Ginny--pain is subjective and docs aren't mind readers. Other than developing a long standing relationship between patient and doc, there are only a few ways for docs to figure out those that are abusing meds. Urine tests and pill counts are the main two. Since regulations can be pressed even at the county level, (maybe even city in some cases) there is a real risk to doc's livelihood and/or freedom. Pain patients can be viewed by many in society as med seeking junkies, but the docs that prescribe their meds can also be viewed as nothing more than drug dealers...

The setting of a standard pain clinic just doesn't seem conducive to a close doctor-patient relationship in many (if not most) cases. Perhaps pysch testing should be a component before patients start opiates. The solutions bring additional burdens and expenses to patients, though.

There is no easy answer. I don't object to urine tests, but I'm not having to personally cover the expense of them either. If there are docs marking up those urine tests to profit off them, to the tune of hundreds of dollars, then that's inexcusable IMO.