# A rant on pain management, in this country.



## mskafka

I would just like to rant about the current status of pain management in the USA!  

Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.  

What I am PISSED about, is the the quality of pain management that we as patients receive.  

For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases. 

I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)

3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.  

I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough. 

And finally down to the point of this entire thread: 
The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."  

I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!  

I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.  

I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.  

What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.  

So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.  

Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.


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## Katzndogz

What about an electronic nerve blocker implant?


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## lizzie

I'd say that the docs in your area must be much different from the ones around here. When I'm on the job, I spend my days popping morphine and dilaudid to patients like candy.


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## mskafka

lizzie said:


> I'd say that the docs in your area must be much different from the ones around here. When I'm on the job, I spend my days popping morphine and dilaudid to patients like candy.



Yes, I also work in healthcare.  We can administer (to an adult) up to 400 mcg fentanyl IV, without additional orders.  I guess these people look at pain management differently.  

My understanding is that it is a federal mandate.  And I could understand if I'd wanted something off the charts....like 200 ms contin.  But TEN PILLS?


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## lizzie

Hmmm- I'll have to check on the federal mandate issue- haven't heard of a change, but that doesn't mean it didn't happen, lol.


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## Mr. H.

I was given an rx for fentanyl patches when I cracked my ribs a couple years ago.
After reading the fine print on the insert, I was afraid to use them LOL.


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## lizzie

I don't blame you Mr H. Fentanyl is one of the drugs that I will refuse to give IV on the floor where I work. I've seen too many patients start declining toward respiratory distress on that crap.

Now, on the issue of the federal mandate, the latest one I see was in 2007. What were you asking for (specifically) that your doctors wouldn't give you?


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## mskafka

lizzie said:


> I don't blame you Mr H. Fentanyl is one of the drugs that I will refuse to give IV on the floor where I work. I've seen too many patients start declining toward respiratory distress on that crap.
> 
> Now, on the issue of the federal mandate, the latest one I see was in 2007. What were you asking for (specifically) that your doctors wouldn't give you?



I asked for 10 pain pills.  I told them I didn't care...tylenol 3, ultram, lortab (the weakest strength)....or something other than the 3200+ mg ibuprofen that I was taking daily.  I told them that I didn't feel like adding dialysis to my problems.


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## lizzie

mskafka said:


> lizzie said:
> 
> 
> 
> I don't blame you Mr H. Fentanyl is one of the drugs that I will refuse to give IV on the floor where I work. I've seen too many patients start declining toward respiratory distress on that crap.
> 
> Now, on the issue of the federal mandate, the latest one I see was in 2007. What were you asking for (specifically) that your doctors wouldn't give you?
> 
> 
> 
> 
> I asked for 10 pain pills. I told them I didn't care...tylenol 3, ultram, lortab (the weakest strength)....or something other than the 3200+ mg ibuprofen that I was taking daily. I told them that I didn't feel like adding dialysis to my problems.
Click to expand...

 
Then it doesn't sound like it was an issue concerning the federal mandate. The mandate, from what I glean reading various articles, is on the triplicate-prescription drugs and long-acting narcotics.


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## whitehall

Legend has it that Elvis used to have a Physicians PDR book next to his bed and a Dr. Feelgood on call. The King would simply mimic symptoms to correspond with the drug he craved at the moment and the druggist would have it ready. Pain is a bitch and chronic pain can be dulled with regular dosages of drugs. Frankly I'm surprised that a person suffering from a disease that causes sudden "flairs" of pain doesn't have the prescription or the medication handy to deal with the problem.


----------



## Kooshdakhaa

I think you should go to the pain clinic.  What's your problem with the pain clinic?

That's the purpose of a pain clinic...managing pain.  You should at least give it a try.

What happens with other people suffering from MS?  Do they also have pain?  How is it treated?  Sounds like a forum for people with MS might provide you with some help and answers.  Maybe?


----------



## Kooshdakhaa

whitehall said:


> Legend has it that Elvis used to have a Physicians PDR book next to his bed and a Dr. Feelgood on call. The King would simply mimic symptoms to correspond with the drug he craved at the moment and the druggist would have it ready. Pain is a bitch and chronic pain can be dulled with regular dosages of drugs. Frankly I'm surprised that a person suffering from a disease that causes sudden "flairs" of pain doesn't have the prescription or the medication handy to deal with the problem.



Yeah, well that sounds basically what Michael Jackson's doctor was doing, and look where it got him.


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## lizzie

Kooshdakhaa said:


> whitehall said:
> 
> 
> 
> Legend has it that Elvis used to have a Physicians PDR book next to his bed and a Dr. Feelgood on call. The King would simply mimic symptoms to correspond with the drug he craved at the moment and the druggist would have it ready. Pain is a bitch and chronic pain can be dulled with regular dosages of drugs. Frankly I'm surprised that a person suffering from a disease that causes sudden "flairs" of pain doesn't have the prescription or the medication handy to deal with the problem.
> 
> 
> 
> 
> Yeah, well that sounds basically what Michael Jackson's doctor was doing, and look where it got him.
Click to expand...

 
You'd probably be surprised at just how many people travel down that road.


----------



## Quantum Windbag

mskafka said:


> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.



You can thank the federal government and the war on drugs for your pain.

Drug Control vs. Pain Control - Reason Magazine


----------



## mskafka

Quantum Windbag said:


> mskafka said:
> 
> 
> 
> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.
> 
> 
> 
> 
> You can thank the federal government and the war on drugs for your pain.
> 
> Drug Control vs. Pain Control - Reason Magazine
Click to expand...


Oh, I totally agree!  Several of us in healthcare have made the joke (well, maybe a little serious) that one of the solutions to the skyrocketing cost of healthcare, would be to put...a cigarette-dispenser-type machine in the waiting room of most emergency room waiting rooms, and fill it with all the narcotics that one could possibly want.  I'll bet you, that EMS call volume would decrease dramatically.  There would be no drug seekers in the ER.  

Or better yet...make it OTC.  Then there is the issue with DUI's and so on.  But it's a thought.  I believe that the cost of healthcare would decrease exponentially.


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## mskafka

Kooshdakhaa said:


> I think you should go to the pain clinic.  What's your problem with the pain clinic?
> 
> That's the purpose of a pain clinic...managing pain.  You should at least give it a try.
> 
> What happens with other people suffering from MS?  Do they also have pain?  How is it treated?  Sounds like a forum for people with MS might provide you with some help and answers.  Maybe?



There is a stigma attached to pain clinics.  I'm just recalling how many people I've intubated and treated from OD's from pain clinics.  In THIS state, they are considered legal drug pushers; and this area....not very highly respected.

I have and do belong to an MS forum/chat.  The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue.  I'm here, because this to me, is a political issue.  And because I belonged to this forum LONG before I was diagnosed with MS.  

And yes, I'm totally with Ron Paul on the "War on Drugs".  I believe it has been a disaster.  Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).  

And no, it's not constant pain.  But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore.  This makes perfect sense to me.  

Now there is constant numbness in certain areas, but pain?  Only after a flare.  And it sux.


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## lizzie

To me, it sounds like an issue between you and your doctors, and not a political issue.


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## mskafka

whitehall said:


> Legend has it that Elvis used to have a Physicians PDR book next to his bed and a Dr. Feelgood on call. The King would simply mimic symptoms to correspond with the drug he craved at the moment and the druggist would have it ready. Pain is a bitch and chronic pain can be dulled with regular dosages of drugs. Frankly I'm surprised that a person suffering from a disease that causes sudden "flairs" of pain doesn't have the prescription or the medication handy to deal with the problem.



Uhm....I KNOW, that you're not suggesting that I don't have MS!  Please tell me that I'm misinterpreting what you're saying!


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## mskafka

lizzie said:


> To me, it sounds like an issue between you and your doctors, and not a political issue.



UGH!  Yes, I have seen debates about it on C-Span.  Jaysus, never mind!


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## mskafka

lizzie said:


> I don't blame you Mr H. Fentanyl is one of the drugs that I will refuse to give IV on the floor where I work. I've seen too many patients start declining toward respiratory distress on that crap.
> 
> Now, on the issue of the federal mandate, the latest one I see was in 2007. What were you asking for (specifically) that your doctors wouldn't give you?



I haven't personally had that experience when administering it.


----------



## lizzie

mskafka said:


> lizzie said:
> 
> 
> 
> To me, it sounds like an issue between you and your doctors, and not a political issue.
> 
> 
> 
> 
> UGH! Yes, I have seen debates about it on C-Span. Jaysus, never mind!
Click to expand...

 
So, exactly what is it that you want? Your congressman to call your doc and tell him to prescribe?

As I said, I haven't found any new mandates on control of narcotics since 2007, and it appears that it is for the triplicate rx drugs- not the synthetics and short-acting drugs. If your issue was that you wanted a less regulated drug, which is what it sounds like, then federal mandates would most likely not have affected the issue you were having.


----------



## whitehall

mskafka said:


> whitehall said:
> 
> 
> 
> Legend has it that Elvis used to have a Physicians PDR book next to his bed and a Dr. Feelgood on call. The King would simply mimic symptoms to correspond with the drug he craved at the moment and the druggist would have it ready. Pain is a bitch and chronic pain can be dulled with regular dosages of drugs. Frankly I'm surprised that a person suffering from a disease that causes sudden "flairs" of pain doesn't have the prescription or the medication handy to deal with the problem.
> 
> 
> 
> 
> Uhm....I KNOW, that you're not suggesting that I don't have MS!  Please tell me that I'm misinterpreting what you're saying!
Click to expand...


I'm suggesting that you are misrepresenting your condition for whatever reason. I'm suggesting that a diagnosed condition that involves flared pain episodes should be covered by prescription medicine. I'm suggesting that maybe the state prescription authorities might want to look into your situation.


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## geauxtohell

mskafka said:


> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.



I don't know why they wouldn't give you Ultram.......... It's non-narcotic.

Other than that, you've hit the nail on the head.  If you think the current crop of doctors is bad, wait until my generation gets in there.  We've been conditioned (by drug seekers) to hate narcotic pain pills.  You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam.  Why?  Because shit bags prick their fingers to contaminate their urine to malinger.  

Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.  

Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.

FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.


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## geauxtohell

Katzndogz said:


> What about an electronic nerve blocker implant?



Useless.


----------



## Quantum Windbag

mskafka said:


> Kooshdakhaa said:
> 
> 
> 
> I think you should go to the pain clinic.  What's your problem with the pain clinic?
> 
> That's the purpose of a pain clinic...managing pain.  You should at least give it a try.
> 
> What happens with other people suffering from MS?  Do they also have pain?  How is it treated?  Sounds like a forum for people with MS might provide you with some help and answers.  Maybe?
> 
> 
> 
> 
> There is a stigma attached to pain clinics.  I'm just recalling how many people I've intubated and treated from OD's from pain clinics.  In THIS state, they are considered legal drug pushers; and this area....not very highly respected.
> 
> I have and do belong to an MS forum/chat.  The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue.  I'm here, because this to me, is a political issue.  And because I belonged to this forum LONG before I was diagnosed with MS.
> 
> And yes, I'm totally with Ron Paul on the "War on Drugs".  I believe it has been a disaster.  Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).
> 
> And no, it's not constant pain.  But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore.  This makes perfect sense to me.
> 
> Now there is constant numbness in certain areas, but pain?  Only after a flare.  And it sux.
Click to expand...


Ever hear of Siobhan Reynolds and the Pain Relief Netwrok? Are you aware that the DOJ conducted a criminal investigation that effectively shut down her advocacy? Just because the government does not issue new rules does not mean that doctors who handle pain relief issues are not under pressure not to prescribe pain meds to people.


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## Quantum Windbag

geauxtohell said:


> mskafka said:
> 
> 
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> 
> 
> 
> I don't know why they wouldn't give you Ultram.......... It's non-narcotic.
> 
> Other than that, you've hit the nail on the head.  If you think the current crop of doctors is bad, wait until my generation gets in there.  We've been conditioned (by drug seekers) to hate narcotic pain pills.  You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam.  Why?  Because shit bags prick their fingers to contaminate their urine to malinger.
> 
> Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.
> 
> Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.
> 
> FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.
Click to expand...


Unfortunately, the government does not agree with you. This is the same government that some people want to trust with health care.


----------



## HUGGY

mskafka said:


> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.



Your pain makes you a more compliant consumer.  Why would they want to change THAT?


----------



## geauxtohell

Quantum Windbag said:


> geauxtohell said:
> 
> 
> 
> 
> 
> mskafka said:
> 
> 
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> 
> 
> 
> I don't know why they wouldn't give you Ultram.......... It's non-narcotic.
> 
> Other than that, you've hit the nail on the head.  If you think the current crop of doctors is bad, wait until my generation gets in there.  We've been conditioned (by drug seekers) to hate narcotic pain pills.  You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam.  Why?  Because shit bags prick their fingers to contaminate their urine to malinger.
> 
> Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.
> 
> Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.
> 
> FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.
> 
> Click to expand...
> 
> 
> Unfortunately, the government does not agree with you. This is the same government that some people want to trust with health care.
Click to expand...


Doctors have a lot of latitude to prescribe medications and no one is going to get in trouble for using narcotics for pain control when it's legitimately indicated.  The physicians that get in trouble are the ones that are completely loose with their script pad for several patients.

This isn't a government regulation issue.  It's an issue of narcotics having a horrible rap now due to all the drug seekers.


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> I don't know why they wouldn't give you Ultram.......... It's non-narcotic.
> 
> Other than that, you've hit the nail on the head.  If you think the current crop of doctors is bad, wait until my generation gets in there.  We've been conditioned (by drug seekers) to hate narcotic pain pills.  You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam.  Why?  Because shit bags prick their fingers to contaminate their urine to malinger.
> 
> Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.
> 
> Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.
> 
> FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.
> 
> 
> 
> 
> Unfortunately, the government does not agree with you. This is the same government that some people want to trust with health care.
> 
> Click to expand...
> 
> 
> Doctors have a lot of latitude to prescribe medications and no one is going to get in trouble for using narcotics for pain control when it's legitimately indicated.  The physicians that get in trouble are the ones that are completely loose with their script pad for several patients.
> 
> This isn't a government regulation issue.  It's an issue of narcotics having a horrible rap now due to all the drug seekers.
Click to expand...


Would you like to bet on that? If no one is get in trouble for the legitimate use of painkillers why are doctors offices being raided? Why are pain patients in prison for using prescription medications?

Port Townsend clinic reopens after search by drug agents -- Port Angeles Port Townsend Sequim Forks Jefferson County Clallam County Olympic Peninsula Daily news

Punishing Pain - New York Times

The problem with your statement is that the government has a different idea of a legitimate need than some doctors, and juries tend to side with the government in cases like the ones above. You are a doctor, you need to educate yourself on the realities of government response to prescriptions for narcotics before you end up being forced to chose between lying about a patient and going to prison. The evidence does not support your naive trust in being right.


----------



## Douger

Injection of ValdureIM 40 yyyyyyyyyyy Dipronova ?
 I'm not sure if those are OK in the land of duh "free" ?
A  2 week vacation in Managua is cheaper than a night in the ER in murka.
They have REAL doctors. Gracias Don Fidel.


----------



## mskafka

geauxtohell said:


> mskafka said:
> 
> 
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> 
> 
> 
> I don't know why they wouldn't give you Ultram.......... It's non-narcotic.
> 
> Other than that, you've hit the nail on the head.  If you think the current crop of doctors is bad, wait until my generation gets in there.  We've been conditioned (by drug seekers) to hate narcotic pain pills.  You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam.  Why?  Because shit bags prick their fingers to contaminate their urine to malinger.
> 
> Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.
> 
> Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.
> 
> FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.
Click to expand...


THANK YOU!  I don't want to stay fried all day long.  I just want to be able to move when the spasms are over.  And I don't want for someone to suggest that I don't hurt.  I was always taught that this was a no-no.  Now, I have given narcs to people before that I KNEW probably didn't need it.  But lying on the bathroom floor screaming....scooting on your ass to the bed...pretty good indication of pain.


----------



## mskafka

Quantum Windbag said:


> mskafka said:
> 
> 
> 
> 
> 
> Kooshdakhaa said:
> 
> 
> 
> I think you should go to the pain clinic.  What's your problem with the pain clinic?
> 
> That's the purpose of a pain clinic...managing pain.  You should at least give it a try.
> 
> What happens with other people suffering from MS?  Do they also have pain?  How is it treated?  Sounds like a forum for people with MS might provide you with some help and answers.  Maybe?
> 
> 
> 
> 
> There is a stigma attached to pain clinics.  I'm just recalling how many people I've intubated and treated from OD's from pain clinics.  In THIS state, they are considered legal drug pushers; and this area....not very highly respected.
> 
> I have and do belong to an MS forum/chat.  The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue.  I'm here, because this to me, is a political issue.  And because I belonged to this forum LONG before I was diagnosed with MS.
> 
> And yes, I'm totally with Ron Paul on the "War on Drugs".  I believe it has been a disaster.  Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).
> 
> And no, it's not constant pain.  But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore.  This makes perfect sense to me.
> 
> Now there is constant numbness in certain areas, but pain?  Only after a flare.  And it sux.
> 
> Click to expand...
> 
> 
> Ever hear of Siobhan Reynolds and the Pain Relief Netwrok? Are you aware that the DOJ conducted a criminal investigation that effectively shut down her advocacy? Just because the government does not issue new rules does not mean that doctors who handle pain relief issues are not under pressure not to prescribe pain meds to people.
Click to expand...


Yes, I personally know several physicians who have been called to the carpet for overprescribing narcotics.  As I said before....my fiance is a pharmacist who told me that while complaining to congress might be cathartic, it is probably a waste of time.  

I think I'm just perplexed.  I don't need dope all the time, but I shouldn't have to beg for it during a flare.  I realize that there are different types of pain, but don't offer me botox injections when I'm on the floor with hip and leg spasms.


----------



## mskafka

whitehall said:


> mskafka said:
> 
> 
> 
> 
> 
> whitehall said:
> 
> 
> 
> Legend has it that Elvis used to have a Physicians PDR book next to his bed and a Dr. Feelgood on call. The King would simply mimic symptoms to correspond with the drug he craved at the moment and the druggist would have it ready. Pain is a bitch and chronic pain can be dulled with regular dosages of drugs. Frankly I'm surprised that a person suffering from a disease that causes sudden "flairs" of pain doesn't have the prescription or the medication handy to deal with the problem.
> 
> 
> 
> 
> Uhm....I KNOW, that you're not suggesting that I don't have MS!  Please tell me that I'm misinterpreting what you're saying!
> 
> Click to expand...
> 
> 
> I'm suggesting that you are misrepresenting your condition for whatever reason. I'm suggesting that a diagnosed condition that involves flared pain episodes should be covered by prescription medicine. I'm suggesting that maybe the state prescription authorities might want to look into your situation.
Click to expand...


Hmmmmm....a lesion on my spinal cord at C-2.  13 oligoclonal bands, per lumbar puncture.  Not a misrepresentation.  I wish it were a fucking nightmare;  but it's very real.


----------



## mskafka

geauxtohell said:


> mskafka said:
> 
> 
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> 
> 
> 
> I don't know why they wouldn't give you Ultram.......... It's non-narcotic.
> 
> Other than that, you've hit the nail on the head.  If you think the current crop of doctors is bad, wait until my generation gets in there.  We've been conditioned (by drug seekers) to hate narcotic pain pills.  You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam.  Why?  Because shit bags prick their fingers to contaminate their urine to malinger.
> 
> Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.
> 
> Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.
> 
> FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.
Click to expand...


Prick their finger to drip blood into their urine?  What the hell is wrong with these fucking people?  PLEASE!  I'll trade my health for yours.  

Let me ski, rock-climb, hike, rappel, kayak...etc...  These things will either be challenging, or impossible, now. And some people can't get past their next fix.


----------



## Quantum Windbag

mskafka said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> mskafka said:
> 
> 
> 
> There is a stigma attached to pain clinics.  I'm just recalling how many people I've intubated and treated from OD's from pain clinics.  In THIS state, they are considered legal drug pushers; and this area....not very highly respected.
> 
> I have and do belong to an MS forum/chat.  The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue.  I'm here, because this to me, is a political issue.  And because I belonged to this forum LONG before I was diagnosed with MS.
> 
> And yes, I'm totally with Ron Paul on the "War on Drugs".  I believe it has been a disaster.  Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).
> 
> And no, it's not constant pain.  But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore.  This makes perfect sense to me.
> 
> Now there is constant numbness in certain areas, but pain?  Only after a flare.  And it sux.
> 
> 
> 
> 
> Ever hear of Siobhan Reynolds and the Pain Relief Netwrok? Are you aware that the DOJ conducted a criminal investigation that effectively shut down her advocacy? Just because the government does not issue new rules does not mean that doctors who handle pain relief issues are not under pressure not to prescribe pain meds to people.
> 
> Click to expand...
> 
> 
> Yes, I personally know several physicians who have been called to the carpet for overprescribing narcotics.  As I said before....my fiance is a pharmacist who told me that while complaining to congress might be cathartic, it is probably a waste of time.
> 
> I think I'm just perplexed.  I don't need dope all the time, but I shouldn't have to beg for it during a flare.  I realize that there are different types of pain, but don't offer me botox injections when I'm on the floor with hip and leg spasms.
Click to expand...


I know about pain, I just had another bout of kidney stones. I have been at the point where the only thing that begins to ease it is screaming in pain, and was thankful that the ER here in San Francisco doesn't wait until a doctor sees the X-rays before they will give it to you. That happened in Fort Worth, more than once. I know people who need pain meds should be able to get it without them, or their doctors, having to worry about the government.


----------



## editec

Thanks to our confused thinking about drugs in general, people who are truly in need of pain meds often don't get the relief they need.

Sucks, doesn't it?


----------



## mskafka

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> I don't know why they wouldn't give you Ultram.......... It's non-narcotic.
> 
> Other than that, you've hit the nail on the head.  If you think the current crop of doctors is bad, wait until my generation gets in there.  We've been conditioned (by drug seekers) to hate narcotic pain pills.  You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam.  Why?  Because shit bags prick their fingers to contaminate their urine to malinger.
> 
> Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.
> 
> Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.
> 
> FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.
> 
> 
> 
> 
> Unfortunately, the government does not agree with you. This is the same government that some people want to trust with health care.
> 
> Click to expand...
> 
> 
> Doctors have a lot of latitude to prescribe medications and no one is going to get in trouble for using narcotics for pain control when it's legitimately indicated.  The physicians that get in trouble are the ones that are completely loose with their script pad for several patients.
> 
> This isn't a government regulation issue.  It's an issue of narcotics having a horrible rap now due to all the drug seekers.
Click to expand...


I do wish that the gov't didn't have so much control over what is acceptable prescribing standards.  However, I'm sure that you have a MUCH bigger grasp on those laws than any of us.  

That's why I got aggravated about being referred to a pain clinic (which I suggested myself, out of desperation).  What I see too often, and I'm sure that you know exactly what I'm talking about, is these people who go in and get a 90-day supply of oxycontin and hit the street-selling them for $10+/pill.  How difficult is it, really, to be productive?  I came from NOTHING.  We were POOR.  

I understand that everyone's situation is different, but it's very frustrating.


----------



## geauxtohell

Quantum Windbag said:


> Would you like to bet on that? If no one is get in trouble for the legitimate use of painkillers why are doctors offices being raided? Why are pain patients in prison for using prescription medications?
> 
> Port Townsend clinic reopens after search by drug agents -- Port Angeles Port Townsend Sequim Forks Jefferson County Clallam County Olympic Peninsula Daily news
> 
> Punishing Pain - New York Times
> 
> The problem with your statement is that the government has a different idea of a legitimate need than some doctors, and juries tend to side with the government in cases like the ones above. You are a doctor, you need to educate yourself on the realities of government response to prescriptions for narcotics before you end up being forced to chose between lying about a patient and going to prison. The evidence does not support your naive trust in being right.



If that link was supposed to be persuasive, it probably wasn't the best example as that physician hasn't been charged with anything and it appears the raid was unfruitful.  

As for the second link, it's more of an example of how stupid mandatory sentencing is for drug crimes.  The patient in question maintains that he didn't forge scripts (a felony), the prosecution managed to convince a jury of his peers that he did.  I am not going to simply accept OPED that the physician lied under oath.  Sorry.  

For the first link, if you hold yourself to be a "pain specialist" and prescribe narcotics, you know you are going to be under the microscope by the DEA.  It's the cost of doing business.  Most medications aren't monitored by the DEA, so if you choose to deal in pain management, you accept that the DEA is going to be up your keester with a microscope.  

Of course, if there weren't well established patterns of wrong doing by physicians and patients for medications that are chemically the same as heroin, then the DEA probably wouldn't care.  

http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf

As for me, after four years as a student, I have seen more patient scams to get narcotics then I can imagine.  From the patient who complained of massive belly pain to the point of crying on physical exam (and then walked out of the hospital tear-free when told she wouldn't get narcotic pain pills) to the "I am allergic to everything but dilaudid" canard to loath narcotics.  They have their place, unfortunately, about a decade of over prescribing them as a whole by the health care community "Pain, the 5th vital sign", there are some real bad actors in the world.

Underlying any physicians actions is (or should be) what is best for the patient - and not fear of legal sanction.  Over prescribing pain pills is bad medicine.


----------



## geauxtohell

mskafka said:


> Prick their finger to drip blood into their urine?  What the hell is wrong with these fucking people?  PLEASE!  I'll trade my health for yours.



Yep.  



> Let me ski, rock-climb, hike, rappel, kayak...etc...  These things will either be challenging, or impossible, now. And some people can't get past their next fix.



They are just junkies.  I like heroin addicts better.  IMO, they are at least honest about their smack addiction.


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> Would you like to bet on that? If no one is get in trouble for the legitimate use of painkillers why are doctors offices being raided? Why are pain patients in prison for using prescription medications?
> 
> Port Townsend clinic reopens after search by drug agents -- Port Angeles Port Townsend Sequim Forks Jefferson County Clallam County Olympic Peninsula Daily news
> 
> Punishing Pain - New York Times
> 
> The problem with your statement is that the government has a different idea of a legitimate need than some doctors, and juries tend to side with the government in cases like the ones above. You are a doctor, you need to educate yourself on the realities of government response to prescriptions for narcotics before you end up being forced to chose between lying about a patient and going to prison. The evidence does not support your naive trust in being right.
> 
> 
> 
> 
> If that link was supposed to be persuasive, it probably wasn't the best example as that physician hasn't been charged with anything and it appears the raid was unfruitful.
> 
> As for the second link, it's more of an example of how stupid mandatory sentencing is for drug crimes.  The patient in question maintains that he didn't forge scripts (a felony), the prosecution managed to convince a jury of his peers that he did.  I am not going to simply accept OPED that the physician lied under oath.  Sorry.
> 
> For the first link, if you hold yourself to be a "pain specialist" and prescribe narcotics, you know you are going to be under the microscope by the DEA.  It's the cost of doing business.  Most medications aren't monitored by the DEA, so if you choose to deal in pain management, you accept that the DEA is going to be up your keester with a microscope.
> 
> Of course, if there weren't well established patterns of wrong doing by physicians and patients for medications that are chemically the same as heroin, then the DEA probably wouldn't care.
> 
> http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf
> 
> As for me, after four years as a student, I have seen more patient scams to get narcotics then I can imagine.  From the patient who complained of massive belly pain to the point of crying on physical exam (and then walked out of the hospital tear-free when told she wouldn't get narcotic pain pills) to the "I am allergic to everything but dilaudid" canard to loath narcotics.  They have their place, unfortunately, about a decade of over prescribing them as a whole by the health care community "Pain, the 5th vital sign", there are some real bad actors in the world.
> 
> Underlying any physicians actions is (or should be) what is best for the patient - and not fear of legal sanction.  Over prescribing pain pills is bad medicine.
Click to expand...


You think the raid was unfruitful? I am willing to bet you that, after the government seized all his patient records, he was unable to actually treat them, and that he lost at least half his patients who, understandably, do not want the government prying into their health. The raid was nothing more than intimidation, and its sole intent was make sure the doctor got the message that treating patients for pain is a risky business.

How is the second link an indication of mandatory sentencing? Did I miss something in the article that talked about prior drug convictions? He was getting pain meds for personal use, the government got his doctor to lie on the stand, and he went to prison for selling drugs. By the way, if you think the doctor was not lying you will have to convince me that the pharmacist, knowing that federal and state laws would hold him responsible for giving to many prescriptions for opiates to a customer never called the doctor to verify them. I only had one prescription for 20 pills, non refillable, and they verified it. 

Do some doctors and patients abuse the system?

Yes.

Does that justify the government restricting everyone?

No.


----------



## merrill

You may well be underinsured in which case the medical insurance people could be saying no. 

Are these pain controllers expensive? 

Pain management can be expensive as well.

Do you have full 24/7 medical insurance coverage no co-pays/no deductibles etc etc etc.

This may be where the problem lies?

If it is a insurance coverage situation going to the ER may be the option. If I were experiencing your level of pain the ER would be my choice STAT!


----------



## Gagafritz

Once you need pain pills even for a legitamite medical condition, you become labeled as a drug seeking ahole addict.  Doesn't matter that you need them to get up and function, that it allows you to continue to be a contributing member to society or whatever.  There is a lot of phony lip service give to pain management.  And, some types of pain seem more real or legitimate than others.  If you have fibromyaligia or other type of harder to pin down pain , then it must not be real cuz other people have never experienced.  It is pretty obvious why we have rampant alcohol and drug addiction in this country because many people are just trying to do whatever they can do to suffer through the day.  Even billionaire Michael Jackson couldn't find relief for his condition without going to drastic extremes.  if someone would have truly helped him medically deal with his condition and given him adequate and proper medication he would still be here today as well.  I can see where people just give up and find solace in the bottom of a bottle.  Sad but reality.


----------



## geauxtohell

Quantum Windbag said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Quantum Windbag said:
> 
> 
> 
> Would you like to bet on that? If no one is get in trouble for the legitimate use of painkillers why are doctors offices being raided? Why are pain patients in prison for using prescription medications?
> 
> Port Townsend clinic reopens after search by drug agents -- Port Angeles Port Townsend Sequim Forks Jefferson County Clallam County Olympic Peninsula Daily news
> 
> Punishing Pain - New York Times
> 
> The problem with your statement is that the government has a different idea of a legitimate need than some doctors, and juries tend to side with the government in cases like the ones above. You are a doctor, you need to educate yourself on the realities of government response to prescriptions for narcotics before you end up being forced to chose between lying about a patient and going to prison. The evidence does not support your naive trust in being right.
> 
> 
> 
> 
> If that link was supposed to be persuasive, it probably wasn't the best example as that physician hasn't been charged with anything and it appears the raid was unfruitful.
> 
> As for the second link, it's more of an example of how stupid mandatory sentencing is for drug crimes.  The patient in question maintains that he didn't forge scripts (a felony), the prosecution managed to convince a jury of his peers that he did.  I am not going to simply accept OPED that the physician lied under oath.  Sorry.
> 
> For the first link, if you hold yourself to be a "pain specialist" and prescribe narcotics, you know you are going to be under the microscope by the DEA.  It's the cost of doing business.  Most medications aren't monitored by the DEA, so if you choose to deal in pain management, you accept that the DEA is going to be up your keester with a microscope.
> 
> Of course, if there weren't well established patterns of wrong doing by physicians and patients for medications that are chemically the same as heroin, then the DEA probably wouldn't care.
> 
> http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf
> 
> As for me, after four years as a student, I have seen more patient scams to get narcotics then I can imagine.  From the patient who complained of massive belly pain to the point of crying on physical exam (and then walked out of the hospital tear-free when told she wouldn't get narcotic pain pills) to the "I am allergic to everything but dilaudid" canard to loath narcotics.  They have their place, unfortunately, about a decade of over prescribing them as a whole by the health care community "Pain, the 5th vital sign", there are some real bad actors in the world.
> 
> Underlying any physicians actions is (or should be) what is best for the patient - and not fear of legal sanction.  Over prescribing pain pills is bad medicine.
> 
> Click to expand...
> 
> 
> You think the raid was unfruitful? I am willing to bet you that, after the government seized all his patient records, he was unable to actually treat them, and that he lost at least half his patients who, understandably, do not want the government prying into their health. The raid was nothing more than intimidation, and its sole intent was make sure the doctor got the message that treating patients for pain is a risky business.
> 
> How is the second link an indication of mandatory sentencing? Did I miss something in the article that talked about prior drug convictions? He was getting pain meds for personal use, the government got his doctor to lie on the stand, and he went to prison for selling drugs. By the way, if you think the doctor was not lying you will have to convince me that the pharmacist, knowing that federal and state laws would hold him responsible for giving to many prescriptions for opiates to a customer never called the doctor to verify them. I only had one prescription for 20 pills, non refillable, and they verified it.
> 
> Do some doctors and patients abuse the system?
> 
> Yes.
> 
> Does that justify the government restricting everyone?
> 
> No.
Click to expand...


Did you read either article?  The first article was about how the clinic was back in business a few days after the raid.  The second article noted that the man was sentenced to 28 years due to mandatory sentencing guidelines for anyone with over 28 grams of painkillers.  

In the second case, it only works if you buy the statement that the physician lied and the patient did not falsify scripts.  That's a leap of faith.  You can make it if you want, but it's hardly a "slam dunk" for what you are arguing.  I am not going to try to convince you of anything.  A jury has already decided this case.  I am just pointing out that this is a house of cards.  There are plenty of people who "never broke the law" or "never tried drugs" or "never touched alcohol" who get in deep with prescription narcotics.  I am sure this guy was in obvious pain.  That doesn't mean he should get whatever he wants when it comes to pain pills.  You see one side to this story, I read between the lines and see another based on the patients I have dealt with.  Who knows what the truth is.  

The nature of the drugs and their addictive nature, coupled with their ability to kill people, makes government restriction practical.  However, if you think the DEA is preventing patients from getting narcotics, you haven't been around healthcare in this country.  

I think Oxycotin is #3 on the "most prescribed list".


----------



## hortysir

Florida's definition of a "Pain Management" doctor is someone that's 60-75 miles away that has a higher co-pay.
No refills, so you get to make the trip every month.


----------



## geauxtohell

Gagafritz said:


> Once you need pain pills even for a legitamite medical condition, you become labeled as a drug seeking ahole addict.  Doesn't matter that you need them to get up and function, that it allows you to continue to be a contributing member to society or whatever.  There is a lot of phony lip service give to pain management.  And, some types of pain seem more real or legitimate than others.  If you have fibromyaligia or other type of harder to pin down pain , then it must not be real cuz other people have never experienced.  It is pretty obvious why we have rampant alcohol and drug addiction in this country because many people are just trying to do whatever they can do to suffer through the day.  Even billionaire Michael Jackson couldn't find relief for his condition without going to drastic extremes.  if someone would have truly helped him medically deal with his condition and given him adequate and proper medication he would still be here today as well.  I can see where people just give up and find solace in the bottom of a bottle.  Sad but reality.



Not quite.  Women get narcotics after vaginal or cesarian delivery.  People with broken bones get narcotics.  People who get wisdom teeth extracted get narcotics.  None of these people are "drug seekers".  Narcotics work well for acute issues where pain control is needed as the body mends itself.  

People become "drug seekers" when they become convinced that chronic conditions (baring certain conditions like sickle cell anemia) can only be managed through narcotics.  After a while, there is no differentiation between organic pain and the pain that comes with withdrawal.   There are two parts to this equation.  One side is a doctor who enables it.  The other side is the patient that either lacks the motivation or desire to try and get "better" however that might be.

You referenced fibromyalgia.  Guess what is emerging as a mainline treatment to fibromyalgia and has the best treatment results in the evidence based literature?

Antidepressants.  Go figure.....

http://www.fmcfs.ca/FMresearch-abstracts-2009.pdf

And yet, the "mean doctors" are lambasted by fibromyalgia patients when they don't want to give them a sedative to control their condition that keeps them on the couch as it stands in favor of trying something that actually works.  

As for Jackson....  He was a addict.  If you need propofol (a powerful anesthetic that should only be administered in a hospital when a patient is on a monitor and intubated) to sleep, you have real problems.  These are most likely psychiatric problems at root (and addiction is a psychiatric problem) and not some overt pathology.  The root of his problem wasn't his pain or his inability to sleep.  It was his underlying addictions.  His doctor was a quack too (he was a cardiologist) and deserved what he got for such malpractice.  He wasn't trying to "help" Jackson.  He was doing it for the outragious sums of money.  I would be willing to bet that Doctor Murrey wouldn't have been willing to try his unique insomnia treatment on a regular person with regular insurance.


----------



## geauxtohell

hortysir said:


> Florida's definition of a "Pain Management" doctor is someone that's 60-75 miles away that has a higher co-pay.
> No refills, so you get to make the trip every month.



And someone that won't treat a patient that doesn't have insurance.  I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.  

Classy.


----------



## hortysir

geauxtohell said:


> hortysir said:
> 
> 
> 
> Florida's definition of a "Pain Management" doctor is someone that's 60-75 miles away that has a higher co-pay.
> No refills, so you get to make the trip every month.
> 
> 
> 
> 
> And someone that won't treat a patient that doesn't have insurance.  I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.
> 
> Classy.
Click to expand...


That's where the drug-seeking-addict label comes from, tho....

My daughter has Fybro and no insurance.
She has share-cost medicaid but no income.
Sometimes the only way she can meet her share of cost is to go to the ER.

Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.


----------



## geauxtohell

hortysir said:


> geauxtohell said:
> 
> 
> 
> 
> 
> hortysir said:
> 
> 
> 
> Florida's definition of a "Pain Management" doctor is someone that's 60-75 miles away that has a higher co-pay.
> No refills, so you get to make the trip every month.
> 
> 
> 
> 
> And someone that won't treat a patient that doesn't have insurance.  I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.
> 
> Classy.
> 
> Click to expand...
> 
> 
> That's where the drug-seeking-addict label comes from, tho....
> 
> My daughter has Fybro and no insurance.
> She has share-cost medicaid but no income.
> Sometimes the only way she can meet her share of cost is to go to the ER.
> 
> Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.
Click to expand...


I don't dispute that she has chronic pain.  I dispute that narcotic pain pills are the best treatment for her chronic pain.  

Show me the evidence based literature that disputes that, and I will take a look.


----------



## Quantum Windbag

geauxtohell said:


> hortysir said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> And someone that won't treat a patient that doesn't have insurance.  I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.
> 
> Classy.
> 
> 
> 
> 
> That's where the drug-seeking-addict label comes from, tho....
> 
> My daughter has Fybro and no insurance.
> She has share-cost medicaid but no income.
> Sometimes the only way she can meet her share of cost is to go to the ER.
> 
> Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.
> 
> Click to expand...
> 
> 
> I don't dispute that she has chronic pain.  I dispute that narcotic pain pills are the best treatment for her chronic pain.
> 
> Show me the evidence based literature that disputes that, and I will take a look.
Click to expand...


What works better? Massage? Acupuncture?


----------



## hortysir

geauxtohell said:


> hortysir said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> And someone that won't treat a patient that doesn't have insurance.  I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.
> 
> Classy.
> 
> 
> 
> 
> That's where the drug-seeking-addict label comes from, tho....
> 
> My daughter has Fybro and no insurance.
> She has share-cost medicaid but no income.
> Sometimes the only way she can meet her share of cost is to go to the ER.
> 
> Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.
> 
> Click to expand...
> 
> 
> I don't dispute that she has chronic pain.  I dispute that narcotic pain pills are the best treatment for her chronic pain.
> 
> Show me the evidence based literature that disputes that, and I will take a look.
Click to expand...



She's willing to try anything that works.
it's just that when you show up at the ER asking for something for pain there's that "look".
Sometimes there's a rude dismissal to go along with it......


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> If that link was supposed to be persuasive, it probably wasn't the best example as that physician hasn't been charged with anything and it appears the raid was unfruitful.
> 
> As for the second link, it's more of an example of how stupid mandatory sentencing is for drug crimes.  The patient in question maintains that he didn't forge scripts (a felony), the prosecution managed to convince a jury of his peers that he did.  I am not going to simply accept OPED that the physician lied under oath.  Sorry.
> 
> For the first link, if you hold yourself to be a "pain specialist" and prescribe narcotics, you know you are going to be under the microscope by the DEA.  It's the cost of doing business.  Most medications aren't monitored by the DEA, so if you choose to deal in pain management, you accept that the DEA is going to be up your keester with a microscope.
> 
> Of course, if there weren't well established patterns of wrong doing by physicians and patients for medications that are chemically the same as heroin, then the DEA probably wouldn't care.
> 
> http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf
> 
> As for me, after four years as a student, I have seen more patient scams to get narcotics then I can imagine.  From the patient who complained of massive belly pain to the point of crying on physical exam (and then walked out of the hospital tear-free when told she wouldn't get narcotic pain pills) to the "I am allergic to everything but dilaudid" canard to loath narcotics.  They have their place, unfortunately, about a decade of over prescribing them as a whole by the health care community "Pain, the 5th vital sign", there are some real bad actors in the world.
> 
> Underlying any physicians actions is (or should be) what is best for the patient - and not fear of legal sanction.  Over prescribing pain pills is bad medicine.
> 
> 
> 
> 
> You think the raid was unfruitful? I am willing to bet you that, after the government seized all his patient records, he was unable to actually treat them, and that he lost at least half his patients who, understandably, do not want the government prying into their health. The raid was nothing more than intimidation, and its sole intent was make sure the doctor got the message that treating patients for pain is a risky business.
> 
> How is the second link an indication of mandatory sentencing? Did I miss something in the article that talked about prior drug convictions? He was getting pain meds for personal use, the government got his doctor to lie on the stand, and he went to prison for selling drugs. By the way, if you think the doctor was not lying you will have to convince me that the pharmacist, knowing that federal and state laws would hold him responsible for giving to many prescriptions for opiates to a customer never called the doctor to verify them. I only had one prescription for 20 pills, non refillable, and they verified it.
> 
> Do some doctors and patients abuse the system?
> 
> Yes.
> 
> Does that justify the government restricting everyone?
> 
> No.
> 
> Click to expand...
> 
> 
> Did you read either article?  The first article was about how the clinic was back in business a few days after the raid.  The second article noted that the man was sentenced to 28 years due to mandatory sentencing guidelines for anyone with over 28 grams of painkillers.
> 
> In the second case, it only works if you buy the statement that the physician lied and the patient did not falsify scripts.  That's a leap of faith.  You can make it if you want, but it's hardly a "slam dunk" for what you are arguing.  I am not going to try to convince you of anything.  A jury has already decided this case.  I am just pointing out that this is a house of cards.  There are plenty of people who "never broke the law" or "never tried drugs" or "never touched alcohol" who get in deep with prescription narcotics.  I am sure this guy was in obvious pain.  That doesn't mean he should get whatever he wants when it comes to pain pills.  You see one side to this story, I read between the lines and see another based on the patients I have dealt with.  Who knows what the truth is.
> 
> The nature of the drugs and their addictive nature, coupled with their ability to kill people, makes government restriction practical.  However, if you think the DEA is preventing patients from getting narcotics, you haven't been around healthcare in this country.
> 
> I think Oxycotin is #3 on the "most prescribed list".
Click to expand...


I can cite hundreds of cases where the feds have harassed doctors and patient pain advocates. Just because you can find a rationalization for two of them does not mean that there is not a problem.

[ame=http://www.youtube.com/watch?v=0PqfXc4XtXM]Will The Feds Ban Your Pain Meds? - YouTube[/ame]


----------



## Gagafritz

Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?


----------



## Quantum Windbag

Gagafritz said:


> Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?



The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.


----------



## Gagafritz

I don't dispute that she has chronic pain. I dispute that narcotic pain pills are the best treatment for her chronic pain.

Show me the evidence based literature that disputes that, and I will take a look.

I think we can show you plenty of evidence that opioids treat pain.  As for chronic pain, there are many components to chronic pain which can also include acute pain.  Just because it is chronic doesn't mean that there isn't acute pain involved that is amenable somewhat to opioids and acute pain type treatments.  Sheesh.


----------



## Kooshdakhaa

mskafka said:


> Kooshdakhaa said:
> 
> 
> 
> I think you should go to the pain clinic.  What's your problem with the pain clinic?
> 
> That's the purpose of a pain clinic...managing pain.  You should at least give it a try.
> 
> What happens with other people suffering from MS?  Do they also have pain?  How is it treated?  Sounds like a forum for people with MS might provide you with some help and answers.  Maybe?
> 
> 
> 
> 
> There is a stigma attached to pain clinics.  I'm just recalling how many people I've intubated and treated from OD's from pain clinics.  In THIS state, they are considered legal drug pushers; and this area....not very highly respected.
> 
> I have and do belong to an MS forum/chat.  The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue.  I'm here, because this to me, is a political issue.  And because I belonged to this forum LONG before I was diagnosed with MS.
> 
> And yes, I'm totally with Ron Paul on the "War on Drugs".  I believe it has been a disaster.  Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).
> 
> And no, it's not constant pain.  But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore.  This makes perfect sense to me.
> 
> Now there is constant numbness in certain areas, but pain?  Only after a flare.  And it sux.
Click to expand...


Wait...you were saying you wanted pain pills.  And now you're saying the trouble with pain clinics is they give people too many pain pills, to the point that they OD?  What do you care what other people think, the stigma of pain clinics?  If you want pain pills, sounds like you should go to the pain clinic.  Sounds like you have a medical background, you should be able to properly handle the pills they give you and not OD.  Doesn't it seem?


----------



## Sarah G

mskafka said:


> lizzie said:
> 
> 
> 
> I don't blame you Mr H. Fentanyl is one of the drugs that I will refuse to give IV on the floor where I work. I've seen too many patients start declining toward respiratory distress on that crap.
> 
> Now, on the issue of the federal mandate, the latest one I see was in 2007. What were you asking for (specifically) that your doctors wouldn't give you?
> 
> 
> 
> 
> I asked for 10 pain pills.  I told them I didn't care...tylenol 3, ultram, lortab (the weakest strength)....or something other than the 3200+ mg ibuprofen that I was taking daily.  I told them that I didn't feel like adding dialysis to my problems.
Click to expand...


Ok, I was going to ask why not take 3 or4 Advil.


----------



## Sarah G

Kooshdakhaa said:


> I think you should go to the pain clinic.  What's your problem with the pain clinic?
> 
> That's the purpose of a pain clinic...managing pain.  You should at least give it a try.
> 
> What happens with other people suffering from MS?  Do they also have pain?  How is it treated?  Sounds like a forum for people with MS might provide you with some help and answers.  Maybe?



I so agree with you.  You get on pain medication and they only work for a short time anyway.  Pain clinics do help manage pain, I realize I know absolutely nothing about what the OP is going through right now but it just seems like a better way to go.


----------



## Kooshdakhaa

Last time I had any pain pills was when I had a root canal.  I got the prescription filled and then read the warnings.  No way would I take those pain pills after I read the possible side effects.  Called the dentist and told him.  He said I needed to take them for the inflammation.  I said what about Bayer aspirin.  He said okay, so that's what I took.  Put the pain pills in my emergency survival kit.

However, the pain wasn't that bad.  If a person is in a lot of pain they deserve to have relief.  That is for sure.  But rather than take those nasty pain pills my whole life I would sure be exploring other ways of managing pain. Someone I knew was paralyzed from the waist down, yet he had terrible pain in his legs.  Ghost pain, I guess, but very real to him.  He told me that out of desperation he had finally learned to block the pain out of his mind.  What power that would give a person, if they could learn to block pain that way.  Much better than pain pills.


----------



## Gagafritz

You wouldn't take a pain pill because you read the nasty side effects?  Do you not think there are side effects and reactions to every medication in the world?  Tylenol has caused liver failure.  No drug is benign.  Nsaids can cause kidney failure and opioids may be a better choice for long term use.  As for mind over matter, yes there is a component of pyschology involved in pain.  But, pain is real and to not treat it is inhumane.  You wouldn't tell someone who just had a limb amputated to just suck it up and think away the pain.  But, for a lot of pain syndromes you cannot see the pain but that doesn't make it less real.  Just because some people get addicted isn't a reason to stop giving people pain medication or doling it out without people getting the proper effect.


----------



## Kooshdakhaa

Gagafritz said:


> You wouldn't take a pain pill because you read the nasty side effects?  Do you not think there are side effects and reactions to every medication in the world?  Tylenol has caused liver failure.  No drug is benign.  Nsaids can cause kidney failure and opioids may be a better choice for long term use.  As for mind over matter, yes there is a component of pyschology involved in pain.  But, pain is real and to not treat it is inhumane.  You wouldn't tell someone who just had a limb amputated to just suck it up and think away the pain.  But, for a lot of pain syndromes you cannot see the pain but that doesn't make it less real.  Just because some people get addicted isn't a reason to stop giving people pain medication or doling it out without people getting the proper effect.



I believe people should be given all the pain meds they need. 

In my case, however, I avoid taking all medications and drugs whenever possible.  As it turned out, the pain meds the dentist prescribed for my root canal were totally unnecessary...all I needed was a couple of Bayer aspirin.  And I only needed that for a day or so, which is good because I don't even like taking aspirin.  Will not take Tylenol.  So why take prescription pain pills with all those risks of side effects?  Hmmm?  The side effects were not just nuisances...they were baaaaad side effects.  Not worth it for pain pills that weren't even necessary.

I like watching out for myself.  Obviously the dentist wasn't.  He just mindlessly wrote a prescripton that I didn't even need.  A prescription for some pretty bad shit.


----------



## Gagafritz

That is you and your opinion.  There are people who have pain after a root canal.  People have different levels and thresholds of pain.  Just because you didn't have pain doesn't make someone else's pain less legitimate.


----------



## Gagafritz

I thought i could "hee hee hoo hoo" through childbirth as well.  Well,  after 5 cm or so screaming seemed like the thing to do.


----------



## Gagafritz

I also take issue with the "i am tougher than you are " kind of thing when it comes to pain.  As if someone is being a wimp or something if they need pain medication.  Maybe people are wimps for needing cholesterol meds, BP meds, diabetes meds.  Maybe they should just toughen up a bit?


----------



## Kooshdakhaa

Gagafritz said:


> I also take issue with the "i am tougher than you are " kind of thing when it comes to pain.  As if someone is being a wimp or something if they need pain medication.  Maybe people are wimps for needing cholesterol meds, BP meds, diabetes meds.  Maybe they should just toughen up a bit?



Most people who take cholesterol, BP and diabetes meds could have avoided them through healthy lifestyle.  And may even be able to get off those meds through healthy lifestyle.

I thought I had high blood pressure a couple of years ago and immediately went on a diet.  Not meds.  A diet.  Turns out I had a faulty blood pressure cuff, not high blood pressure.  But my first reaction was to go on a diet, because I wanted to avoid medications if at all possible.

I don't really care what other people do and I don't think I'm tougher than other people.  I would be the first person screaming bloody murder if someone I cared about was in pain and the doctors did nothing to help them.  Personally, I've never seen that happen.  Any family or friends I've known to be in pain had no trouble getting the help with the pain that they needed.

I actually thought medical people were obligated to treat pain.  I thought it was a law.  If not, it should be.  People should not have to suffer pain.  It's not necessary.  I choose to suffer small pain rather than immediately take aspirin.  The pain usually ends up going away on its own.  But if I was in severe pain, I would expect some help with it.  I would consider it a right.  

Obviously, I think other people have the same right.

But I can also understand the dilemma doctors must face when the possibility of patients becoming dependent on the pain meds exists.  They need to monitor that and make sure the patients aren't asking for pain meds even after the pain is gone.

For terminal cancer, etc. who cares.  Give them all the meds they want.  What difference does it make if they become addicted?


----------



## Gagafritz

OK.  And, there is a balance of things.  And, there are people who want medication for everything and anything and times when we need to learn to tough some things out as well.  I agree.


----------



## Kooshdakhaa

Gagafritz said:


> I thought i could "hee hee hoo hoo" through childbirth as well.  Well,  after 5 cm or so screaming seemed like the thing to do.



Haha...see, now you know the secret.  If I ever really, really need pain meds I will gladly resort to screaming if that's what it takes. : )


----------



## Kooshdakhaa

Gagafritz said:


> That is you and your opinion.  There are people who have pain after a root canal.  People have different levels and thresholds of pain.  Just because you didn't have pain doesn't make someone else's pain less legitimate.



P.S.  I DID have some pain after my root canal.  But the pain was temporary and tolerable, the possible damage to my heart and other side effects from the pain pills would have been permanent.

But you're right, people have different levels and thresholds.  I don't have an issue with people who take prescription pain pills when they need them.  It is just my own personal choice to avoid them if I can.

Pain gets bad enough, I'll take them too!

Well, I'm going to bed.   Don't need sleeping pills.  I have warm, snoring dogs...they make me sleep like a baby. : )


----------



## Gagafritz

Kooshdakhaa said:


> Gagafritz said:
> 
> 
> 
> I thought i could "hee hee hoo hoo" through childbirth as well.  Well,  after 5 cm or so screaming seemed like the thing to do.
> 
> 
> 
> 
> Haha...see, now you know the secret.  If I ever really, really need pain meds I will gladly resort to screaming if that's what it takes. : )
Click to expand...



Well, that didn't work for me.  I wasn't allowed to have any pain meds as a VBAC.


----------



## Douger

Sorry to hear that Muskafa.
Tennessee huh ? Isn't that where Jesus was born ?
It's the heart of murka and drugs is only fer them thar pussies and demoNrats.
Try another state or better yet, go to a country where you'll be treated like an adult. I can walk in a farmacia and get you a basket full of goodies for 1/10 of what your "Chosen" are charging you. The only "permission' I need is a wallet and be tall enough to see over the counter.


----------



## geauxtohell

Quantum Windbag said:


> geauxtohell said:
> 
> 
> 
> 
> 
> hortysir said:
> 
> 
> 
> That's where the drug-seeking-addict label comes from, tho....
> 
> My daughter has Fybro and no insurance.
> She has share-cost medicaid but no income.
> Sometimes the only way she can meet her share of cost is to go to the ER.
> 
> Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.
> 
> 
> 
> 
> I don't dispute that she has chronic pain.  I dispute that narcotic pain pills are the best treatment for her chronic pain.
> 
> Show me the evidence based literature that disputes that, and I will take a look.
> 
> Click to expand...
> 
> 
> What works better? Massage? Acupuncture?
Click to expand...


SSRIs, gaba analogues like lyrica and NSAIDs (which are anti-inflammatory), all of which are supported by the literature as being much more effective than narcotics.  Believe it or not, pain control doesn't begin and end with narcotic pain control.  

In fact, before they came onto the market in pill form in the early 90s, people, in fact, did not die of pain.


----------



## geauxtohell

hortysir said:


> geauxtohell said:
> 
> 
> 
> 
> 
> hortysir said:
> 
> 
> 
> That's where the drug-seeking-addict label comes from, tho....
> 
> My daughter has Fybro and no insurance.
> She has share-cost medicaid but no income.
> Sometimes the only way she can meet her share of cost is to go to the ER.
> 
> Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.
> 
> 
> 
> 
> I don't dispute that she has chronic pain.  I dispute that narcotic pain pills are the best treatment for her chronic pain.
> 
> Show me the evidence based literature that disputes that, and I will take a look.
> 
> Click to expand...
> 
> 
> 
> She's willing to try anything that works.
> it's just that when you show up at the ER asking for something for pain there's that "look".
> Sometimes there's a rude dismissal to go along with it......
Click to expand...


No offense, but that's because she is misusing the EMERGENCY room as a primary care center.  That pisses off every EM physician.  

In doing so, she is putting the EM doctor in an untenable condition:  Let her leave while suffering or be force to mismanage her medical condition with narcotics.  Since EM doctors don't have their own patients and don't do follow up, they aren't going to start her on a long term medication like an SSRI or pregabalin.  

Your daughter needs to establish care with a primary care physician for long term management of her chronic condition so that it can be adequately managed.  Since EM physicians are required by law to give patients a follow up appointment with a PCP, I can't imagine they haven't tried to do this.


----------



## geauxtohell

Quantum Windbag said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Quantum Windbag said:
> 
> 
> 
> You think the raid was unfruitful? I am willing to bet you that, after the government seized all his patient records, he was unable to actually treat them, and that he lost at least half his patients who, understandably, do not want the government prying into their health. The raid was nothing more than intimidation, and its sole intent was make sure the doctor got the message that treating patients for pain is a risky business.
> 
> How is the second link an indication of mandatory sentencing? Did I miss something in the article that talked about prior drug convictions? He was getting pain meds for personal use, the government got his doctor to lie on the stand, and he went to prison for selling drugs. By the way, if you think the doctor was not lying you will have to convince me that the pharmacist, knowing that federal and state laws would hold him responsible for giving to many prescriptions for opiates to a customer never called the doctor to verify them. I only had one prescription for 20 pills, non refillable, and they verified it.
> 
> Do some doctors and patients abuse the system?
> 
> Yes.
> 
> Does that justify the government restricting everyone?
> 
> No.
> 
> 
> 
> 
> Did you read either article?  The first article was about how the clinic was back in business a few days after the raid.  The second article noted that the man was sentenced to 28 years due to mandatory sentencing guidelines for anyone with over 28 grams of painkillers.
> 
> In the second case, it only works if you buy the statement that the physician lied and the patient did not falsify scripts.  That's a leap of faith.  You can make it if you want, but it's hardly a "slam dunk" for what you are arguing.  I am not going to try to convince you of anything.  A jury has already decided this case.  I am just pointing out that this is a house of cards.  There are plenty of people who "never broke the law" or "never tried drugs" or "never touched alcohol" who get in deep with prescription narcotics.  I am sure this guy was in obvious pain.  That doesn't mean he should get whatever he wants when it comes to pain pills.  You see one side to this story, I read between the lines and see another based on the patients I have dealt with.  Who knows what the truth is.
> 
> The nature of the drugs and their addictive nature, coupled with their ability to kill people, makes government restriction practical.  However, if you think the DEA is preventing patients from getting narcotics, you haven't been around healthcare in this country.
> 
> I think Oxycotin is #3 on the "most prescribed list".
> 
> Click to expand...
> 
> 
> I can cite hundreds of cases where the feds have harassed doctors and patient pain advocates. Just because you can find a rationalization for two of them does not mean that there is not a problem.
> 
> [ame=http://www.youtube.com/watch?v=0PqfXc4XtXM]Will The Feds Ban Your Pain Meds? - YouTube[/ame]
Click to expand...


You did? 

At any rate, I found holes in the two examples you provided.  There are usually holes.  As I said, if you think the DEA is preventing patients from getting narcotics, you are not aware of the reality of the situation.  The DEA tries to focus on the "worst case scenarios".  Most patients, even the bad actors, get their fix.


----------



## geauxtohell

Gagafritz said:


> Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?



Did it ever occur to you that someone that will go into a dangerous part of town in the middle of the night to score has an addiction.  

Did it ever occur to you that EDs are, in fact, not Pain Management centers?  

Did it ever occur to you that the reason triage exists so that people that have actual emergent medical conditions go straight back and jump over the people who are just there for pain control and other trivial complaints that clog up the system?  (I once saw someone wait for 8 hours to be seen for "insomnia".  

Don't take my word for it:

Treating a Nation of Anxious Wimps

Have you ever seen someone withdraw from opiates?  Guess what?  They are in extreme pain.  I've seen people with gunshot wounds in less pain.  Ain't that a bitch?  Withdrawal causes the exact symptom you are treating.  Which means, after a point, you aren't actually treating the underlying condition, you are treating withdrawal.  

Wow.  We just went down the rabbit hole.  

It's almost like the physicians who refuse to feed addictions are actually trying to do what is best for their patients.


----------



## MikeK

I have a spinal condition (cervical stenosis) which makes falling asleep and staying asleep virtually impossible because of pressure on the spinal cord.  I've been taking 5mg. Percocet twice during the night (to fall asleep and stay asleep) for the past two years.  I recently switched to Vicodin because it works faster (but doesn't last as long).  

The reason my GP is willing to prescribe so readily is I'm 75 years old and my condition was confirmed by MRI.  Otherwise, because of the DEA's mandates I would have to suffer or destroy my liver with excessive Tylenol.  

The American public is blind to the fact that the War on Drugs is wholly counterproductive and has become one of our Country's most serious problems.  Those who are inclined to drug addiction will become addicted to drugs regardless of any government efforts to prevent it.


----------



## Gagafritz

First, there are NO alternatives.  There are no house calls.  No middle of the night visit to the doctor's office.  No lower level care facilities for people to seek treatment at.  So, blaming the patient is Unfair.  In addition, a layperson does not know  a medical emergency from a pain in the ass which could also be a medical emergency.  You are expecting patients to diagnose and treat themselvles.  Unfair.  Going to the ER with heartburn and pain is a legitimate trip to the ER even if it is just gastritis.  So, laypeople know they don't feel good.  They don't know which ache, pain or symptom is a medical emergency and which is not.  If the health care system was REALLY interested in quelling, this, there would be 24 hour doc in a boxes and so for that were readily  available but that is really the case.  In addition, addiction and withdrawal can have severe life threatening consequences.  Yes, they may have created their own problem, but it is not the job of the ER doctor to begin detoxification and rehab unless the patient is put in a proper facility and level of care to do so.   There is alot of blaming the patient when clearly the health care system has not risen to meet these needs.


----------



## geauxtohell

Quantum Windbag said:


> The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.



1.)  I never said that people who want pain meds are "usually addicts".  
2.)  Addicts most certainly should not get "whatever they want".  There is no way in hell I am going to facilitate a patients early demise due to respiratory failure from opium or liver failure from the shit ton of tylenol they are co-ingesting.  What addicts should get is psychiatric help for managing their addiction as psychiatry is the only field of medicine that is trained to manage addiction.  The "less paternalistic" approach to medicine is all good and fine until patients start demanding you start doing things that are bad medicine.  Then it is time to put your foot down and say no.  
3.)  I personally would have no problem with using T3 for shingles.  Shingles sucks.  You are apparently not getting the difference between acute and chronic pain management.


----------



## geauxtohell

Gagafritz said:


> I don't dispute that she has chronic pain. I dispute that narcotic pain pills are the best treatment for her chronic pain.
> 
> Show me the evidence based literature that disputes that, and I will take a look.
> 
> I think we can show you plenty of evidence that opioids treat pain.  As for chronic pain, there are many components to chronic pain which can also include acute pain.  Just because it is chronic doesn't mean that there isn't acute pain involved that is amenable somewhat to opioids and acute pain type treatments.  Sheesh.



Of course opiods treat pain.  So do NSAIDs and a bullet to the head.  Obviously, along this spectrum of pain management, we can come up with a reasonable approach to pain management.  

What you are talking about is "breakthrough pain".  I am well aware of how pain management works.  Here is a good example of your example:  Sickle Cell Anemia is a genetic condition that causes severe pain.  Most people with it are in some degree of pain daily with the occasional vaso-occlusive crisis that causes severe and debilitating pain.  A reasonable approach to SCA pain management is scheduled long acting low dose narcotics with high dose narcotics for "breakthrough pain" and if that doesn't work, admission for IV dilaudid and hydration for pain control.  

For softer pathologies, as I said, show me the literature where narcotics are considered the first line treatment for chronic pain, and I will take a look.  You can save yourself the trouble, it isn't there.

This isn't just "my opinion", it's based on the evidence.

It's almost like a science or something.


----------



## geauxtohell

Kooshdakhaa said:


> Gagafritz said:
> 
> 
> 
> You wouldn't take a pain pill because you read the nasty side effects?  Do you not think there are side effects and reactions to every medication in the world?  Tylenol has caused liver failure.  No drug is benign.  Nsaids can cause kidney failure and opioids may be a better choice for long term use.  As for mind over matter, yes there is a component of pyschology involved in pain.  But, pain is real and to not treat it is inhumane.  You wouldn't tell someone who just had a limb amputated to just suck it up and think away the pain.  But, for a lot of pain syndromes you cannot see the pain but that doesn't make it less real.  Just because some people get addicted isn't a reason to stop giving people pain medication or doling it out without people getting the proper effect.
> 
> 
> 
> 
> I believe people should be given all the pain meds they need.
> 
> In my case, however, I avoid taking all medications and drugs whenever possible.  As it turned out, the pain meds the dentist prescribed for my root canal were totally unnecessary...all I needed was a couple of Bayer aspirin.  And I only needed that for a day or so, which is good because I don't even like taking aspirin.  Will not take Tylenol.  So why take prescription pain pills with all those risks of side effects?  Hmmm?  The side effects were not just nuisances...they were baaaaad side effects.  Not worth it for pain pills that weren't even necessary.
> 
> I like watching out for myself.  Obviously the dentist wasn't.  He just mindlessly wrote a prescripton that I didn't even need.  A prescription for some pretty bad shit.
Click to expand...


As tylenol and opiods have no anti-inflammatory properties, your intuition was correct.  NSAIDs are better for inflammation.

As for what you can tolerate personally, that is a personal decision.  Some people have higher pain tolerances than others and the point at which pain need to be treated is different for every person, and pain should be controlled to a reasonable point.

The issue is at what point does it become unreasonable.  It's reasonable to take narcotics for an acute pain event for a short term.  To take them for years and years is not reasonable.


----------



## geauxtohell

Gagafritz said:


> First, there are NO alternatives.  There are no house calls.  No middle of the night visit to the doctor's office.  No lower level care facilities for people to seek treatment at.  So, blaming the patient is Unfair.  In addition, a layperson does not know  a medical emergency from a pain in the ass which could also be a medical emergency.  You are expecting patients to diagnose and treat themselvles.  Unfair.  Going to the ER with heartburn and pain is a legitimate trip to the ER even if it is just gastritis.  So, laypeople know they don't feel good.  They don't know which ache, pain or symptom is a medical emergency and which is not.  If the health care system was REALLY interested in quelling, this, there would be 24 hour doc in a boxes and so for that were readily  available but that is really the case.  In addition, addiction and withdrawal can have severe life threatening consequences.  Yes, they may have created their own problem, but it is not the job of the ER doctor to begin detoxification and rehab unless the patient is put in a proper facility and level of care to do so.   There is alot of blaming the patient when clearly the health care system has not risen to meet these needs.



There are certainly alternatives.  If you think otherwise, you have fallen into the trap that narcotics are the only solutions.  I also didn't say it's unreasonable to go to the ER for pain.  For acute pain that arises out of the blue, there ought to be an underlying issue that caused the pain (I.E. "I rolled my ankle and think I might have broken it") which is completely reasonable to be assessed in the ED.  I said it's unreasonable to use the ED to manage chronic pain in the ED.  The kind of pain that doesn't pop up out of the blue.  For that, you need a PCP and should have the proper medication in your medicine cabinet.  

Withdrawing from opiods is not a life threatening event.  Alcohol is another situation.  That will kill people.  

Refusing to feed an addiction is in no way "detoxification" and the only physicians that can legally treat withdrawal are psychiatrists.  However that does not mean every other doctor has to feed an addiction.  It's a physician's license.  They get to decide what scripts they want to write and not write.  When it comes to "not writing" a script, they don't even need a good reason.  On the other hand, if a physician writes a narcotic script to "treat narcotic addiction" as the indication, then (unless they are a psychiatrist) they have broken the law.  

I am not blaming the patient only.  As I said, it's a two way street.


----------



## Quantum Windbag

Kooshdakhaa said:


> Last time I had any pain pills was when I had a root canal.  I got the prescription filled and then read the warnings.  No way would I take those pain pills after I read the possible side effects.  Called the dentist and told him.  He said I needed to take them for the inflammation.  I said what about Bayer aspirin.  He said okay, so that's what I took.  Put the pain pills in my emergency survival kit.
> 
> However, the pain wasn't that bad.  If a person is in a lot of pain they deserve to have relief.  That is for sure.  But rather than take those nasty pain pills my whole life I would sure be exploring other ways of managing pain. Someone I knew was paralyzed from the waist down, yet he had terrible pain in his legs.  Ghost pain, I guess, but very real to him.  He told me that out of desperation he had finally learned to block the pain out of his mind.  What power that would give a person, if they could learn to block pain that way.  Much better than pain pills.



Ever read about the side effects of aspirin?



> All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Aspirin:
> 
> Heartburn; nausea; upset stomach.
> 
> Seek medical attention right away if any of these SEVERE side effects occur when using Aspirin:
> Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; confusion; diarrhea; dizziness; drowsiness; hearing loss; ringing in the ears; severe or persistent stomach pain; unusual bruising; vomiting.
> 
> This is not a complete list of all side effects that may occur.



They are required to list side effects by law. You did not need the pills, which is great, but not taking them because you are afraid of a side effect is a bit like not leaving the house because people get hit by cars. IF you get one of them worry, otherwise take the pills if needed.


----------



## Quantum Windbag

Kooshdakhaa said:


> Gagafritz said:
> 
> 
> 
> I thought i could "hee hee hoo hoo" through childbirth as well.  Well,  after 5 cm or so screaming seemed like the thing to do.
> 
> 
> 
> 
> Haha...see, now you know the secret.  If I ever really, really need pain meds I will gladly resort to screaming if that's what it takes. : )
Click to expand...


I am like you. I rarely take pills, even aspirin. Funny thing though, when a doctor offered me a prescription for pain pills after my kidney stones I took it, those suckers hurt aqnd I wanted to be prepared. Hopefully, I won't need it, but I have it.


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> I don't dispute that she has chronic pain.  I dispute that narcotic pain pills are the best treatment for her chronic pain.
> 
> Show me the evidence based literature that disputes that, and I will take a look.
> 
> 
> 
> 
> What works better? Massage? Acupuncture?
> 
> Click to expand...
> 
> 
> SSRIs, gaba analogues like lyrica and NSAIDs (which are anti-inflammatory), all of which are supported by the literature as being much more effective than narcotics.  Believe it or not, pain control doesn't begin and end with narcotic pain control.
> 
> In fact, before they came onto the market in pill form in the early 90s, people, in fact, did not die of pain.
Click to expand...


The thing is, when I am in pain and need narcotics I have already been through more than most doctors, including you, can possibly understand. I eventually learned to deal with my neuralgia, but I would not have made it without access to opiates when needed. You are just assuming that most people who want pain pills are addicts or do not really understand their symptoms. I have been living with them longer than you have been a doctor, don't try to lecture me when I need a pill.


----------



## geauxtohell

Quantum Windbag said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Quantum Windbag said:
> 
> 
> 
> What works better? Massage? Acupuncture?
> 
> 
> 
> 
> SSRIs, gaba analogues like lyrica and NSAIDs (which are anti-inflammatory), all of which are supported by the literature as being much more effective than narcotics.  Believe it or not, pain control doesn't begin and end with narcotic pain control.
> 
> In fact, before they came onto the market in pill form in the early 90s, people, in fact, did not die of pain.
> 
> Click to expand...
> 
> 
> The thing is, when I am in pain and need narcotics I have already been through more than most doctors, including you, can possibly understand. I eventually learned to deal with my neuralgia, but I would not have made it without access to opiates when needed. You are just assuming that most people who want pain pills are addicts or do not really understand their symptoms. I have been living with them longer than you have been a doctor, don't try to lecture me when I need a pill.
Click to expand...


Using narcotics to treat kidney stones is a no brainer.  People pass kidney stones and it is reasonable to use a big gun to help them through the process.  People also clear post herpetic neuralgia.

You are apparently not comprehending what I have actually written:  which is NOT there is never an indication for pain pills or that everyone who gets pain pills are addicts.  

I have also not lectured you on when you "need a pill".


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> Did you read either article?  The first article was about how the clinic was back in business a few days after the raid.  The second article noted that the man was sentenced to 28 years due to mandatory sentencing guidelines for anyone with over 28 grams of painkillers.
> 
> In the second case, it only works if you buy the statement that the physician lied and the patient did not falsify scripts.  That's a leap of faith.  You can make it if you want, but it's hardly a "slam dunk" for what you are arguing.  I am not going to try to convince you of anything.  A jury has already decided this case.  I am just pointing out that this is a house of cards.  There are plenty of people who "never broke the law" or "never tried drugs" or "never touched alcohol" who get in deep with prescription narcotics.  I am sure this guy was in obvious pain.  That doesn't mean he should get whatever he wants when it comes to pain pills.  You see one side to this story, I read between the lines and see another based on the patients I have dealt with.  Who knows what the truth is.
> 
> The nature of the drugs and their addictive nature, coupled with their ability to kill people, makes government restriction practical.  However, if you think the DEA is preventing patients from getting narcotics, you haven't been around healthcare in this country.
> 
> I think Oxycotin is #3 on the "most prescribed list".
> 
> 
> 
> 
> I can cite hundreds of cases where the feds have harassed doctors and patient pain advocates. Just because you can find a rationalization for two of them does not mean that there is not a problem.
> 
> [ame=http://www.youtube.com/watch?v=0PqfXc4XtXM]Will The Feds Ban Your Pain Meds? - YouTube[/ame]
> 
> Click to expand...
> 
> 
> You did?
> 
> At any rate, I found holes in the two examples you provided.  There are usually holes.  As I said, if you think the DEA is preventing patients from getting narcotics, you are not aware of the reality of the situation.  The DEA tries to focus on the "worst case scenarios".  Most patients, even the bad actors, get their fix.
Click to expand...


Tell me something, why is the DEA involved in medical decisions at all? How is a doctor patient decision about drugs any different than a doctor patient decision about abortion?


----------



## geauxtohell

Quantum Windbag said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Quantum Windbag said:
> 
> 
> 
> I can cite hundreds of cases where the feds have harassed doctors and patient pain advocates. Just because you can find a rationalization for two of them does not mean that there is not a problem.
> 
> Will The Feds Ban Your Pain Meds? - YouTube
> 
> 
> 
> 
> You did?
> 
> At any rate, I found holes in the two examples you provided.  There are usually holes.  As I said, if you think the DEA is preventing patients from getting narcotics, you are not aware of the reality of the situation.  The DEA tries to focus on the "worst case scenarios".  Most patients, even the bad actors, get their fix.
> 
> Click to expand...
> 
> 
> Tell me something, why is the DEA involved in medical decisions at all? How is a doctor patient decision about drugs any different than a doctor patient decision about abortion?
Click to expand...


The DEA concerns itself with medical decisions that involve narcotics that have a high potential for abuse, addiction, and diversion onto the street.  The reason is fairly obvious.  Comparing something that can be turned out on the street for 10-20 dollars a pop to a procedure is really apples and oranges.


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.
> 
> 
> 
> 
> 1.)  I never said that people who want pain meds are "usually addicts".
> 2.)  Addicts most certainly should not get "whatever they want".  There is no way in hell I am going to facilitate a patients early demise due to respiratory failure from opium or liver failure from the shit ton of tylenol they are co-ingesting.  What addicts should get is psychiatric help for managing their addiction as psychiatry is the only field of medicine that is trained to manage addiction.  The "less paternalistic" approach to medicine is all good and fine until patients start demanding you start doing things that are bad medicine.  Then it is time to put your foot down and say no.
> 3.)  I personally would have no problem with using T3 for shingles.  Shingles sucks.  You are apparently not getting the difference between acute and chronic pain management.
Click to expand...


1) Then why keep mentioning addicts when the conversation is about pain management and how the government interferes in medical decisions?
2) Your personal belief system is fine, just do not try to impose it on everyone. I would prefer to see legal drugs administered through an ER than the current system where people buy drugs from pushers who only care about their next fix.
3) You apparently do not understand that pain can be acute and chronic, a prospect I find laughable. You cannot be that stupid, people that live with chronic pain have no choice but to learn to deal with it. I hate talking about it because it makes it worse, and I hate taking pills, but when I need one I do not need some ER intern second guessing me about the level of pain and trying to lecture me about dealing with chronic pain. After 20 years I know more about it than any doctor who has not been through it.


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> SSRIs, gaba analogues like lyrica and NSAIDs (which are anti-inflammatory), all of which are supported by the literature as being much more effective than narcotics.  Believe it or not, pain control doesn't begin and end with narcotic pain control.
> 
> In fact, before they came onto the market in pill form in the early 90s, people, in fact, did not die of pain.
> 
> 
> 
> 
> The thing is, when I am in pain and need narcotics I have already been through more than most doctors, including you, can possibly understand. I eventually learned to deal with my neuralgia, but I would not have made it without access to opiates when needed. You are just assuming that most people who want pain pills are addicts or do not really understand their symptoms. I have been living with them longer than you have been a doctor, don't try to lecture me when I need a pill.
> 
> Click to expand...
> 
> 
> Using narcotics to treat kidney stones is a no brainer.  People pass kidney stones and it is reasonable to use a big gun to help them through the process.  People also clear post herpetic neuralgia.
> 
> You are apparently not comprehending what I have actually written:  which is NOT there is never an indication for pain pills or that everyone who gets pain pills are addicts.
> 
> I have also not lectured you on when you "need a pill".
Click to expand...


I have met doctors who have. I have gone into the ER with kidney stones and waited until the diagnoses was confirmed before I could get any meds, which meant X-rays. I have also gone in and gotten the meds as soon as I saw a nurse. Guess which I prefer.

The difference comes down to how the state handles drug abuse. Texas is hardcore about it, and doctors are extra cautious to make sure you need something before they give it. California is more enlightened, and doctors here more are willing to treat patients based on observed symptoms.

I want the government out of all medical decisions. They can regulate drug safety because there is a need for that, but not drug use because that is a personal decision. They can, however, make sure people who take drugs do not drive.


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> You did?
> 
> At any rate, I found holes in the two examples you provided.  There are usually holes.  As I said, if you think the DEA is preventing patients from getting narcotics, you are not aware of the reality of the situation.  The DEA tries to focus on the "worst case scenarios".  Most patients, even the bad actors, get their fix.
> 
> 
> 
> 
> Tell me something, why is the DEA involved in medical decisions at all? How is a doctor patient decision about drugs any different than a doctor patient decision about abortion?
> 
> Click to expand...
> 
> 
> The DEA concerns itself with medical decisions that involve narcotics that have a high potential for abuse, addiction, and diversion onto the street.  The reason is fairly obvious.  Comparing something that can be turned out on the street for 10-20 dollars a pop to a procedure is really apples and oranges.
Click to expand...


It isn't obvious to me, and it just drives up the cost of medical care.


----------



## geauxtohell

Quantum Windbag said:


> 1) Then why keep mentioning addicts when the conversation is about pain management and how the government interferes in medical decisions?
> 2) Your personal belief system is fine, just do not try to impose it on everyone. I would prefer to see legal drugs administered through an ER than the current system where people buy drugs from pushers who only care about their next fix.
> 3) You apparently do not understand that pain can be acute and chronic, a prospect I find laughable. You cannot be that stupid, people that live with chronic pain have no choice but to learn to deal with it. I hate talking about it because it makes it worse, and I hate taking pills, but when I need one I do not need some ER intern second guessing me about the level of pain and trying to lecture me about dealing with chronic pain. After 20 years I know more about it than any doctor who has not been through it.



1.  Once again, I never claimed all, or even most people, who use narcotics are "addicts".  That the potential for narcotics to create addicts coming into a discussion on narcotics should be obvious.  

2.  It's not my "personal belief".  Sorry to break it too you, but medical professional do not in fact think it's better to simply give into addicts to prevent them from committing felonies.  Refer to "Anxious wimps".  

3.  I also addressed the issue of breakthrough pain and the whole issue that chronic pain shouldn't be managed in the EM.  You might no like hearing it, but it's the truth.  

Since you have chosen to make this personal:  your 20 years of pain control don't equate to a medical education or a medical license.  You also seem to suffer under the delusion that patients call the shots and physicians exist to act as a rubber check on medical scripts their patient's demand.  I hate to burst your bubble.


----------



## geauxtohell

Quantum Windbag said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Quantum Windbag said:
> 
> 
> 
> Tell me something, why is the DEA involved in medical decisions at all? How is a doctor patient decision about drugs any different than a doctor patient decision about abortion?
> 
> 
> 
> 
> The DEA concerns itself with medical decisions that involve narcotics that have a high potential for abuse, addiction, and diversion onto the street.  The reason is fairly obvious.  Comparing something that can be turned out on the street for 10-20 dollars a pop to a procedure is really apples and oranges.
> 
> Click to expand...
> 
> 
> It isn't obvious to me, and it just drives up the cost of medical care.
Click to expand...


Really?  

How?


----------



## geauxtohell

Quantum Windbag said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Quantum Windbag said:
> 
> 
> 
> The thing is, when I am in pain and need narcotics I have already been through more than most doctors, including you, can possibly understand. I eventually learned to deal with my neuralgia, but I would not have made it without access to opiates when needed. You are just assuming that most people who want pain pills are addicts or do not really understand their symptoms. I have been living with them longer than you have been a doctor, don't try to lecture me when I need a pill.
> 
> 
> 
> 
> Using narcotics to treat kidney stones is a no brainer.  People pass kidney stones and it is reasonable to use a big gun to help them through the process.  People also clear post herpetic neuralgia.
> 
> You are apparently not comprehending what I have actually written:  which is NOT there is never an indication for pain pills or that everyone who gets pain pills are addicts.
> 
> I have also not lectured you on when you "need a pill".
> 
> Click to expand...
> 
> 
> I have met doctors who have. I have gone into the ER with kidney stones and waited until the diagnoses was confirmed before I could get any meds, which meant X-rays. I have also gone in and gotten the meds as soon as I saw a nurse. Guess which I prefer.
> 
> The difference comes down to how the state handles drug abuse. Texas is hardcore about it, and doctors are extra cautious to make sure you need something before they give it. California is more enlightened, and doctors here more are willing to treat patients based on observed symptoms.
> 
> I want the government out of all medical decisions. They can regulate drug safety because there is a need for that, but not drug use because that is a personal decision. They can, however, make sure people who take drugs do not drive.
Click to expand...


An X-ray for kidney stones?  

You keep blaming the government for the fact that some doctors are more conservative when it comes to narcotics.  That's not the case.  Most physicians, especially EM physicians, are conservative about narcotic pain pills because they are so used to diversion or drug seekers or patients who are convinced they have to have them even when not indicated.  It has nothing, or little, to do with fear of government reprisal.


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 1) Then why keep mentioning addicts when the conversation is about pain management and how the government interferes in medical decisions?
> 2) Your personal belief system is fine, just do not try to impose it on everyone. I would prefer to see legal drugs administered through an ER than the current system where people buy drugs from pushers who only care about their next fix.
> 3) You apparently do not understand that pain can be acute and chronic, a prospect I find laughable. You cannot be that stupid, people that live with chronic pain have no choice but to learn to deal with it. I hate talking about it because it makes it worse, and I hate taking pills, but when I need one I do not need some ER intern second guessing me about the level of pain and trying to lecture me about dealing with chronic pain. After 20 years I know more about it than any doctor who has not been through it.
> 
> 
> 
> 
> 1.  Once again, I never claimed all, or even most people, who use narcotics are "addicts".  That the potential for narcotics to create addicts coming into a discussion on narcotics should be obvious.
> 
> 2.  It's not my "personal belief".  Sorry to break it too you, but medical professional do not in fact think it's better to simply give into addicts to prevent them from committing felonies.  Refer to "Anxious wimps".
> 
> 3.  I also addressed the issue of breakthrough pain and the whole issue that chronic pain shouldn't be managed in the EM.  You might no like hearing it, but it's the truth.
> 
> Since you have chosen to make this personal:  your 20 years of pain control don't equate to a medical education or a medical license.  You also seem to suffer under the delusion that patients call the shots and physicians exist to act as a rubber check on medical scripts their patient's demand.  I hate to burst your bubble.
Click to expand...


1) The potential for addiction is a concern, but the fact that addicts exist is irrelevant to a medical discussion of pain management, just like the fact that people who bomb abortion clinics exist is irrelevant to medical discussion of abortion.

2) It is your personal belief, not all doctors agree with you.

3) It might not equate to it, but your medical license means squat to me, or anyone else I know, who deals with chronic pain. Unless a doctor specializes in pain management all they know is theory. The ones that do specialize in it spend a lot more time talking to patients and explaining options than others, you all just want to try something because you read something somewhere.

There are exceptions on both sides to that, but that is the general rule.


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> The DEA concerns itself with medical decisions that involve narcotics that have a high potential for abuse, addiction, and diversion onto the street.  The reason is fairly obvious.  Comparing something that can be turned out on the street for 10-20 dollars a pop to a procedure is really apples and oranges.
> 
> 
> 
> 
> It isn't obvious to me, and it just drives up the cost of medical care.
> 
> Click to expand...
> 
> 
> Really?
> 
> How?
Click to expand...


How? It forces doctors to do more tests before dealing with the issue, which is pain.


----------



## Quantum Windbag

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> Using narcotics to treat kidney stones is a no brainer.  People pass kidney stones and it is reasonable to use a big gun to help them through the process.  People also clear post herpetic neuralgia.
> 
> You are apparently not comprehending what I have actually written:  which is NOT there is never an indication for pain pills or that everyone who gets pain pills are addicts.
> 
> I have also not lectured you on when you "need a pill".
> 
> 
> 
> 
> I have met doctors who have. I have gone into the ER with kidney stones and waited until the diagnoses was confirmed before I could get any meds, which meant X-rays. I have also gone in and gotten the meds as soon as I saw a nurse. Guess which I prefer.
> 
> The difference comes down to how the state handles drug abuse. Texas is hardcore about it, and doctors are extra cautious to make sure you need something before they give it. California is more enlightened, and doctors here more are willing to treat patients based on observed symptoms.
> 
> I want the government out of all medical decisions. They can regulate drug safety because there is a need for that, but not drug use because that is a personal decision. They can, however, make sure people who take drugs do not drive.
> 
> Click to expand...
> 
> 
> An X-ray for kidney stones?
> 
> You keep blaming the government for the fact that some doctors are more conservative when it comes to narcotics.  That's not the case.  Most physicians, especially EM physicians, are conservative about narcotic pain pills because they are so used to diversion or drug seekers or patients who are convinced they have to have them even when not indicated.  It has nothing, or little, to do with fear of government reprisal.
Click to expand...


I got an ultrasound as part of a study, which was inconclusive, and a CAT scan in San Francisco. Forth Worth used X-rays 15 years ago, I have no idea what the procedure is now.


----------



## geauxtohell

Quantum Windbag said:


> 1) The potential for addiction is a concern, but the fact that addicts exist is irrelevant to a medical discussion of pain management, just like the fact that people who bomb abortion clinics exist is irrelevant to medical discussion of abortion.



You are just wrong about this.  The thread is, more or less, about why some physicians won't give out narcotics.  Their addictive properties is the reason why.



> 2) It is your personal belief, not all doctors agree with you.



As I said, feel free to find the evidence based literature or clinical guidelines that disagree with my assertion.  



> 3) It might not equate to it, but your medical license means squat to me, or anyone else I know, who deals with chronic pain. Unless a doctor specializes in pain management all they know is theory. The ones that do specialize in it spend a lot more time talking to patients and explaining options than others, you all just want to try something because you read something somewhere.



Good.  Then go to a "pain management" doctor.  In the meantime, don't delude yourself into thinking that you are going to demand narcotics out of me in seven months or that I just suffered through four years of medical school to become a medical Burger King.  

In fact, you basically, on your own, come around to my way of thinking:  go establish care with a physician that will follow up with your condition (as opposed to an ED) for your chronic problems.  



> There are exceptions on both sides to that, but that is the general rule.



Yes, we only know what we've been taught in the formal education process and that pales in comparison to your anecdotes.


----------



## geauxtohell

Quantum Windbag said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Quantum Windbag said:
> 
> 
> 
> I have met doctors who have. I have gone into the ER with kidney stones and waited until the diagnoses was confirmed before I could get any meds, which meant X-rays. I have also gone in and gotten the meds as soon as I saw a nurse. Guess which I prefer.
> 
> The difference comes down to how the state handles drug abuse. Texas is hardcore about it, and doctors are extra cautious to make sure you need something before they give it. California is more enlightened, and doctors here more are willing to treat patients based on observed symptoms.
> 
> I want the government out of all medical decisions. They can regulate drug safety because there is a need for that, but not drug use because that is a personal decision. They can, however, make sure people who take drugs do not drive.
> 
> 
> 
> 
> An X-ray for kidney stones?
> 
> You keep blaming the government for the fact that some doctors are more conservative when it comes to narcotics.  That's not the case.  Most physicians, especially EM physicians, are conservative about narcotic pain pills because they are so used to diversion or drug seekers or patients who are convinced they have to have them even when not indicated.  It has nothing, or little, to do with fear of government reprisal.
> 
> Click to expand...
> 
> 
> I got an ultrasound as part of a study, which was inconclusive, and a CAT scan in San Francisco. Forth Worth used X-rays 15 years ago, I have no idea what the procedure is now.
Click to expand...


They must have not had a CT scanner available.  CT/US is better now.  It's reasonable to start with US, and if that is inconclusive, to go on to a CT scan which is more sensitive (but exposes people to radiation).


----------



## geauxtohell

Quantum Windbag said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Quantum Windbag said:
> 
> 
> 
> It isn't obvious to me, and it just drives up the cost of medical care.
> 
> 
> 
> 
> Really?
> 
> How?
> 
> Click to expand...
> 
> 
> How? It forces doctors to do more tests before dealing with the issue, which is pain.
Click to expand...


That is wrongheaded thinking.  The issue is not the "pain", it's what is causing the pain.  No physician should simply treat "pain".  Pain is a symptom of an underlying problem.  So if you are treating pain, you should be doing the appropriate tests to address the underlying etiology behind the pain.  

If a person's back pain is a metastatic cancer, and a physician doesn't even look, they have committed malpractice.


----------



## Quantum Windbag

geauxtohell said:


> You are just wrong about this.  The thread is, more or less, about why some physicians won't give out narcotics.  Their addictive properties is the reason why.



The tread is about how the government interferes in medical choices involving pain meds. Do you honestly think that the first thing you learn in an ER would be about addicts scamming you to get drugs if it were all drugs, even addictive ones, were legal? Why sin't cocaine, one of the best pain meds known to man, legal to prescribe? Is there a medical reason not to use it in cases where it would clearly be effective? Why does the DEA and the FDA insist that there are no medical uses for marijuana at all? Do you think some pain patients would be better off if marijuana was legally available to everyone? Do you think the OP might be better off with marijuana to help manage chronic pain?

Please, tell me again I am just wrong about the problem being the government.



geauxtohell said:


> As I said, feel free to find the evidence based literature or clinical guidelines that disagree with my assertion.



I do not have access to medical journals, but I do appreciate the way you are trying to assert your authority instead of actually addressing the issues. Do you dispute that some doctors would rather give addicts a fix than see them steal,  or murder, to get one?



geauxtohell said:


> Good.  Then go to a "pain management" doctor.  In the meantime, don't delude yourself into thinking that you are going to demand narcotics out of me in seven months or that I just suffered through four years of medical school to become a medical Burger King.
> 
> In fact, you basically, on your own, come around to my way of thinking:  go establish care with a physician that will follow up with your condition (as opposed to an ED) for your chronic problems.



I do not need help dealing with chronic pain, I learned all I need to know over the past 20 years. What i need, occasionally, is access to opiates to deal the the acute pain that occurs without someone telling me I need to learn to manage chronic pain I already manage. I also know people who are in acute pain on a chronic basis, and they need your advice even less than I do.



geauxtohell said:


> Yes, we only know what we've been taught in the formal education process and that pales in comparison to your anecdotes.



Are you denying that some doctors are more sympathetic to patient than others?


----------



## hortysir

geauxtohell said:


> hortysir said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> I don't dispute that she has chronic pain.  I dispute that narcotic pain pills are the best treatment for her chronic pain.
> 
> Show me the evidence based literature that disputes that, and I will take a look.
> 
> 
> 
> 
> 
> She's willing to try anything that works.
> it's just that when you show up at the ER asking for something for pain there's that "look".
> Sometimes there's a rude dismissal to go along with it......
> 
> Click to expand...
> 
> 
> No offense, but that's because she is misusing the EMERGENCY room as a primary care center.  That pisses off every EM physician.
> 
> In doing so, she is putting the EM doctor in an untenable condition:  Let her leave while suffering or be force to mismanage her medical condition with narcotics.  Since EM doctors don't have their own patients and don't do follow up, they aren't going to start her on a long term medication like an SSRI or pregabalin.
> 
> Your daughter needs to establish care with a primary care physician for long term management of her chronic condition so that it can be adequately managed.  Since EM physicians are required by law to give patients a follow up appointment with a PCP, I can't imagine they haven't tried to do this.
Click to expand...


No job, no income, and nobody wants to piss with share-cost medicaid.
I've tried to get her to at least go to the county health dept.
She's too deep into the pill-mill culture, though.


----------



## MikeK

geauxtohell said:


> [...]
> 
> [...]There is no way in hell I am going to facilitate a patients early demise due to respiratory failure from opium or liver failure from the shit ton of tylenol they are co-ingesting.[...]
> 
> [...]


Your reference to _co-ingestion_ concerns me because the makers of both hydrocodone (Vicodin) and oxycodone (Percocet) add acetaminophen (APAP - Tylenol) to this narcotic, which might soon be affecting my requirements.  

While my daily limit of either narcotic is 10 mg. I'm forced to co-ingest either 700 mg. APAP with oxy or 1G APAP with hydro.  I'm on the safe side because I'm well under the dangerous dose level of APAP, which is 4G.  But what if my condition worsens, which it is sure to do, and/or my tolerance for oxy or hydro increases and I need more?  

The only alternative treatment for my condition is surgery, which my GP (and another) believe is extremely risky because of the position of the growth within the vertebra.  So it seems that unless I die within the next few years I'll be banging heads with these goddam DEA constraints on the medical profession and the legitimate distribution of narcotics.


----------



## MikeK

geauxtohell said:


> [...]That is wrongheaded thinking.  The issue is not the "pain", it's what is causing the pain.  No physician should simply treat "pain".  Pain is a symptom of an underlying problem.  So if you are treating pain, you should be doing the appropriate tests to address the underlying etiology behind the pain.
> 
> [...]


So I will assume you, as a GP, would refer my condition (cervical stenosis) to an orthopedic surgeon, who probably would decide to operate -- mainly because it is me who is at risk of paralysis, not him, but also because he needs a new swimming pool.    

Am I correct?  Or is there another treatment for my condition which my present GP isn't aware of?  

My present GP is an Indian woman who is adamantly opposed to spinal surgery at my age and for my condition.  We've tried Cymbalta but it caused severe constipation, so that's out.


----------



## geauxtohell

hortysir said:


> geauxtohell said:
> 
> 
> 
> 
> 
> hortysir said:
> 
> 
> 
> She's willing to try anything that works.
> it's just that when you show up at the ER asking for something for pain there's that "look".
> Sometimes there's a rude dismissal to go along with it......
> 
> 
> 
> 
> No offense, but that's because she is misusing the EMERGENCY room as a primary care center.  That pisses off every EM physician.
> 
> In doing so, she is putting the EM doctor in an untenable condition:  Let her leave while suffering or be force to mismanage her medical condition with narcotics.  Since EM doctors don't have their own patients and don't do follow up, they aren't going to start her on a long term medication like an SSRI or pregabalin.
> 
> Your daughter needs to establish care with a primary care physician for long term management of her chronic condition so that it can be adequately managed.  Since EM physicians are required by law to give patients a follow up appointment with a PCP, I can't imagine they haven't tried to do this.
> 
> Click to expand...
> 
> 
> No job, no income, and nobody wants to piss with share-cost medicaid.
> I've tried to get her to at least go to the county health dept.
> She's too deep into the pill-mill culture, though.
Click to expand...


So, since your 35 year old daughter can't afford to establish care at a PCP, she uses the ED as her primary care center?

Tell me there isn't a healthcare problem in this country.


----------



## geauxtohell

MikeK said:


> geauxtohell said:
> 
> 
> 
> [...]That is wrongheaded thinking.  The issue is not the "pain", it's what is causing the pain.  No physician should simply treat "pain".  Pain is a symptom of an underlying problem.  So if you are treating pain, you should be doing the appropriate tests to address the underlying etiology behind the pain.
> 
> [...]
> 
> 
> 
> So I will assume you, as a GP, would refer my condition (cervical stenosis) to an orthopedic surgeon, who probably would decide to operate -- mainly because it is me who is at risk of paralysis, not him, but also because he needs a new swimming pool.
> 
> Am I correct?  Or is there another treatment for my condition which my present GP isn't aware of?
> 
> My present GP is an Indian woman who is adamantly opposed to spinal surgery at my age and for my condition.  We've tried Cymbalta but it caused severe constipation, so that's out.
Click to expand...


Not at 75.  There is a world of difference between a 75 year old with a high spinal cord lesion and a 45 year old with the same.


----------



## geauxtohell

MikeK said:


> geauxtohell said:
> 
> 
> 
> [...]
> 
> [...]There is no way in hell I am going to facilitate a patients early demise due to respiratory failure from opium or liver failure from the shit ton of tylenol they are co-ingesting.[...]
> 
> [...]
> 
> 
> 
> Your reference to _co-ingestion_ concerns me because the makers of both hydrocodone (Vicodin) and oxycodone (Percocet) add acetaminophen (APAP - Tylenol) to this narcotic, which might soon be affecting my requirements.
> 
> While my daily limit of either narcotic is 10 mg. I'm forced to co-ingest either 700 mg. APAP with oxy or 1G APAP with hydro.  I'm on the safe side because I'm well under the dangerous dose level of APAP, which is 4G.  But what if my condition worsens, which it is sure to do, and/or my tolerance for oxy or hydro increases and I need more?
> 
> The only alternative treatment for my condition is surgery, which my GP (and another) believe is extremely risky because of the position of the growth within the vertebra.  So it seems that unless I die within the next few years I'll be banging heads with these goddam DEA constraints on the medical profession and the legitimate distribution of narcotics.
Click to expand...


Yeah, I know.  I don't think people are aware of the fact that they are ingesting tylenol on a chronic basis.  Again, these pills were never intended to be long term pain management regimens.  

I don't have an answer to your question.  I would abstain from alcohol and ask your doctor to check your liver enzymes periodically.  

I would also think you would have a hard time convincing a neurosurgeon to operate on you at 75.  It's a risk/reward thing.


----------



## geauxtohell

Quantum Windbag said:


> The tread is about how the government interferes in medical choices involving pain meds.



Not really.  You are trying to make it about that, but that was never the OPs complaint.  You perceive that her physician won't give her narcotics because the DEA is up their ass with a microscope.



> Do you honestly think that the first thing you learn in an ER would be about addicts scamming you to get drugs if it were all drugs, even addictive ones, were legal?



That's a separate issue.  As it stands, I have my doubts that drugs are going to be universally legalize in the next decade, so the problem still stands.



> Why sin't cocaine, one of the best pain meds known to man, legal to prescribe?



What?  Cocaine has no analgesic properties.  It is an effective local anesthetic.  Using it for systemic pain is absurd.

As it stands, it is used medically for what it is indicated for:  local anesthesia - like all the alkaloid anesthetics that end in -caine (i.e. lidocaine, bupivocaine, etc).



> Is there a medical reason not to use it in cases where it would clearly be effective?



No.  That is not pain management.  See above.  Other than that, "getting high" is not a medical indication.    



> Why does the DEA and the FDA insist that there are no medical uses for marijuana at all? Do you think some pain patients would be better off if marijuana was legally available to everyone? Do you think the OP might be better off with marijuana to help manage chronic pain?



Yes.  That's a separate issue.  If I were in charge of the world, I just skip the canard of medical marijuania and legalize it.  Before you ask I would not legalize cocaine, opiates, or amphetamines that carry the potential for acute overdose.  



> Please, tell me again I am just wrong about the problem being the government.



In regards to narcotic pain pills, you are wrong.  



> I do not have access to medical journals, but I do appreciate the way you are trying to assert your authority instead of actually addressing the issues. Do you dispute that some doctors would rather give addicts a fix than see them steal,  or murder, to get one?



Oh lord.......  You have access to google, right?  I am not trying to "assert" anything.  Medicine is an "evidence based" venture.  That means decisions are made, not on what you or someone believes in their gut, but on what the research shows.  I am not being snooty or flippant, I am asking if you can produce a shred of evidence beyond your opinion that would make me reconsider what I have been taught or researched myself.

That is addressing the issue in an academic matter.  If we were on medical rounds, the standard would be the same.  Stomping your feet and insisting that you are right and I am a dick is not. 

I am not disputing that physicians do the wrong thing.  I am just pointing out it's the wrong thing.  We frequently have patients who try and extort pain pills by saying the same thing:  "I am just going to get them off the street". That statement will turn even the most pain-pill liberally minded doctor into a draconian and you can bet your ass we are going to document that statement and that patient isn't going to get any pain meds from any provider with access to our records again.  



> I do not need help dealing with chronic pain, I learned all I need to know over the past 20 years. What i need, occasionally, is access to opiates to deal the the acute pain that occurs without someone telling me I need to learn to manage chronic pain I already manage. I also know people who are in acute pain on a chronic basis, and they need your advice even less than I do.



You still aren't grasping the point I am making about using narcotics on a chronic basis (i.e. daily for years) versus occasionally for acute pain.  



> Are you denying that some doctors are more sympathetic to patient than others?



Capitulating to a patient's every wants and needs isn't "sympathy".


----------



## Kooshdakhaa

Quantum Windbag said:


> Kooshdakhaa said:
> 
> 
> 
> Last time I had any pain pills was when I had a root canal.  I got the prescription filled and then read the warnings.  No way would I take those pain pills after I read the possible side effects.  Called the dentist and told him.  He said I needed to take them for the inflammation.  I said what about Bayer aspirin.  He said okay, so that's what I took.  Put the pain pills in my emergency survival kit.
> 
> However, the pain wasn't that bad.  If a person is in a lot of pain they deserve to have relief.  That is for sure.  But rather than take those nasty pain pills my whole life I would sure be exploring other ways of managing pain. Someone I knew was paralyzed from the waist down, yet he had terrible pain in his legs.  Ghost pain, I guess, but very real to him.  He told me that out of desperation he had finally learned to block the pain out of his mind.  What power that would give a person, if they could learn to block pain that way.  Much better than pain pills.
> 
> 
> 
> 
> Ever read about the side effects of aspirin?
> 
> 
> 
> 
> All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Aspirin:
> 
> Heartburn; nausea; upset stomach.
> 
> Seek medical attention right away if any of these SEVERE side effects occur when using Aspirin:
> Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; confusion; diarrhea; dizziness; drowsiness; hearing loss; ringing in the ears; severe or persistent stomach pain; unusual bruising; vomiting.
> 
> This is not a complete list of all side effects that may occur.
> 
> Click to expand...
> 
> 
> They are required to list side effects by law. You did not need the pills, which is great, but not taking them because you are afraid of a side effect is a bit like not leaving the house because people get hit by cars. IF you get one of them worry, otherwise take the pills if needed.
Click to expand...


Yes, I am aware of the side effects of aspirin.  I think it's pretty obvious that I'm the type of person who reads labels.  I am not allergic to aspirin, so that isn't a problem.  As for the other possible side effects, I've never had so much as an upset stomach from taking aspirin.  Even so, I take it rarely.

If I hadn't read the side effects, I probably would have just gone ahead and taken those pain pills.  which is what most people probably do.  But that would have been ridiculous...I didn't need them.  

I'm not the kind of person to gaze with wide-eyed trust at my doctor while he writes prescriptions for me.  I had a doctor give me a free sample of Welbutrin to take because I have panic attacks.  He said if I "like it" he'd write me a prescription.  I didn't take them, I did some research first.  Came to find out that Welbutrin makes many people's panic worse!  Thanks, Doc, but no thanks.  I've learned to manage the panic on my own, without drugs.


----------



## merrill

Gagafritz said:


> Once you need pain pills even for a legitamite medical condition, you become labeled as a drug seeking ahole addict.  Doesn't matter that you need them to get up and function, that it allows you to continue to be a contributing member to society or whatever.  There is a lot of phony lip service give to pain management.  And, some types of pain seem more real or legitimate than others.  If you have fibromyaligia or other type of harder to pin down pain , then it must not be real cuz other people have never experienced.  It is pretty obvious why we have rampant alcohol and drug addiction in this country because many people are just trying to do whatever they can do to suffer through the day.  Even billionaire Michael Jackson couldn't find relief for his condition without going to drastic extremes.  if someone would have truly helped him medically deal with his condition and given him adequate and proper medication he would still be here today as well.  I can see where people just give up and find solace in the bottom of a bottle.  Sad but reality.



Becoming strung out on pain medication can come quick so all must approach pain accordingly.Then again no one should be left alone lying on a floor due to a medical condition = very risky business. 

However the person opening this thread should have zero qualms about using the ER. 

This situation could develop into a much more intense problem perhaps even bringing on seizures thus compounding a not by choice problematic lifestyle.


----------



## Sunshine

mskafka said:


> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.



Is your MS being treated appropriately?  Have they given you anything like Baclofen?  Or a beta blocker or seizure medicine for the fasciculations?  Maybe you should change neurologists.  I don't know who your employer is, but you need to contact your benefit person and let them know you aren't getting the services you need.


----------



## Sunshine

mskafka said:


> Kooshdakhaa said:
> 
> 
> 
> I think you should go to the pain clinic.  What's your problem with the pain clinic?
> 
> That's the purpose of a pain clinic...managing pain.  You should at least give it a try.
> 
> What happens with other people suffering from MS?  Do they also have pain?  How is it treated?  Sounds like a forum for people with MS might provide you with some help and answers.  Maybe?
> 
> 
> 
> 
> There is a stigma attached to pain clinics.  I'm just recalling how many people I've intubated and treated from OD's from pain clinics.  In THIS state, they are considered legal drug pushers; and this area....not very highly respected.
> 
> I have and do belong to an MS forum/chat.  The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue.  I'm here, because this to me, is a political issue.  And because I belonged to this forum LONG before I was diagnosed with MS.
> 
> And yes, I'm totally with Ron Paul on the "War on Drugs".  I believe it has been a disaster.  Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).
> 
> And no, it's not constant pain.  But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore.  This makes perfect sense to me.
> 
> Now there is constant numbness in certain areas, but pain?  Only after a flare.  And it sux.
Click to expand...


There are non narcotic drugs that will help the muscle contractions.  Aren't they giving you anything for that? 

I go to Vanderbilt for this illness I have.  Have you been there?

I understand what you mean about the pain clinics, though.  When I was practicing in Nashville, one of them called me up and insisted that I guarantee that the patient they were seeing would not kill herself with her pain medicine.  LOL.  I just laughed, but sent a statement that there is no guarantee that  anyone will not suicide, but the patient did not have any drug abuse history, was not suicidal, nor psychotic.


----------



## Sunshine

geauxtohell said:


> mskafka said:
> 
> 
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> 
> 
> 
> I don't know why they wouldn't give you Ultram.......... It's non-narcotic.
> 
> Other than that, you've hit the nail on the head.  If you think the current crop of doctors is bad, wait until my generation gets in there.  We've been conditioned (by drug seekers) to hate narcotic pain pills.  You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam.  Why?  Because shit bags prick their fingers to contaminate their urine to malinger.
> 
> Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.
> 
> Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.
> 
> FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.
Click to expand...


Ultram is a synthetic narcotic, and it is a schedule drug.  Didn't start that way, but is now.


----------



## Sunshine

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> I don't know why they wouldn't give you Ultram.......... It's non-narcotic.
> 
> Other than that, you've hit the nail on the head.  If you think the current crop of doctors is bad, wait until my generation gets in there.  We've been conditioned (by drug seekers) to hate narcotic pain pills.  You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam.  Why?  Because shit bags prick their fingers to contaminate their urine to malinger.
> 
> Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.
> 
> Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.
> 
> FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.
> 
> 
> 
> 
> Unfortunately, the government does not agree with you. This is the same government that some people want to trust with health care.
> 
> Click to expand...
> 
> 
> Doctors have a lot of latitude to prescribe medications and no one is going to get in trouble for using narcotics for pain control when it's legitimately indicated.  The physicians that get in trouble are the ones that are completely loose with their script pad for several patients.
> 
> This isn't a government regulation issue.  It's an issue of narcotics having a horrible rap now due to all the drug seekers.
Click to expand...


When NPs got authority to order schedule drugs, I had to go to a DEA workshop.  At that workshop they told us that more providers lose their licenses over stimulants than any other drug.  There is a law which prohibits giving narcotics to known drug abusers.  Some do, but they make it really clear that the risk of not giving it outweighs the risk of giving it.


----------



## Sunshine

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> Would you like to bet on that? If no one is get in trouble for the legitimate use of painkillers why are doctors offices being raided? Why are pain patients in prison for using prescription medications?
> 
> Port Townsend clinic reopens after search by drug agents -- Port Angeles Port Townsend Sequim Forks Jefferson County Clallam County Olympic Peninsula Daily news
> 
> Punishing Pain - New York Times
> 
> The problem with your statement is that the government has a different idea of a legitimate need than some doctors, and juries tend to side with the government in cases like the ones above. You are a doctor, you need to educate yourself on the realities of government response to prescriptions for narcotics before you end up being forced to chose between lying about a patient and going to prison. The evidence does not support your naive trust in being right.
> 
> 
> 
> 
> If that link was supposed to be persuasive, it probably wasn't the best example as that physician hasn't been charged with anything and it appears the raid was unfruitful.
> 
> As for the second link, it's more of an example of how stupid mandatory sentencing is for drug crimes.  The patient in question maintains that he didn't forge scripts (a felony), the prosecution managed to convince a jury of his peers that he did.  I am not going to simply accept OPED that the physician lied under oath.  Sorry.
> 
> For the first link, if you hold yourself to be a "pain specialist" and prescribe narcotics, you know you are going to be under the microscope by the DEA.  It's the cost of doing business.  Most medications aren't monitored by the DEA, so if you choose to deal in pain management, you accept that the DEA is going to be up your keester with a microscope.
> 
> Of course, if there weren't well established patterns of wrong doing by physicians and patients for medications that are chemically the same as heroin, then the DEA probably wouldn't care.
> 
> http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf
> 
> As for me, after four years as a student, I have seen more patient scams to get narcotics then I can imagine.  From the patient who complained of massive belly pain to the point of crying on physical exam (and then walked out of the hospital tear-free when told she wouldn't get narcotic pain pills) to the "I am allergic to everything but dilaudid" canard to loath narcotics.  They have their place, unfortunately, about a decade of over prescribing them as a whole by the health care community "Pain, the 5th vital sign", there are some real bad actors in the world.
> 
> Underlying any physicians actions is (or should be) what is best for the patient - and not fear of legal sanction.  Over prescribing pain pills is bad medicine.
Click to expand...


Years ago when I had migraines I came to understand the 'acting' though.  The neurologist asked me on a scale of 1 - 10 what my headache was that day.  I said 8.  She cocked her head and said, 'you don't look like you have an 8 headache.'  Over time we compensate for pain and it is not reflected in vitals or in the way we look.  I had to fire her and go to another.  The new one actually figured out the migraines were from Synthroid.  It took a year for the triggers to stop being triggers, but I haven't had a headache in years.


----------



## Sunshine

geauxtohell said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> If that link was supposed to be persuasive, it probably wasn't the best example as that physician hasn't been charged with anything and it appears the raid was unfruitful.
> 
> As for the second link, it's more of an example of how stupid mandatory sentencing is for drug crimes.  The patient in question maintains that he didn't forge scripts (a felony), the prosecution managed to convince a jury of his peers that he did.  I am not going to simply accept OPED that the physician lied under oath.  Sorry.
> 
> For the first link, if you hold yourself to be a "pain specialist" and prescribe narcotics, you know you are going to be under the microscope by the DEA.  It's the cost of doing business.  Most medications aren't monitored by the DEA, so if you choose to deal in pain management, you accept that the DEA is going to be up your keester with a microscope.
> 
> Of course, if there weren't well established patterns of wrong doing by physicians and patients for medications that are chemically the same as heroin, then the DEA probably wouldn't care.
> 
> http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf
> 
> As for me, after four years as a student, I have seen more patient scams to get narcotics then I can imagine.  From the patient who complained of massive belly pain to the point of crying on physical exam (and then walked out of the hospital tear-free when told she wouldn't get narcotic pain pills) to the "I am allergic to everything but dilaudid" canard to loath narcotics.  They have their place, unfortunately, about a decade of over prescribing them as a whole by the health care community "Pain, the 5th vital sign", there are some real bad actors in the world.
> 
> Underlying any physicians actions is (or should be) what is best for the patient - and not fear of legal sanction.  Over prescribing pain pills is bad medicine.
> 
> 
> 
> 
> You think the raid was unfruitful? I am willing to bet you that, after the government seized all his patient records, he was unable to actually treat them, and that he lost at least half his patients who, understandably, do not want the government prying into their health. The raid was nothing more than intimidation, and its sole intent was make sure the doctor got the message that treating patients for pain is a risky business.
> 
> How is the second link an indication of mandatory sentencing? Did I miss something in the article that talked about prior drug convictions? He was getting pain meds for personal use, the government got his doctor to lie on the stand, and he went to prison for selling drugs. By the way, if you think the doctor was not lying you will have to convince me that the pharmacist, knowing that federal and state laws would hold him responsible for giving to many prescriptions for opiates to a customer never called the doctor to verify them. I only had one prescription for 20 pills, non refillable, and they verified it.
> 
> Do some doctors and patients abuse the system?
> 
> Yes.
> 
> Does that justify the government restricting everyone?
> 
> No.
> 
> Click to expand...
> 
> 
> Did you read either article?  The first article was about how the clinic was back in business a few days after the raid.  The second article noted that the man was sentenced to 28 years due to mandatory sentencing guidelines for anyone with over 28 grams of painkillers.
> 
> In the second case, it only works if you buy the statement that the physician lied and the patient did not falsify scripts.  That's a leap of faith.  You can make it if you want, but it's hardly a "slam dunk" for what you are arguing.  I am not going to try to convince you of anything.  A jury has already decided this case.  I am just pointing out that this is a house of cards.  There are plenty of people who "never broke the law" or "never tried drugs" or "never touched alcohol" who get in deep with prescription narcotics.  I am sure this guy was in obvious pain.  That doesn't mean he should get whatever he wants when it comes to pain pills.  You see one side to this story, I read between the lines and see another based on the patients I have dealt with.  Who knows what the truth is.
> 
> The nature of the drugs and their addictive nature, coupled with their ability to kill people, makes government restriction practical.  However, if you think the DEA is preventing patients from getting narcotics, you haven't been around healthcare in this country.
> 
> I think Oxycotin is #3 on the "most prescribed list".
Click to expand...


I have had numerous patients on Oxycontin who come in for treatment of depression.  I just have to tell them that I can't treat their depression as long as they are on Oxycontin.  They are not depressed.  They are narcolyzed.


----------



## Sunshine

geauxtohell said:


> Gagafritz said:
> 
> 
> 
> Once you need pain pills even for a legitamite medical condition, you become labeled as a drug seeking ahole addict.  Doesn't matter that you need them to get up and function, that it allows you to continue to be a contributing member to society or whatever.  There is a lot of phony lip service give to pain management.  And, some types of pain seem more real or legitimate than others.  If you have fibromyaligia or other type of harder to pin down pain , then it must not be real cuz other people have never experienced.  It is pretty obvious why we have rampant alcohol and drug addiction in this country because many people are just trying to do whatever they can do to suffer through the day.  Even billionaire Michael Jackson couldn't find relief for his condition without going to drastic extremes.  if someone would have truly helped him medically deal with his condition and given him adequate and proper medication he would still be here today as well.  I can see where people just give up and find solace in the bottom of a bottle.  Sad but reality.
> 
> 
> 
> 
> Not quite.  Women get narcotics after vaginal or cesarian delivery.  People with broken bones get narcotics.  People who get wisdom teeth extracted get narcotics.  None of these people are "drug seekers".  Narcotics work well for acute issues where pain control is needed as the body mends itself.
> 
> People become "drug seekers" when they become convinced that chronic conditions (baring certain conditions like sickle cell anemia) can only be managed through narcotics.  After a while, there is no differentiation between organic pain and the pain that comes with withdrawal.   There are two parts to this equation.  One side is a doctor who enables it.  The other side is the patient that either lacks the motivation or desire to try and get "better" however that might be.
> 
> You referenced fibromyalgia.  Guess what is emerging as a mainline treatment to fibromyalgia and has the best treatment results in the evidence based literature?
> 
> Antidepressants.  Go figure.....
> 
> http://www.fmcfs.ca/FMresearch-abstracts-2009.pdf
> 
> And yet, the "mean doctors" are lambasted by fibromyalgia patients when they don't want to give them a sedative to control their condition that keeps them on the couch as it stands in favor of trying something that actually works.
> 
> As for Jackson....  He was a addict.  If you need propofol (a powerful anesthetic that should only be administered in a hospital when a patient is on a monitor and intubated) to sleep, you have real problems.  These are most likely psychiatric problems at root (and addiction is a psychiatric problem) and not some overt pathology.  The root of his problem wasn't his pain or his inability to sleep.  It was his underlying addictions.  His doctor was a quack too (he was a cardiologist) and deserved what he got for such malpractice.  He wasn't trying to "help" Jackson.  He was doing it for the outragious sums of money.  I would be willing to bet that Doctor Murrey wouldn't have been willing to try his unique insomnia treatment on a regular person with regular insurance.
Click to expand...


That is right.  When I have a depressed fibro patient my first line of treatmetn for the depression is Effexor.  It cuts both ways.  Cymbalta is good as well, but much more expensive.


----------



## geauxtohell

Sunshine said:


> geauxtohell said:
> 
> 
> 
> 
> 
> mskafka said:
> 
> 
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> 
> 
> 
> I don't know why they wouldn't give you Ultram.......... It's non-narcotic.
> 
> Other than that, you've hit the nail on the head.  If you think the current crop of doctors is bad, wait until my generation gets in there.  We've been conditioned (by drug seekers) to hate narcotic pain pills.  You know it's bad when examining the fingers of a patient who complains of a kidney stone and has blood in their urine is a mandatory part of the physical exam.  Why?  Because shit bags prick their fingers to contaminate their urine to malinger.
> 
> Only proximately related, but I taught an old school doctor something the other day when I pointed out that the patient (with a past history of cocaine use) had a long pinky nail which means they were probably using cocaine currently.
> 
> Anyways, if you have been trained at a community or county or inter city hospital, you've had a significant amount of OJT training to determine who is really sick and who is hustling you.
> 
> FWIW, in my opinion, anyone with any sort of chronic, wasting condition should get whatever pain control they want.
> 
> Click to expand...
> 
> 
> Ultram is a synthetic narcotic, and it is a schedule drug.  Didn't start that way, but is now.
Click to expand...


I guess I have always thought of it as the "non-narcotic" option, since that seems to be the way it is perceived.  I really think the "dependence" issue over tramadol is bullshit.  

I believe you are wrong about it being scheduled.

http://www.deadiversion.usdoj.gov/drugs_concern/tramadol.pdf


----------



## Sunshine

hortysir said:


> geauxtohell said:
> 
> 
> 
> 
> 
> hortysir said:
> 
> 
> 
> That's where the drug-seeking-addict label comes from, tho....
> 
> My daughter has Fybro and no insurance.
> She has share-cost medicaid but no income.
> Sometimes the only way she can meet her share of cost is to go to the ER.
> 
> Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.
> 
> 
> 
> 
> I don't dispute that she has chronic pain.  I dispute that narcotic pain pills are the best treatment for her chronic pain.
> 
> Show me the evidence based literature that disputes that, and I will take a look.
> 
> Click to expand...
> 
> 
> 
> She's willing to try anything that works.
> it's just that when you show up at the ER asking for something for pain there's that "look".
> Sometimes there's a rude dismissal to go along with it......
Click to expand...


Effexor.  Cymbalta.  It takes a while to get enough in the system to work.  I dont know about Lyrica.  It is mostly used for diabetics.  Pristique.  Not more efficacious thatn Effexor.


----------



## Sunshine

Quantum Windbag said:


> Gagafritz said:
> 
> 
> 
> Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?
> 
> 
> 
> 
> The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.
Click to expand...


He is not the only 'medically trained' person on this thread.  And I don't think that is what he is saying.  I have seen my share of drug seekers as well.  Probably more in my 23 years as a nurse than he has.  They exist.  They are out there.  They have a pattern of behavior, usually.


----------



## geauxtohell

Sunshine said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Quantum Windbag said:
> 
> 
> 
> Would you like to bet on that? If no one is get in trouble for the legitimate use of painkillers why are doctors offices being raided? Why are pain patients in prison for using prescription medications?
> 
> Port Townsend clinic reopens after search by drug agents -- Port Angeles Port Townsend Sequim Forks Jefferson County Clallam County Olympic Peninsula Daily news
> 
> Punishing Pain - New York Times
> 
> The problem with your statement is that the government has a different idea of a legitimate need than some doctors, and juries tend to side with the government in cases like the ones above. You are a doctor, you need to educate yourself on the realities of government response to prescriptions for narcotics before you end up being forced to chose between lying about a patient and going to prison. The evidence does not support your naive trust in being right.
> 
> 
> 
> 
> If that link was supposed to be persuasive, it probably wasn't the best example as that physician hasn't been charged with anything and it appears the raid was unfruitful.
> 
> As for the second link, it's more of an example of how stupid mandatory sentencing is for drug crimes.  The patient in question maintains that he didn't forge scripts (a felony), the prosecution managed to convince a jury of his peers that he did.  I am not going to simply accept OPED that the physician lied under oath.  Sorry.
> 
> For the first link, if you hold yourself to be a "pain specialist" and prescribe narcotics, you know you are going to be under the microscope by the DEA.  It's the cost of doing business.  Most medications aren't monitored by the DEA, so if you choose to deal in pain management, you accept that the DEA is going to be up your keester with a microscope.
> 
> Of course, if there weren't well established patterns of wrong doing by physicians and patients for medications that are chemically the same as heroin, then the DEA probably wouldn't care.
> 
> http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf
> 
> As for me, after four years as a student, I have seen more patient scams to get narcotics then I can imagine.  From the patient who complained of massive belly pain to the point of crying on physical exam (and then walked out of the hospital tear-free when told she wouldn't get narcotic pain pills) to the "I am allergic to everything but dilaudid" canard to loath narcotics.  They have their place, unfortunately, about a decade of over prescribing them as a whole by the health care community "Pain, the 5th vital sign", there are some real bad actors in the world.
> 
> Underlying any physicians actions is (or should be) what is best for the patient - and not fear of legal sanction.  Over prescribing pain pills is bad medicine.
> 
> Click to expand...
> 
> 
> Years ago when I had migraines I came to understand the 'acting' though.  The neurologist asked me on a scale of 1 - 10 what my headache was that day.  I said 8.  She cocked her head and said, 'you don't look like you have an 8 headache.'  Over time we compensate for pain and it is not reflected in vitals or in the way we look.  I had to fire her and go to another.  The new one actually figured out the migraines were from Synthroid.  It took a year for the triggers to stop being triggers, but I haven't had a headache in years.
Click to expand...


Imagine that.  Someone actually go to the root of the problem as opposed to just treating your pain.  It's almost like someone was practicing good medicine.  

Sounds like you found a good neurologist.


----------



## geauxtohell

Sunshine said:


> I have had numerous patients on Oxycontin who come in for treatment of depression.  I just have to tell them that I can't treat their depression as long as they are on Oxycontin.  They are not depressed.  They are narcolyzed.



Couldn't agree more.  Also can't figure out why you would every give a depressed person a depressant.  

You might as well hand them a 1/5 of whiskey.


----------



## Sunshine

Kooshdakhaa said:


> mskafka said:
> 
> 
> 
> 
> 
> Kooshdakhaa said:
> 
> 
> 
> I think you should go to the pain clinic.  What's your problem with the pain clinic?
> 
> That's the purpose of a pain clinic...managing pain.  You should at least give it a try.
> 
> What happens with other people suffering from MS?  Do they also have pain?  How is it treated?  Sounds like a forum for people with MS might provide you with some help and answers.  Maybe?
> 
> 
> 
> 
> There is a stigma attached to pain clinics.  I'm just recalling how many people I've intubated and treated from OD's from pain clinics.  In THIS state, they are considered legal drug pushers; and this area....not very highly respected.
> 
> I have and do belong to an MS forum/chat.  The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue.  I'm here, because this to me, is a political issue.  And because I belonged to this forum LONG before I was diagnosed with MS.
> 
> And yes, I'm totally with Ron Paul on the "War on Drugs".  I believe it has been a disaster.  Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).
> 
> And no, it's not constant pain.  But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore.  This makes perfect sense to me.
> 
> Now there is constant numbness in certain areas, but pain?  Only after a flare.  And it sux.
> 
> Click to expand...
> 
> 
> Wait...you were saying you wanted pain pills.  And now you're saying the trouble with pain clinics is they give people too many pain pills, to the point that they OD?  What do you care what other people think, the stigma of pain clinics?  If you want pain pills, sounds like you should go to the pain clinic.  Sounds like you have a medical background, you should be able to properly handle the pills they give you and not OD.  Doesn't it seem?
Click to expand...


I used to work in Nashville.  She is right about the stigma of going to a pain clinic there.  There is supposed to be confidentiality, but the waiting room is not empty nor confidential.  A medical person who goes to a pain clinic in that area casts doubt upon him/herself.  If I had ever had to go to one, I wouldn't have gone in that city.


----------



## strollingbones

old fashioned test for ms.....get into a hot tub...dont do this alone....if you pass out its most  likely ms....if you dont....its something else....


----------



## geauxtohell

Sunshine said:


> hortysir said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> I don't dispute that she has chronic pain.  I dispute that narcotic pain pills are the best treatment for her chronic pain.
> 
> Show me the evidence based literature that disputes that, and I will take a look.
> 
> 
> 
> 
> 
> She's willing to try anything that works.
> it's just that when you show up at the ER asking for something for pain there's that "look".
> Sometimes there's a rude dismissal to go along with it......
> 
> Click to expand...
> 
> 
> Effexor.  Cymbalta.  It takes a while to get enough in the system to work.  I dont know about Lyrica.  It is mostly used for diabetics.  Pristique.  Not more efficacious thatn Effexor.
Click to expand...


Lyrica is a GABA analogue.  The current notion is that people with FM have low thresholds for pain.  So the notion is that, in giving them a gaba analogue, you are raising the fire threshold on their CNS.  

It has some good evidence behind it, but not as good as the SSRIs, which lead me to suspect (but not know) that FM is either a symptom of depression or somehow tied to it neurologically.


----------



## Quantum Windbag

geauxtohell said:


> Not really.  You are trying to make it about that, but that was never the OPs complaint.  You perceive that her physician won't give her narcotics because the DEA is up their ass with a microscope.



I percieve that because the DEA is up every doctors ass with a microscope. If you don't believe me go into pain management and see ho difficult it is to comply with DEA regulations v patient needs. If you can provide evidence that her doctor is the exception to the rule feel free to provide it, until then I will assume that everything I have read, and experienced, is true.

Just like you do when you demand I provide clinical studies to refute your position.



geauxtohell said:


> That's a separate issue.  As it stands, I have my doubts that drugs are going to be universally legalize in the next decade, so the problem still stands.



Exactly, if we could get the government out of determining what is, and what is not, valid treatment we will continue to have a problem doing proper pain management in this country.



geauxtohell said:


> Yes.  That's a separate issue.  If I were in charge of the world, I just skip the canard of medical marijuania and legalize it.  Before you ask I would not legalize cocaine, opiates, or amphetamines that carry the potential for acute overdose.



Legalization does not mean selling it in gas stations. All drugs should be legal, and regulated.  



geauxtohell said:


> In regards to narcotic pain pills, you are wrong.



You just believe that because your moral position is that hard drugs are bad.



geauxtohell said:


> Oh lord.......  You have access to google, right?  I am not trying to "assert" anything.  Medicine is an "evidence based" venture.  That means decisions are made, not on what you or someone believes in their gut, but on what the research shows.  I am not being snooty or flippant, I am asking if you can produce a shred of evidence beyond your opinion that would make me reconsider what I have been taught or researched myself.
> 
> That is addressing the issue in an academic matter.  If we were on medical rounds, the standard would be the same.  Stomping your feet and insisting that you are right and I am a dick is not.
> 
> I am not disputing that physicians do the wrong thing.  I am just pointing out it's the wrong thing.  We frequently have patients who try and extort pain pills by saying the same thing:  "I am just going to get them off the street". That statement will turn even the most pain-pill liberally minded doctor into a draconian and you can bet your ass we are going to document that statement and that patient isn't going to get any pain meds from any provider with access to our records again.



Google, if I am lucky, has a synopsis of an article, the rest is behind a pay wall because journals lock up copyright, often after making researches pay to have their work published in the first place. 

I know medicine is evidence based, never said it wasn't. I am just pointing out that your demand that I provide evidence of things I am not saying, since I never claimed that narcotics is the first choice in pain management, is cheating. 



geauxtohell said:


> You still aren't grasping the point I am making about using narcotics on a chronic basis (i.e. daily for years) versus occasionally for acute pain.



I am getting the point, it is just irrelevant because I never said that. I said that anyone who needs pain meds should have access to them, without having to jump through hoops that the government puts in place to control the availability of narcotics. Making them illegal only inconveniences the people who obey the law, not the addicts.



geauxtohell said:


> Capitulating to a patient's every wants and needs isn't "sympathy".



Because you are better able to judge a patients need than the patient who actually ahs to live in their body, right?


----------



## Quantum Windbag

Kooshdakhaa said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> Kooshdakhaa said:
> 
> 
> 
> Last time I had any pain pills was when I had a root canal.  I got the prescription filled and then read the warnings.  No way would I take those pain pills after I read the possible side effects.  Called the dentist and told him.  He said I needed to take them for the inflammation.  I said what about Bayer aspirin.  He said okay, so that's what I took.  Put the pain pills in my emergency survival kit.
> 
> However, the pain wasn't that bad.  If a person is in a lot of pain they deserve to have relief.  That is for sure.  But rather than take those nasty pain pills my whole life I would sure be exploring other ways of managing pain. Someone I knew was paralyzed from the waist down, yet he had terrible pain in his legs.  Ghost pain, I guess, but very real to him.  He told me that out of desperation he had finally learned to block the pain out of his mind.  What power that would give a person, if they could learn to block pain that way.  Much better than pain pills.
> 
> 
> 
> 
> Ever read about the side effects of aspirin?
> 
> 
> 
> 
> All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Aspirin:
> 
> Heartburn; nausea; upset stomach.
> 
> Seek medical attention right away if any of these SEVERE side effects occur when using Aspirin:
> Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; confusion; diarrhea; dizziness; drowsiness; hearing loss; ringing in the ears; severe or persistent stomach pain; unusual bruising; vomiting.
> 
> This is not a complete list of all side effects that may occur.
> 
> Click to expand...
> 
> 
> They are required to list side effects by law. You did not need the pills, which is great, but not taking them because you are afraid of a side effect is a bit like not leaving the house because people get hit by cars. IF you get one of them worry, otherwise take the pills if needed.
> 
> Click to expand...
> 
> 
> Yes, I am aware of the side effects of aspirin.  I think it's pretty obvious that I'm the type of person who reads labels.  I am not allergic to aspirin, so that isn't a problem.  As for the other possible side effects, I've never had so much as an upset stomach from taking aspirin.  Even so, I take it rarely.
> 
> If I hadn't read the side effects, I probably would have just gone ahead and taken those pain pills.  which is what most people probably do.  But that would have been ridiculous...I didn't need them.
> 
> I'm not the kind of person to gaze with wide-eyed trust at my doctor while he writes prescriptions for me.  I had a doctor give me a free sample of Welbutrin to take because I have panic attacks.  He said if I "like it" he'd write me a prescription.  I didn't take them, I did some research first.  Came to find out that Welbutrin makes many people's panic worse!  Thanks, Doc, but no thanks.  I've learned to manage the panic on my own, without drugs.
Click to expand...


I should have deleted this post, I apologize. After I read further I realized we are kindred spirits when it comes to meds.


----------



## Sunshine

geauxtohell said:


> Sunshine said:
> 
> 
> 
> 
> 
> hortysir said:
> 
> 
> 
> She's willing to try anything that works.
> it's just that when you show up at the ER asking for something for pain there's that "look".
> Sometimes there's a rude dismissal to go along with it......
> 
> 
> 
> 
> Effexor.  Cymbalta.  It takes a while to get enough in the system to work.  I dont know about Lyrica.  It is mostly used for diabetics.  Pristique.  Not more efficacious thatn Effexor.
> 
> Click to expand...
> 
> 
> Lyrica is a GABA analogue.  The current notion is that people with FM have low thresholds for pain.  So the notion is that, in giving them a gaba analogue, you are raising the fire threshold on their CNS.
> 
> It has some good evidence behind it, but not as good as the SSRIs, which lead me to suspect (but not know) that FM is either a symptom of depression or somehow tied to it neurologically.
Click to expand...


Look up the DSM-IV criteria for Somatoform Pain Disorder.


----------



## Quantum Windbag

Sunshine said:


> mskafka said:
> 
> 
> 
> 
> 
> Kooshdakhaa said:
> 
> 
> 
> I think you should go to the pain clinic.  What's your problem with the pain clinic?
> 
> That's the purpose of a pain clinic...managing pain.  You should at least give it a try.
> 
> What happens with other people suffering from MS?  Do they also have pain?  How is it treated?  Sounds like a forum for people with MS might provide you with some help and answers.  Maybe?
> 
> 
> 
> 
> There is a stigma attached to pain clinics.  I'm just recalling how many people I've intubated and treated from OD's from pain clinics.  In THIS state, they are considered legal drug pushers; and this area....not very highly respected.
> 
> I have and do belong to an MS forum/chat.  The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue.  I'm here, because this to me, is a political issue.  And because I belonged to this forum LONG before I was diagnosed with MS.
> 
> And yes, I'm totally with Ron Paul on the "War on Drugs".  I believe it has been a disaster.  Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).
> 
> And no, it's not constant pain.  But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore.  This makes perfect sense to me.
> 
> Now there is constant numbness in certain areas, but pain?  Only after a flare.  And it sux.
> 
> Click to expand...
> 
> 
> There are non narcotic drugs that will help the muscle contractions.  Aren't they giving you anything for that?
> 
> I go to Vanderbilt for this illness I have.  Have you been there?
> 
> I understand what you mean about the pain clinics, though.  When I was practicing in Nashville, one of them called me up and insisted that I guarantee that the patient they were seeing would not kill herself with her pain medicine.  LOL.  I just laughed, but sent a statement that there is no guarantee that  anyone will not suicide, but the patient did not have any drug abuse history, was not suicidal, nor psychotic.
Click to expand...


Which is all you can do.


----------



## strollingbones

i am going with the op...pain management in the us is a fucking joke....does one really care if a terminally ill patient becomes addicted to pain meds?  really?  why?  

and doctors are the biggest drug dealers on the planet....a friend of mine has simple outpatient surgery in florida.....she was given 90 oxies....wtf?  and look at the kids on drugs in this country...adderall...the poor man's cocaine

look around your doctors office next time you are in there....ever fucking thing from the sticky notes to the pens are from drug companies....doctors are cheap ass dealers for the large drug companies....then the fucking charlatans balk at giving pain meds to people truly in pain..what dicks

seems the end of your life is the fucking time doctors care about how addicted you are


----------



## Sunshine

strollingbones said:


> old fashioned test for ms.....get into a hot tub...dont do this alone....if you pass out its most  likely ms....if you dont....its something else....



MS is diagnosed by the use of MRI scanning.  Deterioration/disruption of the myelin sheath around the nerve cell is the cardinal sign of MS.


----------



## Sunshine

geauxtohell said:


> Sunshine said:
> 
> 
> 
> I have had numerous patients on Oxycontin who come in for treatment of depression.  I just have to tell them that I can't treat their depression as long as they are on Oxycontin.  They are not depressed.  They are narcolyzed.
> 
> 
> 
> 
> Couldn't agree more.  Also can't figure out why you would every give a depressed person a depressant.
> 
> You might as well hand them a 1/5 of whiskey.
Click to expand...


They would enjoy it more, that's for sure!


----------



## Quantum Windbag

Sunshine said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> Gagafritz said:
> 
> 
> 
> Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?
> 
> 
> 
> 
> The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.
> 
> Click to expand...
> 
> 
> He is not the only 'medically trained' person on this thread.  And I don't think that is what he is saying.  I have seen my share of drug seekers as well.  Probably more in my 23 years as a nurse than he has.  They exist.  They are out there.  They have a pattern of behavior, usually.
Click to expand...


I did not know you were trained. 

My experience with drug addicts is that you can usually spot them. My guess is that, as a nurse, you are even better at it than I am. One thing I have noticed, people in severe pain usually do not feel better until after they actually get a med and it has a chance to work, addicts can react to the knowledge that they will get what they want.


----------



## Sunshine

geauxtohell said:


> Sunshine said:
> 
> 
> 
> 
> 
> hortysir said:
> 
> 
> 
> She's willing to try anything that works.
> it's just that when you show up at the ER asking for something for pain there's that "look".
> Sometimes there's a rude dismissal to go along with it......
> 
> 
> 
> 
> Effexor.  Cymbalta.  It takes a while to get enough in the system to work.  I dont know about Lyrica.  It is mostly used for diabetics.  Pristique.  Not more efficacious thatn Effexor.
> 
> Click to expand...
> 
> 
> Lyrica is a GABA analogue.  The current notion is that people with FM have low thresholds for pain.  So the notion is that, in giving them a gaba analogue, you are raising the fire threshold on their CNS.
> 
> It has some good evidence behind it, but not as good as the SSRIs, which lead me to suspect (but not know) that FM is either a symptom of depression or somehow tied to it neurologically.
Click to expand...


Yeah, it's usually a chicken/egg thing.


----------



## Quantum Windbag

strollingbones said:


> i am going with the op...pain management in the us is a fucking joke....does one really care if a terminally ill patient becomes addicted to pain meds?  really?  why?
> 
> and doctors are the biggest drug dealers on the planet....a friend of mine has simple outpatient surgery in florida.....she was given 90 oxies....wtf?  and look at the kids on drugs in this country...adderall...the poor man's cocaine
> 
> look around your doctors office next time you are in there....ever fucking thing from the sticky notes to the pens are from drug companies....doctors are cheap ass dealers for the large drug companies....then the fucking charlatans balk at giving pain meds to people truly in pain..what dicks
> 
> seems the end of your life is the fucking time doctors care about how addicted you are



BINGO. If the guy is dying from terminal cancer give him whatever he needs to interact with the world instead of laying in bed all day in pain.


----------



## strollingbones

and now did they do it before mri's?   just cause its an old trick doesnt mean it doesnt work

and i am very much aware of ms and how its diagnosed and treated

the abc's of ms


----------



## Sunshine

strollingbones said:


> and now did they do it before mri's?   just cause its an old trick doesnt mean it doesnt work
> 
> and i am very much aware of ms and how its diagnosed and treated
> 
> the abc's of ms



Like everything else that doesn't have an objective test for it, by signs and symptoms:



> Signs and symptomsMain article: Multiple sclerosis signs and symptoms
> 
> Main symptoms of multiple sclerosisA person with MS can suffer almost any neurological symptom or sign, including changes in sensation such as loss of sensitivity or tingling, pricking or numbness (hypoesthesia and paresthesia), muscle weakness, clonus, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis including phosphenes,[13][14] or diplopia), fatigue, acute or chronic pain, and bladder and bowel difficulties.[1] Cognitive impairment of varying degrees and emotional symptoms of depression or unstable mood are also common.[1] Uhthoff's phenomenon, an exacerbation of extant symptoms due to an exposure to higher than usual ambient temperatures, and Lhermitte's sign, an electrical sensation that runs down the back when bending the neck, are particularly characteristic of MS although not specific.[1] The main clinical measure of disability progression and symptom severity is the Expanded Disability Status Scale or EDSS.[15]
> 
> Symptoms of MS usually appear in episodic acute periods of worsening (called relapses, exacerbations, bouts, attacks, or "flare-ups"), in a gradually progressive deterioration of neurologic function, or in a combination of both.[6] Multiple sclerosis relapses are often unpredictable, occurring without warning and without obvious inciting factors with a rate rarely above one and a half per year.[1] Some attacks, however, are preceded by common triggers. Relapses occur more frequently during spring and summer.[16] Viral infections such as the common cold, influenza, or gastroenteritis increase the risk of relapse.[1] Stress may also trigger an attack.[17] Pregnancy affects the susceptibility to relapse, with a lower relapse rate at each trimester of gestation. During the first few months after delivery, however, the risk of relapse is increased.[1] Overall, pregnancy does not seem to influence long-term disability. Many potential triggers have been examined and found not to influence MS relapse rates. There is no evidence that vaccination and breast feeding,[1] physical trauma,[18] or Uhthoff's phenomenon[16] are relapse triggers.



Multiple sclerosis - Wikipedia, the free encyclopedia

Some old wives tale is not an objective test for a medical illness.


----------



## strollingbones

While I don&#8217;t have an exact statistic on this, I can say that most of us are sensitive to the heat. In fact, for many years, the "hot bath test&#8221; was used to diagnose MS. A person suspected of having MS was immersed in a hot tub of water, and watched to see if neurologic symptoms appeared or got worse, which would earn them a diagnosis of MS. (This practice was stopped when MRIs came on the scene, but is still practiced in some countries where MRIs are not readily accessible.) 

Heat Intolerance and Multiple Sclerosis - Heat and MS - Pseudoexacerbations in MS

you are such a fucking dumb bitch at times


----------



## geauxtohell

Quantum Windbag said:


> I percieve that because the DEA is up every doctors ass with a microscope. If you don't believe me go into pain management and see ho difficult it is to comply with DEA regulations v patient needs.



I think "Pain Management" is the last thing I need to go into, LMAO.  Though, my mentor doctor, who I have worked with weekly and then on a daily basis for one month out of each year, is board certified in Pain Management.  So I have encountered a lot of patients who are pain management issues and know how things need to be charted to be kosher with the DEA.  So I am not completely ignorant of this issue.

Showing an indication and then the name, number, and amount of refills for a narcotic is not asking too much of a doctor.

Physicians that do pain management full time should understand that the DEA is going to be watching them as the potential for fraud and abuse is highest there.   



> If you can provide evidence that her doctor is the exception to the rule feel free to provide it, until then I will assume that everything I have read, and experienced, is true.



I take exception to you claiming that your opinion is the rule.  This is a cause and effect issue.  We both understand the effect.  We disagree on the cause.  You think doctors are stringent about prescribing narcs because they fear the DEA.  I think they are stringent because over prescribing narcs is bad medicine that leads to universally bad outcomes.  



> Just like you do when you demand I provide clinical studies to refute your position.



*sigh*.  I haven't demanded anything.  This is, at heart, an academic issue.  If you don't want to treat it as such, then fine.  However, don't lambaste me for trying to elevate it from a matter of opinion to a matter of science.



> Exactly, if we could get the government out of determining what is, and what is not, valid treatment we will continue to have a problem doing proper pain management in this country.



For the most part, the DEA is out of what is and is not proper treatment.  Though, if you feel that prescribing narcotics to prevent someone from getting them on the street is a proper indication for their use, then perhaps you would get some heat from the DEA.  

As you should.  That's just boneheaded.  



> Legalization does not mean selling it in gas stations. All drugs should be legal, and regulated.



Okay.



> You just believe that because your moral position is that hard drugs are bad.



No it's not.  You have no clue what my "moral position" is, thank you very much.  

My position is that physicians should not contribute to harming their patients if they have the opportunity.  

That means avoiding giving them addictive and potentially lethal medications if their are better alternatives.  

I could give a shit less if someone wants to smoke pot for whatever reason (to include simply getting high).  I resent medical providers being drug into the issue under the guise of "medical need" simply because people want to get high.  Marijuania for anxiety?  Give me a frigging break.  Marijuania for cancer patients on Chemo or HIV patients on HAART to reduce nausea and stimulate appetite?  I am all for that.  

However, to avoid the stupidity of the people that want to simply get high and will invent new and fabulous indications that only marijuania can treat (in their opinion), I think they should just legalize it.  



> Google, if I am lucky, has a synopsis of an article, the rest is behind a pay wall because journals lock up copyright, often after making researches pay to have their work published in the first place.
> 
> I know medicine is evidence based, never said it wasn't. I am just pointing out that your demand that I provide evidence of things I am not saying, since I never claimed that narcotics is the first choice in pain management, is cheating.



I am not trying to "cheat".  I don't want you to pay for something (obviously) and not every article is behind a pay wall.  I should know, I linked a clinical guideline for FM from pubmed.  

However, if you don't think narcotics are first line drugs, then the point is moot (as that is the point I am making).



> I am getting the point, it is just irrelevant because I never said that. I said that anyone who needs pain meds should have access to them, without having to jump through hoops that the government puts in place to control the availability of narcotics. Making them illegal only inconveniences the people who obey the law, not the addicts.



That's your opinion.  The issue of "who needs narcotics" is the obvious sticking point and if that was clear, there would be no need for debate.  



> Because you are better able to judge a patients need than the patient who actually ahs to live in their body, right?



No.  At the same time, I would be negligent if I simply gave people what they wanted without consideration for the pros and cons of the issue.

Just a basic tenant of treatment.


----------



## geauxtohell

Sunshine said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Sunshine said:
> 
> 
> 
> Effexor.  Cymbalta.  It takes a while to get enough in the system to work.  I dont know about Lyrica.  It is mostly used for diabetics.  Pristique.  Not more efficacious thatn Effexor.
> 
> 
> 
> 
> Lyrica is a GABA analogue.  The current notion is that people with FM have low thresholds for pain.  So the notion is that, in giving them a gaba analogue, you are raising the fire threshold on their CNS.
> 
> It has some good evidence behind it, but not as good as the SSRIs, which lead me to suspect (but not know) that FM is either a symptom of depression or somehow tied to it neurologically.
> 
> Click to expand...
> 
> 
> Look up the DSM-IV criteria for Somatoform Pain Disorder.
Click to expand...


I know what it is.  I don't think that is the issue for most people with FM.


----------



## geauxtohell

Quantum Windbag said:


> strollingbones said:
> 
> 
> 
> i am going with the op...pain management in the us is a fucking joke....does one really care if a terminally ill patient becomes addicted to pain meds?  really?  why?
> 
> and doctors are the biggest drug dealers on the planet....a friend of mine has simple outpatient surgery in florida.....she was given 90 oxies....wtf?  and look at the kids on drugs in this country...adderall...the poor man's cocaine
> 
> look around your doctors office next time you are in there....ever fucking thing from the sticky notes to the pens are from drug companies....doctors are cheap ass dealers for the large drug companies....then the fucking charlatans balk at giving pain meds to people truly in pain..what dicks
> 
> seems the end of your life is the fucking time doctors care about how addicted you are
> 
> 
> 
> 
> BINGO. If the guy is dying from terminal cancer give him whatever he needs to interact with the world instead of laying in bed all day in pain.
Click to expand...


And you wouldn't have any sort of debate on that issue as everyone excepts that hospice care is about making people comfortable (even if it shortens their life).

This issue is not about hospice care.


----------



## Sunshine

geauxtohell said:


> Sunshine said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> Lyrica is a GABA analogue.  The current notion is that people with FM have low thresholds for pain.  So the notion is that, in giving them a gaba analogue, you are raising the fire threshold on their CNS.
> 
> It has some good evidence behind it, but not as good as the SSRIs, which lead me to suspect (but not know) that FM is either a symptom of depression or somehow tied to it neurologically.
> 
> 
> 
> 
> Look up the DSM-IV criteria for Somatoform Pain Disorder.
> 
> Click to expand...
> 
> 
> I know what it is.  I don't think that is the issue for most people with FM.
Click to expand...


Not for MS.  But the symptoms of FM sound a lot like it.  It is a neurosis.


----------



## geauxtohell

strollingbones said:


> While I dont have an exact statistic on this, I can say that most of us are sensitive to the heat. In fact, for many years, the "hot bath test was used to diagnose MS. A person suspected of having MS was immersed in a hot tub of water, and watched to see if neurologic symptoms appeared or got worse, which would earn them a diagnosis of MS. (This practice was stopped when MRIs came on the scene, but is still practiced in some countries where MRIs are not readily accessible.)
> 
> Heat Intolerance and Multiple Sclerosis - Heat and MS - Pseudoexacerbations in MS
> 
> you are such a fucking dumb bitch at times



And hysterectomies were used to treat ill behaved (read:  "women who don't want to have sex with their husbands) at one time.

The link between latitude and MS incidence (sun/heat exposure) has been disproven.  

I really think a hot bath is a wives tale.  It's a hell of a lot cheaper than an MRI w/ T2 Flair, and if it were at all accurate, would be a better test.


----------



## geauxtohell

Sunshine said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Sunshine said:
> 
> 
> 
> Look up the DSM-IV criteria for Somatoform Pain Disorder.
> 
> 
> 
> 
> I know what it is.  I don't think that is the issue for most people with FM.
> 
> Click to expand...
> 
> 
> Not for MS.  But the symptoms of FM sound a lot like it.  It is a neurosis.
Click to expand...


I am not a big proponent of FM, but I just don't believe that it's somatoform.  For one thing, there isn't always sexual and multi-internal organ dysfunction.

I really think it's people with a low pain tolerance who, because we know have tricked people into thinking we can treat it, demand treatment.


----------



## Sunshine

geauxtohell said:


> strollingbones said:
> 
> 
> 
> While I dont have an exact statistic on this, I can say that most of us are sensitive to the heat. In fact, for many years, the "hot bath test was used to diagnose MS. A person suspected of having MS was immersed in a hot tub of water, and watched to see if neurologic symptoms appeared or got worse, which would earn them a diagnosis of MS. (This practice was stopped when MRIs came on the scene, but is still practiced in some countries where MRIs are not readily accessible.)
> 
> Heat Intolerance and Multiple Sclerosis - Heat and MS - Pseudoexacerbations in MS
> 
> you are such a fucking dumb bitch at times
> 
> 
> 
> 
> And hysterectomies were used to treat ill behaved (read:  "women who don't want to have sex with their husbands) at one time.
> 
> The link between latitude and MS incidence (sun/heat exposure) has been disproven.
> 
> I really think a hot bath is a wives tale.  It's a hell of a lot cheaper than an MRI w/ T2 Flair, and if it were at all accurate, would be a better test.
Click to expand...


Exactly.  You know they USED to diagnose mumps by having the kid eat a pickle.  If the parotid gland hurt then he/she had the mumps.  Well this Remodulin I'm on causes that to happen every time I take a bite of anything.  According to the wives tale, I will have mumps until the day I die.  Think I can get disability?  LOL


----------



## Sunshine

geauxtohell said:


> Sunshine said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> I know what it is.  I don't think that is the issue for most people with FM.
> 
> 
> 
> 
> Not for MS.  But the symptoms of FM sound a lot like it.  It is a neurosis.
> 
> Click to expand...
> 
> 
> I am not a big proponent of FM, but I just don't believe that it's somatoform.  For one thing, there isn't always sexual and multi-internal organ dysfunction.
> 
> I really think it's people with a low pain tolerance who, because we know have tricked people into thinking we can treat it, demand treatment.
Click to expand...


Well, it's a money maker for rheumatologists!  That's for sure.


----------



## Quantum Windbag

geauxtohell said:


> I think "Pain Management" is the last thing I need to go into, LMAO.  Though, my mentor doctor, who I have worked with weekly and then on a daily basis for one month out of each year, is board certified in Pain Management.  So I have encountered a lot of patients who are pain management issues and know how things need to be charted to be kosher with the DEA.  So I am not completely ignorant of this issue.
> 
> Showing an indication and then the name, number, and amount of refills for a narcotic is not asking too much of a doctor.
> 
> Physicians that do pain management full time should understand that the DEA is going to be watching them as the potential for fraud and abuse is highest there.



Do you think filing a report on all abortions which included the name and phone number would be too much for a doctor? Or do you think that might violate doctor/patient confidentiality? My point is the government should not be in doctor/patient relationships at all, you seem to think it is justifiable as long as your personal morality agrees with it.



geauxtohell said:


> I take exception to you claiming that your opinion is the rule.  This is a cause and effect issue.  We both understand the effect.  We disagree on the cause.  You think doctors are stringent about prescribing narcs because they fear the DEA.  I think they are stringent because over prescribing narcs is bad medicine that leads to universally bad outcomes.



You are free to do so. My position is consistent, and based on giving all patients privacy from government interference. I therefore see the DEA as the problem. Your is based on the psotion that some government interference in patient privacy is justifiable because, as you have pointed out to me, a small number of patients are addicts.

Frankly, if most people who tried to get pain meds were addicts you might have an argument, which is why I was giving you the benefit of the doubt earlier before you insisted that was not your position. I would still disagree with you, but I could see the basis of an argument based on the fact that more addicts try to get meds than people who actually need them.



geauxtohell said:


> *sigh*.  I haven't demanded anything.  This is, at heart, an academic issue.  If you don't want to treat it as such, then fine.  However, don't lambaste me for trying to elevate it from a matter of opinion to a matter of science.



To me pain is personal, just like it is to anyone who has really experienced it. I have had both shingles and kidney stones, and have neuralgia and paralysis from the shingles. You can talk about science all you want, just remember that patients are people, not case studies.



geauxtohell said:


> For the most part, the DEA is out of what is and is not proper treatment.  Though, if you feel that prescribing narcotics to prevent someone from getting them on the street is a proper indication for their use, then perhaps you would get some heat from the DEA.
> 
> As you should.  That's just boneheaded.



I did not say I agree with it, I just think that if a doctor and patient decide that, the government should not have a voice in the decision. 



geauxtohell said:


> No it's not.  You have no clue what my "moral position" is, thank you very much.
> 
> My position is that physicians should not contribute to harming their patients if they have the opportunity.
> 
> That means avoiding giving them addictive and potentially lethal medications if their are better alternatives.
> 
> I could give a shit less if someone wants to smoke pot for whatever reason (to include simply getting high).  I resent medical providers being drug into the issue under the guise of "medical need" simply because people want to get high.  Marijuania for anxiety?  Give me a frigging break.  Marijuania for cancer patients on Chemo or HIV patients on HAART to reduce nausea and stimulate appetite?  I am all for that.
> 
> However, to avoid the stupidity of the people that want to simply get high and will invent new and fabulous indications that only marijuania can treat (in their opinion), I think they should just legalize it.



I can't argue with that. I will point out that, addiction is more a matter of the person than the drug. I have been in the hospital twice for pain management, the last time was for over a week. I got narcotics the entire time on both occasions, and left without a trace of withdrawal. I also took Vicodin 4 times a day every day for almost a month when I had shingles,  I have a friend who got addicted after three days and not only had to go through withdrawal, he attends NA meetings to make sure he stays away from temptation. I hope he never needs treatment for acute pain again.

I am aware of the potential for addiction, I just think I am more typical than my friend.



geauxtohell said:


> That's your opinion.  The issue of "who needs narcotics" is the obvious sticking point and if that was clear, there would be no need for debate.



The issue should be decided by a doctor, not the government. 



geauxtohell said:


> No.  At the same time, I would be negligent if I simply gave people what they wanted without consideration for the pros and cons of the issue.
> 
> Just a basic tenant of treatment.



If I present to you with kidney stones and you start examining my fingers for pinpricks I am going to demand a doctor that knows that my kidneys have nothing to do with my fingers.

Just saying.


----------



## geauxtohell

Sunshine said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Sunshine said:
> 
> 
> 
> Not for MS.  But the symptoms of FM sound a lot like it.  It is a neurosis.
> 
> 
> 
> 
> I am not a big proponent of FM, but I just don't believe that it's somatoform.  For one thing, there isn't always sexual and multi-internal organ dysfunction.
> 
> I really think it's people with a low pain tolerance who, because we know have tricked people into thinking we can treat it, demand treatment.
> 
> Click to expand...
> 
> 
> Well, it's a money maker for rheumatologists!  That's for sure.
Click to expand...


I hate just dismissing potential pathology.  I know FM has a terrible rap as a condition that "lawyers invented" to rack up damages, but at the same time I think it's a real thing.  

It's just frustrating to treat.  One of the reasons I am glad I am going into EM is that I won't have to deal with it.


----------



## Sunshine

geauxtohell said:


> Sunshine said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> I am not a big proponent of FM, but I just don't believe that it's somatoform.  For one thing, there isn't always sexual and multi-internal organ dysfunction.
> 
> I really think it's people with a low pain tolerance who, because we know have tricked people into thinking we can treat it, demand treatment.
> 
> 
> 
> 
> Well, it's a money maker for rheumatologists!  That's for sure.
> 
> Click to expand...
> 
> 
> I hate just dismissing potential pathology.  I know FM has a terrible rap as a condition that "lawyers invented" to rack up damages, but at the same time I think it's a real thing.
> 
> It's just frustrating to treat.  One of the reasons I am glad I am going into EM is that *I won't have to deal with it*.
Click to expand...


Famous last words!  LOL


----------



## geauxtohell

Sunshine said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Sunshine said:
> 
> 
> 
> Well, it's a money maker for rheumatologists!  That's for sure.
> 
> 
> 
> 
> I hate just dismissing potential pathology.  I know FM has a terrible rap as a condition that "lawyers invented" to rack up damages, but at the same time I think it's a real thing.
> 
> It's just frustrating to treat.  One of the reasons I am glad I am going into EM is that *I won't have to deal with it*.
> 
> Click to expand...
> 
> 
> Famous last words!  LOL
Click to expand...


Well.... Other than telling FM patients that they aren't getting narcotics or long term management of their condition and they need to establish care with a PCP.


----------



## Montrovant

geauxtohell said:


> Did it ever occur to you that the reason triage exists so that people that have actual emergent medical conditions go straight back and jump over the people who are just there for pain control and other trivial complaints that clog up the system?  (I once saw someone wait for 8 hours to be seen for "insomnia".



Why is the word emergent used that way by the medical community?  My understanding of the definition was that it would be describing something as emerging, and that you should say 'people that have actual emergency medical conditions'.  The couple I live with both work in hospitals (he on the clerical side, she as an ER nurse) and their use of the word was the first I had heard it used in such a way.  It just seems so unnecessary to me. 

/end unrelated rant


----------



## Montrovant

To speak to the point of the thread, as I stated in my previous post, I live with a couple who both work in/around hospital ER's.  Both of them have told me stories of the many people who come to the ER just hoping to score some pills, without any real medical condition.  Obviously this is hearsay, and equally obviously the few hospitals they have worked in are not necessarily indicative of conditions everywhere in the country.  That said, based on what I have heard from them (and through them, what they have heard from other nurses and doctors) abuse of the ER to obtain narcotics either for recreational use or to sell is pretty widespread.  

Whether that is more an issue of unneeded government intrusion or what constitutes sound medical treatment I could not say.


----------



## Gagafritz

Honestly, i don't get the hysteria over pain medication and opioids.  Yeah, some people will become addicts.  If they dont' medicate themselves with that they will use alcohol or whatever.  Not every pain syndrome is inflammation.  Some pain is simply pain.  Chronic use of NSAIDs can cause GI problems, GI bleeding and kidney failure.  And, for some reason there seems to be a notion that chronic pain isn't worthy of being treated with opioids.   Opioids are the gold standard of pain relief.  And, toradol and motrin are helpful adjuncts but often do not really treat the pain.  Opioids target specific mu receptors that are not targeted by nsaids  and tylenol.   To withhold pain medication out of irrational fears of addiction is cruel and inhumane.


----------



## Sunshine

geauxtohell said:


> Sunshine said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> I hate just dismissing potential pathology.  I know FM has a terrible rap as a condition that "lawyers invented" to rack up damages, but at the same time I think it's a real thing.
> 
> It's just frustrating to treat.  One of the reasons I am glad I am going into EM is that *I won't have to deal with it*.
> 
> 
> 
> 
> Famous last words!  LOL
> 
> Click to expand...
> 
> 
> Well.... Other than telling FM patients that they aren't getting narcotics or long term management of their condition and they need to establish care with a PCP.
Click to expand...


I went to a pain management seminar a few years back before pain was the '5th vital sign.'  The guy who taught it was an oncologist.  He was gung ho for giving cancer patients everything they needed, but didn't consisder spinal injuries a source of pain.  I spoke to him after the seminary and he commented 'those people have something mentally wrong to start with.'  There ARE others out there who discount legitimate pain people are having.

I've had degenerative arthritis in my spine for 33 years.  Early on I took a little Baclofen, but after about 5 years stopped that and have managed it with therapeutic massage,  good work chairs, and a super duper expensive mattress to sleep on.  I still have a little pain and in reality it really mimics the compaints that FM patients have.  But I've never considered that  AND I like working and want something out of life other than narcotics.  So, I just deal with it.  But when I do have pain from some other source, I think it looks exaggerated and it may be simply because after dealing with constant pain all the time, any more on top of it  puts me over the limit.

Last knee replacement was so bad the surgeon said I would have plenty of pain medicine and he  kept his word.  I took 4 Lortabs a day for 8 weeks.  At the end I tapered myself off, but still had horrible cramps when I stopped it.  Death from opiate withdrawal is unlikely, but you may WISH to die.  I can't even imagine what it would be like for someone who had a genuine addiction with all the psychological craving along with the physical.

Obviously there ARE a lot of doctors and pharmacists too who basically deal in drugs.  Over the years just seeing so many addicted patients, I have come to understand how much is available on the streets.  Sure, some comes from other countries, but I really believe most of the problems are from prescribers.  

The people who do this are dangerous clinicians.  Oversight IS needed and the decisions should definitely NOT be left between the provider and the patient, and that is in the interest of patient safety.  

I dig what you mean about the cannabis as well.  When it was up for a vote in California, I had patients throwing that in my face every day.  My response to them was 'move to California, I'll be happy to transfer your care to someone there.'  But it quieted down when that referendum didn't pass.  It makes you weary.  When I was in law school, I was still practicing and Tenncare became 'concerned' about how much benzodiazepine was available on the street. So they mandated that everyone on a benzo had to get it through a mental health clinic.  I had sweet little old ladies shaking their fists at me over xanax.  After about 8 months of that, I quit practice and went into academia for about 4 years.  Only those of us who have had to deal with the realities of the drug culture in this country really have a clue the extent to which it exists.


----------



## Sunshine

Gagafritz said:


> Honestly, i don't get the hysteria over pain medication and opioids.  Yeah, some people will become addicts.  If they dont' medicate themselves with that they will use alcohol or whatever.  Not every pain syndrome is inflammation.  Some pain is simply pain.  Chronic use of NSAIDs can cause GI problems, GI bleeding and kidney failure.  And, for some reason there seems to be a notion that chronic pain isn't worthy of being treated with opioids.   Opioids are the gold standard of pain relief.  And, toradol and motrin are helpful adjuncts but often do not really treat the pain.  Opioids target specific mu receptors that are not targeted by nsaids  and tylenol.   To withhold pain medication out of irrational fears of addiction is cruel and inhumane.



The problem with treating chronic pain with opiates is the tolerance to the drug that is built up over time.  Eventually the person is on such mega doses that at some point it will become lethal.  Reputable providers prefer not to kill their patients.


----------



## Sunshine

Montrovant said:


> geauxtohell said:
> 
> 
> 
> Did it ever occur to you that the reason triage exists so that people that have actual emergent medical conditions go straight back and jump over the people who are just there for pain control and other trivial complaints that clog up the system?  (I once saw someone wait for 8 hours to be seen for "insomnia".
> 
> 
> 
> 
> Why is the word emergent used that way by the medical community?  My understanding of the definition was that it would be describing something as emerging, and that you should say 'people that have actual emergency medical conditions'.  The couple I live with both work in hospitals (he on the clerical side, she as an ER nurse) and their use of the word was the first I had heard it used in such a way.  It just seems so unnecessary to me.
> 
> /end unrelated rant
Click to expand...


Maybe because it's the correct word to use at the time:



> eÂ·merÂ·gentÂ (-mÃ»rjnt)
> adj.
> 1.
> a. Coming into view, existence, or notice: emergent spring shoots; an emergent political leader.
> b. Emerging: emergent nations.
> 2. Rising above a surrounding medium, especially a fluid.
> 3.
> a. Arising or occurring unexpectedly: money laid aside for emergent contingencies.
> *b. Demanding prompt action; urgent.*4. Occurring as a consequence; resultant: economic problems emergent from the restriction of credit.
> n.
> One that is coming into view or existence: "The giant redwoods . . . outstrip the emergents of the rain forest, which rarely reach two hundred feet" (Catherine Caulfield).



emergent - definition of emergent by the Free Online Dictionary, Thesaurus and Encyclopedia.


----------



## Gagafritz

Sunshine said:


> Gagafritz said:
> 
> 
> 
> Honestly, i don't get the hysteria over pain medication and opioids.  Yeah, some people will become addicts.  If they dont' medicate themselves with that they will use alcohol or whatever.  Not every pain syndrome is inflammation.  Some pain is simply pain.  Chronic use of NSAIDs can cause GI problems, GI bleeding and kidney failure.  And, for some reason there seems to be a notion that chronic pain isn't worthy of being treated with opioids.   Opioids are the gold standard of pain relief.  And, toradol and motrin are helpful adjuncts but often do not really treat the pain.  Opioids target specific mu receptors that are not targeted by nsaids  and tylenol.   To withhold pain medication out of irrational fears of addiction is cruel and inhumane.
> 
> 
> 
> 
> The problem with treating chronic pain with opiates is the tolerance to the drug that is built up over time.  Eventually the person is on such mega doses that at some point it will become lethal.  Reputable providers prefer not to kill their patients.
Click to expand...


Reputable providers know how to manage and use these medications correctly, not just put a black box label on them and disregard them.


----------



## Gagafritz

What is wrong with the word "emergent" ?  It is used correctly .


----------



## Sunshine

Gagafritz said:


> Sunshine said:
> 
> 
> 
> 
> 
> Gagafritz said:
> 
> 
> 
> Honestly, i don't get the hysteria over pain medication and opioids.  Yeah, some people will become addicts.  If they dont' medicate themselves with that they will use alcohol or whatever.  Not every pain syndrome is inflammation.  Some pain is simply pain.  Chronic use of NSAIDs can cause GI problems, GI bleeding and kidney failure.  And, for some reason there seems to be a notion that chronic pain isn't worthy of being treated with opioids.   Opioids are the gold standard of pain relief.  And, toradol and motrin are helpful adjuncts but often do not really treat the pain.  Opioids target specific mu receptors that are not targeted by nsaids  and tylenol.   To withhold pain medication out of irrational fears of addiction is cruel and inhumane.
> 
> 
> 
> 
> The problem with treating chronic pain with opiates is the tolerance to the drug that is built up over time.  Eventually the person is on such mega doses that at some point it will become lethal.  Reputable providers prefer not to kill their patients.
> 
> Click to expand...
> 
> 
> Reputable providers know how to manage and use these medications correctly, not just put a black box label on them and disregard them.
Click to expand...



Giving opiates to patients with chronic pain is not a sound practice, due to increased tolerance over time.  As I have already stated.  The person who does that is the one who is not reputable and doesn't know how to manage and use the medications correctly.

Sometimes patients just have to learn how to live with their pain.  As I have.  Distraction is the best intervention for chronic pain.  That's one reason I still work.  It keeps me busy and I don't think about it.  The OP on which this thread started is not having chronic pain.  She is having acute exacerbations.  Narcotics are appropriate in that situation.  However, the question remains if anything has been done to stop/prevent the spasms which cause the pain.


----------



## Gagafritz

Opiates are a reasonable line of treatment and should be included along in a wholistic or total approach to the patient and pain response.  There are different pain pathways that are treated my opioids versus NSAIds and tylenol and so forth.  In addition  to biofeedback, heat/cold therapy and PT and whatever else.  To dismiss chronic pain as not amenable to opioids is unfair to the patient in chronic pain.


----------



## Sunshine

Gagafritz said:


> Opiates are a reasonable line of treatment and should be included along in a wholistic or total approach to the patient and pain response.  There are different pain pathways that are treated my opioids versus NSAIds and tylenol and so forth.  In addition  to biofeedback, heat/cold therapy and PT and whatever else.  To dismiss chronic pain as not amenable to opioids is unfair to the patient in chronic pain.



It is even more unfair to allow a build up of tolerance to opiates such that they die from overdose.


----------



## Gagafritz

I'm sorry.  But opioids can be properly managed and used just like any other medication.  Just like any other, there are side effects that need to be monitored and managed.  There are many people in this country who would be incapicitated but can now live a relatively normal life due to proper treatment with opioids.  I really don't understand your fear of that.  Pain medication is used safely everyday in this country .


----------



## Sunshine

The picture of the drug seeker _emerges.  _


----------



## Gagafritz

What is the picture of a drug seeker?  Someone who needs pain medication becomes labeled as a drug seeker.  It is a nice label to toss about until you or someone you loved is in pain.  But, if you are tossing that label at me, then you are pretty ignorant.


----------



## Gagafritz

As for pain, my mom cries every night over severe diabetic neuropathy of her feet.  SHe has tried everything, advil, ASA, tylenol, lyrica, gabapentin.  The only thing that helped take the edge off a bit was Darvocet which they took off the market.  She is 80 years old.  Does it really matter if she gets "addicted"to opioids?  Why can't she be made to be comfortable.  Sheesh.


----------



## mskafka

So all I needed was about 10 pain pills.  I was given exactly 10....or 3-days supply.  I still have 2 left, and these were written....what.....3-4 days ago?  Haven't needed it today.  

Now again...had I asked for 90 oxycontin, it would have been a different matter altogether.  I don't generally ask for narcotics.  I guess so many practitioners have been burned, they are gun shy.


----------



## Gagafritz

How much pain medicine someone else needs really isnt' anyone's business.  I know people on Fentanyl patches or take oral morphine for cancer pain and on and on.  They aren't Addicts and to make such implications is extremely rude and ignorant.


----------



## mskafka

merrill said:


> You may well be underinsured in which case the medical insurance people could be saying no.
> 
> Are these pain controllers expensive?
> 
> Pain management can be expensive as well.
> 
> Do you have full 24/7 medical insurance coverage no co-pays/no deductibles etc etc etc.
> 
> This may be where the problem lies?
> 
> If it is a insurance coverage situation going to the ER may be the option. If I were experiencing your level of pain the ER would be my choice STAT!



Me?  Underinsured?  No.  I have excellent insurance.  I pay a pretty penny for it through work, but I can't complain.  The diagnosis alone has been over $10,000.  So far, all I've been responsible for has been $500.  

I'm sure there's more to come, but that's it, thus far.  I've been blessed.  It makes you think-how many times you thought of just walking out of that job and telling the boss to go to hell.  How THANKFUL I am that I never did that.


----------



## mskafka

hortysir said:


> geauxtohell said:
> 
> 
> 
> 
> 
> hortysir said:
> 
> 
> 
> Florida's definition of a "Pain Management" doctor is someone that's 60-75 miles away that has a higher co-pay.
> No refills, so you get to make the trip every month.
> 
> 
> 
> 
> And someone that won't treat a patient that doesn't have insurance.  I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.
> 
> Classy.
> 
> Click to expand...
> 
> 
> That's where the drug-seeking-addict label comes from, tho....
> 
> My daughter has Fybro and no insurance.
> She has share-cost medicaid but no income.
> Sometimes the only way she can meet her share of cost is to go to the ER.
> 
> Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.
Click to expand...


I just find myself wondering if she's had everything ruled out.  My doctor first suspected either MS or Lupus in 2003.  They were right on the money.  It just took until 2011 to confirm it.  If she hasn't had autoimmune diseases ruled out, she definitely needs to.  Especially if you have a family history, or if she's had mono, for one.  

Of course, Geaux will tell you that no one knows for certain what the cause of MS is; but Epstein-Barr has been implicated...possibly.


----------



## Montrovant

Sunshine said:


> Montrovant said:
> 
> 
> 
> 
> 
> geauxtohell said:
> 
> 
> 
> Did it ever occur to you that the reason triage exists so that people that have actual emergent medical conditions go straight back and jump over the people who are just there for pain control and other trivial complaints that clog up the system?  (I once saw someone wait for 8 hours to be seen for "insomnia".
> 
> 
> 
> 
> Why is the word emergent used that way by the medical community?  My understanding of the definition was that it would be describing something as emerging, and that you should say 'people that have actual emergency medical conditions'.  The couple I live with both work in hospitals (he on the clerical side, she as an ER nurse) and their use of the word was the first I had heard it used in such a way.  It just seems so unnecessary to me.
> 
> /end unrelated rant
> 
> Click to expand...
> 
> 
> Maybe because it's the correct word to use at the time:
> 
> 
> 
> 
> eÂ·merÂ·gentÂ (-mÃ»rjnt)
> adj.
> 1.
> a. Coming into view, existence, or notice: emergent spring shoots; an emergent political leader.
> b. Emerging: emergent nations.
> 2. Rising above a surrounding medium, especially a fluid.
> 3.
> a. Arising or occurring unexpectedly: money laid aside for emergent contingencies.
> *b. Demanding prompt action; urgent.*4. Occurring as a consequence; resultant: economic problems emergent from the restriction of credit.
> n.
> One that is coming into view or existence: "The giant redwoods . . . outstrip the emergents of the rain forest, which rarely reach two hundred feet" (Catherine Caulfield).
> 
> Click to expand...
> 
> 
> emergent - definition of emergent by the Free Online Dictionary, Thesaurus and Encyclopedia.
Click to expand...


What I wonder is how it became the right word.  Emergent seems to be a derivation of the word emerge, rather than a derivation of emergency.  More, it seems to be simply replacing the word emergency without any change in meaning; is there a difference between saying 'emergent medical condition' and 'emergency medical condition'?

I wonder how and why it came to be defined so that it means emergency.


----------



## mskafka

Douger said:


> Sorry to hear that Muskafa.
> Tennessee huh ? Isn't that where Jesus was born ?
> It's the heart of murka and drugs is only fer them thar pussies and demoNrats.
> Try another state or better yet, go to a country where you'll be treated like an adult. I can walk in a farmacia and get you a basket full of goodies for 1/10 of what your "Chosen" are charging you. The only "permission' I need is a wallet and be tall enough to see over the counter.



LMAO!  Yes, Tennessee is where I've lived most of my life.  I've lived in KY and MI.  Not much difference, but a little bit of diversity.  

Not everyone in TN is shallow and ignorant.  You know that you're going to find that anywhere you go, my man.  I'm just trying to figure out if it's that my dr. is afraid to prescribe, if the medical assistant isn't conveying what I'm saying, clearly, or if doc likes my PPO and wanted to add botox injections to my tab.  

At that moment, I was in so much pain, that I probably would have kicked one of them, had they been in the same room with me, and said the same thing.  You know....that's what the stuff's there for!  I was basically told-" Well, hang in there.  We're going to send a home health nurse over there, tomorrow, for solu-medrol infusions.".  WOW!  And all the while, I'm almost screaming....."It hurts!".


----------



## mskafka

Gagafritz said:


> Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?



Good point, Gaga.  At my level, we're told to treat pain; no questions asked.  If they hurt, you treat.


----------



## mskafka

Quantum Windbag said:


> Gagafritz said:
> 
> 
> 
> Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?
> 
> 
> 
> 
> The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.
Click to expand...


Only medically trained?  Are you speaking at a physician level?  I'm a paramedic, and I treat (or used to treat before the MS) many people with narcotics.


----------



## mskafka

Sunshine said:


> geauxtohell said:
> 
> 
> 
> 
> 
> Sunshine said:
> 
> 
> 
> Look up the DSM-IV criteria for Somatoform Pain Disorder.
> 
> 
> 
> 
> I know what it is.  I don't think that is the issue for most people with FM.
> 
> Click to expand...
> 
> 
> Not for MS.  But the symptoms of FM sound a lot like it.  It is a neurosis.
Click to expand...


Yes, no somatoform here.  I've never in my life (minus nights after too much alcohol) not walked to bed from the bathroom.  My fiance was screaming "This is ridiculous!  I'm calling 911!!!"  And me being the hard-headed paramedic that I am, "DON'T YOU DARE CALL 911!"  

I thought that I'd broken my hip.  I couldn't imagine anything else hurting that badly.


----------



## Againsheila

mskafka said:


> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.



One of the reasons my sister picks up large amounts of tylenol 3 whenever she visits Canada, you can get it up there without a prescription.

I have pain issues too and when my muscle spasms are at their worst, I can't beleive that it's against the law for the local clinic to give me a shot which doesn't even get rid of the pain, but at least gets it to a leval I can handle..


----------



## Sunshine

mskafka said:


> Gagafritz said:
> 
> 
> 
> Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?
> 
> 
> 
> 
> Good point, Gaga.  At my level, we're told to treat pain; no questions asked.  If they hurt, you treat.
Click to expand...


That's the good thing about emergency work as opposed to clinic work.  The drug addicts drive us up the wall!


----------



## Sunshine

Montrovant said:


> Sunshine said:
> 
> 
> 
> 
> 
> Montrovant said:
> 
> 
> 
> Why is the word emergent used that way by the medical community?  My understanding of the definition was that it would be describing something as emerging, and that you should say 'people that have actual emergency medical conditions'.  The couple I live with both work in hospitals (he on the clerical side, she as an ER nurse) and their use of the word was the first I had heard it used in such a way.  It just seems so unnecessary to me.
> 
> /end unrelated rant
> 
> 
> 
> 
> Maybe because it's the correct word to use at the time:
> 
> 
> 
> 
> eÂ·merÂ·gentÂ (-mÃ»rjnt)
> adj.
> 1.
> a. Coming into view, existence, or notice: emergent spring shoots; an emergent political leader.
> b. Emerging: emergent nations.
> 2. Rising above a surrounding medium, especially a fluid.
> 3.
> a. Arising or occurring unexpectedly: money laid aside for emergent contingencies.
> *b. Demanding prompt action; urgent.*4. Occurring as a consequence; resultant: economic problems emergent from the restriction of credit.
> n.
> One that is coming into view or existence: "The giant redwoods . . . outstrip the emergents of the rain forest, which rarely reach two hundred feet" (Catherine Caulfield).
> 
> Click to expand...
> 
> 
> emergent - definition of emergent by the Free Online Dictionary, Thesaurus and Encyclopedia.
> 
> Click to expand...
> 
> 
> What I wonder is how it became the right word.  Emergent seems to be a derivation of the word emerge, rather than a derivation of emergency.  More, it seems to be simply replacing the word emergency without any change in meaning; is there a difference between saying 'emergent medical condition' and 'emergency medical condition'?
> 
> I wonder how and why it came to be defined so that it means emergency.
Click to expand...


Well, when a patient goes bad we say they 'crapped out' or 'crashed' or other some such.  I don't really think people, like me, who use medical jargon in our workday lives really cares how the words evolved.  There is a certain Tao to them. The just ARE.


----------



## Quantum Windbag

mskafka said:


> Quantum Windbag said:
> 
> 
> 
> 
> 
> Gagafritz said:
> 
> 
> 
> Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?
> 
> 
> 
> 
> The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.
> 
> Click to expand...
> 
> 
> Only medically trained?  Are you speaking at a physician level?  I'm a paramedic, and I treat (or used to treat before the MS) many people with narcotics.
Click to expand...


Geaux has made it clear that he is on his way to being a doctor. You may have emntioned being a paramedic, but I have not read all your posts.


----------



## geauxtohell

Montrovant said:


> geauxtohell said:
> 
> 
> 
> Did it ever occur to you that the reason triage exists so that people that have actual emergent medical conditions go straight back and jump over the people who are just there for pain control and other trivial complaints that clog up the system?  (I once saw someone wait for 8 hours to be seen for "insomnia".
> 
> 
> 
> 
> Why is the word emergent used that way by the medical community?  My understanding of the definition was that it would be describing something as emerging, and that you should say 'people that have actual emergency medical conditions'.  The couple I live with both work in hospitals (he on the clerical side, she as an ER nurse) and their use of the word was the first I had heard it used in such a way.  It just seems so unnecessary to me.
> 
> /end unrelated rant
Click to expand...




> emergent
> [ih-mur-juhnt] &#8194; Origin
> e·mer·gent
> &#8194; &#8194;[ih-mur-juhnt] Show IPA
> adjective
> 1.
> coming into view or notice; issuing.
> 2.
> emerging;  rising from a liquid or other surrounding medium.
> 3.
> coming into existence, especially with political independence: the emergent nations of Africa.
> 4.
> arising casually or unexpectedly.
> *5.
> calling for immediate action; urgent*.



Emergent | Define Emergent at Dictionary.com


----------



## OohPooPahDoo

mskafka said:


> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.




Doctors are reluctant to prescribe opiate pain relievers because they are extremely easy to get addicted to - and in fact many many many addicts of opiates started off as legal users of them as a result of a disease or accident.

Not saying its right, just giving you their logic.

But I'm surprised its still that hard for you. I have a busted disc in my back but its not really that severe (yet), and about 4 years ago I was able to get refills of Lortab over the phone, 30 pills at a time, for a year. I decided to not go in for the yearly re-script because I thought i was over depending on them, so its a good thing that had that stop-gap measure in there. But I can't imagine my pain is anything close to yours so that's not really even a good comparison. 


Have you thought of trying marijuana? Its a miracle drug. Not saying it will work, but if it does, it will work really well.


----------



## Gagafritz

Well, it is very simple.  Those who don't want pain medication or prefer to take Tylenol for pain conditions that warrant opioids, don't take them.  But, don't prevent others from taking them who do need them.  ANd, i find it a little disturbing that an ER provider on this board takes the "patient as addict" attitude right off the bat.


----------



## OohPooPahDoo

Gagafritz said:


> Well, it is very simple.  Those who don't want pain medication or prefer to take Tylenol for pain conditions that warrant opioids, don't take them.  But, don't prevent others from taking them who do need them.  ANd, i find it a little disturbing that an ER provider on this board takes the "patient as addict" attitude right off the bat.



Unfortunately the law only allows physicians to prescribe substances - like opiates - that have an extreme potential for addiction even in patients who have previously never had problems with addiction to anything. The law will not all physicians, in most states, to prescribe pot. While marijuana certainly isn't going to work for all pain, it works a lot better the ibuprofen and tylenol


----------



## geauxtohell

Gagafritz said:


> Well, it is very simple.  Those who don't want pain medication or prefer to take Tylenol for pain conditions that warrant opioids, don't take them.  But, don't prevent others from taking them who do need them.  ANd, i find it a little disturbing that an ER provider on this board takes the "patient as addict" attitude right off the bat.



I find it a little disturbing that you and your cohorts keep attributing sentiments to me that I never said and don't believe.  

Then again, you guys continue to miss the ball on this matter.  If you really knew what you were talking about, you'd understand why the ED is not the appropriate place for people to try and manage their chronic pain.


----------



## geauxtohell

OohPooPahDoo said:


> Gagafritz said:
> 
> 
> 
> Well, it is very simple.  Those who don't want pain medication or prefer to take Tylenol for pain conditions that warrant opioids, don't take them.  But, don't prevent others from taking them who do need them.  ANd, i find it a little disturbing that an ER provider on this board takes the "patient as addict" attitude right off the bat.
> 
> 
> 
> 
> Unfortunately the law only allows physicians to prescribe substances - like opiates - that have an extreme potential for addiction even in patients who have previously never had problems with addiction to anything. The law will not all physicians, in most states, to prescribe pot. While marijuana certainly isn't going to work for all pain, it works a lot better the ibuprofen and tylenol
Click to expand...


Really? Pharmacologically, MJ has absolutely no analgesic properties.  Ibuproffin (and other propionic acids like aleve) are analgesics and anti-inflammatory.  Tylenol is an analgesic but not an anti-inflammatory, but has anti-pyretic properties.  The mechanisms of action of these drugs can clearly be mapped out.

I understand that altering your perception w/ MJ might work for some people's pain, but it's not really a pain medication.


----------



## OohPooPahDoo

mskafka said:


> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.




I think you will find this relevant:


> SACRAMENTO, Calif. (AP) -- The first U.S. clinical trials in more than two decades on the medical benefits of marijuana confirm* pot is effective in reducing muscle spasms associated with multiple sclerosis* and pain caused by certain neurological injuries or illnesses, according to a report issued Wednesday.




Marijuana Provides Pain Relief, New Study Says


----------



## OohPooPahDoo

geauxtohell said:


> OohPooPahDoo said:
> 
> 
> 
> 
> 
> Gagafritz said:
> 
> 
> 
> Well, it is very simple.  Those who don't want pain medication or prefer to take Tylenol for pain conditions that warrant opioids, don't take them.  But, don't prevent others from taking them who do need them.  ANd, i find it a little disturbing that an ER provider on this board takes the "patient as addict" attitude right off the bat.
> 
> 
> 
> 
> Unfortunately the law only allows physicians to prescribe substances - like opiates - that have an extreme potential for addiction even in patients who have previously never had problems with addiction to anything. The law will not all physicians, in most states, to prescribe pot. While marijuana certainly isn't going to work for all pain, it works a lot better the ibuprofen and tylenol
> 
> Click to expand...
> 
> 
> Really? Pharmacologically, MJ has absolutely no analgesic properties.  Ibuproffin (and other propionic acids like aleve) are analgesics and anti-inflammatory.  Tylenol is an analgesic but not an anti-inflammatory, but has anti-pyretic properties.  The mechanisms of action of these drugs can clearly be mapped out.
> 
> I understand that altering your perception w/ MJ might work for some people's pain, but it's not really a pain medication.
Click to expand...


Really? Sure, if by "absolutely no" you mean "many studies suggest yes"



From article linked in above post:





> A laboratory study supported by the center examined if pot could be helpful in treating migraine headaches and facial pain. In that study,* rats given a cannabis-like drug exhibited reduced activity of nerve cells that transmit pain.*




From another source:


> CB2 receptors appear to be responsible for the* anti-inflammatory* and possibly other therapeutic *effects of cannabis.*


Cannabinoid Receptors




> Moreover, as I discuss here, a wealth of information also indicates that these drugs have immunosuppressive and *anti-inflammatory* properties; therefore, on the basis of this mode of action, the therapeutic usefulness of these drugs in chronic inflammatory diseases is now being reassessed.


http://www.nature.com/nri/journal/v5/n5/execsumm/nri1602.html



> These effects were found to be due to the suppression of spinal and thalamic nociceptive neurons, and independent of any actions on either the motor system or sensory neurons that transmit messages related to non-nociceptive stimulation. Spinal, supraspinal, and peripheral sites of *cannabinoid analgesia* have been identified. The discovery of endocannabinoids raised the question of their natural role in pain. *Multiple lines of evidence indicate that endocannabinoids serve naturally to suppress pain.*


'

Cannabinoid analgesia. [Pharmacol Ther. 2002] - PubMed - NCBI


> Cannabinoids mediate analgesia largely via peripheral type 1 cannabinoid receptors in nociceptors


http://www.nature.com/neuro/journal/v10/n7/full/nn1916.html


> Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain.


http://www.ncbi.nlm.nih.gov/pubmed/16449552


> High hopes for cannabinoid analgesia


http://www.bmj.com/content/329/7460/257.full


http://scholar.google.com/scholar?hl=en&as_sdt=0,19&q=cannabinoid+analgesia


Sorry - but your suggestion that marijuana has "absolutely no" analgesic or anti-inflammatory properties is simply _not supported _by the available evidence. Why did you even make that claim?


----------



## xotoxi

Mr. H. said:


> I was given an rx for fentanyl patches when I cracked my ribs a couple years ago.
> After reading the fine print on the insert, I was afraid to use them LOL.



Prescribing a Fentanyl patch for fractured ribs is MALPRACTICE.  Unless you have been taking significant doses of oral narcotics for several months or more, the topical fentanyl could kill you.  It is VERY strong.


I have only prescribed fentanyl to people with severe chronic pain or cancer.


----------



## freedombecki

mskafka said:


> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.


Mskfka, I'm sorry for your pain, and I don't know what to tell you, except You might do a search on pain management caregivers who approach pain differently from your current cabal. I too have an autoimmune pain complex, which took me over 10 years to truly learn ways to manage my pain better, and a change of physicians (when we moved to a warmer climate) who found another issue that truly helped when it was fixed.

The trouble with some physicians is they can't know how much you are suffering because one cannot feel another's pain. The pain-free caregivers may tend to therefore select the option that might carry fewer career-threatening lawsuits. An example would be the lawsuit for which Michael Jackson's pain doctor was incarcerated for his death. 

I still have some pain occasionally, but not like it was the first 5 years of screaming-out-loud pain, but most of the time, I get by.

My prayers for you finding a panacea that works for you. Pain seems to be the ugly duckling of all diseases.


----------



## Gagafritz

geauxtohell said:


> Gagafritz said:
> 
> 
> 
> Well, it is very simple.  Those who don't want pain medication or prefer to take Tylenol for pain conditions that warrant opioids, don't take them.  But, don't prevent others from taking them who do need them.  ANd, i find it a little disturbing that an ER provider on this board takes the "patient as addict" attitude right off the bat.
> 
> 
> 
> 
> I find it a little disturbing that you and your cohorts keep attributing sentiments to me that I never said and don't believe.
> 
> Then again, you guys continue to miss the ball on this matter.  If you really knew what you were talking about, you'd understand why the ED is not the appropriate place for people to try and manage their chronic pain.
Click to expand...


I do know what i am talking about and i didn't say the ER was the ideal place and venue to manage pain.  But, the reality is that there are people with chronic pain who are going to have breakthrough pain and at times present to the ER.   If you wan't to deal with that kind of stuff then maybe ER medicine isn't for you.  People go to the ER for any and all things whether they should or shouldn't is beside the point , they do and they have to be treated adequately based on their condition.


----------



## geauxtohell

OohPooPahDoo said:


> geauxtohell said:
> 
> 
> 
> 
> 
> OohPooPahDoo said:
> 
> 
> 
> Unfortunately the law only allows physicians to prescribe substances - like opiates - that have an extreme potential for addiction even in patients who have previously never had problems with addiction to anything. The law will not all physicians, in most states, to prescribe pot. While marijuana certainly isn't going to work for all pain, it works a lot better the ibuprofen and tylenol
> 
> 
> 
> 
> Really? Pharmacologically, MJ has absolutely no analgesic properties.  Ibuproffin (and other propionic acids like aleve) are analgesics and anti-inflammatory.  Tylenol is an analgesic but not an anti-inflammatory, but has anti-pyretic properties.  The mechanisms of action of these drugs can clearly be mapped out.
> 
> I understand that altering your perception w/ MJ might work for some people's pain, but it's not really a pain medication.
> 
> Click to expand...
> 
> 
> Really? Sure, if by "absolutely no" you mean "many studies suggest yes"
> 
> 
> 
> From article linked in above post:
> 
> 
> From another source:
> Cannabinoid Receptors
> 
> 
> 
> http://www.nature.com/nri/journal/v5/n5/execsumm/nri1602.html
> 
> '
> 
> Cannabinoid analgesia. [Pharmacol Ther. 2002] - PubMed - NCBI
> 
> http://www.nature.com/neuro/journal/v10/n7/full/nn1916.html
> 
> 
> 
> Cannabinoid analgesia as a potential new therapeutic option in the treatment of chronic pain.
> 
> Click to expand...
> 
> Cannabinoid analgesia as a potential new th... [Ann Pharmacother. 2006] - PubMed - NCBI
> 
> 
> 
> High hopes for cannabinoid analgesia
> 
> Click to expand...
> 
> High hopes for cannabinoid analgesia | BMJ
> 
> 
> cannabinoid analgesia - Google Scholar
> 
> 
> Sorry - but your suggestion that marijuana has "absolutely no" analgesic or anti-inflammatory properties is simply _not supported _by the available evidence. Why did you even make that claim?
Click to expand...


Because, as far as conventional teaching goes, MJ is not associated with anti-inflammatory or analgesic properties.  (Tylenol is also not an anti-inflammatory).

Thanks for the links.  I'll have to wait until I am at school to actually pull the articles and see what they say.


----------



## geauxtohell

Gagafritz said:


> I do know what i am talking about and i didn't say the ER was the ideal place and venue to manage pain.  But, the reality is that there are people with chronic pain who are going to have breakthrough pain and at times present to the ER.   If you wan't to deal with that kind of stuff then maybe ER medicine isn't for you.



LMFAO! 

You haven't really spoken with many EM physicians, have you?  

You don't really understand the difference between Emergency Medicine and primary care, do you?

Suffice to say, people in chronic pain should have a pain control regimen worked out with their Primary Care Provider that covers breakthrough pain.  That is how pain is managed. 

If you come to the ED with intractable pain and you have a chronic condition, like cancer, you are going to get admitted for pain management.

The ED is not a pain management center.



> People go to the ER for any and all things whether they should or shouldn't is beside the point , they do and they have to be treated adequately based on their condition.



Actually, it is the point.  See "Anxious Wimps" for more.  People are entitled to a primary survey in the ED.  They are not entitled to have their every want, need, or symptom addressed.


----------



## Gagafritz

I don't see the need for you to be condescending.  I do know the differerence between ER physicians and PMDs and their roles and so forth.  But, whatever.  Apparently, i am not allowed to disagree .


----------



## geauxtohell

Gagafritz said:


> I don't see the need for you to be condescending.  I do know the differerence between ER physicians and PMDs and their roles and so forth.  But, whatever.  Apparently, i am not allowed to disagree .



Wait, you just told me that, after four years of slaving through Medical School, you tell me that I am going into the wrong field because my idea of the appropriate use of narcotics doesn't conform to your perceived notion of what they should be, and you say I am being condescending?

My viewpoints are tame compared to most of the ED attending physicians I have worked under.


----------



## Sunshine

geauxtohell said:


> Gagafritz said:
> 
> 
> 
> I don't see the need for you to be condescending.  I do know the differerence between ER physicians and PMDs and their roles and so forth.  But, whatever.  Apparently, i am not allowed to disagree .
> 
> 
> 
> 
> Wait, you just told me that, after four years of slaving through Medical School, you tell me that I am going into the wrong field because my idea of the appropriate use of narcotics doesn't conform to your perceived notion of what they should be, and you say I am being condescending?
> 
> My viewpoints are tame compared to most of the ED attending physicians I have worked under.
Click to expand...


Yes, they are.  And they are tame compared to those of us who work in psychiatry and have to deal with this shit on a daily basis!  

The general public doesn't seem to be cognizant of the fact that it is ILLEGAL to give narcotics to a known drug abuser.  A person who tells the provider that he/she is using marijuana then becomes a _known drug abuser_ because the use of cannabis is illegal.  A person who tells his provider that he took his sister's xanax and it worked, is now a_ known drug abuser_ because it is illegal to take a narcotic that has been prescribed for someone else.  And yet they NEVER understand why those things constitute substance abuse.  Nor to they ever get, even though you explain it to them, why you are now precluded by law from ordering controlled substances.  To them  you are just a mean old prick or a mean old bitch.  And then there are the ones who lie and think they are slick.  That is why we do a drug screen on everyone who is on or who is asking for controlled substances.  Some controlled substances along with alcohol will kill you.  Alone they will not in low doses, but together they are lethal.  And those ones will refuse a BAL.  BUT they will consent to a GGT (gamma-glutamyl transpeptidase) which will spike within 72hours of the patient using alcohol.  Caveat: there are other substances like Dilantin which will cause this elevation as well, so it isn't 100%.  But it is a help, and I have had patients think I am psychic when the first thing I say is, 'I see you have been drinking along with your medication.'

Condescending.  LOL!  One should be so lucky.  I just think the ones arguing against safe and legal clinical practice are stupid.  I didn't spend thouands of dollars on my education to throw it away on a drug addict.


----------



## Gagafritz

Well, what did you spend thousands of dollars on?  You sound very condescending toward the patients you supposedly treat?  You don't seem to like your job much or the people you deal with.  And, i would assume substance abuse often goes hand in hand with pyschiatiric problems as well and part of your job would involve that also.  
  As for your rude comments toward me, i have never taken an illegal drug in my life.   But, apparently you want to resort to character assassination so i will do likewise.


----------



## Gagafritz

As for people drinking, drinking is legal.  And, i guess you are missing my point of people trying to medicate themselves for issues such as untreated or inadequetly pain, mental illness and so forth.  Sounds like you are part of the problem instead of the solution.  Tell people they are crazy, present them with your expensive degree leave them lay in the gutter and dont' get your hands dirty.  .


----------



## MikeK

Sunshine said:


> He is not the only 'medically trained' person on this thread.  And I don't think that is what he is saying.  I have seen my share of drug seekers as well.  Probably more in my 23 years as a nurse than he has.  They exist.  They are out there.  They have a pattern of behavior, usually.


That reflects a problem with the level of suspicion and fear of censure imparted to medical professionals by the DEA.  My GP told me that my age, MRI confirmation of my condition and the relatively small dosage I require enable her to _comfortably_ prescribe for me.  

Her comment calls to mind the question of how many legitimate requests for pain medication are denied because the orientation of suspicion and the subtle intimidation by DEA thereby leaves those whose _profiles_ are not as acceptable as mine to suffer unnecessarily.


----------



## Gagafritz

What suprises me is that i am arguing for adequate treatment of pain and the realization that some people do present to the ER with pain and for some reason this is viewed as controversal and met with hositility.  And, there are lots of providers who are hostile and supsicious towards patients.  Sometimes rightly so.  But, there are also a host of mental health issues that we simply choose to ignore and not address.  And, i think untreated mental illness is often and underlying factor because of the stress and distress it causes and the stigma so people do the only thing they can do which is self medicate.  And for those with inadequately treated pain, what else do doctors expect them to do?  Yeah, they are going to drink alcohol and/or show up in the ER when they can no longer stand it.  Funny how things like West Nile virus and Lyme's disease and other illnesses were all in your head until somebody did enough research to come up with tests to prove these things were real.   But, i am sure there was a lot of untreated pain and suffering prior to those things being diagnosed because they weren't real until there was a test to prove it was.


----------



## mskafka

OohPooPahDoo said:


> mskafka said:
> 
> 
> 
> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.
> 
> 
> 
> 
> 
> I think you will find this relevant:
> 
> 
> 
> SACRAMENTO, Calif. (AP) -- The first U.S. clinical trials in more than two decades on the medical benefits of marijuana confirm* pot is effective in reducing muscle spasms associated with multiple sclerosis* and pain caused by certain neurological injuries or illnesses, according to a report issued Wednesday.
> 
> Click to expand...
> 
> 
> 
> Marijuana Provides Pain Relief, New Study Says
Click to expand...


If I weren't a licensed healthcare provider, I would definitely try marijuana.  But if I were to test positive for that on the job, my career in healthcare would be over. 

I believe that it probably does make one feel better.  Although, injections into the sciatic (sp?) feel awesome too!  I got my first today.  It's working very well.


----------



## mskafka

Sunshine said:


> geauxtohell said:
> 
> 
> 
> 
> 
> strollingbones said:
> 
> 
> 
> While I dont have an exact statistic on this, I can say that most of us are sensitive to the heat. In fact, for many years, the "hot bath test was used to diagnose MS. A person suspected of having MS was immersed in a hot tub of water, and watched to see if neurologic symptoms appeared or got worse, which would earn them a diagnosis of MS. (This practice was stopped when MRIs came on the scene, but is still practiced in some countries where MRIs are not readily accessible.)
> 
> Heat Intolerance and Multiple Sclerosis - Heat and MS - Pseudoexacerbations in MS
> 
> you are such a fucking dumb bitch at times
> 
> 
> 
> 
> And hysterectomies were used to treat ill behaved (read:  "women who don't want to have sex with their husbands) at one time.
> 
> The link between latitude and MS incidence (sun/heat exposure) has been disproven.
> 
> I really think a hot bath is a wives tale.  It's a hell of a lot cheaper than an MRI w/ T2 Flair, and if it were at all accurate, would be a better test.
> 
> Click to expand...
> 
> 
> Exactly.  You know they USED to diagnose mumps by having the kid eat a pickle.  If the parotid gland hurt then he/she had the mumps.  Well this Remodulin I'm on causes that to happen every time I take a bite of anything.  According to the wives tale, I will have mumps until the day I die.  Think I can get disability?  LOL
Click to expand...


Yeah, I think that you should get right on that.


----------



## mskafka

I finally got some pain management.  I just spent two nights in-hospital.  Diagnosis-4 gastric ulcers.  

As soon as my endoscopy was finished, my fiance (pissed) walked into my neurologist's office and demanded to speak to someone.  The ulcers were caused by the 10-day prednisone dosage I was taking, and the massive amounts of ibuprofen I was ingesting...for pain management.  

Demoral and zofran every 3 hours, IV.  This controlled the excruciating pain in my gut, and while off the prednisone for 2 days, once again, I was unable to walk-due to the almost unbearable spasms in my left hip and thigh.  So then the demoral was administered for the hip.

  And I've FINALLY got some pain pills and an injection-in or around my sciatic nerve (geaux, you understand how that works better than I) so that I can have SOME quality of life.  I don't want them for the rest of my life.  Just until this flare is over with, and MAYBE I can return to work.  HATE sitting at home.  

That injection did an amazing thing.  I can now walk heel-to-toe on my left foot again.  I was having to walk toe-to-heel, and sit down every fifteen to twenty seconds.

Gosh I would love to go to medical school!


----------



## mskafka

Geaux, are you an LSU grad?  My fiance is LSU through and through!


----------



## Sunshine

Gagafritz said:


> Well, what did you spend thousands of dollars on?  You sound very condescending toward the patients you supposedly treat?  You don't seem to like your job much or the people you deal with.  And, i would assume substance abuse often goes hand in hand with pyschiatiric problems as well and part of your job would involve that also.
> As for your rude comments toward me, i have never taken an illegal drug in my life.   But, apparently you want to resort to character assassination so i will do likewise.



Playing into the hands of a drug addict and losing your license does not make one a more effective provider.  There are resources out there for addicts who want to recover.  Every addict I see gets and appropriate referral.  Whether they take advantage of that referrral or not is entirely up to them.  Beating my door down does not indicate they have any intent to recover.  It merely indicates that they want me to feed their addiction.  No responsible provider allows him/herself to be taken down by a drug addict.

As to how you sound.  Well, that's your baby.  Don't advocate the illegal practice of medicine and you won't lead anyone to undesired conclusions.


----------



## Sunshine

mskafka said:


> I finally got some pain management.  I just spent two nights in-hospital.  Diagnosis-4 gastric ulcers.
> 
> As soon as my endoscopy was finished, my fiance (pissed) walked into my neurologist's office and demanded to speak to someone.  The ulcers were caused by the 10-day prednisone dosage I was taking, and the massive amounts of ibuprofen I was ingesting...for pain management.
> 
> Demoral and zofran every 3 hours, IV.  This controlled the excruciating pain in my gut, and while off the prednisone for 2 days, once again, I was unable to walk-due to the almost unbearable spasms in my left hip and thigh.  So then the demoral was administered for the hip.
> 
> And I've FINALLY got some pain pills and an injection-in or around my sciatic nerve (geaux, you understand how that works better than I) so that I can have SOME quality of life.  I don't want them for the rest of my life.  Just until this flare is over with, and MAYBE I can return to work.  HATE sitting at home.
> 
> That injection did an amazing thing.  I can now walk heel-to-toe on my left foot again.  I was having to walk toe-to-heel, and sit down every fifteen to twenty seconds.
> 
> Gosh I would love to go to medical school!



Those nerve blocks are good.  But they wear off.  Several years back I had rotator cuff surgery and they gave me a nerve block to incapacitate that arm.  Just so happened that is the side where I have a disc bulge between C 6 and 7.  Even after the arm came back to life, I had no pain in that side for months.  It never really came back as bad as it was.  But had the pain reverted to where it was before the block, I would have gone to a neurologist for another one.  I know people who get them on a regular basis.  And they get good relief from those blocks.  

You can do this.  I have known incredible pain in my life.  It would have been oh so easy to just yield to narcotics.  I'd probably be dead by now though.  But I wanted more out of life than drugs.  

I believe you have a protected disability.  Keep the job as long as you can.  When you no longer can do the job, look in other directions.  You have to be in good health to go to medical school, but there may be something else.  Just remember that MS is a disease that is often in a state of flux.  There can be remissions.  Hope for the best.

I don't know which government you work for but in TN the state has a great plan.  I'm guessing Metro probably does as well.  When I was teaching, I took a 65% pay cut to teach rather than practice in order to have more time for law school.  Since I wasn't making much I took the best plan they had a 90/10 PPO.  I had 2 major surgeries under that plan.  $1300 dollars out of pocket was all I had to pay and I only got that high on the second one.  It was way better than what I have now which is $5000 out of pocket before everything goes to 100%.


----------



## Gagafritz

I am in no way advocating any illegal practice whatsoever and how dare you would imply that i do.  There are people with real pain syndromes that do present to ERs and that are treated by ER physicians and that is in no way "illegal".  If you wish to assume that every patient presenting to the ER is a drug seeking Ahole, then i guess that is your perogative.


----------



## Gagafritz

Really.  I am not sure how advocating treatment of people in pain elicits such an angry reaction from you.  No doubt there are people who abuse the system.  It comes with the territory.  But, would you rather err on the side of giving an addict their fix versus assuming someone is lying?  Obviously, clinical judgement comes into play but i wonder why you seem so angry about this?
  As for how i "sound" i am not sure why that is  a concern to you or am i not entitled to voice my opinion or what?  You seem like the one with a chip on your shoulder.


----------



## OohPooPahDoo

mskafka said:


> Geaux, are you an LSU grad?  My fiance is LSU through and through!



B.S. LSU 2000
Ph.D. LSU 2011

GEAUX TIGERS


----------



## OohPooPahDoo

mskafka said:


> OohPooPahDoo said:
> 
> 
> 
> 
> 
> mskafka said:
> 
> 
> 
> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.
> 
> 
> 
> 
> 
> I think you will find this relevant:
> 
> 
> 
> SACRAMENTO, Calif. (AP) -- The first U.S. clinical trials in more than two decades on the medical benefits of marijuana confirm* pot is effective in reducing muscle spasms associated with multiple sclerosis* and pain caused by certain neurological injuries or illnesses, according to a report issued Wednesday.
> 
> Click to expand...
> 
> 
> 
> Marijuana Provides Pain Relief, New Study Says
> 
> Click to expand...
> 
> 
> If I weren't a licensed healthcare provider, I would definitely try marijuana.  But if I were to test positive for that on the job, my career in healthcare would be over.
> 
> I believe that it probably does make one feel better.  Although, injections into the sciatic (sp?) feel awesome too!  I got my first today.  It's working very well.
Click to expand...



Jeez, how often do they test you? That's fucked up. I'm sorry to hear that. I think the pot would really help you.

Move to California.

World's a messed up place. Here we have a drug that is a) all natural b) easy and cheap to produce  c) effective at treating a wide variety of problems (including MS) d) has very few negative side effects - and someone with MS can't use it.

Many of its medicinal effects can be felt long before one gets really "stoned", too. E.g. nausea. My brother got married this past October, and I got way too drunk at the wedding. Woke up nauseated out of my mind, couldn't sleep because of it. I lingered in misery for hours, then remembered I had some pot. I took one hit - didn't even get high - and the nausea went away almost instantly. Went to sleep almost right away.


----------



## Sunshine

Gagafritz said:


> I am in no way advocating any illegal practice whatsoever and how dare you would imply that i do.  There are people with real pain syndromes that do present to ERs and that are treated by ER physicians and that is in no way "illegal".  If you wish to assume that every patient presenting to the ER is a drug seeking Ahole, then i guess that is your perogative.



And you have disagreed with the LEGAL ways that chronic pain is treated as put forth by myself and gaux.  Of course you are advocating something illegal.  You don't like the way it's done legally.


----------



## Sunshine

Gagafritz said:


> Really.  I am not sure how advocating treatment of people in pain elicits such an angry reaction from you.  No doubt there are people who abuse the system.  It comes with the territory.  But, would you rather err on the side of giving an addict their fix versus assuming someone is lying?  Obviously, clinical judgement comes into play but i wonder why you seem so angry about this?
> As for how i "sound" i am not sure why that is  a concern to you or am i not entitled to voice my opinion or what?  You seem like the one with a chip on your shoulder.



Angry?  Gaux or me? LOL.  WE are not the ones posting in huge letters and arguing for something illegal.  We tell you the way it is and you argue with it.  Sorry you don't like it.  But that's how it is.


----------



## Gagafritz

What am i arguing for that is illegal that you are accusing me of?  Exactly what did i say or what is "illegal".  An ER physician can legally prescribe and give medications for conditions that warrant whatever drug and condition they are treating.  I didn't say that ERs should be a 24/7 pharmacy for whomever and whatever.  If that is what you think i am saying then you can't read.  And, again, i really dont' know why you are so defensive about it.  I certainly didn't say give anybody anything they want whenever they want it, so grow up.


----------



## Gagafritz

Sunshine said:


> Gagafritz said:
> 
> 
> 
> Really.  I am not sure how advocating treatment of people in pain elicits such an angry reaction from you.  No doubt there are people who abuse the system.  It comes with the territory.  But, would you rather err on the side of giving an addict their fix versus assuming someone is lying?  Obviously, clinical judgement comes into play but i wonder why you seem so angry about this?
> As for how i "sound" i am not sure why that is  a concern to you or am i not entitled to voice my opinion or what?  You seem like the one with a chip on your shoulder.
> 
> 
> 
> 
> Angry?  Gaux or me? LOL.  WE are not the ones posting in huge letters and arguing for something illegal.  We tell you the way it is and you argue with it.  Sorry you don't like it.  But that's how it is.
Click to expand...


What i "like" or don't like i really don't get your point.  I am talking about adequately treating pain.  I find it interesting that you are trying to imply that i am a drug seeker or whatever.  I don't take pain pills or have pain so whatever you are trying to accuse me of is BS.  But, apparently that is your approach to your patients and that is too bad.


----------



## geauxtohell

Gagafritz said:


> What suprises me is that i am arguing for adequate treatment of pain and the realization that some people do present to the ER with pain and for some reason this is viewed as controversal and met with hositility.  And, there are lots of providers who are hostile and supsicious towards patients.  Sometimes rightly so.  But, there are also a host of mental health issues that we simply choose to ignore and not address.  And, i think untreated mental illness is often and underlying factor because of the stress and distress it causes and the stigma so people do the only thing they can do which is self medicate.  And for those with inadequately treated pain, what else do doctors expect them to do?  Yeah, they are going to drink alcohol and/or show up in the ER when they can no longer stand it.  Funny how things like West Nile virus and Lyme's disease and other illnesses were all in your head until somebody did enough research to come up with tests to prove these things were real.   But, i am sure there was a lot of untreated pain and suffering prior to those things being diagnosed because they weren't real until there was a test to prove it was.



It's Lyme Disease, after Lyme Connecticut.  Pain is a symptom.  Pain should be addressed in the ED, however, the issue is the underlying problem that is causing the pain.  

Treating chronic pain that is known to the patient and has been adequately worked up and is not an emergent condition is not what the ED exists for.  I have not claimed that people should suffer.  I claimed that people need a primary doctor to manage that condition.  

There are obviously exceptions.  I've seen patients with terminal metastatic cancer be admitted for pain control.  That's obviously different than the patient with a bulging disk who presents for pain control because they burned through their norco prescription.


----------



## geauxtohell

mskafka said:


> I finally got some pain management.  I just spent two nights in-hospital.  Diagnosis-4 gastric ulcers.
> 
> As soon as my endoscopy was finished, my fiance (pissed) walked into my neurologist's office and demanded to speak to someone.  The ulcers were caused by the 10-day prednisone dosage I was taking, and the massive amounts of ibuprofen I was ingesting...for pain management.
> 
> Demoral and zofran every 3 hours, IV.  This controlled the excruciating pain in my gut, and while off the prednisone for 2 days, once again, I was unable to walk-due to the almost unbearable spasms in my left hip and thigh.  So then the demoral was administered for the hip.
> 
> And I've FINALLY got some pain pills and an injection-in or around my sciatic nerve (geaux, you understand how that works better than I) so that I can have SOME quality of life.  I don't want them for the rest of my life.  Just until this flare is over with, and MAYBE I can return to work.  HATE sitting at home.
> 
> That injection did an amazing thing.  I can now walk heel-to-toe on my left foot again.  I was having to walk toe-to-heel, and sit down every fifteen to twenty seconds.
> 
> Gosh I would love to go to medical school!



This goes right to the heart of "pain is a symptom and should be worked up and not simply have pills thrown at it".  

I am glad the injection helped you.  I hope it lasts for several months.  I am also glad you got adequately treated.  I know NSAIDs are famous for causing gastric ulcers (because they inhibit prostaglandin production, and prostaglandin is protective to your stomach).  I didn't know that steroids had an effect on that.  I'll have to look into that.  

At any rate, I am glad you feel better.


----------



## geauxtohell

mskafka said:


> Geaux, are you an LSU grad?  My fiance is LSU through and through!



No, I went to Tulane for undergrad.  The name is kind of an inside joke.  

My wife got her Master's from LSU, but I have no connection to the school at this point.


----------



## mskafka

geauxtohell said:


> mskafka said:
> 
> 
> 
> Geaux, are you an LSU grad?  My fiance is LSU through and through!
> 
> 
> 
> 
> No, I went to Tulane for undergrad.  The name is kind of an inside joke.
> 
> My wife got her Master's from LSU, but I have no connection to the school at this point.
Click to expand...


My SO was a pharm instructor at Tulane years ago.


----------



## mskafka

I remember at 8 years old, I wanted to be a physician more than anything in the world; and this was a possibility, as I was a "gifted" child.  Parents divorced...fell into the wrong crowd.  

Some of my fellow students went on to pre-med after paramedic school.  I think one has actually made it to med school.  Would've, should've, could've.  Maybe PA school.


----------



## mskafka

So you must be a medical student now.  I can't imagine that as a resident you would have time to blink or breathe, let alone be posting in here.  Unless some things have changed; which rumor has it that it has.  That's a good thing.  A physician who hasn't slept in 30 hours is a menace to society.


----------



## Sunshine

Gagafritz said:


> Sunshine said:
> 
> 
> 
> 
> 
> Gagafritz said:
> 
> 
> 
> Really.  I am not sure how advocating treatment of people in pain elicits such an angry reaction from you.  No doubt there are people who abuse the system.  It comes with the territory.  But, would you rather err on the side of giving an addict their fix versus assuming someone is lying?  Obviously, clinical judgement comes into play but i wonder why you seem so angry about this?
> As for how i "sound" i am not sure why that is  a concern to you or am i not entitled to voice my opinion or what?  You seem like the one with a chip on your shoulder.
> 
> 
> 
> 
> Angry?  Gaux or me? LOL.  WE are not the ones posting in huge letters and arguing for something illegal.  We tell you the way it is and you argue with it.  Sorry you don't like it.  But that's how it is.
> 
> Click to expand...
> 
> 
> What i "like" or don't like i really don't get your point.  I am talking about adequately treating pain.  I find it interesting that you are trying to imply that i am a drug seeker or whatever.  I don't take pain pills or have pain so whatever you are trying to accuse me of is BS.  But, apparently that is your approach to your patients and that is too bad.
Click to expand...


Well how about this:  How about you just go enroll in school now to be an MD or NP.  You can be an MD in 8 years and an NP in 7.    OR you could throw in another 3 or 4 and get a law degree as well like I did.  THEN you could stake YOUR OWN license on your theories.


----------



## Sunshine

mskafka said:


> So you must be a medical student now.  I can't imagine that as a resident you would have time to blink or breathe, let alone be posting in here.  Unless some things have changed; which rumor has it that it has.  That's a good thing.  A physician who hasn't slept in 30 hours is a menace to society.



I think you are right.  Last I heard the VA in Nashville had put their NPs in charge of the psych units and freed the residents up so they could learn and not just be slave labor.  I heard everyone was loving that.  Especially the patients.


----------



## geauxtohell

mskafka said:


> I remember at 8 years old, I wanted to be a physician more than anything in the world; and this was a possibility, as I was a "gifted" child.  Parents divorced...fell into the wrong crowd.
> 
> Some of my fellow students went on to pre-med after paramedic school.  I think one has actually made it to med school.  Would've, should've, could've.  Maybe PA school.



I went to med school after a change of careers. It's doable.  The hardest part is getting in.  After that, it's hard, but statistically the odds are in your favor,


----------



## Sunshine

geauxtohell said:


> mskafka said:
> 
> 
> 
> I finally got some pain management.  I just spent two nights in-hospital.  Diagnosis-4 gastric ulcers.
> 
> As soon as my endoscopy was finished, my fiance (pissed) walked into my neurologist's office and demanded to speak to someone.  The ulcers were caused by the 10-day prednisone dosage I was taking, and the massive amounts of ibuprofen I was ingesting...for pain management.
> 
> Demoral and zofran every 3 hours, IV.  This controlled the excruciating pain in my gut, and while off the prednisone for 2 days, once again, I was unable to walk-due to the almost unbearable spasms in my left hip and thigh.  So then the demoral was administered for the hip.
> 
> And I've FINALLY got some pain pills and an injection-in or around my sciatic nerve (geaux, you understand how that works better than I) so that I can have SOME quality of life.  I don't want them for the rest of my life.  Just until this flare is over with, and MAYBE I can return to work.  HATE sitting at home.
> 
> That injection did an amazing thing.  I can now walk heel-to-toe on my left foot again.  I was having to walk toe-to-heel, and sit down every fifteen to twenty seconds.
> 
> Gosh I would love to go to medical school!
> 
> 
> 
> 
> This goes right to the heart of "pain is a symptom and should be worked up and not simply have pills thrown at it".
> 
> I am glad the injection helped you.  I hope it lasts for several months.  I am also glad you got adequately treated.  I know NSAIDs are famous for causing gastric ulcers (because they inhibit prostaglandin production, and prostaglandin is protective to your stomach).  I didn't know that steroids had an effect on that.  I'll have to look into that.
> 
> At any rate, I am glad you feel better.
Click to expand...


Exactly.  Here I sit having degenerative arthritis of the spine since I was 40, a hysterectomy in 81, rotator cuff in 06, and two knee replacements.  And a poster talking to me like I have never even heard the word pain.  I have had patients with just the spine problem on morphine through their PC providers.  And here I am at 64, never having taken any kind of opiate long term.  I have used holistic therapies like massage, good chairs, and a super expensive mattress for the spine thing.  I still have pain, but it is bearable and I stay busy as a distraction.  And I have had an active and full life.  And you know the new disease I have now, not painful but debilitating, but I'm still in the swim.  There is SO much more to life than pills.  But to some people pills are the easy way when in fact they are the deadly way.  If one does manage to survive by some miracle they have no life BUT pills!  IMO that's no life and I would rather be pushing up daisies!

And steroids can lead to a GI bleed.  I had a coworker yesterday ask me about a symptom I won't mention.  She was on 3 medicines that can do that, steroids being one.  I referred her to her medical provider ASAP.


----------



## Sunshine

mskafka said:


> I remember at 8 years old, I wanted to be a physician more than anything in the world; and this was a possibility, as I was a "gifted" child.  Parents divorced...fell into the wrong crowd.
> 
> Some of my fellow students went on to pre-med after paramedic school.  I think one has actually made it to med school.  Would've, should've, could've.  Maybe PA school.



You might want to think NP.  PAs have to retest every 6 years.  I know one who didn't make it the last go around and she had been one for several years.  NPs recredential every 5 years by getting CMEs.


----------



## Gagafritz

Sunshine said:


> Gagafritz said:
> 
> 
> 
> 
> 
> Sunshine said:
> 
> 
> 
> Angry?  Gaux or me? LOL.  WE are not the ones posting in huge letters and arguing for something illegal.  We tell you the way it is and you argue with it.  Sorry you don't like it.  But that's how it is.
> 
> 
> 
> 
> What i "like" or don't like i really don't get your point.  I am talking about adequately treating pain.  I find it interesting that you are trying to imply that i am a drug seeker or whatever.  I don't take pain pills or have pain so whatever you are trying to accuse me of is BS.  But, apparently that is your approach to your patients and that is too bad.
> 
> Click to expand...
> 
> 
> Well how about this:  How about you just go enroll in school now to be an MD or NP.  You can be an MD in 8 years and an NP in 7.    OR you could throw in another 3 or 4 and get a law degree as well like I did.  THEN you could stake YOUR OWN license on your theories.
Click to expand...


Oh OK.  I forgot, ony YOU are entitled to have an opinion.  They could amputate your leg while you bite on a bullet.  Yippe for you.  You get the gold star!


----------



## mskafka

I've apparently had two bulging disks in my lumbar spine for years.  I must have a high pain tolerance, because while my back has felt uncomfortable, I've always just taken NSAIDs and soldiered on.  But this pain has kicked my ass.  At the height of this flare, the sciatica was just incredible.  I don't think that I've ever hurt so much that my eyes were wide open while I was screaming.  It almost felt like I was being electrocuted during the fasciculations with a simultaneous hip fracture.  Never had a hip fracture, but it felt fractured because it was excruciating to move it.  Oh, and it was numb and tingling too just like it had been asleep.  Just all kinds of nice sensations.

I would like to go further in the medical field and research autoimmune diseases.  Because being sent baclofen and zanaflex (I might as well have been swallowing sugar cubes) didn't cut it.  There was always the option of going to ER, but I didn't want to waste a bed.  In retrospect, it was a legitimate problem...just not an emergency.  Too many providers don't understand the pain and discomfort with this disease.  But it's understandable.  With only about 400,000 people in the US acknowledging that they have MS, it really isn't seen that often-while physicians treat the 307+ million people in this country.


----------



## mskafka

Gagafritz said:


> Sunshine said:
> 
> 
> 
> 
> 
> Gagafritz said:
> 
> 
> 
> What i "like" or don't like i really don't get your point.  I am talking about adequately treating pain.  I find it interesting that you are trying to imply that i am a drug seeker or whatever.  I don't take pain pills or have pain so whatever you are trying to accuse me of is BS.  But, apparently that is your approach to your patients and that is too bad.
> 
> 
> 
> 
> Well how about this:  How about you just go enroll in school now to be an MD or NP.  You can be an MD in 8 years and an NP in 7.    OR you could throw in another 3 or 4 and get a law degree as well like I did.  THEN you could stake YOUR OWN license on your theories.
> 
> Click to expand...
> 
> 
> Oh OK.  I forgot, ony YOU are entitled to have an opinion.  They could amputate your leg while you bite on a bullet.  Yippe for you.  You get the gold star!
Click to expand...


Oh now...come on, ladies.  Remember Ecclesiastes-"all is vanity".  But sunshine being an attorney, you're going to have a difficult time getting her to back down, gaga.  Remember that.


----------



## OohPooPahDoo

geauxtohell said:


> mskafka said:
> 
> 
> 
> Geaux, are you an LSU grad?  My fiance is LSU through and through!
> 
> 
> 
> 
> No, I went to Tulane for undergrad.  The name is kind of an inside joke.
> 
> My wife got her Master's from LSU, but I have no connection to the school at this point.
Click to expand...


....and the Greenies roll out of the huddle....


----------



## geauxtohell

OohPooPahDoo said:


> geauxtohell said:
> 
> 
> 
> 
> 
> mskafka said:
> 
> 
> 
> Geaux, are you an LSU grad?  My fiance is LSU through and through!
> 
> 
> 
> 
> No, I went to Tulane for undergrad.  The name is kind of an inside joke.
> 
> My wife got her Master's from LSU, but I have no connection to the school at this point.
> 
> Click to expand...
> 
> 
> ....and the Greenies roll out of the huddle....
Click to expand...


You sound just like my Great Uncle, God rest his soul.  He went to LSU on the G.I. Bill after serving as a ball turret gunner in World War II.

Though, after that inspiring performance against Alabama, I'd be a little humble. 

At last report, the LSU Tigers were stuck in New Orleans, because someone painted a 50 yard line on I-10.


----------



## geauxtohell

Sunshine said:


> geauxtohell said:
> 
> 
> 
> 
> 
> mskafka said:
> 
> 
> 
> I finally got some pain management.  I just spent two nights in-hospital.  Diagnosis-4 gastric ulcers.
> 
> As soon as my endoscopy was finished, my fiance (pissed) walked into my neurologist's office and demanded to speak to someone.  The ulcers were caused by the 10-day prednisone dosage I was taking, and the massive amounts of ibuprofen I was ingesting...for pain management.
> 
> Demoral and zofran every 3 hours, IV.  This controlled the excruciating pain in my gut, and while off the prednisone for 2 days, once again, I was unable to walk-due to the almost unbearable spasms in my left hip and thigh.  So then the demoral was administered for the hip.
> 
> And I've FINALLY got some pain pills and an injection-in or around my sciatic nerve (geaux, you understand how that works better than I) so that I can have SOME quality of life.  I don't want them for the rest of my life.  Just until this flare is over with, and MAYBE I can return to work.  HATE sitting at home.
> 
> That injection did an amazing thing.  I can now walk heel-to-toe on my left foot again.  I was having to walk toe-to-heel, and sit down every fifteen to twenty seconds.
> 
> Gosh I would love to go to medical school!
> 
> 
> 
> 
> This goes right to the heart of "pain is a symptom and should be worked up and not simply have pills thrown at it".
> 
> I am glad the injection helped you.  I hope it lasts for several months.  I am also glad you got adequately treated.  I know NSAIDs are famous for causing gastric ulcers (because they inhibit prostaglandin production, and prostaglandin is protective to your stomach).  I didn't know that steroids had an effect on that.  I'll have to look into that.
> 
> At any rate, I am glad you feel better.
> 
> Click to expand...
> 
> 
> Exactly.  Here I sit having degenerative arthritis of the spine since I was 40, a hysterectomy in 81, rotator cuff in 06, and two knee replacements.  And a poster talking to me like I have never even heard the word pain.  I have had patients with just the spine problem on morphine through their PC providers.  And here I am at 64, never having taken any kind of opiate long term.  I have used holistic therapies like massage, good chairs, and a super expensive mattress for the spine thing.  I still have pain, but it is bearable and I stay busy as a distraction.  And I have had an active and full life.  And you know the new disease I have now, not painful but debilitating, but I'm still in the swim.  There is SO much more to life than pills.  But to some people pills are the easy way when in fact they are the deadly way.  If one does manage to survive by some miracle they have no life BUT pills!  IMO that's no life and I would rather be pushing up daisies!
> 
> And steroids can lead to a GI bleed.  I had a coworker yesterday ask me about a symptom I won't mention.  She was on 3 medicines that can do that, steroids being one.  I referred her to her medical provider ASAP.
Click to expand...


Looks like it roughly doubles the risk.

Steroids and Risk of Upper Gastrointestinal Complications


----------



## geauxtohell

mskafka said:


> I've apparently had two bulging disks in my lumbar spine for years.  I must have a high pain tolerance, because while my back has felt uncomfortable, I've always just taken NSAIDs and soldiered on.  But this pain has kicked my ass.  At the height of this flare, the sciatica was just incredible.  I don't think that I've ever hurt so much that my eyes were wide open while I was screaming.  It almost felt like I was being electrocuted during the fasciculations with a simultaneous hip fracture.  Never had a hip fracture, but it felt fractured because it was excruciating to move it.  Oh, and it was numb and tingling too just like it had been asleep.  Just all kinds of nice sensations.



It really depends on how much they bulge.  Most people have a bulging disk.  It's one of those things people hear and fixate on as a cause of pain, but unless there is significant impingement, it's probably not clinically relevant.  I say that without knowing (of course) how much they bulge.  

You basically described neuropathic pain, which sciatica (of course) is.  



> I would like to go further in the medical field and research autoimmune diseases.  Because being sent baclofen and zanaflex (I might as well have been swallowing sugar cubes) didn't cut it.  There was always the option of going to ER, but I didn't want to waste a bed.  In retrospect, it was a legitimate problem...just not an emergency.  Too many providers don't understand the pain and discomfort with this disease.  But it's understandable.  With only about 400,000 people in the US acknowledging that they have MS, it really isn't seen that often-while physicians treat the 307+ million people in this country.



I don't think anyone that doesn't have the disease could comprehend it.  You know, you could always volunteer to help research on a matter like that.  You won't have to go back to school, you will learn a ton, and you will be facilitating treatment.


----------



## kevinbrownaaa

Legend Elvis has a doctor's PDR book to his bed and feel good next to a doctor on call. King will simply imitate, in line with his desire at the moment and the pharmacist will prepare the drug symptoms. Pain is the son of a bitch, can be slow with conventional doses of drugs and chronic pain. Frankly, I was surprised, no one was suffering from a disease that causes sudden pain "flairs" easy to deal with prescription or drug problems.


----------



## waltky

With hip pain, I can relate to this...

*Crackdown on painkiller epidemic hurts legitimate patients*
_26 Feb.`12  When Antoinette Tortorella's doctor took her off narcotics in January because she would not agree to a spinal implant, she decided to get a new doctor._


> Finding someone else who would treat her with the painkiller oxycodone was harder than Tortorella anticipated, though. Calls to several pain physicians were initially fruitless. Either they were not taking new patients or did not return her calls.  Tortorella, 45, suffers from degenerative scoliosis  curvature of the spine  and can only walk slowly, hunched over and wracked with agony. As the days went on without a new doctor, she began to worry she'd run out of the pills and the Fentanyl patches that make her pain bearable. She also faced the prospect of severe withdrawal from the addictive medication.
> 
> Tortorella, who until her pain got so bad about three years ago had worked in banking and sales, finally found a new doctor. The doctor reduced her medication, however.  Tortorella is a casualty of the painkiller epidemic that has engulfed Delaware and much of America. With so many patients selling or misusing their drugs, pain medications now have a stigma, leaving many doctors unwiling to take on legitimate pain patients. Others simply don't have the expertise.
> 
> The state's recent crackdown on doctors who irresponsibly prescribe narcotics has compounded the problem for people with severe, debilitating pain. When doctors get stripped of their licenses, legitimate patients can have a difficult time getting someone else to treat them, often leading to desperate trips to emergency rooms.  Dr. Brent Passarello, an emergency room physician at Christiana Hospital, said he's treated some patients of doctors recently suspended from prescribing painkillers and anticipates more in the same predicament.  "There's been a number of patients who are struggling," Passarello said. "It's been a struggle for us because of the volume of patients we're being asked to manage."
> 
> Delaware regulatory and medical officials say they are aware of the dilemma and encourage patients to work with their insurers to get the appropriate care.  James L. Collins, director of the state Division of Professional Regulation that oversees the medical disciplinary board, said his agency recently started alerting physicians and hospitals "when a doctor was getting suspended so they would prepare for the effects of that suspension."  Doctors, however, often have thousands of patients and many don't want to take on more. Sheila Grant, a registered nurse who is president of the Hospice and Palliative Care Network of Delaware, said doctors are concerned by media coverage of prescription drug abuse and by tough action of late by Collins' office.
> 
> MORE


----------



## eots

mskafka said:


> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.



try smoking some good herb...if it works for you it is a much safer choice ,I know two people  personalty that swear by it

[ame=http://www.youtube.com/watch?v=Z8kG_nq3PoM]Montel Williams on Multiple Sclerosis and Marijuana! - YouTube[/ame]


----------



## mskafka

eots said:


> mskafka said:
> 
> 
> 
> I would just like to rant about the current status of pain management in the USA!
> 
> Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011.  I'm not looking for pity; and this is totally not the point of this thread.
> 
> What I am PISSED about, is the the quality of pain management that we as patients receive.
> 
> For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares".  Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.
> 
> I recently had a flare that lasted for 7 days.  My left hip began to spasm on New Year's night.  I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg.  I couldn't walk when they would start.  I found myself on the bathroom floor three nights in a row, unable to walk back to bed.  The pain was excruciating, that I thought I'd fractured my hip, spontaneously.  Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few.  (TMI?  Okay....I'll get to the point.)
> 
> 3 days into this, I finally contacted my neurologist.  Pain medication?  No.  Even though I was biting my lip not to scream on the phone.  I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there.  And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations.  I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort.  Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned.  Gee thanks, doc.
> 
> I received the infusions, which stopped the contractures.  And now, it feels like I've spent a week hiking and rock climbing.  And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days.  I was in fantastic shape before all this began.  Also, rheumatoid arthritis hasn't been ruled out, yet.  We're just trying to halt the (MS) disease process, right now.  One lesion on my cervical spinal cord is enough.
> 
> And finally down to the point of this entire thread:
> The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions).  I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well.  This didn't even strike a c-major in this woman.  "Well......Dr. (no giving name) wants to try botox injections."
> 
> I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever.  Nope.  SOL and JWF!
> 
> I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for.   Nothing more.  Nothing less.  I wasn't asking for 90 oxycontin, or 50 fentanyl patches.  This is the FIRST time I have asked for something narcotic-wise since this disease process began.  And now, I feel like a criminal.  I have been referred to a "pain clinic".  I find that very insulting.  All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities.  I'm getting physical therapy, trying to exercise...doing all the right things.
> 
> I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell.  Has it ever crossed your minds to get off your duff and get a job.....do something with yourself?  You make me sick to my stomach.
> 
> What do I do?  Write my representative.  My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.
> 
> So what if you have bulging disks in your lower back.  I have 2, and have managed to work...FOR YEARS....without pain medication or disability.  Now, I have a true disability, with occasional disabling pain, and I can't get the help I need.  Life is not fair...but this is BEYOND UNFAIR.  Just 10 pills please, doc.  That's all I'm asking.
> 
> Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.
> 
> 
> 
> 
> try smoking some good herb...if it works for you it is a much safer choice ,I know two people  personalty that swear by it
> 
> [ame=http://www.youtube.com/watch?v=Z8kG_nq3PoM]Montel Williams on Multiple Sclerosis and Marijuana! - YouTube[/ame]
Click to expand...


I still work in healthcare, my man.  If I back into someone's mailbox on the ambulance, that's an automatic piss test for me.  

I would not only lose my job, but at the very least, my paramedic license would be placed on probation-and it would be online for the whole internet world to see.  I think that pot would work VERY WELL, but at this point, I just can't do it.  

I take daily Copaxone injections, which equal about $3500 per month.  I pay $80 a month.  If I didn't have health insurance through work, I wouldn't be able to pay for this medicine.  

If I ever get out of healthcare, I will certainly look at marijuana as an alternative.


----------



## mskafka

waltky said:


> With hip pain, I can relate to this...
> 
> *Crackdown on painkiller epidemic hurts legitimate patients*
> _26 Feb.`12  When Antoinette Tortorella's doctor took her off narcotics in January because she would not agree to a spinal implant, she decided to get a new doctor._
> 
> 
> 
> Finding someone else who would treat her with the painkiller oxycodone was harder than Tortorella anticipated, though. Calls to several pain physicians were initially fruitless. Either they were not taking new patients or did not return her calls.  Tortorella, 45, suffers from degenerative scoliosis  curvature of the spine  and can only walk slowly, hunched over and wracked with agony. As the days went on without a new doctor, she began to worry she'd run out of the pills and the Fentanyl patches that make her pain bearable. She also faced the prospect of severe withdrawal from the addictive medication.
> 
> Tortorella, who until her pain got so bad about three years ago had worked in banking and sales, finally found a new doctor. The doctor reduced her medication, however.  Tortorella is a casualty of the painkiller epidemic that has engulfed Delaware and much of America. With so many patients selling or misusing their drugs, pain medications now have a stigma, leaving many doctors unwiling to take on legitimate pain patients. Others simply don't have the expertise.
> 
> The state's recent crackdown on doctors who irresponsibly prescribe narcotics has compounded the problem for people with severe, debilitating pain. When doctors get stripped of their licenses, legitimate patients can have a difficult time getting someone else to treat them, often leading to desperate trips to emergency rooms.  Dr. Brent Passarello, an emergency room physician at Christiana Hospital, said he's treated some patients of doctors recently suspended from prescribing painkillers and anticipates more in the same predicament.  "There's been a number of patients who are struggling," Passarello said. "It's been a struggle for us because of the volume of patients we're being asked to manage."
> 
> Delaware regulatory and medical officials say they are aware of the dilemma and encourage patients to work with their insurers to get the appropriate care.  James L. Collins, director of the state Division of Professional Regulation that oversees the medical disciplinary board, said his agency recently started alerting physicians and hospitals "when a doctor was getting suspended so they would prepare for the effects of that suspension."  Doctors, however, often have thousands of patients and many don't want to take on more. Sheila Grant, a registered nurse who is president of the Hospice and Palliative Care Network of Delaware, said doctors are concerned by media coverage of prescription drug abuse and by tough action of late by Collins' office.
> 
> MORE
Click to expand...


Sciatica is a BITCH FROM HELL!!!  The best way I know to describe it, is it feels like your hip is fractured, and that you're being electrocuted at the same time (muscle fasciculations with the spasms).  I'm changing neurologists, so I suspect that things will get better.  

Thank you for the reply.


----------



## Jos

Smoke some weed


----------



## pfuzzy57

I understand what you're going through.  Although I don't have MS, I have a chronic, permanent pain condition called Complex Regional Pain Syndrome (CRPS) that I developed after I broke my foot several years ago.  I've had 2 surgeries just on it, so it would heal, then about 9 months later I developed this condition.  

I was given Neurontin, Lortab, and a couple of other drugs that didn't help one bit.  Non of the narcotics worked for that problem.  I eventually got to a pain management specialist in a town 2 hours away, and as a last resort, now have a spinal cord stimulator, also called a neurostimulator.  It's the only thing that has helped my pain at all.  Unfortunately, I've had 6 surgeries just on it.  I've had it implanted, taken out, implanted again, and had the battery changed 4 times.  Not exactly fun, but it works.  

Now I've developed severe osterarthritis in my back and hips, for which I've been treated with steroid injections every 2 months.  That's been going on since July 2011, and the last one I had in February didn't work.  My next one is scheduled in May, I'm hoping that one works, because it's getting harder and harder for me to deal with it.  Cooking is a real chore, but I think I've found a solution to that.  I'll just have to get a rolling stool and I can zip around it and do my cooking without standing up.  I refuse to have a scooter or anything like it just to do those kinds of things because I won't give in to this thing.  

I also have fibromyalgia, which is really painful, especially when the weather changes.  I live in Texas, but whenever we get a cold front or the like I'm in pain for a couple of days.  I've recently become allergic to both Lortab and Tramadol, it's cousin that's non-narcotic, and just can't take either of them because I itch incessantly.  I just had surgery on my other foot, the foot that wasn't broken, to remove a neuroma, and my doc gave me Percoet, which worked quite well, but not on my back.  I just don't know what to do with it until I can see my pain doc and ask him what I can do next if the injections aren't going to work anymore.  I called his office a few weeks ago and all they told me was to put heat on it.  Yeah, that'll work well.  

Pain is hard to deal with, and most primary care docs don't know how to treat it, but they're not trained to either.  Neither are most anesthesiologists, which pain management  docs are.  They're just specially trained in that area.

I hope you're pain gets better.


----------



## pfuzzy57

mskafka said:


> Kooshdakhaa said:
> 
> 
> 
> I think you should go to the pain clinic.  What's your problem with the pain clinic?
> 
> That's the purpose of a pain clinic...managing pain.  You should at least give it a try.
> 
> What happens with other people suffering from MS?  Do they also have pain?  How is it treated?  Sounds like a forum for people with MS might provide you with some help and answers.  Maybe?
> 
> 
> 
> 
> There is a stigma attached to pain clinics.  I'm just recalling how many people I've intubated and treated from OD's from pain clinics.  In THIS state, they are considered legal drug pushers; and this area....not very highly respected.
> 
> I have and do belong to an MS forum/chat.  The reason that I am posting in here, is I'm wondering if anyone is aware of anything political...recently...that has addressed this ridiculous issue.  I'm here, because this to me, is a political issue.  And because I belonged to this forum LONG before I was diagnosed with MS.
> 
> And yes, I'm totally with Ron Paul on the "War on Drugs".  I believe it has been a disaster.  Now...do we need someone to make sure that people don't place harmful chemicals into the drugs that we swallow? Yes. (Even though it somehow continues in cigarette smoke with no problems).
> 
> And no, it's not constant pain.  But when you have 7-10 days of involuntary contractions in a part of your body...it's going to get sore.  This makes perfect sense to me.
> 
> Now there is constant numbness in certain areas, but pain?  Only after a flare.  And it sux.
Click to expand...


The first thing about pain meds is that you can't become addicted to them if you don't NEED the drug.  If you DO need it then you won't.  I've had more than one doc tell me that, including my pain management doc.  I've been on pain meds for several years and have never OD'd.  Part of that problem is that the _patient _ is responsible for taking the meds properly.  If they can't or won't do that it's not the doc's fault.  Blaming it on the doctor doesn't make sense.  Just because you've seen people who have OD'd on these meds doesn't mean they got them from a pain clinic, they probably got them off the streets.  

There also seems to be an issue with the treatment of your MS.  It doesn't seem like you should have flares where you have contractions like that.  I'm sure there's a drug or something out there that can help you with that, and please don't tell me you don't want to take any drugs for it.  That won't help you.  If you need the meds, you should take them.  I happen to be on 12 different ones, but 4 of them are for bipolar disorder.  I am very proactive about my health.  I have to be.  I don't take pain meds unless I absolutely have to.  If I do, then I take them exactly as prescribed.  

I'm sorry about your situation.  I do understand your pain problem.  I believe you need to be seen by a pain specialist, and soon.


----------



## waltky

Mebbe we need to be more like the Brits...

*NICE releases new pain relief guidelines*
_22 May 2012 - Morphine is one of several powerful painkillers known as opioids_


> Many patients with advanced cancer and other debilitating conditions are being "under-treated" for their pain, new guidance from the health watchdog says.  NICE wants doctors in England and Wales to make more use of morphine and other strong opioids - the only adequate pain relief source for many patients.  The guidelines recommend doctors discuss patients' concerns.  These may include addiction, tolerance, side-effects and fears that treatment implies the final stage of life.  The guidance deals with five opioids: morphine, diamorphine (heroin), buprenorphine, fentanyl and oxycodone. They come either from the opium poppy or are synthetically produced versions.
> 
> NICE - the National Institute for Clinical Excellence - says "misinterpretations and misunderstanding" have surrounded the use of strong opioids for decades, which has resulted in errors "causing under-dosing and avoidable pain, or overdosing and distressing adverse effects".  There is also the legacy of Dr Harold Shipman who used diamorphine to murder his victims. It has made many doctors wary of prescribing strong opioids.  NICE says the aim is to improve both pain management and patient safety.
> 
> Mike Bennett, St Gemma's professor of palliative medicine at the University of Leeds, said: "Almost half of patients with advanced cancer are under-treated for their pain, largely because clinicians are reluctant to use strong opioids."  Prof Bennett said the issue also applied to the late stages of other conditions such as heart failure and neurological disorders.  In a summary of the guidance in the British Medical Journal, he said doctors should address patients' concerns and reassure them that addiction is "very rare".  Doctors are also told to advise patients about side-effects, including constipation, which can be treated with laxatives.
> 
> Dr Damien Longson, Chair of the NICE Guideline Development Group said: "People worry they can become addicted, particularly if opioids are prescribed over an extended period of time. This guideline puts a strong emphasis on good communication between healthcare professionals and patients, which is key to ensuring any worries or uncertainties are addressed with timely and accurate information."
> 
> Dr Fiona Hicks, chairwoman of the Royal College of Physicians' recent working party on improving end-of-life care, said she welcomed the new NICE guidelines with its "emphasis on strong communication with patients, including how to help patients cope with both taking opioids and deal with the side-effects."  Sarah Wootton, chief executive of Compassion in Dying, said: "This guideline will support healthcare professionals in providing good end-of-life care across all settings, and will help to ensure that many people have what they consider to be a good death with their pain properly managed."
> 
> BBC News - NICE releases new pain relief guidelines


----------



## waltky

Make sure the doctor don't share pain med vials...

*Superbug MRSA linked to pain injections*
_July 12`12 (UPI) -- U.S. health officials investigated two outbreaks of invasive Staphylococcus aureus infection linked to the use of single-dose vials for more than one patient._


> The Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report said in each outbreak, the use of single-dose or single-use vials for more than one patient was associated with infection transmission.  In both investigations, clinicians reported difficulty obtaining the medication type or vial size that best fit their procedural needs, the report said.
> 
> The Arizona Department of Health Services was notified in April of a patient with fluid cultures positive for methicillin-resistant Staphylococcus aureus, who had undergone procedures recently at an outpatient pain management clinic.  "Investigations confirmed that the three MRSA-infected patients received pain injections on the same day, along with 25 other patients," the report said. "Two MRSA-infected patients received epidural steroid injections. Ten people, including the MRSA-infected patients, received contrast injections for radiologic imaging to guide medication needle placement."
> 
> The three Arizona patients with MRSA were hospitalized for nine to 41 days, with additional long-term acute care required for one patient. A fourth recipient was found deceased at home, six days after treatment at a clinic, the report said.  The Delaware Department of Health and Social Services was notified March 19 of seven patients admitted to a hospital with evidence of septic arthritis or bursitis.
> 
> Cultures from the affected sites -- knee, hip, ankle and thumb -- indicated all of the patients had MRSA. All seven required hospitalization from three to eight days.  "Previously, the orthopedic practice had used 10 milliliter single-use vials of bupivacaine for single-patient use," the report said. "When a national drug shortage disrupted the supply, staff began using larger vials of bupivacaine for multiple patients."
> 
> Read more: Superbug MRSA linked to pain injections - UPI.com


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## waltky

Uncle Ferd's back goes to actin' up on him when Granny tells him to do sumpin' `round the trailer...

*Gene flaw linked to low back pain*
_21 September 2012 - Scientists have identified a gene flaw linked to disc problems that are a common cause of lower back pain._


> The UK study, published in the Annals of Rheumatic Diseases, looked at 4,600 people and found the PARK2 gene was linked to age-related disc problems.  A third of middle-aged women have problems with at least one spinal disc - and the condition is known to be inherited in up to 80% of patients.  Experts said finding the gene could lead to new treatments being developed.  Back pain costs the UK about £7bn a year in sickness leave and treatment costs, but the causes of the condition are not fully understood.
> 
> In lumbar disc degeneration (LDD), discs become dehydrated and lose height, and the vertebrae next to them develop bony growths called osteophytes, leading to lower back pain.  The King's College London researchers carried out MRI scans of all those in the study and looked at differences in their genetic make-up.  They found variants of the PARK2 gene appeared to have an effect in people with degenerate discs and influence the speed at which their condition deteriorated.
> 
> Environmental effects
> 
> The researchers, funded by the Wellcome Trust and Arthritis Research UK, say more research is now needed to find out how the gene influences the condition.  But they suggest it could be switched off in people with LDD.   And they say it could be that environmental factors - such as diet and lifestyle - could make what are known as epigenetic changes to the gene.  The researchers say that once the mechanism is fully understood, their finding could lead to the development of new treatments of lower back pain.
> 
> Dr Frances Williams, of the department of twin research and genetic epidemiology at King's College London, who worked on the study, said: "We know that people whose discs wear out are at increased risk of episodes of lower back pain, but normal human discs are hard to get hold of to study so until now our knowledge of normal human biology was incomplete.  "Further work by disc researchers to define the role of the PARK2 gene will, we hope, shed light on one of most important causes of lower back pain.  "It is feasible that if we can build on this finding and improve our knowledge of the condition, we may one day be able to develop new, more effective treatments for back pain caused by this common condition."
> 
> Prof Alan Silman, medical director at Arthritis Research UK, said: "Lumbar disc degeneration is a common cause of lower back pain, and it's known that up to 80% of cases have a genetic basis, but this is the first time a gene has been identified as linked to this often painful and disabling condition.  "It's a promising start and provides us with the first clue to the genetic basis of this condition, and with further research, may potentially lead to the development of more effective treatments".
> 
> BBC News - Gene flaw linked to low back pain


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## waltky

Uncle Ferd knows all `bout dat...

*Cannabis can make patients 'less bothered by pain'*
_21 December 2012 - Cannabis can offer pain relief to some people_


> Cannabis makes pain more bearable rather than actually reducing it, a study from the University of Oxford suggests.  Using brain imaging, researchers found that the psychoactive ingredient in cannabis reduced activity in a part of the brain linked to emotional aspects of pain.  But the effect on the pain experienced varied greatly, they said.  The researchers' findings are published in the journal Pain.  The Oxford researchers recruited 12 healthy men to take part in their small study.
> 
> Participants were given either a 15mg tablet of THC (delta-9-tetrahydrocannabinol) - the ingredient that is responsible for the high - or a placebo.  The volunteers then had a cream rubbed into the skin of one leg to induce pain, which was either a dummy cream or a cream that contained chilli - which caused a burning and painful sensation.  Each participant had four MRI scans which revealed how their brain activity changed when their perception of the pain reduced.  Dr Michael Lee, lead study author from Oxford University's Centre for Functional Magnetic Resonance Imaging of the Brain, said: "We found that with THC, on average people didn't report any change in the burn, but the pain bothered them less."  MRI brain imaging showed reduced activity in key areas of the brain that explained the pain relief which the study participants experienced.
> 
> Dr Lee suggested that the findings could help predict who would benefit from taking cannabis for pain relief - because not everyone does.  "We may in future be able to predict who will respond to cannabis, but we would need to do studies in patients with chronic pain over longer time periods."  He added: "Cannabis does not seem to act like a conventional pain medicine. Some people respond really well, others not at all, or even poorly.  "Brain imaging shows little reduction in the brain regions that code for the sensation of pain, which is what we tend to see with drugs like opiates.  "Instead cannabis appears to mainly affect the emotional reaction to pain in a highly variable way."
> 
> Mick Serpell, a senior lecturer in pain medicine at Glasgow University, said the study confirmed what was already known.  "It highlights the fact that cannabis may be a means of disengagement for the patient, rather than a pain reliever - but we can see that happen with opioids too."  The study was funded by the UK Medical Research Council and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre.
> 
> BBC News - Cannabis can make patients 'less bothered by pain'


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