Why it Sucks to Be a Pain Management Doctor or Patient

In Tennessee, there are strict Chronic Pain Management Guidelines.

First, doctors have to have you go through a screening process. They won’t prescribe you any medications for the first month. If you have any kind of mental disorder, anxiety, depression, current or past history of drug abuse, you have to go through another evaluation. (In my case, I have to go see a psychologist to see if me taking opiods is a risk because I have bi-polar disorder and anxiety. Oh Goody! Another doctor’s appointment! I love getting out. It feels so good when I have to walk, sit or stand!)

They have to take a urine sample to check for illegal drugs, current medication levels and pregnancy before they can start treating me. They also do this periodically. Some do everytime. Some do random check-ins.

The doctor is supposed to come up with a treatment plan and make reasonable attempts that includes things besides solely prescribing pain medication. I’m guessing that’s why he referred me to a PT for aquatic therapy and a prescription lidocaine cream. (Like I said, I just love getting out. It helps my nerve inflammation feel so much better, especially in the colder weather!) I also asked him about having an injection in my piriformis because I have a lot of pain in that area. Worth a try.

“The goal of chronic opioid therapy is to increase function and reduce pain, not eliminate pain.”

Then there are prescription restrictions, including

·       not prescribing more than four doses of a short-acting opiod per day unless documentation can clearly show a medical reason.

·       not prescribing methadone. (Thank you. I don’t want or need that anyway.)

·      no prescriptions for oral or sublingual buprenorphine, avoid combining certain medications with opioid therapy.

·       If patient is taking “benzo” – (such as Xanax, Valium, Klonopin, Restoril, Ativan,) the opiod dose should not exceed 120mg morphine equivalents daily dose, unless you consult that doctor and they say it’s ok to come off of that Benzo.

More regulations for pain management doctors and patients in TN:

·       Doctors are supposed to prescribe the lowest dose of opioid first, then go up.

·       Patients have to sign a treatment contract that covers why they may stop prescribing me opioids, refill policies, must use one pharmacy, if you lose your medication or it gets stolen - too bad, so sad.

·       They must continually monitor patients for signs of abuse or misuse and must do random drug screenings at least twice a year. I must take all of my medications in with me. They can ask for random pill counts at any time. (Some places do this every time.)

·       All opioid therapy has to be handled by one single doctor or practice and all prescriptions have to be filled at a single pharmacy. So, can’t ever get any pain pills from another doctor.

·       Opioids should be used at the lowest effective dose.

·       They cannot use more than one short-acting opiate at a time unless clearly documented why it is medically necessary.

·       They must continually look at patient behavior, drug history results in the CSMD, Urinary Drug Tests, patient risk of misuse or abuse.

·       If a patient goes to the ER, the doctor must inform the Pain Med Doctor about any changes, emergencies or conditions. IE – The ER can’t prescribe me pain meds or inject me with pain meds without letting the Pain Clinic Doctor know.

So, there you have it folks! I’d like to take a moment to thank all of the recreational drug abusers and pill mill doctors for making it as difficult and longs as possible for doctors and patients in chronic pain to receive the treatment they need. Thank you legislators for leaving out the part where research shows that people who suffer from chronic pain have shorter life spans. We wouldn’t want to freak anyone out! The longer you suffer, the shorter your life will be. Thank goodness I live everyday as if it was my last and I’m ready to meet Jesus! 

Here's a copy of the contract I have to sign to have treatment with narcotics.