One of the most important things to better managing any condition is education. Knowledge in better understanding chronic pain and the ways it can be managed and how you can function better is powerful. Gaining this type of knowledge and insight leads to confidence and more independence in how to manage things and lead your life. Even patients with fancy health plans often don't get enough important education on chronic pain management from their doctors, and obviously, you won't get this from expensive medications, either.

Because resources and books are so cheap now on places like Amazon.com, I think with a modest investment, you could start with some sound educational resources to get you going in the right direction. For example, I created my own book so that a person could develop their own self-management program at home and in their community based on whatever resources they had available. I just checked Amazon, and a used copy is only a few bucks: http://www.amazon.com/Take-Charge-Your-Chronic-Pain/dp/B0058M9GAK/ref=sr_1_18?s=books&ie=UTF8&qid=1343309572&sr=1-18&keywords=chronic pain . Of course, their are plenty of other good books and DVDs out there besides mine, including one by Dr. Caudill who writes for our Fibromyalgia Community, and I often recommend books by Jon Kabat-Zinn, as well as his 8 week MBSR program (there is probably one in your area).

The American Pain Society offers recommendations for finding resources and educational material on their website: http://www.ampainsoc.org/about/ .

One of the challenges of living with chronic pain is staying physically active and maintaining the rest of your health. Consider looking into affordable community resources that could help you with that, like a local YMCA or classes at a community center.

The goal is to come up with your own daily self-management plan and tools that you can stick with so you can keep your pain in a box and move forward with your life. I hope this helps.
 
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KatMit524 replied to JennSeattle's response:
Jenn,

Methadone works in the same ways for Pain patients who also have addiction issues. Methadone is also used in addiction clinics to wean addicts off of narco's.

And in the last 10 years it's made a very impressive showing in the Pain Management world as a Long Acting pain med. So when you ask about the Sub, ask about Methadone also, that at least gives you 2 choices, in case 1 doesn't work.

Hang in there, sending up good thoughts and prayers for ya!

Kat
 
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TDXSP08 replied to KatMit524's response:
Kat you have to remember this individual has already had an addiction issue so Methadone unless done through a street outreach type program would be highly dangerous and NO Methadone programs accept Chronic Pain Patients. whereas under the implementation of the DATA Act in 2000 Suboxone and Subutex can be prescribed in a DR's office for dual treatment of addiction and Chronic Pain. so that is why i suggested those rather than Methadone and because they can treat pain but if abused the slam you into withdrawal which is a good thing for a dual diagnosis patient, not to mention that with the increasing use of methadone their has been an equal number of accidental or unknown intention overdose deaths from it, it is not a drug that if you are having a really bad pain day that you can say "i'll just take an extra one today" methadone requires a really stable cool headed patient who understands that this drug can not be arbitrarily trifled with without planning between your Doctor and you.
i have no small step for man, but i have 6 tires for mankind,Watch your Toes!
 
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annette030 replied to Peter Abaci, MD's response:
I am so glad you mentioned education, I also feel this is so important in managing our own health issues.

I have used Dr. Margaret Caudill, MD, PhD's book, "Managing Pain Before It Manages You", it is a great book, I got it at our local big box book store. I have also seen it advertised in an on line Nurse's book store. I also have read and shared, "Feeling Good" by Dr. David Burns MD. It is also very good and I have used techniques from this book, it literally saved my life. Also available anywhere in the self help section of a quality book store. Each book cost about $20 new, but I have also seen them at thrift shops, really cheap.

Thanks Dr. A for writing your own book, I will read it as soon as I can. I really feel one can always gain something by reading a book if they are open to learning at all.

Take care, Annette
 
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annette030 replied to TDXSP08's response:
Sorry, I must disagree with part of your post. A number of folks have posted here that they got their methadone for their chronic pain at a methadone clinic for addiction. I do agree that it is not a good choice.

Doctors can use methadone for chronic pain, I use it and have never had any kind of addiction issue, my husband used it in the past twice for chronic pain issues, and he also has not ever had any kind of addiction. The dosing, and the frequency of dosing is very different than that for addiction.

It cannot be used legally outside of an addiction clinic for addiction. I doubt there are any laws to deal with using it for chronic pain at these clinics if you pass their entry rules.

I do not know the present status of the buprenorphene type drugs, my 2010-2011 drug hand book states that one type should only be used for addiction and one type for pain. It also states that a doctor must have specific addiction training to use it for addiction. I know nothing personally, having never used these drugs at all. Dosing, etc. can be found on line or in a drug handbook.

Having worked with opiate type drug addicts and methadone back in the early 1970s, I really respect opiate addiction and would rather have chronic pain than addiction. I also really respect methadone, you are so right that you never take more than is prescribed to you, no doubling up the dose because you are having more pain.

A recovering addict who has pain issues is really caught between a rock and a hard place. Given a choice I would suggest a pain clinic that also has addiction help, but I know clinics like that are few and far between, especially for someone with $$ and insurance issues. I hate our healthcare system.

Good luck, and take care, Annette
 
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JennSeattle replied to annette030's response:
My father (a psychologist) gave me Feeling Good to read - awesome book. I've done all I can with psychotropics and anti-inflammatory is maxed out - but all I see is the worried look in there eyes when I come in. I'm seeing her again (maybe for the last time) tomorrow and will just ask out right to try narcotics with a contract. I see no other alternative. I totally agree with eh MD - being uninsured they only treat my symptoms as they appear. But I think the bigger picture is that something is really wrong with my sympathetic nervous system as I also itch and tingle all over. The advice about NA/AA is somewhat helpful - I was told by those I trust in the program that I don't have to me a damned martyr and no - NO ONE I know in the program is a prescribing doctor - but that if I am on narcotics I would be advised NOT to share in meetings. I understand this. I will let y'all know tomorrow what progress I make with the doctor...
 
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TDXSP08 replied to JennSeattle's response:
Jenn I don't know if you have an automobile or drive but one other suggestion i have for you is Renton Community Hospital when i was out there in 1999 my wife had a massive stroke and Renton Community wrote the whole bill off to charity they did not charge us a cent for her month and a half in ICU ,her Surgery nothing ,those people where awesome and they are really friendly to, so if you can get out there maybe you could get some help there even if it's just a month or two of high quality care and Med's it would be worth it. and my wife was a chronic pain patient at the time.

Peace
i have no small step for man, but i have 6 tires for mankind,Watch your Toes!
 
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JennSeattle replied to TDXSP08's response:
I was given Methadone for chronic pain before- but I have doubts they'd do that again - it was 15 years ago, but still....

I have found some places that will do Charity - Swedish does too. I will check out what is in the new area we are moving too. I have HCV too and want treatment asap - so finding a good free doctor and getting my meds thru the pharm company is my plan. I am meeting with a SS doctor next week for disablity.....cross your fingers.
Do or do not - there is no try. YODA
 
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annette030 replied to JennSeattle's response:
"Feeling Good" is one of the best books I have ever read.

Do whatever you think is the best thing for you. I would not share in a 12 step program that I used prescribed pain meds, I just do not trust anyone enough. My friend went through AA and different alcohol/addiction related programs, and they often teach that any use of opiates , even proper use of prescribed opiates means addiction, not true. I might share other aspects of my recovery process though.

As far as I am concerned "clean" means free of alcohol, and abuse of prescribed meds. Clean can include the proper use of prescribed meds as far as I am concerned. YOU DO NOT NEED TO BE A MARTYR TO CHRONIC PAIN.

Anytime you wish to share how long you have been clean, it would be nice to know.

How did it go with your doctor appt.?

Take care, Annette
 
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JennSeattle replied to annette030's response:
So the doctor is checking me for hemochronotosis (?) iron build up in joints. She also put me on Neurontin - no results from that. No results on the blood work either....she ran several tests. I am having my bad episodes today. Flu like symptoms, headache, muscle ache, absolute fatigue - wipes me out. I try working thru it but it make it way worse - all I can do is lie down and sleep. And of course my doctor is on rotation some where is so I can't show her how weak and how much pain I'm in when this happens. Started about eight years ago. I think it's the HCV. They tell me the numbers aren't there for these symptoms. Whatever. I know something is very wrong. I am trying to do this narcotic free. I am moving though and am considering changine doctors (long drive) and discussing narcotics with he new one. Thanks for asking.
Do or do not - there is no try. YODA


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