I've never had any luck with the hospital system. My problem being I had hip surgery in 2008, the surgery caused many chronic problems I deal with every day. Given the job market today I work a very physically demanding job (60 hours a week with lots of heavy lifting) with really no other options for employment. The pain I go through every day to support my family is unbearable and I can't get a doctor to take me seriously. The last times I've went I've been shooed away like some punk kid trying to get pharms to get high off (I'm 24). The biggest problem in my situation is my medical records were lost when I was discharged from the army so there's no record of my surgery/chronic pain. Where I live people have ruined the system and there is no doctor with any sympathy towards pain. I'm terrible at talking to doctors or complaining about my pains and that doesn't help at all. While I was in the army I was used as a guinnea pig and have been on just about every pain med/nsaid available, I already know what works well for me. What I really want is just some advice on where to find a sympathetic doctor in the Washington State area and how to talk with the doctor without being treated like a junkie. All I want is to be able to continue supporting my family, I really feel like I'm breaking down from this. Thank you for any help you guys can give me.

Hi Ryan,

I feel for you. My son sustained a head injury during his first deployment and when he returned to the states and tried to file for a partial disability, the Army had lost all of his records.

Wish I could help. Where in WA do you live (you don't have to give an exact location). I used to live there and know a lot of people so maybe one of them can help with a doctor's name.

Good luck!

The whole premise that you need pain meds to work 60 hours a week doing heavy lifting is probably not something most doctors are going to find a way to justify. One question is are you injuring yourself further by overworking your old injury?

I should mention that current standard of care practices for chronic non-cancer pain require that the goal of opioid therapy be to improve phycical functioning (improve your ablity to move around) rather than a goal of simply reducing pain.

Also consider that usually people with injuries that result in severe pain may become disabled and maybe not even able to walk to the bathroom unaided. In that case giving them strong pain meds can easily be demonstrated to improve their ability to move around, care for themselves, and maybe even go back to some type not-too-demanding work. How are you going to demonstrate that such a treatment is going to improve your ability to function? By showing that you can then work 80 hours a week instead of only the 60 that your are working now?

Also, whenever you go to a new doctor for pain treatment, they need to document the reasons for the therapy they are giving you. During that process, opioids are usually reserved as a treatment of last resort, after other more conservative measures have been tried and failed. Often even if you do have good records, a new doctor will want to start over. Unfortunately from your perspective, you probably have to decide if your pain is bad enough that you are willing to work through the existing system even though it is not what you want.

We just need docs who give us what works, and quit being afraid to do the right thing. As long as we don't continue to increase dose, or get out of control, they should be reasonable. It's getting ridiculous!

I understand the way you feel. However, what you believe is the right thing, what doctors (given what they now know about the long-term effects of opiates) think is the right thing, and what the DEA thinks is thing -- these are all very differnt conclusions that each group ends up with.

You see, they now know that long-term opioid use always to some extent increases sensitivity to some types of pain! And that it doesn't necessarily lower senstivity to some other types of pain! Were you aware of that? One test they to to prove that is get somebody who is being treating on chronic opioids to stick their hand in a a bucket of really cold, but not quite freezing, ice water. They are told to remove their hand when the pain becomes unbearable. Normal people who are not on opioids will last about one minute on average. People on opioids will last only about 20 seconds before the pain becomes to much for them to stand. So this observation started a lot of scientific investigation about what chronic opioids really do to people. Other bad things have been discovered. Also, it has become clear that the more opioids you give people, beyond some minimal level, they actually reduce their functioning in normal daily activites. The sedating side effects of the drugs cause people to spend more time in bed, not go out of the house as much, not spend as much time with family and friends, etc. There is much more I could go on to say about opioids and current trends in pain management, but since I don't have time to write too much, I will just reiterate what I already said: The use of opioids to treat chronic non-cancer pain is falling into increasing disrepute in some medical circles. Also in the last five years, prescriptions for opioids have increased 30% which has alarmed the government and many doctors. They don't know exactly why that has happend, but they are investigating, they are scared it means something dangerous for society, and they are going to clamp down and make sure those drugs are limited to people who really need them for the right reasons. Merely reducing pain so someone can work 60 hours a week doing heavy lifting is not going to fly. Maybe that person's body is telling them that can't do that any more and they need to find another line of work, even if that means going back to school, or moving to another area where more suitable work can be found, or even going on unemployment or disabilty for a while. Sorry, I know its not what people want may want to hear, but it is the way the reality of medical care for chronic pain is headed. You have to try conservative measures first before juming into long-term opioid use.

I disagree. We let people do all types of things to their bodies in our society. People eat junk food, yet doctors do very little about it (other than recommend, on occasion, better diet). Docs prescribe medications for every single symptom that people have, rather than treating the actual root of the problems. The drug business is worth trillions, and this has nothing to do with docs worried about opioid use. No, this simply has to do with our govenernment once again thinking they need to stop people from having access to beneficial meds in the name of "the right thing to do". You go to other countries, and their governments could care less. So, the docs get pressured to stop or lose their licenses, and so they end up punishing ALL of us for the sins of a few. People who legitmately need them, can't get them. You show your doc your medical history, and explain that you have tried anti-inflammatories but they don't work, and he says, "Well, let's try another anti-inflammatory", or perhaps he pushes surgery on you again. They can't just do what it right, because they are afraid of getting busted by a system that is screwed up.

Think about this...years ago steroid use was thought of as wrong, because body builders were using them for the wrong reasons. So, big governement steps in and puts a choke hold on getting them. Now, years later, we find that supplemental testosterone has MANY positive health benefits for me, so now we are finally seeing docs rethink it. When the governement punishes everyone, and docs join in, people suffer.

MarkhW, this is a very comprehensive and informative post. Do you have sources for the studies?

I have a view on this as well. I wonder if these studies include the correlation between the 30% increase of opioid prescriptions in the last 5 years, and the 40% of our population who has reached senior citizen status in the past 5 years? We have a disproportionate percentage of our population that were born after WWII and along with the Vietnam vets, many are breaking down and getting old and suffering chronic pain from battle injuries. It's ridiculous that 'we' (I mean the government, doctors, etc. associated with the US) were so lassaiz-faire with the opioids when that generation was fairly young and healthy, and now that the need has increased the supply is suddenly yanked? Give me a break!

The US is the youngest country in the world and also the most strict about prescription drugs as far as I can tell (with the exception of perhaps China, who lost not one but TWO opium wars). And I'll bet anything that China's 'elite' (businessmen in power) still get their hands on as much as they want.

Oh sure, there is a history of some large-scale mistakes being made in the history of medicine. A recent example would be the recommendation for the use of hormone replacement therapy in post-menopausal women. Now we know it increases the risk of cancer and so the guidelines have been changed to take that risk into consideration.

But what I said about opioid use is just a recitation of what many medical experts are saying at this time. I left out a lot since I don't have time to write about all the supporting reseach and other details. In the end it probably doesn't matter if you agree or not. The bottom line is if you have chronic pain in this country at this time and you want treatment for it, then you are probably going to have to go along with what doctors now consider to be an appropriate process of evaluation, diagnosis, trying conservative treatments first, etc. You can take it, or leave it if you don't like it. Complaining and arguing about it is probably not going to get you very far as a practical matter.

I totally agree about complaining and arguing not getting people anywhere. I think it's become really important for every person to really honestly think about opioid treatment and for us as a complete society to make a choice. Do we make an effort to keep ourselves from beoming abusers and educate others on the benefits of such treatment, or do we continue to act like spoiled children for it? After all, it is our basic 'constitutional right' that we can choose our government according to what we need as a society. That means that social communication and cooperation is what determines our government, plus we choose the officials who make the decisions.

Seriously I think the only thing that really wrecked the availability of legal marijuana was the fact that users and abusers were so frequently and chronically anti-productive and irresponsible.

If we're all able to show more self-regulation, there would probably not be so much of a need for outside regulation. So we can self-regulate into a skinnier central government and doctors who have authority (theoretically). So it's up to us to increase awareness and education and make a decision as a group.

Actually, by complaining and making legitimate arguments, to the right people (such as the Obama administration), perhaps we can make it easier for people to get the meds they need.

If you are a person who thinks it is okay to have such stringent Rules to get pain meds, then you clearly don't have real pain. Wait until you have real pain, and have to fight a system that supposedly is "protecting" you.

P

pwilliam, That's absolutely what I mean. But we need to have a very strong group voice to be heard. Each of us suffering on our own and complaining to our husbands and family members won't do a darn thing. Us using this forum to communicate about changing the law would be an excellent first step, as there are many watchers and the posts are thoroughly visible on google without logging in. Those of us who can, should seek more powerful positions and try to insert our influence. Those of us who can't should educate others around about what drugs they are taking and what would help and do not be embarrassed to say the doctor doesn't want to help. Hopefully others who were not previously involved will become aware and try to provide influence themselves. Most people who aren't really aware because they're not in pain or abusers just don't know what's going on or what the big deal is. Give them an experience like mine; watching my mother and grandmother dying without help, and there will be many more activists.

ChelRenee,

Here is an article about the increasing use of opioids:
http://www.addictionstudies.org/pdfs/Bridget%20Kuehn/opioidprescriptionsrise.pdf

I'm not sure if you would like to see supporting information regarding any of the other things I talked about. Let me know if there is anything specific you are looking for.

Thanks for posting that - it's a good article. This paragraph seems to sum up the situation nicely:

'While it is important to ensure that patients who need pain relief continue to have access to prescription opioid drugs, Quirion said, physicians need to "ask more questions to make sure when [patients] get this type of drug that they really need it for the treatment of their pain and after that that it's not abused".'

It seems to me that some of us (by that I mean chronic pain patients) are finding it difficult to get the pain relief we genuinely need because of the people who are abusing the system, either because they are addicts who do not really require pain relief, or frauds aiming to sell the drugs for profit. Another problem I've encountered is doctors not knowing the difference between dependence and addiction, and withholding opioids through unfounded fears of creating junkies.

Another thing I wonder about is whether drugs like hydrocodone aren't being overprescribed in some cases, to patients with relatively minor pain who do not really need something that strong. The increase in prescription of hydro/Apap combination meds is quite staggering, if that article is accurate. I've heard from a lot of people who have had it prescribed for very minor pain, the kind of thing that would normally only warrant a codeine prescription, if that, in most countries.

I think the main priority should be that the people who genuinely need these drugs receive them, and, sadly, it seems that a lot of folks still face obstacles in this regard..

This IS a very good article.

Bear with me while I think aloud - the following my have several different opinions. I wonder, if we were doctors, how would we diffrentiate between those who were in pain and those who are merely acting like they are in pain? When I see a doctor for a migraine, my pain is very real but I hear stories of people who are able to get pain medications for simply saying they have a migraine. Initially, it starts to make sense why they might start only prescribing it for obvious sources of pain, like your guts falling out or a broken bone. But then what about all the other possible sources of pain? What about my tooth that needs a root canal and doesn't seem to have an abcess on the x-rays, but still keeps me awake at night? If I were a doctor, do I have to make the judgment about whether or not someone is lying? A doctor, not a judge! I guess if someone is showing obvious signs of being a junkie, that would make it fairly easy, but what about really good liars? What if someone borrow's somebody else's x-ray showing a bad back? Yet without the doctor's discrimination, they mnight as well be as open as the drugstore pharmacist, relegated to simply explaining why you need this medication as opposed to the other one because of interaction problems.

Oh our poor doctors stuck in the middle! We need to empower the doctors to make individual decisions. Given a choice, most of them do not want to see their patients suffer. That is, most of them. Some of them are mainly concerned with money.

See, that's what my ramble on this post is about. Who does the discrimination to decide who needs what - us, the doctors, the government, and what are the motivations of the ones doing the discriminating? With us, motivation *could* be abuse. With doctors, motivation *could* be money, including whatever it takes to keep the DEA off their backs. With the government, the motivation I'm sure is the control and regulation of society.

It's too bad that there isn't a set of objective criteria that can establish if someone is truly in pain. I know that when my pain level is high, my blood pressure goes up. Last week when I had to go to the ER, my BP was 135/100 - my normal is 110/70 to 120/80. But, other than that, the only other way to verify my pain is through touch - and I know people can fake that.

135/100 - my normal is 110/70 to 120/80.

That isn't bad at all for someone over 50.

Some doctors don't prescribe opioids at all, or do not do so for chronic non-cancer pain. Of those that do, they ususally only do so in selected patients that they think may be appropriate candidates for such a treatment. When they are considering whether opioids should be used for a particular patient they look for various indications to help guide them. Here are some examples:

Positive things include a willingness to try treatments other than opioids, inculding other types of medications as well as non-drug treatments such as meditation and physical therapy. No history of drug abuse or misuse. Patient is primarily interested in regaining the ability to phyically move around so that more normal activites can be resumed, and also so the patient can get reasonable exercise to improve health. Patient complies exactly with doctor's orders. Patient keeps detailed pain logs and activity logs. Family members go to doctor visits and confirm patient's status reports and improvements with treatment. And so on, etc...

Negative things include appearing at the first appointment asking for opioids, perhaps a specific drug(s), maybe even a specific brand of drug. Medical records that do not support treatment patient is seeking. Asking for early refills. Asking for frequent increases in dose. Refusing other treatments. Too much focus on only pain relief and not enough focus on wanting to improve function, become more active, return to work, etc. Once given opioids, insufficient improvments in function, becoming more active, returning to work, etc. Family members and/or friends do not verify patient is getting out of bed, becoming more active, able to engage in more normal social activities, moving around better, returning to work, etc. And so on...

Ryan D - it would seem that several folks have hijacked your thread. MarkhW comes to mind.

You know, on the realistic, personal side of things - maybe some people HAVE to work as much as they can to support their family. Young children, mortgage, etc. Yes, I am concerned that you are only 24, but your work is very taxing. And docs are going to be reluctant to give you opiates because of your age. There IS a good reason for this. If you develop a tolerance at such a young age - what are you going to do when you grow older?

MarkhW, you seem to know alot. Not sure about the cold water stuff. I'm cold in 80 degree weather (well, OK, 70 degrees), but that's mostly because I am 5 feet and 115 lbs. And a woman. BUT, if I HAD to stick my hand in very cold water (and why would I do that?) I could.

And, for a guy (I am assuming you are a guy) who doesn't have any time, you seem to do OK making it. Thank you.

I have many friends and relatives in very physical trades and I've seen the way they walk. They don't need to playact in front of me. Ages are from early 20s to 50s. Course, the ones in their 50s are, hmmm, worse.

The warning still remains - if you are 24 Ryan, look into alternative therapies. Perhaps even consider an alternative profession (college?) These are perhaps more practical, but I am taking your situation very seriously. You (at age 24) have already had hip surgery. Please, please don't completely wear out your body so young. Disks in the vertebrae start drying up in your early 20s (maybe even younger.)

I know because at 9 months pregnant when I was 25, I was climbing trees, picking fruit. Gathered 1000 lbs of apples, washed them, used the cider press and froze 70 gallons of juice. . . .all in one day. With 3 children of my own and 2 that I looked after. I can tell you that my back was a wreck for weeks. Never did that again. But you do that (not juice making - but physical labor) every day and it'll cost you - as you already know.

And, finally, MarkhW - I have been on ER opiates w/ breakthrough (not cause of the apples, lol) for almost 9 years. I won't get into all the reasons, but I can tell you that they have been a complete blessing. I am never pain free, but it gets it down there enough to make life tolerable. If you don't mind me saying so - please don't tell someone that opiates are bad. I love you scope of knowledge - it is obvious - but none of us knows what another has to endure.

Be well everyone, and BE HAPPY (as this life allows).

And, BTW, I seem to always be a thread killer. LOL.

PWNRain,

Please don't get me wrong. I take opioids too, and I am not happy about the direction thing are going for chronic pain patients like me.

However, I was just explaining where things are going in terms of current research and guidelines for doctors prescribing opioids.

Origianlly Ryan D was looking for what might be considered preventative opioid treatment. He wants pain meds now because he is worried that he might not be able to keep working because of his pain. The problem he faces, as I was trying to explain, is that doctors are not trained to give chronic opioids because someone *might* not be able to keep working long hours doing heavy lifting. Doctors are told they can use opioids for chronic non-cancer pain if the patient is already disabled from being able to do reasonable normal daily activities because the pain prevents the patient from being about to move around (such as in the example of being able to walk around the block for exercise). Then the goal of opioid therapy would be to restore the lost function, that is so the patient can now walk again. The doctor is supposed to make sure that the goal is working (i.e. this patient is now walking more). If the treatment goal of improved function is not reached, then the treatment is deemed a failure and further use of the medication is not warranted, according to the guidlines and many medical books on managing chronic non-cancer pain.

I'm sure lot's of people on this board don't know about all that, and probably don't like it when they hear about. But that's the way it is, and things are probably only going to get stricter in that regard as time goes forward.

MarkhW are you a doctor?

No. However, I have been working in health care for a long time -- around 25 years.

Mark, I agree to a point about using conservative methods to treat pain, but I destroyed my stomach and small intestines with nasty ulcers from taking NSAIDS, mostly ibuprofen for several years every day. The endoscopies and colonoscopies I had showed horrible ulceration and the only alternative was surgery since they had formed a mass with scar tissue where some of them had healed and then new ones popped up on top of them. That's what conservative medicine can do. I finally got pain treatment and a pain clinic, and then an even better doctor who prescribes better than the clinic, but this was after a year of hospitalizations, including one that lasted 3 months until my surgery. I've got a doctor now who some people would say was giving me enough meds for a terminal cancer patient and I don't have cancer, but to me, he is just an old school, compassionate, wonderful doctor who doesn't want his patients in pain and knows I can never take NSAIDS again. Ever.

Anyhow, sorry to hijack your thread too, Ryan. I don't know how you work 60 hrs. a week in that much pain.

Ghost

jeeze it wouldnt have increased 30% because of the baby boomers coming of age would it? doesnt take a genius to figure this out.

our govt amazes me to no extent.

Of course it is. The Social Security system is a HUGE "ponzi Scheme". You know, The EXACT SAME system that Nadar [sp] was doing. Now who is going to sentence our government leaders to 150 years in prison. The worse part is, They are STILL using the same system. Double Standards????? NAH....

Mark - thank you for your response. I guess I should have read Ryan's post more carefully. I did not realize it was preventative so he could work 60 hours (which is alot of work!) When I read he had already had hip surgery, I thought he was suffering on a daily basis (the criteria - in my mind - for chronic opiate therapy.)

If you could offer Ryan some examples of alternative therapy, that would be extremely helpful - and not just to Ryan.

Your knowledgeable posts are most welcome.

Hope that, in spite of your maladies, you are doing well.

Ghost - wowie zowie! What a nightmare you went thru. You are OK now. . . .right? Barrett's Syndrome? If you don't know what it is, you don't have it, lol. No more Advil for you - wagging my finger at you.

PNWRain - It looks like Ryan only ever made one post here, so he may be gone at this point.

If he comes back or if somebody else asks about their own issues , I will be happy to chime in on the discussion if I have something useful to add.

Ryan, everything else aside, when your records are lost, they are not completely lost forever. The military keeps more than one set but they can be difficult to track down. However, so many have had to reconstruct their records and it just takes time and patience.

The first step is to to send SF 180 to National Personnel Records Center, 9700 Page Avenue, St. Louis, Missouri 63132 and specify which records you need. To save time, also include your DD214.

You can contact the National Archives but they get so many requests you may have to wait quite a while. If you have a VA office near you, they will help you. They also keep copies of veterans' records.

You may also call this number when it is important that you have copies of your medical records.
Army, 314-538-4261

Additionally, call the facility where you had your surgery. You will be able to get at least a partial set of the records. If all else fails, the VA can request a search for your records or a reconstruction. That will take time but it is a good thing to go ahead and do.

My advice is while you are waiting, find a doctor who was former military. Not only will they understand the situation but I have found them to be very compassionate. Call the local Tricare office and ask them if they know which providers were military.

you can also go down to your local recruiters office, with your 214 thet most likely can help you face to face with better results..than you calling.. I saved all my records and turned my 214 into the county clerk in case anything happens to it.. should be more carefull with you military records just saying...