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The Pain vs Pill Dilemma

posted 7/14/2010 12:17:53 AM |
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tagged: pain, frustration

I was diagnosed with Rheumatoid Arthritis over a year ago. RA is classed as one of the many "auto immune" disorders, which basically means your immune system attacks your joints, sometimes to the point of deformity. Thanks to the millions and billions spent on research these day, there are plenty of medications being peddled that slow the progression of the disease and that make most of the symptoms go away.
But enter what I like to call the "pain vs pill dilemma". When you have an illness like RA, you never know when you'll have pain. Sometimes it's every day, and then some times you go for a stretch pain-free. When the pain hits, it's very intense, and can keep you in bed as any amount of movement "hurts". So because of these episodes, I consult a doctor.
The search for a Rheumatologist has been an interesting journey. Since I am what doctors call "sero-negative RA" (all this means is that the clues doctors look for in your blood that indicate RA are not present in mine), which automatically sets me apart from other RA sufferers. When people with RA have pain, inflammation and swelling, doctors call this a "flare". Usually they want to see us RAers when we are experiencing a flare. This way they can evaluate the symptoms and determine what course of action to take.
So I found out early on that most Rheumatologists do not want to deal with pain management. I don't know if it's because they are afraid of dealing with narcotic pain medications (maybe because their regulation is so strict as to be mind boggling?). When I complain about my pain to my Rheumatologist, her favorite thing to say is, "If I treat the pain, I'm not treating the disease." Now I understand where she's coming from, but when you're suffering from chronic pain it's not exactly what you want to hear.
So I figured I'd find a doctor who does treat chronic pain with narcotics. Enter the "pain management specialist". They make you sign an agreement where you promise to use only one pharmacy to fill your scripts and that you'll not go to another doctor to receive pain medication while you're under his/her care. I have no problem with these rules. I understand they are put into place to protect both the doctor and patient. seems these days that everything about narcotic pain meds is "regulated". Any doctor can run a "list" on a patient and find that patient's medication history and what pharmacies the patient has used.
So up until April I was seeing a pain management doctor in Hamilton, which is about 30 minutes away from where I work. Once at his office, patients would be made to wait two to three hours, even if you were early for your appointment. Recently my job has become extremely strict- even if you have vacation time you are not encouraged to use it- and although you used to be able to "make up" missed time, that is also frowned upon. If you're me, that is! Anyway, my boss tells me I can't take anymore time off during a regular work day to go to my pain management appointments. I'm told I have to schedule them "after work". That would be no problem....IF my doctor had later appointments. Which, alas, he did not. So I left his practice and began searching for a new pain management doctor. Now, had I known this would be the BIGGEST single mistake of my life up to this point, I would have told my boss to go screw himself, and told the doctor to get better office hours, and stayed with that doctor.
But me, being the big doofus that I am, began my search for a new doctor in earnest, as most pain med scripts are only written for 30 days. I found a doctor registered in my insurance, who had great office hours. I went to see him, and he was nice enough (orginally from Taiwan but I had no problems understanding him). However, his staff made me feel like a criminal for needing medication to manage my chronic pain. Needless to say one visit did for first and last with that doc.
I had my family doc "refer" me to a pain management specialist in his practice. I went to the appointment and loved this doctor! She took great pains (every pun intended) to listen to me tell about my RA ups and downs. But then she informed me that she believes in a more holistic approach and wrote me a script for physical therapy, but no meds for the pain. Back to the damn drawing board.
I found yet another doctor who specializes in pain management, had my family doctor write another referral, and called to make an appointment. That office kept telling me they hadn't received the referral from my family doctor. Two weeks after it was sent I had my practice send it again. Another two weeks went by and finally, by some miracle of God, the fax had gone thru and I was able to make an appointment for 6/10. I was calling at the beginning of June, and I found it strange they were able to see me so quickly, but since it's an orthopaedic/sports medicine place, I figured they had lots of doctors in the pain management area.
I went to my appointment and met with the doctor. He was awesome. He listened to my symptoms and was very sympathetic. Then he said, "I think you should do pain management." I said, "That's what I came to see you for." I explained that the appt. desk had set me up with an appt. with him. He then left the room for a moment saying he'd be right back. I could hear him talking to someone out in the hallway about how there'd been "a mixup" and that I was there to see pain management and not an orthpaedic doc. The doc came back in the room and said, "We'll get you an appointment with the other doctor, and obviously you're going to need some medication, right?" I told him yes and he proceeded to write me a script and even gave me some samples to tide me over since I couldn't see the pain guy until 7/13.
My appt was at 3 today. When I left work at 2:30 it was raining cats and dogs. I got soaked going to the car. The rain didn't let up at all on the drive over to the doc's office, so I got wet again (even with an umbrella) going into the medical arts building!
I got all checked in, handed the thousand pages of patient info to the front desk, and sat down to wait. After 45 minutes I was called back to a room. The first thing the nurse tells me is that they will run a drug screen. The standard urine test is for all new patients I'm told. No problem. I informed the nurse that I had meds in my system (from the doctor in this practice) and that my pain was so bad yesterday I hit the local hospital ER and was given a shot. So she understood I was going to "pop" positive from the start.
Then the doctor comes in. Introduces himself, and we make small talk. He asks me what I do for a living while he peruses my paperwork. Then starts the Spanish Inquisition. I literally felt like I was being burned alive at the stake! He pulls out this print out and says,'Why do you use 13 pharmacies?" I was flabbergasted. I couldn't speak for a second. Finally I asked him what he meant by 13 pharmacies. He shows

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Jul 14 @ 12:38AM  
me "the list". There, right in front of me, is my history over the last year. Every medication I've ever had filled and where I filled it! I'm floored. I didn't even know such a list existed. And isn't that information private? I guess when dealing with controlled substances, no information is sacred.
So this doctor basically accuses me of being a drug addict. He asks if I have a boyfriend. I say no. Do I have a "friend" (I'm thinking he's working the "pimp" angle here). I tell him No. Do I share my meds with others? HELL NO. Do I sell my medication to others? OH HELL NO. The whole time I'm thinking, "Did he REALLY just ask me these questions?
Needless to say I'm frustrated. This doctor told me he'd see me again in three weeks. He also said, "You have the right NOT to come back. But if you do come back, you have to follow the rules or you're going to be in trouble!"
I just can't believe I was treated this way. But I have a plan. I plan on going to the next appointment. I'll use the same pharmacy to fill all my scripts. And once he trusts me, and says he's going to give me real pain medication, that's when I'm going to tell him to go FUCK himself! And make a complain to my insurance company.
I know this blog doesn't really have anything to do with sex, but I'm just angry and frustrated I had to blog my way out of this mood I'm in. I know myself better than anyone, and I know I'm no addict. And yeah, I know the old adage, "Me thinks she doth protest too much." But all that matters is the truth. And I'll do whatever I can to make this doctor change his mind. Then slam him over his bad behaviour.
Thanks for putting up with my rant. I appreciate it!

Jul 14 @ 4:08AM  
First of all...I really want you to know how impressed I am with you. I have met so many people who did not take an active role in their medical care and it is paramount if you are going to get better.

Secondly...I'm so sorry you've had such a difficult time. It sucks when you have a long-term illness and you can't get a medical team assembled. Just a may want to look for another doctor and forget about "getting even" with your current doctor. Yeah...I know...revenge seems really great right now...but I think your energy would be better spent looking for another doctor. JMHO.

Lastly...I've had 3 family members over the last 2 decades who have been diagnosed with RA. Their struggle with this disease was really heartbreaking some my heart goes out to you. I know that my great aunt swore by some of the holistic remedies out there so perhaps a happy combination between holistic and western pain meds will be your magic mojo.

Whatever you decide...I wish you pain relief...and the best of luck while you're
searching for a doctor you can work with.

Btw...I'm leaving you a green cookie because I hear they have healing powers.


Jul 14 @ 9:46AM  

Jul 14 @ 10:53AM  
There is a well known problem with people doctor and pharmacy shopping for controlled substances so it is scrutinized. Now, I must say that 13 pharmacies sounds very weird and suspicious to me. Why so many?

I would get a new doctor and explain the medications up front.

Jul 14 @ 12:29PM  
Aww darlin.. I feel for you.. my darned joints feel like someone kicked me in em all the time now.. I'm too damned stubborn for my own good though.. I just graduated up to 800 mg ibuprofen.. it's not cutting it really but it does help some.

Tender hugs.

Jul 15 @ 5:58PM  
I have been through pain management school after dealing with chronic back and ankle pain for years. I learned a lot about why the docs act the way they do. They haven't a clue and don't want to be sued for overmedicating or enabling an addict.

However, the good stuff I learned was how to manage my pain more effectively. How to understand it and tame the beast.

1st thing is get a journal and start a pain diary. Write down the time, date and what you were doing when you started to feel the pain. Also what you were eating... food causes pain trust me... the ph in different foods can set off a joint attack. LEARN THE PAINS PATTERNS.

2nd thing is to medicate before the pain hits or when you first feel it. It takes less medication and it works faster and lasts longer if you take it when it starts rather than when you are having a full fledged flare up!.. THINK KEEP THE HORSE CORALLED RATHER THAN CHASE IT DOWN AFTER IT GOT LOOSE.

3rd thing is identify activities that make it worse. Mine is walking or mowing the lawn so I strap my ankles after rubbing on anti inflamatory cream and take my Aleve before heading out.

4th thing is to keep moving even when it hurts. Sitting around makes the muscles atrophy (waste away) and causes a build up of lactic acid which makes pain worse. Moving helps the body create its own pain dampening endorphins like seratonin think runners high.

5th thing sit in the sun with your hat off for 15 minutes a day so the sunlight can activate the hypothalmus gland to produce depression fighting vitamin D.

6th thing is find a distraction activity that helps keep your mind off the pain. Visualisation can help.... you know calm blue ocean rhythmically lapping at the shore.... sounds like hocus pocus but it works.

7th sleeeeeeeeeeeeeeeeeeeeeep!!! Even if you need meds to sleep. Pain loop is pain keeps you awake, no sleep causes brains pain killing chemicals to drop as sleep helps regulate these hormones in the brain, so you feel more pain.

8th Pain Gate Theory. Pain is carried on a different nerve pathway in the body from every other sensation... hot, cold, touch etc. They run parallel like a country road (pain) by a major freeway (other sensation) Like a traffic intersection only one signal can reach the brain at a time and the major traffic has the right of way. Ever notice how if you hit your leg or arm you automatically rub it and the pain is less while you are doing it but comes back when you stop? That's how it works. Counter irritation... this is why heat or ice packs and electrical stimulation machines (Tens) help. Have someone tickle you with a feather. Or adding pressure to a joint with an ace bandage can make a difference. I started wearing elastocated weight lifting gloves while sewing and that really helped relieve the swelling in my hands during the day.

9th thing is learn nerve blocking accupressure pain points. A visit to an accupunturist will help even if you are scared of needles like me. They do accupressure too and will show you what you can do to help relieve your pain during attacks.

10th thing is drink lots of water and eat regularly... 6-8 smaller meal over the traditional 3 really help regulating pain spikes. The digestion process or lack of it can cause all kinds of pain related problems.

Hang in there as there is a lot that you can do to help lesson the symptoms


Jul 15 @ 6:12PM  
Oh yea i forgot one of the most important things!!!

ORGASMS create pain killing endorphins as well as providing great exercise

So just one more reason to have sex!!

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The Pain vs Pill Dilemma