How to re-enter a pain management program without looking like a drug seeker

[RavynRae]

I am a chronic pain patient, I have sculiosis where my spine jumps to the right in two places and I have a chiari malformation (meaning my skull presses into my spinal cord). I used to be in pain management and regularly on pain medications, but I didn't like them and decided to seek to manage my pain through chiropractic care, massage therapy, and yoga. I admit I have not been seeing them for several months as funds have been cut short. I recently had surgery and feel that I won't be able to go back to chiropractic care (the one that really relieves my back pain) until atleast a month and a half after my surgery. The hydrocodone they've had me on has been working really well at helping me control my pain in the mean time. However now that I am recovering from my surgery my surgeon won't be able to write me any more scripts for hydrocodone. I want to see a pain management doctor to have a script for hydrocodone to control my pain until I can get back into the chiropractor and the two weeks in that it takes to control my pain (a script for 7 weeks). However, I don't want to be put on anything stronger and I know tylenol with codeine does not work (and I'm a crohns patient so I can't take NSAIDS and I had an adolescent seizure disorder so I can not take tramadol) so I specifically want to be on hydrocodone because I know what works and it is a medication I am comfortable with being on for 7 weeks.

The thing is, I do not know how to explain this to the doctor so I do not come across as a drug seeker. Any advice on how to explain/express this to the doctor such that they don't think I'm a drug seeker and will be willing to work with me for the said 7 weeks (aka not putting me on some drug to keep me as their patient and make money as a result)? Because I know they don't react well when the patient is this knowledgeable about their conditions and controlled medications and specifically don't like it when a patient has a plan of treatment so the patient is basically coming to them asking them to comply with their own plan of treatment... I just have dealt with pain management doctors in the past and they always want to put you on something like morphine sulfate or OxyContin for long term pain, but those medications turn me into a zombie and I don't want to be on them.

 

[Smoky]

True, surgeons don't want to be liable and are very hesitant to write a 3rd script, sometimes 2nd. Mine was a brain surgeon. He remarked to me, " We are not a pharmacy " - when I asked for a refill after surgery. He was pushing the Ultram.
Also, in California anyways, there are stricter rules enforced now for hydro scripts.

I also went through pain management, have scoliosis in spine, stenosis and pain/pressure into skull and left side of head. I lost my hearing temporarily due to this, then had a surgery. I do understand the doctors want to prescribe something longer acting, although those medications can be more difficult to withdraw from.

Do you have a date/name for the chiropractor? For me, when I did take pills, I would usually show proof of when my treatment would be for my neck. If they know you have something coming up, they might be more responsive to prescribe in the interim.

 

[RavynRae]

Yes here is Texas the laws recently changed to be stricter on the prescribing of hydrocodone as well. Also, doctors are on the super-alert to be wary for pain-pill seekers, which is why I'm trying to find the best way to approach the doctors. I understand they're inclination for long-acting drugs such as morphine sulfate and OxyContin, but due to how hard it is to get off of them that you mentioned (along with the fact that they turn my into a zombie), I don't want to take those medications. I only want to be on pain medications for a short period of time, just long enough for me to be able to regain control of my pain and set my life back in order to work on it all homeopathically (sp?). However, because the doctors are on the super-alert, when someone comes to them asking for a specific, short-term pain medication such as hydrocodone, even if the patient had a homeopathic plan, they only see a pain-pill seeker (our system is so screwed up that those of us who really need the meds have to go through all this crap to get them and have to endure the stigma attached to the meds, but I digress).

So do you think it would be best to arrive to the doctor with my most recent chest x-Ray that shows my spine going the wrong direction and a letter from the chiropractor stating that I have an appointment with them to start treatment on a certain date? This would be the way to show the doctor that I have a real issue and that I am serious about not being on the medication for too long? Or will this translate back into the whole "she has put way too much effort into proving that she should have the drug therefore she is a seeker of the drug" category? Should I get my previous medical records from previous pain management doctors and bring all of that along as well? I really don't want to bring all the documentation from past doctors, because I honestly don't feel like going through the hassle of tracking it all down and picking it all up and all when my appointment with my PCP is on Monday (I have to get a referral for my HMO so I have to see my PCP first). I'm kinda hoping (in a long shot) that my PCP will see that I only want to be on the medication for 7 weeks and will be willing to write me the script for the whole 7 weeks instead of sending me to a pain management doctor who will try to out me on the long-acting medications and will order MRI's to confirm my condition (why spend the extra money to have tests done that I already know the answer to because I already know what I live with? Am I right? Haha). But I know that is a long shot, but maybe it will happen, if not I'm entirely open to the pain management doctor because i know it's the only way to go otherwise.

How do you get a chiropractor to write the letter that states you have the appointment and plan of treatment anyway? Is that a regular thing they do? I never needed to ask for such before.

 

[Smoky]

I do understand not wanting to have more tests done. I am seeing a brand new doc (pcp), under a new provider next week, and have mris of my condition. I'm contemplating if I should bring in all my past info or just start fresh. I need many referrals.

I think it really depends on the doctor sometimes. Some doctors want to see an mri or at least a tech report to get an idea of what's going on. Although ime, sometimes they want a fresh mri. I do doubt he/she would feel you are using the mri as a motive for pill seeking if it's a legitimate issue.

I honestly would just see your pcp first, then go from there. I know it's so difficult to not project ahead, but this could save you a lot of time thinking about it for now.

I can't say for sure what is best, but maybe just make an appointment with the chiropractor and let the doctor know that this is your following up after surgery with treatment. Maybe you don't need it in writing. Most doctors know that one shouldn't see a chiropractor close to any type of surgery, especially spinal. It takes time for the spine to heal first. I was in pt 6 months actually before seeing a wholistic type chiropractor and even a cmt at that.

BTW: I just remembered there is a pain management section, or at least thread here somewhere on BL. I commented on it yesterday. I bet there are a lot of folks with some similar issues on there.

In all sincerity, you do have a legitimate issues. If you have no history or record of drug use in data, even with the new laws .. I wouldn't think it would be too much of an issue, but I could be wrong. I do agree that pain management might not prescribe short acting pills though.

Let me know what you decide to do.

Best,
Smoky