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Where to go from here and how do I get my doctor treat me after I've been labeled pain management
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An_251502 posted:
I've had multiple hospitalization a, pain clinic classes through stanford UCSF UCDAVIS and kaiser most recently 3 surgeries37 corticosteroid injections. Forced retirement ddd l L1-L5 and now lower plus C7 and neck. I have a GP managing mess and physical medicine dr for injections. Since last week of Nov 2012 curled up in fetal position. After pleading with my doctors for help over 3.5 mos finally prescribed new mri s discovering 2 new injuries. Finally prescribed a caudal injection which has helped w ith sciatica in both legs. I asked my physical med dr( that's what they call pain drs at kaiser) what to do so I am not in agony again for so long. I was told to do what I have been taught in pain class. I take morphine and oxycodone. I have always followed ex to the letter. Never lost prescriptions or requested refills early. Not once. My doctors seem to be fine with my minimum mobility but I am not. They ask me to give them a number when I go on 1-10 with 10 saying my pain is so bad that I need someone to drone me to the ER. In dec I called the on call nurse who determines what I should do. The last 2 times I have called they told me to go to Er. It is an hour away. When I arrived they checked meningitis took my $50 copayment brought me in a room. When the dr came in he did not even examine me but said " we don't treat chronic pain patients in the ER." Wouldn't it have been nice if they had said that before my husband had to drive home an hour from work to drive me an hour to kaiser and obviously before they took my money. And big question why is the on call nurse and they're own reference materials telling me to go if they then refuse to treat me there? Many questions. Many things that make no sense. In the meantime what do I need to do to get help when I am in crisis? Please help.

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ctbeth responded:
Hello from Connecticut,

You really have a lot going on.

My thought on the ER referral is that ruling out meningitis is very important.

If your symptoms that you described to the on-call nurse indicated that you may have a serious, life-threatening illness, then getting that ruled out or confirmed is a real emergency. Thankfully, it wasn't meningitis.

Being assessed for meningitis is an emergency; chronic pain is not. Most ERs nationwide do not treat chronic pain.

As an RN myself, I would say that the on-call RN did the right thing.

What if she had not told you to get checked for meningitis and you did have it, that could have been a fatal mistake, so probably a good plan would be for you to accept that the nurse made the right call, and that not having meningitis and being tested is the better of the options.

So, the caudal block helped you, but has since worn off- is this correct? If this is a successful treatment, it would seem that this treatment could be repeated, or your MD may have other similar options, like RFA, for example.

I am assuming, and correct me if I'm wrong, that you take Morphine (Contin) long acting, and Oxycodone for "breakthrough", or as needed.

If you're generally doing okay pain-wise with this Rx, and what you really want/ need is a stronger (higher dose) pain med for breakthrough, when the pain is insane, then you really should discuss this with your MD who prescribes the MS and Oxy.

I see that you said that you've has multiple hospitalizations. I'd suspect that there is some back surgery, but you didn't say.

If your "injuries" (is it degenerative disc or trauma?) could be surgically repaired, now that your pain is really troublesome to your life, you may wish to consult with an orthopaedic or neuro surgeon.

Regarding the $50. co-pay: that's what your Kaiser policy has set for an ER visit. The ER did treat you in the testing that ruled out a potentially-fatal infection.

Emergency rooms are not the venue for treatment of chronic pain.

So, can you let us know a little more about your multiple hospitalizations and injuries?

Thanks, and I hope that you can get this worked out.

CTB
 
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dfromspencer responded:
Well, I was going to answer, but I got beat by Beth. She is right, the er is not for treating chronic pain. It sounds like you need something stronger when you have these episodes? Try and get your physical dr. to prescribe something stronger for when you have them. Its worth a try, right?

I wonder if surgery on your back may be in order, now?

Best of luck to you!!! And please keep us informed!

Dennis
LIVE LONG-LOVE WELL!!!
 
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77grace responded:
HI There,
Well.I must tell you ,first of all I also have KaSIER!PROBALLYspelt wrong!Anyway,I find them o.k. for daily medical needs ,refilling pain meds.staying on top of most health issues!But I would not want to have to deal with any Surgical or heavy duty medical needs,I think they are programmed so far and that's about it!!What do you think???
I hope you feel better and things calm down for you!
Blessings.77grace
 
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annette030 replied to ctbeth's response:
Listen to Beth, she is correct about this one.

Take care, Annette
 
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annette030 replied to 77grace's response:
I have to say that Kaiser varies in quality somewhat from place to place. My mom had Kaiser in Marin County, Calif. She had and died from lung cancer. As an RN I could not have asked for better care, she was in the hospital three times for varying lengths of time, her oncologist was great. I went down and went with her for every single appt. with her doctors.

Other friends and family, who use this same Kaiser area hospital system, are very happy with their treatment plans, and care. One of them has arthritis and had knee replacement surgery, etc. there.

That said, a friend of mine here in Gresham, OR, was consistently put off when he had a chronic heart condition, Atrial Fib. It was several months before he got an appt. with a cardiologist after being diagnosed in the ER. I was not happy with his treatment at all. I guess it is like any system, it has good doctors and poorer ones.

Take care, Annette
 
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ctbeth replied to annette030's response:
Someone recently posted here that Kaiser, as a whole, no longer prescribes opiate meds for anyone.

Do you recall that discussion?

I'm going to go to Kaiser home page and poke about a bit.
 
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77grace replied to ctbeth's response:
Hi Beth,
I kind of doubt that because I get all my pain meds from my Kaiser Doctor!
There always seems to be things being said about Kasier,I don't know why!!They are good at diagosos,(SP0 and treatment! That's good enough for me for now!
Peace 77grace
 
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blessedladyptl replied to ctbeth's response:
CTBeth,
Is this the one you're referring to ? Kaiser Permanente will NOT use opiods for Chronic Pain anymore !

http://forums.webmd.com/3/pain-management-exchange/forum/5354/5#5
 
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ctbeth replied to blessedladyptl's response:
not me. I live in CT

another person said that she couldn't get opiates from Kaiser, and yet another said that she could get her meds with Kaiser.

There is no Kaiser where I live.

I have to run, but look back at the beginning of the discussion and you can see who posted, ok?
 
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blessedladyptl replied to ctbeth's response:
CTBeth,
Sorry.I misread your reply above.
 
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ctbeth replied to blessedladyptl's response:
I finally read the link you posted above, and yes, that is the discussion.

It's an interesting discussion, too.

Someone posted that she couldn't get her opiate meds as Kaiser has a new policy by which no opiate meds can be prescribed. Another person posted that he/ she was able to get meds from Kaiser.

I have private insurance and live in Connectcut, but I lived in Los Angeles a while back and recall Kaiser Permante as a huge provider.

Has anyone posted any info regarding what is Kaiser policy?
I'd search, but I'm a bit pre-occupied with other matters right now.

I would like to know, even though it doesn't effect me.

Beth


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