Wednesday, June 12, 2013

Pain "Management" Clinics

Many people have serious, debilitating pain issues. This blog article is not about you. Don't send me hate emails. This blog article is about those people who are taking advantage of pain management clinics AND/OR about the pain management clinics that are taking advantage of people.

Pain Management Clinics are everywhere. We have several in my city. We get patients coming in month after month, year after year, for the same Oxycodone 30mg #180 month after month. Occasionally someone will try to pass off a fake prescription from these clinics thinking we'll not question it because we get so many prescriptions. But for the most part there's no need for a fake prescription. If you go to a pain management clinic and pay the fee, they'll give you a prescription.

I'd like to think that most of these clinics are really, genuinely concerned about their patients. Unfortunately, when I see the SAME patients going to the SAME clinic, month after month, year after year, I have to wonder if much is being done to HEAL the patient instead of just HIDING the pain.

If you're a chronic pain sufferer that continually sees a Pain Management Clinic, here's some questions to think about:

Do you ever expect to get better?
Do you really want the pain to go away?
Does the doctor talk to you about how he/she is going to treat your condition other than with pain meds?
How long have you been going to the pain management clinic?

If you don't expect to get better, maybe you should reevaluate. People do heal, or there are alternative treatments. In some cases, surgery is an option. You don't need to be in pain forever, and you certainly don't want to see the doctor EVERY month and take pain meds six to eight times a day FOREVER, do you?

If you have been going to a pain management clinic for several years, did it occur to you that maybe, just maybe, they're really not doing anything to help you HEAL? Oh they'll be happy to keep you coming back, but shouldn't their goal be to NOT have you come back?

Maybe what's really going on there is that you're a customer and in any business you really don't want to lose a customer. I guess you haven't figured out that they really don't want you to get better because if you stop coming to see them, then they lose your office visit co-pay.

Some doctors admit to their tendency to just write a prescription and be done with it. Here's the STORY of one you can read about. Seriously, folks, if you think you're being drained of your savings one co-pay or office visit at a time, think about seeing another doctor. Get another opinion. No one wants you to suffer, but not everyone wants you to HEAL. There's a big difference there...


C said...

The husband goes to a pain management clinic. They do steroid injections in his back in a series. Usually it is in combination with PT. I know that there are pill mills out there and they are great for getting people hooked on drugs and that makes me so mad because you are right-they just take advantage of people. Once you are hooked on those meds though-you have to go back, and they know it.

C said...

The husband goes to a pain management clinic. They do steroid injections in his back in a series. Usually it is in combination with PT. I know that there are pill mills out there and they are great for getting people hooked on drugs and that makes me so mad because you are right-they just take advantage of people. Once you are hooked on those meds though-you have to go back, and they know it.

drsteverx said...

There are so many fly by night pain clinics out there. I have one near me that prescribes oxys for everyone, of course there is some obligatory baclofen, meloxicam and various diagnosis codes written on every script. not one patient is on an extended release pain med. Almost all patients are from another state an hour plus away. Frustrating as all hell. Are there real pain patients I there? I have no idea most seem like the entrepreneurial type to me. Just think have the state pay for the med and you get to sell it for several thousand dollars-all profit. I have no idea how these places are don't get busted. And why are we the ones that have to police fake doctors. Rant over

Bryan said...

Is this a common perception of pain clinics? I am a PA, I work in a pain management/neurology clinic. I see patients every day that I fully expect never to heal. Is this bad?

Your cartoon made me laugh as I had a patient last Thursday who had her tailbone removed in order to try and stop her pain.

The majority of my patients are either failed surgical or poor surgical candidates. Those that are not generally have RSD, intractable migraines or Fibromyalgia. Yes we do work with all of our patients and try to help them heal, restore and increase function and quality of life. We do use a multimodal approach to healing. We do try to prevent and deal with addiction and drug seeking.

Still, do I expect my patients to eventually be healed? For the most part no, not really. Perhaps this is jaded. Perhaps it is just realistic.

Knot Telling said...

People like me (with metastatic cancer) use pain clinics too. I get really, really angry at the malingers and enablers who make it so hard for those of us who really need the drugs and other interventions legit pain clinics provide.They make it humiliating to ask for help with pain.

This was an important post. Thanks for writing it.

Surgeon In My Dreams said...

I went to my former pain doc for 9 years. I've had injections; 7 rounds of physical therapy; acupuncture; arthritis water class; TENS unit; Gels; creams; pills; stronger pills; fentanyl patch (made depression worse - had to get off that one real fast); even stronger pills; wash-rinse-repeat.

For 9 years we never had an issue. Never. Not one. My Rx was never "stolen". It was never lost nor did I ever "spill it down the sink". My former doc invited me to dog shows where he showed his $3000 dogs. I took him Christmas cakes and even took a small "pocket pet" or two for him to see.

Two years ago, I was asked for a urine sample at my monthly appointment. I gave the sample at 12:40. I last took my Percocet at 5:30 that morning. Over 7.5 hours had passed since I took 20 mg of Percocet. In between these times I had been to the water class & taken the 50 minute exercise class.

I got a call 2 weeks later from a nurse at the clinic. She told me I failed the drug test, (no Percocet showed up in my urine) and they would no longer see me. I begged to go do a retest then and there. Against their policies.

I find another clinic that will see me in spine of my "failed" drug test. I called my workers comp carrier to let them know I was changing doctors. They wanted to know why and I told them.

At my workers comp hearing, I was awarded lifetime care for my back injury. Lifetime. After I failed this test - the carrier explained to me they no longer had any obligation to cover my injury because I did not comply with my doctors orders.

Just like that. I did absolutely nothing wrong, but my lifetime of care was gone.

My life changed dramatically when I hurt my back. I can no longer enjoy the hobbies I used to have. No more hiking with my husband. I have even had to cut down on my passion - animals - because I am unable to clean animals and cages like they need. There is not a moment when I am not in pain.

I still go to the pool every day. That is the only exercise that does not greatly increase my pain for the day. I take several Excedrin when I get out of bed in the mornings. It helps - doesn't take the edge off like the Rx meds used to do, but it helps a little.

They say it is not surgical so no miracles there.

When you get bored, do some research about oxy meds and urine tests versus blood tests. I had more than 25 articles (and not from junk science sites either) stating it is much more accurate to test for oxy meds through blood rather than urine.

All I know is, I took my meds just like I was supposed to. I did nothing wrong but wound up being screwed. This changed my life. I have been treated for depression since 1992 and this little episode threw me for a loop. A long one.

I'm sorry I got so long...I guess you can tell this still hurts me when something brings it to mind like this post did.

Anonymous said...

Pain management clinics are just what the name says. They are not pain CURE clinics. Their purpose is to help people with chronic, intractable, incurable pain. Meds are usually part of the package - heavy duty meds. Please don't just characterize them all as pill mills. That is insulting to people who are really in pain. No, I am not one of them... never taken a oxycodone or a hydrocodone in my life. Just have a lot of sympathy for, say, my rheumatoid arthritis customer whose hands are all deformed from her disease... no cure for her but with appropriate med mgmt she can get through the day with less agony, swipe her credit card, sign her name... things most of us take for granted!

pharmaciststeve said...

Many of these pain clinics are referred to as "needle jockeys".. they typically run pts thru cortisone/lidocaine type drugs in their spine, botox, RF abalation... They will keep repeating these "treatments" as long as the insurance company will pay for it.. even though the "treatments" will last for a much short time than should be expected..
IMO.. these "treatments" are good diagnostic procedures to determine if the problem is acute or chronic
Many of those who have opted for back surgery.. end up no better or worse..
You have seemed to have forgotten that what medical science knows is dwarfed by what it doesn't know...
pain is subjective.. like thirst, hunger,need for sleep.. many times the genesis of pain is inconclusive and/or current medical science has no way to "fix it"..
at that point.. you have the choice to try and help the pt manage their pain.. or you tell them to "suck it up"
If you are uncomfortable filling the opiate Rxs for people that live far away.. turn them down...
plain and simple...

Crazy RxMan said...

Many thanks to all the comments. I really appreciate the various points of view. My view is from one perspective-- the pharmacist, so it is great to hear the other perspectives.

Thank you thank you thank you.

Crazy RxMan

Pill Pusher said...

Every once in awhile I like to ask the people their diagnosis. I would say the majority of them say it's from some sort of cancer or cancer treatment, which is fair. But I cringe as soon as the words "idiopathic" leaves a patient's mouth.

Chris Rock in one of his stand ups gets it right: "Drug companies don't want to cure a person or a disease because they know like every other drug dealer on the street that the drug game is all about the come back!" You want those people to come back time after time to keep seeing you and filling their scripts!

Mary said...

I too am a patient at a pain clinic. After multiple surgeries over 7 years and several doctor's opinions about the lack of chances of a "cure" I ended up taking regular pain medications. However, I have been on a stable dose for 4 years, at the lowest level that allows me to manage my pain and get through the day. My pain doc and my primary care provider have called my doses baby doses (in a good way), but it works for me and I do everything else I can to manage the pain (water exercise, lost a lot of weight, relaxation techniques, heat or ice. many rounds of PT). Unfortunately a few bad apples spoil it for all of us.

Anonymous said...

As much as I hate to admit it, I am the caregiver of a spouse in chronic intractable pain (the 'rep' extends to spouses, as well). I hate to admit it because I am also a nurse, and I see how meds are abused by those who could be healed, and others. Frankly, I don't know how Pharmacists manage, given what they have to deal with as a routine.

The physiology of some chronic pain sufferers is what it is, and there IS NO HEALing. Not happy with the bad apples, not happy with the life savings being eaten up with the Rx copays, but until the miracle of modern medicine can figure out how to short-circuit the abnormal physiology, it is what it is. What I wouldn't give for a healing alternative!

Thank you for sharing your perspective, too.

Anonymous said...

My husband has a severed thoracic nerve from when he was 18. He was told (20 years ago) that there was nothing they would do for the pain. He went most of those 20 years with a winged scapula and arm, shoulder and chest pain on a daily basis. He has worked most of that time as a machineist (sorry about spelling) using his arms to lift plastic and steel parts all day long. He can't hold his arms over his head (like to fix a shower curtain) for long. I finally convinced him to see a pain doc. He's been going there for 2 years, got a TENS unit, and never has been given a script for narcotics, just nerve drugs. Everytime he sees the doctor, the doctor shakes his head and says something about how he can't believe my husband waited 20 years to see someone about the pain. He is still in pain, but the nerve drugs take some of it down.

Its too bad the pain management clinics around you sound like drug mills - I do think there are some that are drug seeker havens, but some have decent docs trying to do the right thing.

Anonymous said...

Oh doctors...

They won't remove the source of my chronic pain (my ovaries and uterus) and no pain management place will take me because they'll just be "masking" the pain.

Why won't they remove my uterus and ovaries? Because I'm "too young". I'm 28 years old. Nevermind there's not a chance in Hell I can have kids. Oh, and my boyfriend has a vasectomy, so clearly we don't want kids in the first place.

Oh Doctors, you make me laugh until I cry...from pain...

Unknown said...

I like the picture. I don't like the surgical treatment because of its complexities after surgery. Every patient want to check out the pain for ever avoiding the other complexities.
physical therapist in bergen county

Anonymous said...

As some people have said, some conditions have no end. There is no healing. My husband suffers from peripheral neuropathy. No cure for that. And yes, he takes the recommended non-narcotic meds but still needs narcotics to help with daily life. Sees his pain md every month and gets his long acting opiate rx. Only gets #60 of short acting opiate every 2 months. I'd say that's responsible.

Elizabeth said...

I work at a pain management clinic and it really is hard to deal with patients who only want narcotics. When they don't get what they want, they move on. Some people deny all types of treatments and only want the pills. They don't want to be helped. It's stressful and its even more stressful to the doctors. Imagine being talked to terribly at least 5 x a day, every work day, because you aren't going to write them the narcotics they want..

Anonymous said...

Thank you for the wonderful blog-post, it needed to be said. I am unfortunately one of those pain patients that will never be cured. I have RSD/CRPS and live in a world of pain beyond most people's understanding. I thank God everyday for my fentanyl patch and oxycodone. I surely would have put a bullet behind my ear without narcotics. Sorry to be so graphic, but it's sad but true. I wish the junkies out there would stop trying to ruin my and every other legit pain patients access to pain meds. Makes me so flippin' angry...anyway, sorry for the rant and I hope everyone has a zero to low pain day. :-)

Unknown said...

I am afraid for the true pain patients anymore. I've been a pharmacist for 20 years. I have 3 active children and a spouse, and I work long hard 12 hour days and have done so for those 20 years. I am now to a point where I am in pain. Not so bad that I can't get out of bed in the morning, but bad enough that it distracts me from just about everything. I asked my md for hydrocodone about a year ago, and what a difference it makes. I can move, I can sleep, I'm not crabby. And I only take it when I work or am very sore from working. I am probably the only person in the world that was excited about the long acting hydrocodone that has been tossed around for a while. One dose would cover my whole shift! I'm genuinely afraid of the schedule change they have proposed on this drug. I can't take NSAIDS (which actually do help) because of an AVM that I really don't want to aggrevate (who would?) and also years of NSAID use has pretty much destroyed my stomach (before I found out about the AVM...oops). So,just to point out, even those working behind the counter have pain too. I don't use a pain specialist, but I still have 20+ years of work to go. It may be in my future.

Anonymous said...

If you would like pain control without all the stigma of feeling like a criminal because you live in constant pain and need relief, it's simple.
You see, DEA/pharmacists are demonizing pain meds because people with pain are serious "drug addicts" looking for a fix, not pain relief. It was also decided they had best limit the mg of Tylenol in the medication to limit damage to the liver. I doubt anyone in pain would take a separate dose of Tylenol with the medication to offset that limit. Oh, and God forbid anyone suffering feel any "happy feeling" as a possible side effect from this evil medication.
so...anyone who's weary of being labeled a drug addict, treated like a criminal at you local pharmacy, worn out from the huge restrictions, guidelines, laws, dirty looks, being at the mercy of disgruntled pharmacists there is such an easy solution! No stigma, widely accepted,and so simple. Buy alcohol & marijuana (both by the way legal and gleefully encouraged in society)Nobody lectures nor seems preoccupied about any abuse potential, nor do they have those same restrictions where they're so concerned about liver problems or that dreaded addictive happy feeling! It can be bought on a whim, day or night most relieves pain, and everyone who's anyone uses it. Yup, might even be able to kick back, open a cold one, toke a little and be pain free while in the company of your local jerk pharmacist.

pain clinic los angeles said...

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Heal My Fingers said...

I have attended quite s few pain management clinics for my naggingfinger pain and getting really good results. These clinics are very effective and can be very helpful in healing process.

Anonymous said...

Aaaaaaaaaaaaaarrrghhh!! It's posts like this one that make those of us in chronic, intractable, all-the-time pain want to scream.

I am NOT a pill seeker. I have (takes breath) spinal stenosis, SEVEN ruptured discs, osteoarthritis of the spine, facet syndrome, and fibromyalgia.

It's all as fun as it sounds.

I also puke every NSAID I take, so I can't even go there.

Tried Lyrica and Cymbalta for the acute nerve pain, and both made me feel crazy, so that won't work.

Currently taking Tramadol for daily management and Norco for breakthrough pain. I HATE taking pain meds, but more than that I HATE the pain.

I also am made to feel like a criminal at the pharmacy when I go each month. I've seen the eye rolls and the head shakes as I turn over the 'script. Why? Because I don't look sick. Yeah, that's because I take these meds so I can function, put on some make-up, go out and work to support those who won't/can't (don't get me started on that one), and still have enough energy left to enjoy life a little. Without them, I'm reduced to a pathetic mess, barely able to function, and no joy to be around.

So, go ahead, add to my frustrations by painting the world with your gigantic brush.

Thanks a lot.

Crazy RxMan said...

To the author of the last comment, please reread the first paragraph again. Thank you.

Anonymous said...

All well and good, Crazy, but the rest of your diatribe quickly devolves and demonizes all of us.

Read my last line.

IFA said...

These kind of clinics really making life of many people easy.

trigger finger treatment

Anonymous said...

Hey its not your fault there are so many junkies out there. I have chronic pain, have had it since I was in a serious accident at age 9 and now that Tramadol is the next morphine I don't take anything but Tylenol. Lots and lots of Tylenol. Anyway I'm sorry you got so much crap from people about your post, I liked it. I hate dealing with pain docs, I can't afford PT and they look at me funny when I ask for Ultram (Like I'm asking for Vicodin or something) Honestly I don't even know how people get that stuff. I'm glad I don't need to deal with that crap. Just ignore them. Keep writing. And calling 'em out on their bull.

Anonymous said...

To the chronic pain sufferers: there are two types of "Pain Management Clinics". The first type is probably the pain specialist you visit- they will do PT, steroid shots, etc. They also take insurance, are an established medical clinic, and spend time with you to help your pain. This is not the type of pain clinic the poster is describing.
The second type of pain clinic is the one that barely looks like a doctors office. It may be in a run-down strip mall, they may have an armed guard out front. The staff seem barely educated, and the business doesn't take insurance- cash only (they have an ATM right inside the door). This is the pain clinic that will see anyone for a few hundred dollars a month and give out 180 oxy at a time. This is what the poster is decrying.

Ask yourself: which clinic do you go to?

Unknown said...

I have chronic intractable burning, fiery, muscle spasm pain, secondary to multiple sclerosis. NOTHING and I mean NOTHING touches it! I should be so lucky to benefit from opioids. Tried them all from Dilaudid to fentanyl patches. Intrathecal dilaudid pump and NOTHING. All I got was increased tolerance and constipation. No thanks! I have accepted this pain as my (worst, most debilitating) MS issue. I know my disease course could be much worse.