If PMC doesn't use medications & primary doctor won't prescribe opioids?

[DrFong]

My  (HMO) primary doctor for 20 years has retired; he had been prescribing low dose hydrocodone or tylenol 3 at bedtime only, for pain from arthritis in hip & damaged rotator cuff so I could fall asleep. New primary will not prescribe ongoing pain medications because of "danger of suicide, overdose and long term effects".  She defines chronic pain as any pain that recurs for long periods of time even tho it is not always present & says that chronic pain is controllable without using pain medication by using exercise , meditation & 'healthy lifestyle'. I already do that stuff.  I'm not a suicide risk according to the psychologist who manages my antidepressant. I'm 68; the long term effects from tiny amounts of pain meds are probably less of a problem than sleep deprivation. I don't think new doctor takes pain seriously; she thinks that OTC medications are enough.

She referred me to the HMO's *chronic pain clinic*, which is completely -0- medication. This is not the same as their *pain management* which is too far away for me to use anyway. .  When I continued to ask things like "If I'm in pain that keeps me from lying down long enough to fall asleep, how do I sleep?" she asked if I'd prefer to "just be seen at orthopedics for hip and shoulder issues" and referred me to them.

Today I had to go to urgent care because of pain/minor shoulder damage from  a car accident last week. They decided I needed  a Toradol injection and 5 days of Oxycodone. There was no lecture about the *opioid crisis*.

I'm worried that having asked for pain meds from  new primary and later having been given some at urgent care will get me labelled as a 'drug seeker' if I change primary care doctors right now ( pain meds aren't the only problem with her).  From what I've read here and other places on the internet, pain management clinics are often antagonistic & view everyone who uses pain meds as active or potential abusers.  I'm not sure how to sort this out other than X number of Dr appointments  which don't have anything to do with pain issues and THEN change doctors. I'm in a State where cannabis is legal but I don't want to do that unless there aren't any other options.

[backhurtz]

Wounded,
If I were you, I would try first for a physiatrist/physical medicine and rehab dr. Most also do pain management, including prescribing of meds.
During my 20 plus years of living with chronic pain, my best overall care has come from a physiatrist/PMR dr.
As far as getting scripts from urgent care centers go or ERs, be very, very cautious. The prescription monitoring databases look at how many drs prescribe to you, frequency, amounts, and full history..all of those things can bite you when trying to get a PM doctor.

[woundedwing]

N2braves, you are probably correct, but I have transportation issues, so I'd probably just call the PM Office. As for disposal... I didn't even think of that! Hmm. And to Backhurtz, you are right: I need to re-read what I signed. I haven't had the chance, yet. I find my new situation daunting.

[n2braves]

You shouldn't have any issues with your primary unless you were to sign a med contract with them.  They aren't going to care if you need to go to urgent care or er because their name isn't on the script and that's their issue.

If I were you I would start checking out any pain management clinic that is feasible for you to get to once a month.  Not all of them are that strict.  You just have to build trust with them.  

Right off the bat if I had to go to dentist or ER and got a small script, I would stop by the office first and have the nurse look at it and tell me it was ok.  Then I would only use the minimum and take the rest to my next appt and they would watch me get rid of them.  Maybe a bit much, but they totally trust me now.

You may have to interview a few pain clinics to find the right fit and then build the trust.  Primary docs just are not scripting long term meds at all anymore.  It's sad but just the way it is.  Don't worry, do a little leg work, find a pm and it will all work out.

[woundedwing]

I am in similar situation. I am in PM, and not too happy with it... but I believe that one of their documents stated that if you obtain opioids from another facility (for acute care), that it was OK, so long as you notified them. I think that if you call or explain situation-- preferably within 48 hrs. (ie., if you are formally with another PM or other doc), you will not be considered to be a drug seeker-- as it was up to that facility, and because you were/are in acute situation. You are LUCKY that urgent care gave you something, though! Where I live, I don't even think the ERs are dispensing pain meds.

[backhurtz]

It depends on the practice policy, which is why each patient must READ and understand the contracts we sign and ask questions if something is unclear.
Some PM doctors only want their office prescribing ANY scheduled medications, no matter what. Others require immediate notification to their office if there is an emergency requiring scheduled meds. Still others require explicit permission from the doctor, not his staff before filling any medication from an urgent/dental/emergency.

[backhurtz]

Primary care doctors in most states will not prescribe opiates long term. Your best options are referral to pain management or physical medicine and rehab physicians and perhaps evaluation by an orthopedic to document the injuries.