Dr. Kraus is well educated on this issue. Unfortunately, the doctors at our local pain management clinic doesn't see things qiute that way.
They play "cat & mouse" with the patient's medicine, one may be on a medicine for a while, & doing good. Then, after the usual counting of pills by the nurse & doctor, at least once a year, you are led into the bathroom and instructed to flush the pills down the toilet, for a "drug holiday".
With no regard as to mabye the patient is in their gap, or "donut hole", and many have had to pay $600 to $800 for their prescriptions, and very few consumed from the bottle/package. That's heartless. Having to flush nearly a months worth of medicine down the toilet. At that time, it was a balancing act between purchasing medicine & food. The total cost of health care was the #1 item in our budget.
I could see it if the counts of the meds weren't right, or the bloodwork not showing the proper levels of meds in my bloodstream. Or if my spouse had reported to the clinic that I was abusing/selling my drugs. I was taking my meds as directed, even though my pain wasn't under control, an issue that I had discussed with him twice.
He was trying his best to drive it down my throat that I had a psychological issue, and it wasn't true. He had me to lie down & take imaginery shopping trips, going to concerts, purchasing cars, things of that nature. To no avail.
Well, I'll tell it straight like as it is, I refused to flush my expensive medications (at that time 75mcg Fentanyl patches & 5mg Opana IR tablets), left the office, went to my primary care doctor, as well as the surgeon who referred me to that quack clinic, and was able to continue to maintain on these meds (after some minor adjustments) for over another year before tolerance set in. I was then switched to Opana ER 40mg (along with the quick release 5mg Opana). All was well for another year.
Usually, my meds needs to be swapped once a year. I can live with that. But not all pain management clinics are equal. To be a good doctor (& patient), communication is vital. I was holding up to my end of the contract. The only thing that may have remotely suggested a problem, I was withdrawn. But that was because the lack of pain control. Some days, when people spoke to me, it sounded as though they were screaming. I was irritable.
That was nearly 5 years ago, around the beginning of 2007. I have some other issues, but at least for the most part, the burning, almost crippling pain of a failed four level lumbar fusion is managed fairly well.
Thanks for sharing your article, Dr. Kraus. You show that there is still humanity in medicine. I wish the very best for you.
Cat
Hi Cat,
For some doctor or nurse to demand that you trash your medication is absurd. I'd question their credibility for certain. Just who do they think they are?
I would find this incredibly inappropriate EVEN if the situation was one where the patient has an addiction question, or straight up obvious that addiction is present. In what country did this occur in?
Insane! And yet we the chronic pain patients are the demoographic that are constantly suspect or questioned.
Thank you Karen for taking the time and effort for this valuable interview. It was validating for me in many ways.
Thank you Dr Kraus for what feels like a sincere and compassionate approach to chronic patients.
I have a few comments in response to a couple statements by Dr Kraus., and you Karen.
In response to dark Kraus' statement: "We've got to have physicians understand about pain."
I cannot agree with anything he said with more passion. If this does not come to fruitarian,
which it has not for the past 28 years that I have been involved as a patient with chronic pain, than
this country's health will continue to falter and cause people to either live a life in pain that
could be well managed, or death. Not everyone will manage living in pain every day.
The Physician is the holder of relief, of peace, of life. Without his or her's assistance what chance would we have? My faith in the system as it has been draining as the years go by and I see little progress.
Not much has changed for the betterment to the patient in the last 28 years in my experience. And I cannot say that the management of my pain has been amiss. I have had great care for the most part. Having been treated for 10 yrs by the same internist who took it upon himself to research with others in the industry who deal with pain management. He sought consults from an anesthesiologist to a Pharmacist specialist. Although my pain had been treated
almost ten years prior. for the first time it was finally being managed.
I slowly but surely began to retrieve my life. For 10 years I was grateful to have my pain managed so well and with so much concern for me.
Than I moved from one state to another. Back to where I came from.
Only I needed to find a new doctor. I spent the first 4 years being bounced from one doctor who would prescribe anything, to a doctor who I wound up with only because my previous split without any notice. Had it not been for his colleague who agreed to take my case and prescribe my pain medication until I could find another doctor I'd have been in trouble. But she did. She also told me right up front that she was not experienced in treating chronic pain and she would help
me temporarily but I needed to find another doctor to manage my pain and pain medication.
She was willing to see me as a general practice patient. Through this physician I was referred to my current "Pain Specialist. Today I see a Pain Specialist who is an anesthesiologist who found treating chronic pain with patients in a clinical setting.
And in reply to Karen's Statement:
"but that from what I hear from patients, that kind of relationship and teamwork is more of a rarity than it is commonplace."
I have been very fortunate in that in the last 3 years the Pain Specialist I see has managed my pain well with just a few bumps along the way. I have never in 3 years been questioned or asked to take a UA or a blood test to check for compliance.
I believe that the relationship I have developed with my doctor is not typical, but it's been a time of learning that we can trust each other, and that we will never ask of each other to do something that we are not comfortable with. The first moment that bond that we have built on trust is broken the value of the relationship is over.
Finding a doctor to prescribe medications is not too difficult, finding one to manage my pain is.
.
Dear Karen,
I was so glad to read this article and to hear this doctor express a reasonable and rational explanation regarding the differences of addiction and physical dependence for pain patient.
In my case, 3 1/2 years in bed with severe nerve and back pain, misdiagnosed by my doctors and on very high doses of everything, I was very concerned about the addiction issue. Finally, an orthopaedic surgeon realized that I had severe Adult degenrative scolios. I had disk replacement surgery, decompression and fusion from S1 to L/3 to try to correct the scolios.
This changed my life and my future however, because it was left untreated for so many years and because it is a progressive condition I will always have some pain and neuropathy pain albeit much less than before.
All this to say that, I was able to get of Oxycontin completely and use fast acting morphine only when needed. I did this by slowly reducing the dosage as I felt I could tolerate and with my doctors' guidence.
I never felt a high from my pain medicine. I never felt like I wanted to have more of it .......... just because it was a nice feeling. I followed the doctor's dosages to the letter, all those years. My body was dependent but not my mind.
I wish more doctors understood this difference for pain patients and then so would our family members. We have enough to deal with without judgements from others about addiction.
Thank you again for this interview,
dockside (Deb)
I agree with you completely! It is always to emphasize the differences between dependence and addiction. Granted, the physical dependence on opioids does occur, much as it occurs with many other medications that are not opioid class drugs. So, if a patient needs to continue taking one of those medications, does their doctor and/or friends and family think of them as an addict? Of course not! They need that medication for whatever malady they have. So we have a chronic problem and it is pain. It is managed with pain medications. I have only recently needed to increase my long acting pain medication due to tolerance and it has been nearly two years. I'm thankful to have a pain doctor who understands this situation, trusts me to communicate with him, and prescibes the medication that I need in order to make the most of my life.
As for your misdiagnosis situation and problems with getting the proper treatment. I wonder how many pain patients have a physical situation where some treatment could improve their situation, and how many pain patients are pretty much "stuck" with their pain. Misdiagnosis does occur. Yet many of us have chased down every "cure" we can find, only to end up broke, still in pain, and completely discouraged and defeated. There has to be a balance for each person between "fix it" and "accept it."
I truly wish physicians, family, and friends of chronic pain patients would read this article and understand pain better and stop thinking of us as addicts who make excused to take medication.
I live in a rural area where the nearest pain management doctor is about 200 miles away. Yet my primary doctor who is very familar with my condition acts like I will become addicted any day now. The orginal doctor that treated me when I got a unknow caused spinal infection involving t12 - s1 was willing to maintain my pain level. The second doctor acts like he is afraid of being in trouble with the government for prescribing the medication. He rarely allow refills even though the state allows 5 refills and medicare and the phmaracy will not fill them early. I wait as long as I can before running out so that he will provide refills.
He wants me to go to a pain management doctor which we have done before and they agreed with my treatment plan and due to the permenant damage, the amount of medication could increase.
What do you do when you are completely open with your doctor and he still doesn't want to provide the leve of care needed and the number os foctors in our area is very limited?
Personally, I think the doctor avoided answering the question about why we continue to be treated as potential addicts even after years of being a good opiod patient. I guess you could sum up his answer to "education" -- but it's such an over simplified answer, it's not really helpful in finding a solution.
I've tried for years to start that sort of realtionship with my pain specialists -- they don't have the interest, the time, or even give a damn.
And I don't think his answer about what a family member of friend should do if they suspect someone has become an addict is very helpful. As a person who had been dealing with addicts my entire life -- I can tell you, 99% of them are NOT going to let you go to their doctor to explain your concerns. They're going to do everything in their power to keep doing what they're doing, and keep you from affecting change. And I would also suggest that nearly half or more of the symptoms of addiction you mentioned, such as missing family functions, changing hygiene, isolating, etc -- are also symptoms of simply living in chronic pain.
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Very interesting interview. However, I would like to know why opoids give me energy. Someone said that was because I was an addict, which isn't true. After 3 1/2 years I still take the same dose.
When I asked my doctor why I felt like I had more energy when I took my pain meds, he told me that there was a simple answer to that question. He told me that my body was so very tired from fighting the pain, that when the pain level is reduce, I feel as if I have more energy. In others words, my body doesn't use up as much energy fighting pain when the pain levels are reduced, thus I have more energy for other things.