I am also worried about this pain management situation. All the Dr.s are doing it cause the DEA are cracking down on Dr.s that are prescribing narcotics/opiates and they think that you might take your prescription and sell the pills on the street. Its basically an issue of your Doctor not trusting you. What gets me is that they are forcing you to take medication even if you dont need to take it. So I guess you cant get a script anymore that says " take as needed for pain" Instead, if the script says "take 1 pill 4 times a day" then that means you have to take 1 pill 4 times a day if you need it or not. Because when they test your blood/urine you HAVE to have a certain amount of the prescribed drug in your system or they think that your selling it and they will stop writing you prescriptions and cut you off and remove you from their clinic. THIS IS TOTALLY WRONG and we need congress to change this system!!!

I think about the situation we have facing pain patients too. I was also prescribed to take a med four times a day. I am not doing this. I am only taking when needed. I already take morphine, and didn't want to add another medicine that I would have to be weaned down from. I take this other one percocet, only when I have to walk, like in a mall, or to a dinner with friends etc. If I am not walking the pain isn't too bad. I will bring the container and show him where on my chart that I am taking the med. I keep track of each day, writing all of it down. since this is the first time, I am not following direct orders, I am not sure what he will do. I will find out this thursday. I am not afraid to tell him the truth, or present to him what I am doing and why. I have also decided I don't want the surgery right now for a joint replacement. I am more or less being forced to do this surgery. So I will just have to tell him what I am thinking, and go from there. I want another opinion, and from a different field of medicine.
This state has had terrible trouble with clinics that are underhanded in their dealings with pain pills. I live in florida, where this problem is so bad, the Governor will sign a bill this week to have all state employees test. So far all medicare patients are doing this too, as if it will stop the problem. This issue has made many doctors frightened to prescribe for legitimate pain patients. We also have a list of synthetic drugs, that are hitting the stores, so called designer drugs. This has got to be stopped for the sake of all those who really do need medicines to control their pain. In our state, it has gotten very out of control. I do feel sorry for our pain specialists. ginnie

What is totally wrong is that Congress, the DEA, or insurance companies are involved in the practice of medicine at all. Pain management, like every other kind of medicine, is and should be a matter between doctor and patient, and no-one else.

http://www.aapsonline.org/painman/pbmaterials.htm

Many prescriptions for pain medications are written, "as needed"; others are written, "up to x times a day" and various other ways. However there comes a point, or situations, when round the clock medication is medically warranted, and only those prescriptions are written that way. For patients in chronic pain, medications work better when taken as early in the pain cycle as possible, and/or when maintained at certain levels in the bloodstream.

Large pain management clinics require testing to protect themselves and their other patients from political witch-hunts. It is less common with doctors who have/take the time to know their patients well.

Doc

Unfortunately, yes. So is the insurance company. They have put me in withdrawell so many times, that now I horde my medicine in case I can't GET ENOUGH. It's terrible and unfortunately it has helped me to use ice and relaxation techniques and not depend on anyone/anything I can't get by myself.

They call that something like not in compliance or something... oh, not taking the dose you are ordered to take. It's a catch 22. If you do and they deny it later, you go into withdrawel, if you don't so that THE AMOUNT THEY ORDER, SO you can wean yourself off, (if thEy deny it again) then you forget when to call in a refill and think you don't NEED it.

You can't win.

A true pain specialist is your best route to go. My doctor keeps me with adequate pain control. He does not abruptly take you off them. I was allowed to stay at a reduced amount to control my pain. Hope you find that good physician. ginnie

yes because he is sending you to another dr for help.

I also have cervical herniated/prolapsed discs. They cause hot pain down arm and numb hands mostly the right. Also weakness in that hand which is the one I use most. It's been a few years. I was on Norco first, then when they herniated my Dr. immediately wrote me morphine script. It was necessary, there's no way the Norco or even Oxycodone covered the pain. I've been able to come down from 300mg/day to 120mg. I'm prescribed 180 but only take 2 tabs so I can save 1-I do this bc. I had the horrible experience of losing a great pain dr. to a sudden MI. He died and I had no meds to cover me through to find a new doc. The dr. who covered for him said he didn't believe in giving pain meds, so I was simply out of luck. I've heard of dr's just not caring if you go without for whatever reason, and leave you to fend for yourself. In fact, mine has recently changed positions from believing in prescribing pain meds to saying he prefers "procedures", and doesn't want to do the long term pain med route, although after he brought everyone down drastically he's allowing us to stay at this level indefinately, but who knows when he may change his mind again. I feel alright at this dose, didn't help much with the constipation tho, and there IS more pain experienced, but I feel like I can deal with it. If I had to go off the morphine though, I would just have constant unremitting pain, and lose all quality of life. I DID have an addiction to crack cocaine over 18 yrs. ago and bc of this my whole family thinks I'm just addicted to the morphine and maybe dont even have pain, even tho the MRI shows the nucleus pulposa sitting right on the nerves, but they still insist I'm ruining my life. I don't care anymore, I just tell them I wouldn't have a life if I didn't have pain relief. It sure would be nice to have one that addressed the physical pain without the side affects, the physical addiction, lack of sex drive, constipation, lethargy etc. but until then I pray I don't have to go thru withdrawel. I'm very careful about taking it right. And, just like many of you, it's completely different from getting high--I don't crave it mentally at all, I will sometimes forget to take it until the pain kicks in again ect. I know also that if I do surgery the chances of scar tissue/adhesions causing even worse pain is very high. Not good enough odds yet for me to elect surgery, although as soon as something better comes along I'll be the first to want it done. For now I think morphine is a Godsend and thank the kind dr's willing to help. The ones that percieve us as drug seeking addicts just don't understand or don't care.
One question for you all out there. How long before a person can test negatively on a urine test for narcotics if they suddenly stop their morphine? Also, some emergency rooms won't even help if you go in for help with withdrawel pain. Why is it so hard for some folks to understand we don't love the medication, but it allows us to function somewhat and if that's the only choice what choice is it really? I'm sure most would do the same, they just don't realize how bad the pain is I guess. I used to be a practicing chiropractor, and ironically only about 2 yrs after state liscensure I had my cervical discs herniating and wasn't able to practice anymore. I lost a whole career and have had a very difficult time with things since. Now I'm on SSI and making a paltry $845 a month. Any ideas folks? Thanks for any suggestions, I also have fibromyalgia and strange sleep schedule/or no schedule. I tend to be awake at night and asleep in the daytime which is REALLY disabling. Even more so than the medications and chronic pain.

I want to welcome you to Neruo Talk. You found a good place to get some help, and most of all compassion. I too take morphine after two spinal fusions. I know about the quality of life issues you face. Someone not in your shoes does not know what it is like to be in your position, where most of your life has been taken from you due to pain. Many of us here, struggle with pain issues. Please seek another pain specialist that can also deal with the depression, and emotional issues that come with pain. After 4 yearsm with my pain specialist, and being reduced to a wheel chair, I sought out more help. I found a pain specialist that is also a Board Certifiedn Physiatrist. Not only does she deal faily with me with my medications, she tried to treat the whole person, not just as a pain specialist/patient, but as a human being which we are. I hope you can find someone like this. I searched a long long time, and it was actually my pharmasist, who helped direct me to this physician. Find more help, and a better group of doctors to take you under their care. Physically and mentally it helps, when you know for sure your doctors are in your corner. Both my PCP and this new doc. are on the same page, and also are willing to communicate with each other. I really do wish you all the best in your situation. None of it is easy. Keep coming back here to NT, with questions, just to talk and hang out. I come here all the time for help and compassion, when I feel lost. Take care, ginnie

http://en.wikipedia.org/wiki/Drug_test

Hi kstauffer, Welcome.

You bring up many good points.

Many doctors are changing their policies regarding longterm pain medications. The reasons are often political rather than medical.
Google: politics of pain and the related searches that appear at the bottom of that page.

One option is methadone.
Google: methadone for chronic pain and related searches for more information. It can be very effective for treating chronic pain, but like other opioids, it is not risk-free. Research thoroughly and discuss with your doctor.

You might consider seeing a pain management specialist (if you haven't/aren't already) to explore alternatives to medication.

I would also recommend The Intractable Pain Patient's Handbook for Survival by Dr. Forest Tennant, which can be downloaded free.

Lack of sex drive and lethargy can/may be due to hormone imbalance caused by intractable pain and/or longterm opioid use. This can have a significant effect on quality of life issues as well. Here are some further detailed articles by Dr. Tennant on this:

http://www.practicalpainmanagement.c...-pain-patients

http://www.practicalpainmanagement.c...tractable-pain

http://www.practicalpainmanagement.c...in-update-2010

and my own experiences:
http://neurotalk.psychcentral.com/thread156416.html

Doc

This mixture has worked well for many (not all) chronic painers:
http://neurotalk.psychcentral.com/post741073-26.html
Diabetics can leave out the brown sugar, and/or substitute molasses to taste.

Doc