doctor thinks I'm lying - frustrated

About a month ago I hurt my back while playing with my kids.   I had sciatica with both pregnancies and that is what it feels like it is.

The pain progressively got worse until and I ended up going to the emergency room.They told me to go see an osteopath which I did the following day.  They also gave me a script for15 oxycodone.  When I went to see the doctor the following day, he told me to walk on my toes and heels and bend - these activities don't hurt to do. He took XRays which showed nothing.   And that day i was feeling better, just a dull ache.  He asked if I wanted pain meds and I said "no, I have some from yesterday".  He marked "doesn't need meds" on my chart.

6 days later I called and asked for some percocet, which a nurse called in for me.  It was for 20 pills, which I took pretty consistently that week.  The pain did not improve and I had to wait for a physical therapy appointment.

The following Sunday (6 days later) i realized I was low on them (had 1 left) and the pain was not better so I called and asked them to page the on call doctor to see if he could call me in something.  A different doc was on call - he called back and was immediately very hostile.  He said "I don't know you, why would I call in narcotics for you?" VERY harshly. Like I had done something wrong by calling for pain meds..  i was very upset.  "why won't you help me?" I asked - "take something over the counter" he said so nastily and HUNG UP THE PHONE.

i started crying and was furious.  It wasn't what he said, it was how he said it.  I was on fire with anger - I called the number back from my caller ID.  He didn't pick up -  I went on a rant on his voicemail - it was ugly and very out of character for me.  But I was so upset that he would hang up on me without giving me any suggestions.  

The following day I left a message for my doctor at the office.  They called around 4pm to say my script was ready.  i went down there and saw he wrote it for Lortab, which I know is Vicoden and something I cannot take because it makes me queasy.  I've had surgeries before (ceasarians with both births) and know that Vicoden is not my friend.  

I was exhausted from lack of sleep and being in pain all day.  The doctor wasn't there, but I told the receptionist I couldn't take Lortab, can someone please write me one for percocet.  She said "he's not here to do it for you".  I said 'can you call him?  I'll wait".  i know they didn't want me to wait but I wasn't leaving without a script.  I honestly didn't feel like moving anyway.  I looked like a mess, i'm sure, but I was calm - I'm sure I looked annoyed and I'm sure they did not want me there.  But I was not at all rude to them, and I understood they couldn't do anything without the doctor's approval, which I just assumed he'd give.


Later, I could feel the nurses looking at me like I was a junkie.  It was uncomfortable, but I know who I am and how I handle meds.  I think Percocet is great stuff, but I would never ask for it if I didn't need it.

The office manager came in after 45 mins and told me the doctor wouldn't give me a script and I needed to make an appointment.  She was very condescending.  I made an appointment with the receptionist (who was very nice and the only person in the office who seemed to care).  I left without taking the lortab script.

The following day I went to my appt.  The doctor came in and started screaming - he wouldn't even look at me.  and it was horrible.  "You come storming in demanding percocet!" he said. " and I get a colleague to write you Lortab and it's not good enough for you!".  i was stunned....It's not like I was sending back undercooked steak at a restaurant, I'm very sensitive to medications.

I asked if I could explain and started feeling like crying, which I began to do.  "can you hear my side of it?" I asked.  But it didn't matter, he had heard my message to his colleague and was hateful towards me, which I understand but feel like I my side is valid.  He said "why would i give you percocet for what you have?"  like I wasn't in real pain.  It seems like I never am in real pain when I go to see them.  it isn't constantly bad.  but when it's bad its horrible.  He said no more pain meds for me.  i left humiliated.

Now I'm stuck with the pain, which is ok right now, 1 hour ago i could barely walk.  i don't know when it will happen.  I feel hopeless and helpless.  I have 2 little kids who I need to be available to all the time, but I'm miserable.  I think I have a herniated disc from what I've been told by the physical therapist.  Im scared to ask for what I need now.  

not sure what to do...

[Elmijack15]

That is horrible!! Some doctors forget that i'n reality they work for us, we are the customer and in no other industry would they be able to treat a customer like that. They all think people who need pain meds are junkies but sometimes there is a very valid reason to take them. If you have a primary doctor I would try them first, they don't need to be a specialist to write you a script for percocet! Look the doctors up on Health Grades where you can write/read reviews, don't give up, I really hope you get your meds and that your back feels better real soon, hang in there!

[femmy29]

Hi yeseyes,

I am sorry to hear that you are in a lot of pain and that the doctors are not listening to you nor addressing your pain.  I think that it is important for you to have your doctor schedule an MRI of your lumbar spine so that know what is causing your pain.  Sciatica is a symptom usually spawned from a bigger issue such as a herniated disc that is pressing on a nerve root/roots.  Most doctors will treat your pain as acute (pain that lasts less than 3 months) until it turns chronic (pain that has lasted more than 3 months) and/or until you have a diagnosis.  Acute pain treatment may not be continuous; in other words, doctors typically will prescribe and then refill an opioid pain medicine for a fixed amount of times versus refilling it indefinitely.  

Before I had a diagnosis of DDD with lumbar radiculopathy and myofascial pain syndrome, my pain was treated at a minimal level.  Even after the MRIs showed the damage, I still experienced suboptimal care.  I have been battling chronic pain for 12 years and running.  If you read the posts here on MedHelp, you will find that there are many others that share a similar story as yours and you will find a select few that are happy with the care they are receiving from their doctor for management of their chronic pain.  Unfortunately, there are more patients that aren't being adequately treated than are and it highlights the issue of undertreatment of pain in America.  The undertreatment of pain comes from misinformed doctors, media exaggeration of prescription drug abuse, and DEA paranoia.  There are guidelines sent to all physicians that prescribe opioid medications that highlight several things that drug seeking patients do, which are sometimes true but most of the time are false.  Examples are:

- Calling at the end of office hours demanding more pain medication (1)
- Looking unkept (2)
- repeated loss or stolen prescriptions (3)
- requesting a certain medication by name and stating that it is the only one that works (4)

From what you wrote in the post, your doctor probably thought that you met drug seeking criteria (1- possibly), (2- possibly) and (4).  However, I know you showed up at the office and proceeded to wait there for your prescription because you only had one pill left period.  Not because you injected or snorted them all or because you are worried about where your next high might come from.  I also know from your post that you looked unlike yourself simply because you were in pain and you turned down the Vicodin because it has made you sick numerous times in the past.  Unfortunately, as you stated, the doctors didn't give you ample time to explain all of this to them.  And in fact, their conduct was very unprofessional but it happens all to often.  There are way more uncompassionate doctors than compassionate doctors.  I just realized this the beginning of this year when I switched insurances and had to find a new primary care physician.  I was simply focused on maintaining my current regimen of pain medications despite the fact that they weren't controlling my pain very well and I was surprised by the most compassionate doctor I have ever met in my entire life!  He switched my meds up and most of the day I am in no pain versus in a lot pain with few moments of little pain inbetween.  I had no idea my pain could be controlled so well such that I feel almost cured from over a decade of suffering.  That's when my eyes opened and I realized that my previous doctor wanted me to always feel pain (always at his mercy) and I find that grossly disgusting to Lord over someone's suffering like they are God!

All I can tell you is to get a diagnosis.  A diagnosis is the key to treatment as it gives doctors comfort should the DEA knock on their door.  This shouldn't be how it works as not everyone can find a valid diagnosis yet that doesn't mean their pain is not real!  Secondly, get away from your current doctor and his team of baffoons and search diligently for a compassionate physician.  They are out there, they just need to be sought for.  Try checking websites that have the patient reviews of physicians like http://www.RateMDs.com.  My new physician had a review from a patient on one of these websites that said that he was the most compassionate physician she had ever met...I knew he was going to be doctor at that moment! :)

There is Voltaren Gel that might help your pain, not as well as the percocet does but it will take the edge off.  It is an anti-inflammatory gel that you apply directly where it hurts 4 times a day.  I am absolutely amazed at how well it works!  It works way better than oral anti-inflammatories like motrin, aleve, and advil and doesn't irritate your stomach either since it doesn't go directly through the GI tract.  You can usually tell when a physician is not "the one".  If he isn't, ask him about Voltaren Gel (seriously!).  He'll prescribe it because it isn't a scheduled substance and you can use it until you find the right doctor.  And don't forget to schedule your MRI scan so that hopefully you will know what has been causing the sciatica throughout the years.  I also had sciatica during pregnancy and still have it but it is well controlled such that I don't feel it much at all anymore.

I don't know how you feel about back surgery but if there is a disc pressing on a nerve root they can extract only the part of the disc that is bulging in a minimally evasive way.  I am personally not ready for surgery because it is still only about 60% successful and many times it can increase the severity of the chronic pain due to scar tissue.  So if I can manage with medications and other modalities, I will do that until it is absolutely necessary.  You may have an opposite view from me and that's okay.  I have friend whom had a successful surgery (mostly I should say).  She still gets flare ups that are quite nasty which makes me wonder, what was the point? LOL!

Anyways, don't be a stranger.  We are here to help you, provide an ear for listening, and to support you.  Welcome! :)

femmy

[Tuckamore]

Hello and Welcome to the Pain Management Forum.

I am so sorry to hear how you were treated, unfortunately this is not unusual... sadly it happens more often they one might think! Why? Because there are many drug seekers and abusers in this world and because not all physicians are trained or educated in chronic pain.

Femmy is absolutely correct. You need a diagnosis. Most physicians will not prescribe opiates for ppl without a definitive diagnosis (DX). I suggest that you make that your primary goal.

I found this statement enlightening, "I had sciatica with both pregnancies and that is what it feels like it is."  Based on that statement I am going to humbly suggest that you may have SIJD ... which should have been considered by your D.O.  Does he practice OMT (Osteopathic Manipulation Therapy)? Is he good at it?  Can he "feel" pain and misalignments by touch?

SIJD (Sacroiliac Joint Dysfunctions).  SIJD is vastly under-recognized and often misdiagnosed. Even those practitioners who routinely treat it are frequently perplexed and frustrated by its complexity. It often shows up in pregnancy, especially the second and third trimesters.... hence I thought of it when you said the pain began or felt like the pain you experienced during pregnancy.

There is a lot of information on the web regarding this condition. I encourage you to search and determine if the symptoms described fit your symptoms. SIJD can be difficult to DX but not impossible. An MRI will not reveal SIJD.

Once you have a DX you can expect treatment... until then you are at the mercy of a trusting physician. Again with all the bad media about drug seekers and the FDA breathing down the necks of physicians it's very difficult to obtain opiate prescriptions. Obviously these guidelines and laws are needed but they often interfere with the proper treatment of pain.  

I wish you the best and hope you are able to find the correct DX. I know you are frustrated and disheartened but don't give up. You are your own best health care advocate. Ignore the rude practioneers...never stoop to their cruelities. It will pay off in the long run. Be kinder then necessary... you'll catch more fly with honey!

I have SIJD and know how every painful it can be. If you have any questions feel free ask.

We'll look forward to hearing from you. I'll be very interested to read your updates... and learn how you are doing.

Take Care,
~Tuck

[yeseyes]

Thanks everyone for your very thoughtful replies.  

Lol Femmy - I definitely met 3 out of 4 of the criteria.  Had I known I would be judged by my appearance I would have done my hair.  My (now former) doctor said something about me calling on a Sunday and how it was wrong.  I didn't know that.  I didn't know any of that stuff.

FYI - I left a message yesterday with the doctor's nurse explaining that I would try to find a new doctor but could he please just provide something other than Lortab in the interim, I said it does not have to be percocet.  when she called back, she said "unfortunately we are not going to be able to give you any percocet or any more pain medication".  It keeps ringing in my head how he said "why would I prescribe percocet for what you have?"  I feel so rejected.

Now, about getting a diagnosis, who does that?  I'm pretty sure it is a disc problem based on what the PT said.  

And now I'm worried that if I try to find a new doctor I will be handled the same way or that maybe he put me into some database of percocet seeking liars.  am I being paranoid?

[yeseyes]

Wow - tuck, I just read about SIJD - I forgot to mention I found out last week that one of my legs is longer than the other and my pelvis is out of line, It totally makes sense.  thank you :-)

[femmy29]

Hi yeseyes,

I was very surprised as well when I came across information on drug seeking.  And they are now including it the prescription information for healthcare practitioners that is provided by drug companies that manufacture opioid medications.  It is every where!  Just how you didn't know, I didn't know either.  The guidelines are very stereotypical such that doctors are destined to mislabel someone as a drug-seeker going by those guidelines.  I think they are very unfair and very one sided.  I knew just by reading your post that you are not an addict nor a drug seeker.  And the others that posted saw that as well.  Many of these doctors have no idea what it feels like to wake up every day for days/months/years in pain and to always have more pain after trying to join in on more of life.  You are not alone...I've caused more injury repeatedly just by giving my son baths (hubby has to do it most of the time) and going overboard on house cleaning to please my hard to please friends.  A normal person would be just fine and might proceed to head to the gym after all that, for me and you it means time in bed and time trying to find relief of the pain.

I think Tuck provided some great info!  I wonder now if I may have been misdiagnosed or at least partially misdiagnosed.  I looked up SIJD on wikipedia and I have experienced almost all of those symptoms.  You have no idea how many times I've torn a ligament in my low back from house cleaning and giving my son baths.  I thought I would strengthen it over time but instead it has weakened.  And the symptom of sciatic pain during pregnancy fits the both of us.  I read that it was a common diagnosis in the early 1900s up until the invention of the MRI in the 70s at which time it fell by the wayside.  And it did say that an MRI does a poor job at diagnosing SIJD.  It went on to say that the gold standard for diagnosing SIJD is by injecting a steriod/anesthetic mixture into the sacroiliac joint and if the pain is reduced by at least 75% twice, it is mostly likely SIJD causing the pain.  I plan to discuss this possibility with my spine orthepedic specialist next month when I go in for my next appointment.

If you have commercial insurance that doesn't require endless referrals for everything, you could make your own appointments to see a specialist.  A good specialist to see would be a spine orthepedic specialist.  They are usually the ones that order and read MRI scans and then recommend treatment.  You could also find a good D.O. or internist and they can guide you in the right direction.  Even if it is SIJD, it is also good to get an MRI just to see if anything else is going on.  If there is, it can be a tool for you to use to receive pain medication to help treat your condition.  I know my new PCP read my MRI results in detail and then proceeded to offer medication options to me as if I had just been approved per my MRI.  lol!  You will more than likely have to request an MRI from the doctor as often times it isn't offered up due to cost (typically not to you but that the insurance company has to fork over).

Lastly, in addition to opioids for management of chronic pain, I also take an anti-convulsant called neurontin (it helps a lot with nerve pain), a muscle relaxer, a benzodiazepine (valium - is a potent muscle relaxer alongside acting as an anxiety reducer), and an anti-depressant - helps the brain better process pain signals being sent up through the spinal cord and improves mood which has been shown to help with pain.  All of these together help significantly than just one of them alone.  The additional medications are known as adjuvant therapies as they are commonly used in addition to opioid therapy.

I wouldn't worry too much about being put into a database that labels you as a drug seeker as I'm sure it is not truly executed most of the time by doctors as many members here have found another pain management doctor that treats them with opioids after reportedly being red flagged.  The database is more for patients that are doctor shopping (obtaining multiple prescriptions for the same/different opioid and filling them all at the same time to get high) and forging prescriptions, you haven't done any of that.

Tuck is right, you are your own best healthcare advocate.  Please keep us updated on your progress.  Don't give up, you'll find the right doctor and the right treatment.  :)

femmy

[houseofgirls]

I agree with all the above comments about being unfairly treated when someone has pain.  You definately need to get to the bottom of what is causing your pain in order to be properly treated.  Unfortunately, some of your "behavior" did send up red flags to your doctor.  I completely understand how chronic moderate to severe pain can make you feel crazy and desperate.  I've been there!!

Most doctors will not call anything in on a weekend, and especially if its not your own doctor who is on call.  I've had many surgeries, and even on their voice mails it says meds will only be called in during normal  business hours.  It always confused me, since people don't only have pain during business hours, lol!

I'm sure you were beyond frustrated and in pain when you left that message to the oncall doctor.  Unfortunately, that too sent up a red flag.  I doubt it will affect you in the long run, but obviously that practice of doctors are not your biggest fan.

I too am sensitive to many medications.  You might want to consider handling it differently in the future.  My example, I have horrible reaction to prednisone.  At times I've had no choice but to take it for whatever condition I had.  But the side effects make me crazy.  I get horrible muscle and joint pains, and psycologically I don't feel well.  The last time my dr wanted to put me on it for a sinus infection that would not clear completely, I said that I would take it if he was willing to treat the horrible side affects.  If he couldn't do that, then we would need to find another option.  He instead gave me a nasal steroid and it did the trick.

My point here, is rather than freaking out and saying you can't take loratab, only percocet because it makes you queasy, offer other options you are willing to try.  There are a ton of great anti nausea meds out there, and taking one of those along with the loratab may have worked beautifully for you.

I'm sorry for your pain, and I hope you are able to find out what specifically is causing it so you can finally get the treatment that you need!

[yeseyes]

thanks everyone.  I'm going to check out new doctors Monday.  Femmy, what is your diagnosis, if you don't mind me asking?  

Houseofgirls - you are right.  I totally agree I handled it wrong.  Absolutely.  And I'm upset that I did that. I look for the lesson in every experience.  I know my angry response is the reason they aren't treating me any more.

I am 38 and in my life time I can recall 3 times I have been that angry.  I have beaten myself up plenty for my reaction, but I truly think the doctor on call should own his part in it.  I know he won't, and that's fine.   I honestly had no clue.  Had he said "I'm sorry you're in pain but I can't help you because blah blah" I would have been bummed but I would never have gotten angry about it.  He just assumed I was "bad" and treated me that way.   There is a reason the drugs exist, after all.  

I feel fine today.  Wish I understood what makes it come and go like that.  

Anyway, you are all so nice.  I'm really glad I found this place.  xo

[femmy29]

Hi yeseyes,

We are very happy you found us.  We have all helped each other out through all of our struggles with pain over the years.  I have been a member of other pain management message boards where I received very unpleasant responses from a whole bunch of grumpy and angry retired nurses on the forum.  I have always gotten helpful and supportive responses at MedHelp.  :)  I hope you will stick around.

I don't mind you asking what my diagnosis is.  I have degenerative disc disease (DDD) in my lumbar spine.  The L4-L5 disc has ruptured and nucleus of the disc has spilled out and is pressing on my spinal cord.  The L5-S1 disc is bulging and pressing on my S1 nerve root (this is where I think most of my pain is coming from).  The disc that presses on my S1 nerve root causes lumbar radiculopathy (radiating pain up the sides of my back and down through the buttocks and then through the legs).  I also have nerve damage in my mid back (thoracic spine)...my first love drove 15-20 punches into my thoracic spine during an argument.  Then I was rear ended in a car accident at 45 mph while I was at a complete stop waiting on the bus to pick up passengers...the guy that hit me admitted that he was looking at a chick on a bike!  Lastly, I suffer from myofascial pain syndrome (severe muscular pain throughout the back caused by several active trigger points).  

Without pain medication each step I take is excrutiating!  It is like the movement is irritating a nerve and pain shoots down my legs and radiates across my low back with every step.  Additionally, standing for more than 10 mins causes sharp radiating pain that shoots down to my ankles.  Bending over repetitiously is very painful even when I try to bend at the knees.  Pain medication has given me part of my life back.  I still have limitations; if I try to do too much the pain breaks through the medication and I have to take more medication that sometimes doesn't work.  So I try to pace myself and not overdo it.  I hate pain...I've endured too much of it already and I have become somewhat paranoid of further pain.  

I started off 12 years ago with just a muscle relaxer and 800 mg ibuprofen tablets (the ibuprofen eventually tore a hole in my stomach - ulcer).  Then I requested valium as I heard through my massage therapist that she had another patient on it and she said that it really helps with her pain.  And it did!  But only at night...my pain was almost always relieved only at night.  But when morning struck it was back to the battle.  It took a lot of effort on my part to get my doctor to listen to me 5 years ago when I told her I can't take the pain anymore.  I had MRIs taken of my thoracic and cervical (neck) spine and they showed a minor bulge in both regions plus a bony structure, none of which my doctors believed were causing my pain.  I broke down in tears at one of my appointments as my son was only 1 year old at the time and I was depressed; I couldn't be active with him and I was wasting precious time that I would never get back.  My doctor finally gave in and prescribed me Tramadol.  It worked extremely well and I slowly joined back into life.  But after a year, I started noticing that the pain wasn't fading as much as it used too. 2 years in, I noticed that I would get pain relief for about an hour and then the pain would come back in full force.  3 years in, it only worked for 15 mins.  I had a different doctor at the time it stopped working and we agreed to switch out half the daily dose of tramadol for Vicodin.  He also ordered an MRI of my lumbar spine.  As I was getting out of the machine after the MRI images were taken, I heard one of the radiology technicians say, "Wow! Look at that!!"  I knew something was terribly wrong with my lumbar spine.  I was referred for injections after the first round of MRIs but got denied...5 years later after my lumbar MRI I was referred again and when I arrived for my appointment the PA said, "so your back! You must still be in pain." Ummm...Ya!!!  LOL  I was approved for epidural steroid injections based on the damage in my low back.  I have had 5 epidurals so far and I am overdue for a sixth one but since my new pain meds are covering that additional pain, I am hoping I can hold off on the injections as they cause bone loss with repeated injections over the long term.

The vicodin/tramadol mix I was on fizzled out and I was emailing my doctor about my pain and he kept ignoring me numerous of times.  Finally, I went in for an appointment and slammed my pill bottles on the table and said, "I'm not abusing my meds! You may count them if you like.  They aren't working anymore and I am in pain and can't do much of anything without excrutiating pain."  His first option was for me to switch to Vicodin at 8 pills a day.  I pushed that right back at him because the tylenol intake would be way too high.  At that time my doctor gave me the choice between morphine and methadone; I chose morphine.  I was also on a trial of percocet that one of his other physicians in his practice gave me as he initially told me flat out no when I asked about them.  They weren't working well alone but after I started the morphine, they began to work a lot better.  I had to go through one titration of both my long acting med and short acting med.  After the titrations, I was still in pain more than I would like but I was humble (if you want to call it that) and stuck with the dosing.  I brought up at my exit interview prior to switching insurances that the morphine didn't work well alone and that to make it through my day, I had to take at least 3 doses of percocet.  He told me that since I was leaving, he didn't want to make any changes to my meds and that I should talk to my new doctor about Oxycontin as he believed it would control my pain much better.  He gave me a referral to my current doctor and a couple of internists.  I decided to try to find one on my own first and I went to see a spine orthepedic specialist.  He told me that they don't prescribe medication but instead only provide recommendations and then proceeded to tell me I was on enough pain medication to be a cancer patient!  That comment didn't mow over with me well at all as you might imagine.  But, I plan to go in for my next appointment next month and see when we can expect to start at least trigger point injections versus lumbar epidural injections.  So I went to see the doctor that my old PCP referred me to and he hated that I was up to 7 percocet a day with the morphine and wanted me to try Opana ER.  It works great!  My pain is more controlled than it has ever been! I only need 2 or 3 percocets a day...most days only 2 are needed.  I was amazed that he prescribed my medication on the first visit.  So I believe this doctor is my new permanent PCP.

[femmy29]

I posted my history just so you could get an idea of the road travelled to this point.  I was so afraid to switch insurances even though it was an option every year.  I just didn't think any other doctor could control my pain better and I was wrong.  I feel I lost out on a lot of life tinkering around with my previous doctor.  So my advice to you is if your pain still isn't controlled on the meds another doctor gives you and he refuses to make changes consider going somewhere else as there are way more fish in the sea (so to speak).

I also wanted to respond to what the doctor said to you about how he doesn't prescribe percocet for what you have.  That prescribing practice is his own personal opinion and doesn't reflect the opinions of other doctors so don't let that get you down.  As I wrote, my spine orthepedic specialist said I was on as much medication to be a cancer patient and proceeded to try to coach me into weaning off of all my meds as over the long term as I was destined to become stupid and in pain due to my tolerance.  All of which isn't true as most opioids have no ceiling and none of the opioids out there cause brain deterioration.  While some doctors won't prescribe above a certain amount, most Pain Management physicians will.  I did ask would he be able to fix my pain such that weaning would be appropriate and he said NO.  His comments upsetted me but I have come across that so many times before and I knew it was simply his opinion.  So keep your head up.  If the percocet helps with your pain that is all that matters.  Everyone is different and different meds work for different people and this is a fact not a opinion.  I also ran into a doctor that said she didn't prescribe valium to patients under 30 years of age.  Doctors tend to be able to make their own rules when it comes to medications and prescribing, which is mostly based on their own personal opinion.  So you just have to find a doctor that shares the same views as you.  

femmy  :)