Chronic Pain Treatment Controversy

[Lucky]

With the death last week of the 39 year old producer of the Narnia Chronicles from a reported Oxycontin overdose, those who advocate against pain doctors have been given more ammunition. Doctors specializing in chronic pain have become controversial for their willingness to prescribe larger doses of pain medicine than family doctors are usually comfortable with, thus leaving the patient in a dilemma. Listen to the family doc and suffer the pain, or take the risk that the pain doc might give you too much medicine.

Family docs argue the risk of addiction, dependency, and overdose. Pain docs claim that with a constant flow of drugs, there will be no withdrawal issues so addiction or dependence is not a problem. Why have people suffer needlessly?

We've seen an advance in the use of morphine for terminal patients, something family doctors resisted until recent years. What the ultimate answer is, I don't know. Right now I lean towards the pain docs, but I am not a 39 year old film producer...

UPDATE: In an odd coincidence, shortly after I posted this I noticed an article on the topic in today's San Francisco Chronicle's website, sfgate.com. Still in my edit period, so read on:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/02/19/MNVL1HLHKN.DTL&tsp=1

[Lucky]

Only 11 views? That hurts!

[Guest zipperzone]

Only 11 views? That hurts!

Give them a chance Lucky - some people just don't read this as often as we do.

[TampaYankee]

I also go with the pain docs.

It not only is about quality of life it is also about bearing to be able to live.

I live pretty much in constant discomfort due to osteoarthritis. Nothing I can't tolerate with the help of OTC analgesics and herbs so I am better off than many. However, I know there are those who live with excruciating chronic pain. That is no way to endure life 24/7 no matter what busybodies may think, even physican busybodies. Nobody who doesn't walk in those shoes shouldn't presume to know what is best for another unless they have a truly effective alternative to offer.

As long as the patient understands the side effects and potential consequences of treatment/meds it should be his/her choice. It is not unheard of that some resort to suicide when relief cannot be obtained. To leave them with that as the only alternative is a poor choice for society.

I can't tolerate those who know what is best for others when they haven't walked in their shoes.

[Lucky]

I also go with the pain docs.

It not only is about quality of life it is also about bearing to be able to live.

I live pretty much in constant discomfort due to osteoarthritis. Nothing I can't tolerate with the help of OTC analgesics and herbs so I am better off than many. However, I know there are those who live with excruciating chronic pain. That is no way to endure life 24/7 no matter what busybodies may think, even physican busybodies. Nobody who doesn't walk in those shoes shouldn't presume to know what is best for another unless they have a truly effective alternative to offer.

As long as the patient understands the side effects and potential consequences of treatment/meds it should be his/her choice. It is not unheard of that some resort to suicide when relief cannot be obtained. To leave them with that as the only alternative is a poor choice for society.

I can't tolerate those who know what is best for others when they haven't walked in their shoes.

Well said, TY. I tend to side with the pain docs, but then you read about this 39 year old dying. But I don't have enough facts on him...maybe it was intentional, maybe other drugs were in the mix. But if it was just because of prescribed dosages, then I worry!

[Lucky]

Give them a chance Lucky - some people just don't read this as often as we do.

I couldn't resist saying "it hurts" on a thread about pain.

[Guest zipperzone]

I couldn't resist saying "it hurts" on a thread about pain.

Very clever - I totally missed that

[KYTOP]

After reading this topic I have tried to think long and hard about responding since this topic hits a bit close to home for me.

My son-in-law was experiencing some back pain from an unknown cause. Upon visiting a pain doctor he was prescribed Oxycontin for his pain. After some time on the med he became addicted and lost his job. In the spring of 2009 he was arrested for breaking into cars, stealing purses and such for money to feed his habit. When he got caught he had my grand-daughter in her car seat in the car with him while he broke into a car. My daughter was called to come to the scene to retrieve my grand-daughter from the police. Her home was then ransacked while the police searched her home for stolen items, even turning over the mattresses on the beds, including the child's. As you could imagine this tore our family up very badly.

My son in law was quickly placed on probation by a judge because he agreed to go to a very expensive rehab center, for 3 months, out of state in Florida on my daughter's health insurance. I had to step in to help my daughter and grand-daughter with some finances during this time. Upon returning from rehab my daughther reluctantly allowed him to visit his daughter and eventually allowed him to return to their home, allowing him a second chance and hoping to rebuild their her homelife and family. I bit my tongue allowing it was her decision to make and not mine, trying to let her live her own life, she is an adult.

One day this past spring she came home and their flatscreen TV was gone and he told her it had messed up and he had taken it to be repaired. Then other things of value started disappearing from the house. Then a neighbor, who he had known all his life had their house broke into. The items, including hunting rifles, shotguns, and hand guns ended up at a pawn shop. The police traced it back to my son-in-law and he was again arrested for theft to feed his "pain medicine" habit of Oxycontin. There were numerous other breakins in the area they were also able to tie back to him. Yes as you can guess the items missing from her own home, including her class rings and other jewelry was also at numerous pawn shops throughout the city. He actually told my daughter where to find the pawn slips he had hidden. I spent a day traveling from pawn shop to pawn shop with her, PAYING to retreive what items they still had and had not yet sold. My daughter was humilated.

Then she got a notice in the mail were their house was being auctioned by the mortgage company. For over 6 months he had not paid their house payment and had spent the money on his "pain medicine habit". It was a very nice, large home they built about 5-6 years ago. He had intercepted the notices from the bank and she never knew he had not payed the payments.It was too late to save it and my daughter's income was not enough to bail out the mortgage, pay other bills and everyday living expenses. I then gave my daughter enough money to move into a small 2 bedroom apartment with my grand-daughter. Moving day was an emotional nightmare watching my daughter breakdown throughout the day, curling up in a fetal position crying as we went through things to move into the apartment or to put into storage and taking my grand-daughter from her home. I watched her cry as we left her family pets of several years, 3 black labs she had raised since puppies, at the animal shelter because she could not care for them and have them at her apartment. I have been trying to help her as much as I can over the past few years but I have had some medical problems that forced me into retirement while all this was going on.

He was in jail for awhile awaiting trial but due to overcrowding he has been released without having to pay the original bail set for him. He is set to go to trial in a few months. I've had to deal with my daughter crying about how she will explain to her daughter about her father possibly being in prison and not being in her life. He is allowed supervised visitation with my grand-daughter while awaiting trial.

As you can imagine this has been a hard emotional couple of years because of a "pain doctor" giving my son-in-law the highly addictive "pain medicine" Oxycontin. Due to the problems with Oxycontin in our state all prescriptions for it are now highly tracked including how often the "pain doctors" prescribe it. Now it is a common practice for people from my state to travel to "pain doctors" in Florida, due to tracking here, where they are quick to write them prescriptions on a first visit from out of state patients of course for an inflated office fee. The State Police has started stopping cars randomly returning to the state and finding numerous out of state prescriptions for some of these people for their "pain medicine".

So as you can see this Chronic Pain Treatment Controversy has hit very close to home for me and it has ruined and caused much emotional pain on my family.

Do people need pain medicines sometimes? Of course but it has created a nightmare in it's wake for many like my family.

What is the solution? I wish I knew but it obvious many of these "pain doctors" are too quick with handing out the medicines, not following up on these patients and then not dealing with the fallout they are helping to create.

[Lucky]

KyTop, thanks for sharing these events. They are very sad to hear. What I gather is that the pain docs cut him off, yet he was by then addicted. That is something the pain docs need to explain, I can't.

They will argue that with chronic pain, and by that I assume they mean pain that will last a lifetime, then addiction is not a problem because there will be a constant source for the drugs. But therein lies the rub. Who wants to be on a drug they are addicted to, and have to have? I think it is the pain itself that makes the decision for you. If you can live with it, fine, do so. If you can't, then you have to make the choice for the drugs and then hope for the best.

I wish your daughter a happy resolution, if one can be found.

[KYTOP]

KyTop, thanks for sharing these events. They are very sad to hear. What I gather is that the pain docs cut him off, yet he was by then addicted. That is something the pain docs need to explain, I can't.

They will argue that with chronic pain, and by that I assume they mean pain that will last a lifetime, then addiction is not a problem because there will be a constant source for the drugs. But therein lies the rub. Who wants to be on a drug they are addicted to, and have to have? I think it is the pain itself that makes the decision for you. If you can live with it, fine, do so. If you can't, then you have to make the choice for the drugs and then hope for the best.

I wish your daughter a happy resolution, if one can be found.

Actually the doctor never "cut him off". It was just after awhile it seemed he needed or wanted more of the drug than the doctor was prescribing for him.

Thanks very much for your wishes and thoughts. In our situation at least I keep telling myself no one has died from our situation unlike in so many other cases. But I did have a gun removed from their house when the first situation arose, still wonder why he had not taken it to the pawn shop. It also scares me to think what if someone had attacked him while he was breaking into cars with my grand-daughter in the car with him. I am so thankful she was not harmed physically during this.

[TampaYankee]

Actually the doctor never "cut him off". It was just after awhile it seemed he needed or wanted more of the drug than the doctor was prescribing for him.

KYTOP,

I too am sorry to hear about your daughter's nightmare. The problems are always so devastating to families. I can't speak to this case example other than to say it is very sad and I understand your very legitimate misgivings and uncertainty about the practice. This story gives pause for thought.

There is certainly potential for abuse by patients and doctors alike. I would like to see more doctors held accountable for prescription abuse such as the Florida physicians who appear to run a meds-mill-opeartion.

Based on the facts, my fault with the doctor was the willingness to prescribe heavy-duty meds on a first visit for an undetermined cause of pain. The facts of your case may be more complex than space permitted and no need to go any deeper. At this point is really doesn't matter. What does matter is the damage done to your family.

It is always important to understand that there are many sides to an issue. Your perspective reminds us that there is the possibility of serious abuse with devasting fallout for innocents. Something good to keep in mind, for doctors too.

[Lucky]

And now it seems that some docs would rather just prescribe the pain meds than spend the time needed to find the cause of the pain. It's a messy world and the medical profession stands out in good and bad ways.