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Topic: Would someone explain pain mgt to me... (Read 789 times) |
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BarbaraD
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Would someone explain pain mgt to me...
« on: Mar 5th, 2006, 8:08am » |
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My daughter-in-law (an RN) works for a pain managemnt doc and it's NOT what I thought it was.
I thought Pain Management was where you learned to deal with the pain - NOT where you went to get drugs! From what I'm getting from her, they dispense drugs more than anything else - and some GOOD ones at that. They run tests to make sure everyone is taking them the way they're prescribed, but this isn't what I thought pain management was all about.
The reason I bring this up - she was threatened by a "junkie" cause he didn't get his "fix" (he'd taken all is meds too soon and she was his target when she told him he couldn't have any more). I just think something doesn't sound right about this doc. He's seeing up to 75 patients a day and dispensing this much drugs.
Anyone been to a pain management clinic? I know we've had discussions on them in the past, but can't find the threads. I was under the impression that these clinics were to help you get "off" drugs and learn to "deal" with pain thru other methods if possible.
Anyone -- if you can give me some insight on this I'd appreciate it. I just can't believe this is what these places should be doing - even in LA.
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Grandma_Sweet_Boy
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Re: Would someone explain pain mgt to me...
« Reply #1 on: Mar 5th, 2006, 8:22am » |
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I don't know about a private clinic setting, but in a hospital - the Pain Management Team is generally there to try and find the meds that do work to control the severe pain.
When our grandson was in hospital - he had a Pain Management Team and they were wonderful in helping to figure out which meds would take the pain levels down to something a 2-1/2 year old could handle without turning him into a little zombie.
When it's a private clinic dispensing meds - I too would wonder what it's all about.
In my field of work I find those types of clinics are generally designed to help people find coping mechanisms and treatments designed to help with pain, rather than feeding them more meds. They're also damnably expensive but they are not prescription centres.
Interesting thoughts Barb - wonder what's really going on there?
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purpleydog
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Re: Would someone explain pain mgt to me...
« Reply #2 on: Mar 5th, 2006, 8:43am » |
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Pain management clinics evaluate your pain, your physical health, your psychological health, then decide on a plan of action to deal with your severe chronic pain.
Docs do dispense pain medicine to manage chronic pain, and if taken as directed, does not cause a problem. That is why they test people's level of meds in their system, to make sure they aren't over doing it. They also have patients sign contracts to agree not to take more than the alloted supply, and if you run out early, then you are stuck.
Pain clinics also employ ansthesiologists, who deal with severe pain by implanting a pain drug release system in your body, usually a morphine drip of some kind. That way it takes much less of the drug to be effective, than taking it in another form. The anesthesiologist then has to replace the drug in the pump, and only an anesthesiologist is licensed to do this.
Please be aware, most people who are going to a pain clinic only want their pain load to stop, or lessen. They know they won't be totally out of pain, but get just enough relief so that it is not at the front of their mind, so they can concentrate on other things besides their pain.
They also use other ways to help people deal with the pain, especially break through pain, but in most people's cases, drugs are the only way to get any relief. The doc may use a combination of pain meds to reach this goal.
Pain medicine is the most common way to help people to acheive this goal. People just want to be out of pain, not to have the doc be their drug supplier. There are lot's of conditions that will put you in chronic pain, and severe chronic pain at that. I don't begrudge anyone pain relief.
Not evey patient is a "junkie". That's pretty rare, actually. Patients are screened with a psych evaluation, and have to go through testing, before the doc determines if the patient will be helped by pain management. Some people are turned away. Most people are helped.
Yes, there is a physical dependency that happens while on some drugs, and when you stop taking them, your body goes into withdrawl. But with most pain management patients, the psychological dependency isn't there, so addiction isn't a problem.
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BarbaraD
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Re: Would someone explain pain mgt to me...
« Reply #3 on: Mar 5th, 2006, 8:55am » |
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What really bothers me is that they're dispensing Meth a whole lot. Isn't that what atticks take? Sorry, I'm not up on drugs. Aspirin is about all I have in the cabinet for pain. (Actually Aleve and Advil - depending on which kind of pain - reg or arthritis).
But 75 patients a day -- that guy doesn't even have time to READ the charts much less figure out what the patients NEED!
This has really got me worried.
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purpleydog
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Re: Would someone explain pain mgt to me...
« Reply #4 on: Mar 5th, 2006, 9:18am » |
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Methadone is a legitimate pain control medication. As with most meds, it can be used for more than one thing (think verap, BP med, and CH med, etc... ). Yes, methadone is used to wean herion addicts off of herion, and maintain them. It is also a damn good pain med in itself.
The great thing about methadone, is that once you find the dose that works for you, you don't need to adjust it upwards, because the same dose will continue to control your pain. With other pain meds, you develop a tolerance to them, and your dose has to increase in order to control the pain. Methadone doesn't work this way. You can be on the same dose for a long long time, and it will continue to work.
Methadone has a bad reputation, just because it is used to help herion addicts stay off the heroin. But it works great for pain control.
edited to add: Most docs are familiar with their patients, it's not like these people are walking in for the first time, so he may not need to read the entire chart every time a patient comes in.
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FramCire
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Re: Would someone explain pain mgt to me...
« Reply #5 on: Mar 5th, 2006, 9:29am » |
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I went to the local Pain management doctor when I had the disk problem in my neck and shooting pain in my arm. I got shots in my spine (I would have got pain meds but I already had them). These shots were part of an attempt to fix the problem (with PT) without surgery (which I later had).
I think the previous poster was mostly correct but I believe that people with chornic pain that are untreatable fall into 2 categories. 1. Legit pain that needs to be managed. 2. Drug seekers (most likely addicted from a previous injury/painful condition). Since it can be tough for your family doctors to distinguish between the 2 in cases where there is no good test to show the injury/condition, the pain management doctor is a great resource to send these patients to because they have more experience in figuring out the difference between the two.
Anyway, most people with chronic pain probably need drugs in some form to help. Shoot, I had wondered if I should contact the doc about my CH and see if it was something he knew anything about but found a headache clinic 25 miles away instaed.
Our local pain management doctor is a very good guy. However, I get a feeling drug seekers wont be happy when they get reffered to him. Also, I am shocked any doctor sees 75 patients a day without PAs or NPs working with them.
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| « Last Edit: Mar 5th, 2006, 9:30am by FramCire » |
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You've overstayed your welcome since the day we met but it doesn't seem to matter to you. No medications are your master, nothing makes you fret, it's a helpless feeling having nothing I can do
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FramCire
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Re: Would someone explain pain mgt to me...
« Reply #6 on: Mar 5th, 2006, 9:34am » |
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BTW, no doctor has the time to read the entire chart on a patient. The nurses job is to gather all the info and takes notes that will allow the doctor to "know" the patient without reading the entire chart. Obviously, it is the patient's job to tell the doctor important things that are relevant (to the best of his/her knowledge).
If a doctor has good nurses, they can see a lot more patients per day, although 75 is a ton more than I can imagine.
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You've overstayed your welcome since the day we met but it doesn't seem to matter to you. No medications are your master, nothing makes you fret, it's a helpless feeling having nothing I can do
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chewy
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Re: Would someone explain pain mgt to me...
« Reply #7 on: Mar 5th, 2006, 9:40am » |
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Mthadone is also one of the most difficult meds to detox from.
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purpleydog
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Re: Would someone explain pain mgt to me...
« Reply #8 on: Mar 5th, 2006, 9:44am » |
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When I went to see my doc, he and I went through my chart page by page. We discussed all the docs I had seen, and all the meds I have tried, and everything else that was in it. This is an intake appointment, and this takes a long time. Not your usual, 10 minutes in and out, then lets start treatment. And don't forget the testing. So, yes the docs in a pain management clinic do read your entire chart. It's just that they don't need to re- read it on every visit, because they are familiar with you and your case, and only need to see the updated notes the nurse has taken when you are there for a return visit.
The doc may have NP's and PA's, this wasn't mentioned. It would be hard, otherwise, to see that many patients, I agree. He or she would definitely rely on the excellent note taking capabilites of the staff, and the instinct of the staff. My doc works closely with the nurses, who also know the patient too.
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Melissa
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Re: Would someone explain pain mgt to me...
« Reply #9 on: Mar 5th, 2006, 9:47am » |
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This is a bit off topic, sorry. 
There has been only 1 RX drug I've ever been addicted to in my life, and that is Tylox. Has anyone else ever taken it or know what it is derived from?
TIA
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chewy
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Re: Would someone explain pain mgt to me...
« Reply #10 on: Mar 5th, 2006, 9:58am » |
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Tylox
Brand Name: Percocet
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purpleydog
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Re: Would someone explain pain mgt to me...
« Reply #11 on: Mar 5th, 2006, 10:00am » |
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Tylox is a mixture of oxycodone, and tylenol. Also known as perocet. A lot of pain meds are mixed with tylenol, or ibuprofen, or caffeine to help them work better, and to kill the pain faster/ better.
Oxycodone is a narcotic that relieves moderate to severe pain, and comes in many forms. You can become physically dependent on it. Your doc will wean you off of any meds that can cause physical dependency, so your body doesn't go into withdrawl, if you have to take them for the short term, meaning a few weeks or so, as opposed to months or years.Of course, you will be weaned off of any drug you stop taking, but when you say addicted, Mel, this was a physical thing, right? When you stopped taking it, you noticed the effects, correct?
There is a difference between physical depency and psychological dependency.
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Melissa
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Re: Would someone explain pain mgt to me...
« Reply #12 on: Mar 5th, 2006, 10:05am » |
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on Mar 5th, 2006, 9:58am, chewy wrote:Tylox
Brand Name: Percocet |
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Holy crap! I had no idea.
That stuff made me feel so good! Not only with pain, but it made me so relaxed and happy.... NOT a good thing for someone like myself!
Wow. Ever since that stuff, I would only ask for Tylenol 3 after having surgeries.
It amazing the amount of rx meds rx'd to patients that are addictive compared to the illegal ones. Just WHO is right here anyway?  (don't answer that, it should be for a different thread  )
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Melissa
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Re: Would someone explain pain mgt to me...
« Reply #13 on: Mar 5th, 2006, 10:08am » |
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on Mar 5th, 2006, 10:00am, purpleydog wrote:Tylox is a mixture of oxycodone, and tylenol. Also known as perocet. A lot of pain meds are mixed with tylenol, or ibuprofen, or caffeine to help them work better, and to kill the pain faster/ better.
Oxycodone is a narcotic that relieves moderate to severe pain, and comes in many forms. You can become physically dependent on it. Your doc will wean you off of any meds that can cause physical dependency, so your body doesn't go into withdrawl, if you have to take them for the short term, meaning a few weeks or so, as opposed to months or years.Of course, you will be weaned off of any drug you stop taking, but when you say addicted, Mel, this was a physical thing, right? When you stopped taking it, you noticed the effects, correct?
There is a difference between physical depency and psychological dependency. |
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I guess you would have to say psychological? As it enhanced my mood, even when the pain was gone. I didn't want to stop taking it due to my outlook on everything had changed.
When I did stop taking it though, it seemed like I dropped. I was very sad for about a month or so, and then things evened out for me again.
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chewy
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Re: Would someone explain pain mgt to me...
« Reply #14 on: Mar 5th, 2006, 10:13am » |
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Then you were on the path of addiction. Glad you stopped when you did.
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john_d
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Re: Would someone explain pain mgt to me...
« Reply #15 on: Mar 5th, 2006, 10:14am » |
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on Mar 5th, 2006, 9:18am, purpleydog wrote:Yes, methadone is used to wean herion addicts off of herion, and maintain them. It is also a damn good pain med in itself.
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I just saw an HBO special on that stuff, apparantly the heroin heads can take it with one of the Valium or Xanax family of drugs and it chemically changes it into a heroin high. If they can't get heroin, they can usually get Xanax and methadone- thanks to the taxpayers. What a sham.
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chewy
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Re: Would someone explain pain mgt to me...
« Reply #16 on: Mar 5th, 2006, 10:21am » |
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A high enough dose produces the heroin high without additional drugs. You do however develop a tolerance to it in the sense that in time the heroin effect wears off at a consistent dosage.
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john_d
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Re: Would someone explain pain mgt to me...
« Reply #17 on: Mar 5th, 2006, 10:23am » |
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on Mar 5th, 2006, 10:08am, Melissa wrote:
I guess you would have to say psychological? As it enhanced my mood, even when the pain was gone. I didn't want to stop taking it due to my outlook on everything had changed.
When I did stop taking it though, it seemed like I dropped. I was very sad for about a month or so, and then things evened out for me again. |
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I got some Vicoden, hydrocodone- an opiate as well, for a tooth ache and after I finished the bottle I craved more. Those opiates are scary.
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chewy
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Re: Would someone explain pain mgt to me...
« Reply #18 on: Mar 5th, 2006, 10:28am » |
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The phenomenon of craving is one of the first indicators of addiction. Doesn't take much or take long for it to manifest. Especially in individuals who are predisposed to addictive behaviors.
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deltadarlin
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Re: Would someone explain pain mgt to me...
« Reply #19 on: Mar 5th, 2006, 10:49am » |
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on Mar 5th, 2006, 10:05am, Melissa wrote:
Wow. Ever since that stuff, I would only ask for Tylenol 3 after having surgeries.
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Hates to tell you this Mel, but Tylenol 3 also contains codeine.
Lorcet/Lortab also contain a form of codeine, hydrocodone. As does Hycodan, Vicodin and a few others.
ALL of them can be addictive.
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Azrael
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Re: Would someone explain pain mgt to me...
« Reply #20 on: Mar 5th, 2006, 10:52am » |
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My GP once prescribed Percs for my CH (this was before I was correctly diagnosed)... When I had the follow-up, I told him it didn't help the attacks, but a double dose was almost enough to make me not care once the attack was over... He almost prescribed it again... "At least it does something." LOL Prolly a good thing he gave up and sent me to a neuro a couple of weeks later.
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purpleydog
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Re: Would someone explain pain mgt to me...
« Reply #21 on: Mar 5th, 2006, 10:53am » |
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on Mar 5th, 2006, 10:14am, john_d wrote:
I just saw an HBO special on that stuff, apparantly the heroin heads can take it with one of the Valium or Xanax family of drugs and it chemically changes it into a heroin high. If they can't get heroin, they can usually get Xanax and methadone- thanks to the taxpayers. What a sham.
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Yes, it's too bad there will always be people who try to take advantage of the availablity of pain meds to feed their own cravings. And yes, the tax payers pay for it. But the tax payers also pay for the legitimate pain relief for a lot of people, i.e. those on disability. In my opinion, there are far more people being helped than users taking advantage. Because of the few who are abusing the system, it's not to say that everyone who is being helped, whether on disability or if they have private insurance, or not, should not be taking medicine for the relief of chronic pain.
Just be glad you aren't one of those who has a psychological dependency, and are addicted, and has to search for your drug of choice, just so you can get high, so you can waste your life. And that is a monkey on your back, some people realize this and get help for it.
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chewy
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Re: Would someone explain pain mgt to me...
« Reply #22 on: Mar 5th, 2006, 11:01am » |
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Quote:| Yes, it's too bad there will always be people who try to take advantage of the availablity of pain meds to feed their own cravings. |
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Doctors are finally getting wise to that though. Most Docs will have you sign a contract now if they are going to Rx pain meds. They will also do baselines to determine if are taking the prescribed dosage or not.
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tanner
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Re: Would someone explain pain mgt to me...
« Reply #23 on: Mar 5th, 2006, 11:09am » |
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Barb, There are pain management centers like the one that I travel to the dc area to go to that would rather cut off your arm to give you something else to focus on then prescribe drugs. The team of doctors i see try all kinds of alternatives like acupuncture, bio-feedback, physical therapy, herbal remedies etc. Now I should point out that chronic back pain is what I am being treated for there not ha's.
When we lived in California there was a clinic (so called pain mngt) that people could go to, say that they had migraines and trouble sleeping and walk out with a script for 200 ten mg Valiums and 100 quaaludes. often they did not even see the doctor himself and they filled their scripts right there at the attached pharmacy. We know this to be true because one Linda's sisters was a regular customer. Clearly a drug pushing scam. I think that the different law enforcement agencies have since cracked down hard on those kinds of places but it does not mean they don't exist.
http://opioids.com/oxycodone/medicolegal.html
I would think that your daughter-in-law as an RN would be able to tell the difference but I would be concerned also.
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lilboo
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Re: Would someone explain pain mgt to me...
« Reply #24 on: Mar 5th, 2006, 11:22am » |
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My husband was seeing a pain managment doc. and they put him on methadone, yeah they have you sign a contract but that dosent keep you from over doing it. I can tell when he's on it, I still think he takes more than is prescribed but he won't admit to it, his whole personality changes he becomes overly nice and spend happy, then when it runs out he becomes very moody and wants to sleep all the time.
We changed Insurance companies back in Nov. and they are keeping him on the meth but they have yet to send him to a pain managment doc. By the way he does have a very addictive personality and was a drug user, he quit for about 4 months and was going to NA meetings, then he had his heart attack and they put him on pain meds. and that's when the vicous cycle started over.
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