Please help, need advice about first appointment

[Emmy_84]

Hello everyone, I am new to this website and want to thank anyone in advance for any advice the might have. Here goes, my situation is kind of complicated. I am a 27 year old female with a history of heroin addiction. A few years back I was rear ended at 70 mph and suffered a whiplash injury, for which I did almost 1 year of physical therapy for. The pain seemed to go away and never really resurfaced.

Three months ago, I started having excruciating pain in my back neck and shoulders and was unable to sleep, could no longer lay  on my side or stomach and had numbness in my arms as soon as I was able to fall asleep. After going to my primary care Dr, she basically dismissed my pain. I felt like yes this is my problem and what I get for having been an addict in the past. My pain persisted and got worse, so I went to my neuro who I had originally seen for my car accident injury. After examining me and running tests and X-rays, he confirmed that I had mild scoliosis, an impingement in my shoulder, and thoracic outlet syndrome. He told me that with physical therapy the pain should get better, he prescribed me Sa and Percocet, which didn't help due to my tolerance do I just stopped taking them. After two months of PT twice a week, I am still unable to sleep and have moderate and persistent pain that is truly making my life miserable.

I am currently on Subutex and have been clean for one year (yay!) So I finally just couldn't deal with the chronic, everyday pain anymore, and had my neuro give me a referral to a PM doctor who I found that had great reviews on heath grades and vitals.com I am hoping I can get on the Butrans patch. I have a high tolerance for pain medication AND pain. But I just don't think I should have to live in pain everyday because of my past. I am hoping with my neuro records and the fact that I am doing PT an active in my treatment hopefully this will be the doctor who can understand and treat the complexity of my case. I have never actually abused medication prescribed to me, crazy as that is, and I want to be as upfront as possible with this doctor in order for him to be able to treat me properly. I am just afraid the first thing that is going to happen when I go there is he will say you were an addict? Sorry cant help you. I have been stigmatized even by addiction specialist doctors! And this has made me lose hope and really feel low self worth that I am just labeled an addict.

I feel stuck in a catch 22 having a history of an addiction but also chronic pain. I am just wondering if there is anyone else in a situation similar to mine and have any advice about how to approach the first appointment? Like do I tell him right when I see him before anything that I have addiction history? How about when I make the appointment on the phone do I mention it then? I am just so nervous, more about being rejected and having to continue living with pain each and every day, not to mention the lack of sleep and how it affects my life, as I work and am in school full time finishing my bachelors degree, one more semester to go! I just know I want to be as upfront as possible, I just wish everyone appreciated that honesty is the best policy and how hard it is for me to open up with the situation time and again with another doctor who may not understand. Please, anyone who has any advice I would so appreciate hearing it!!! Thank you again

[Emmy_84]

Kjoy thank you for the encouraging words and I am do sorry to hear of your situation. My aunt went through the same thing for years before a doctor finally gave her an MRI and realized she had two herniated disks and I know the frustration that comes alOng with no diagnosis and the depression that can develop from the pain, I hope that you are able to get a diagnosis soon. I too have a family history of addiction and lost my uncle to a heroin overdose. You are in my thoughts, I hope things get better for you

[kjoy85]

Emmy,
I wish you the best of luck with your doc. I have chronic pain, but no diagnosis. We are still trying to figure out what is wrong with me. I urge you to be patient, honest, and obedient with the pain specialist.
I don't have a personal history of addiction, but I've had family members who did. I do tend to be sensitive to medications. Last year, while trying to find an appropriate treatment for a tremor, my body quickly became dependant on diazapam. I had only been taking for a week the first time my neurologist tried to switch me something else. I unknowingly went into withdrawal, but thought it was side effects of the when med and went back on the diazapam. I took it exactly as directed and didn't abuse it. A month later, we tried switching again. This time I was tapered off, but I still went through withdrawal. All that to say, that I have an idea of how hard you have worked to get and stay clean. I hope that your new doc will appreciate and take into consideration how hard you've worked to get where you are.

[Emmy_84]

Thank you Gemini, that was the first encouraging thing I have heard. Of course the first thing I will do when I meet with the doctor is come right out and tell him everything, I may have been an addict but I have always been honest and forthcoming, all addicts aren't liars. The only reason I was going to suggest the Butrans is because it is only a partial opioid agonist, which I would think drs would be more comfortable to prescribe to ex addicts, and also it is the same med I am on now only in patch form, and the patch form makes it that less abuseable. I don't expect medication to completely eliminate my pain obviously, but I am seeking some relief to the round the clock persistent pain I am experiencing, even a little improvement would be great. I am feeling confident that my doctor, once he talks to me, will be able to sense that I am I'm actual pain and that I am honest about everything and not seeking meds, but hoping to find a treatment plan that will improve my quality of life in regards to pain. I'm sure doctors face addicts seeking meds all the time and I shouldn't be worried that they are probably able to read people well, so I should just tell him everything and he is the professional and hope he will do what is right for me all things considered.

[geminigirl1963]

I'm sorry to hear of your pain and difficulty in finding a doctor who will treat you.

While it may be a pain mgmt doc's job to treat chronic pain, they are NOT required to treat that pain with narcotic medications.  Actually, there are many pain mgmt docs who do not prescribe narcotics at all - rather they use other methods for pain management such as injections, PT, etc.

I fully understand that you have already been through the PT route without any relief.  Most definitely take those PT records with you to your PM appointment.  Having them to show the doc will show him that you are not just saying you've already done PT, but you have th records that show this.

I agree about not mentioning your past addiction to the receptionist when you make your appointment - however, I do believe you need to tell the doctor about it.  This is not only for a trust/comfort level issue, but also so that he can more safely treat your pain.  Also, I'm presuming (and correct me if I'm wrong), that you are on subutex for the past addiction?  If so, if you don't tell the doc about the past addiction, he most certainly will discover it when he finds out you are on subutex - and yes, he will find out - either by prescription records, medical records, or drug testing.  Most PM doc do periodic drug testing, and many of them do them at the first appointment prior to writing any prescriptions.  Therefore, it's imperative that you are completely honest with the doctor about the subutex and any othe rmedications you are currently taking - not only for the drug testing, but also again for your own safety.

Don't be alarmed if the doctor does not prescribe any narcotics on your first appointment.  Some PM docs, even if they do prescribe narcotics, will not prescribe them on the first appointment until they have gotten all testing, records, etc.  So just be aware that is a possibility.

It's also not a good idea (in my opinion anyway) to go into any doctor appointmetn requesting a specific medication Isuch as the Butrans patch) - this quite often will send up red flags to the doctor, and I'm afraid with your past history, this may be even more so the case.  You're much better off letting the doctor make suggestions as to what he feels would be best for you.  Of course, you can let him know if you've tried whatever he's suggesting before and waht your experience with it has been.  It's apt to be difficult to find the right medication at the right level because, as you stated, your tolerance level.  Just try to be patient and work along with your doctor to find the right things for you.

Believe me, I'm not saying that because of your past addiction history you don't deserve to receive pain relief - however, it just may take longer to find the right medication and doctor who can/will work with you to find the right combination/level to avoid a possible relapse, but also giving you good pain control.

I wish you the best of luck and hope you can get some pain relief soon.

[femmy29]

Hi Emmy,

I am sorry to hear that you are in pain and not getting adequate treatment given your past addiction to opioids.  Doctors are required to treat your pain but they don't have to use opioid medications to do it.  They could do physical therapy, injections, anti-inflammatories, nerve medications, etc. excluding opioids.  Whether those treatments work or not, it doesn't matter...they are treating your pain.  Most chronic pain patients are still in pain even on opioid therapy.  Opioids are most likely not going to take away all of your pain.

There are so many undertreated chronic pain patients out there that have never been addicted to opioids.  These patients without a past history of addiction many times are unable to get a prescription for an opioid medication.  Doctors are required to treat your pain but it doesn't have to be with opioid medications.  

Your high tolerance from the heroin abuse could limit the pain relief you get from any opioid that may be prescribed.  If you noticed no change in pain levels after taking percocet, it is likely many other opioids will not make a dent in your pain either.  Many doctors have limits on how much opioid medication they will prescribe...once a patient hits that soft limit they have to try rotation to a different opioid or go on a drug holiday (i.e., detox) to reset the opioid receptors.  I wish I had better news to give you but unfortunately this is how it is due to the rise of prescription drug abuse and the hot breath of DEA officials trickling down doctor's necks.

You need to build the doctor's trust in you.  Going in making demands on how you want your pain treated will end up at dead end.

Another option is to switch from suboxone to methadone.  Methadone is a powerful painkiller along with being a step stool for getting off opioid addiction.  You can get methadone through the treatment center that is treating your addiction.  

femmy

[Emmy_84]

Pain management doctors ARE required to treat chronic pain, that is their specialty. And I would guess they treat many patients who have addictions for pain, because it is going to happen where addicts have chronic pain that requires narcotic pain medication when all else had failed! I'm sure I am not a rare anomolie and there are many addicts who are successfully treated while a doctor carefully monitors their medication and treatment

[Totie]

I would think he may start you off with non-narcotics first & go from there. Basically you will start from square one with him. Make sure you have all your records, including the physical thearpy ones.

Do not go in and say I have tried all those they don't work, just let him gain trust with you first. It may not be immediate that you earn his trust but if he is truly a caring doctor then he will start out with small steps with you considering you history.

Unfortunately dmoonchild is correct in her opinion. Doctors are not required to treat chronic pain if they don't want too, it is totally up to them on who they want as a patient or not.

When it comes to chronic pain, unfortunately it is very hard on just about everyone involved due to a few bad apples.

Good luck.

[Emmy_84]

A doctor cannot withhold pain medication to someone who is in pain. I can't be the only person who needs pain meds that has a history of addiction. Obviously I have already tried everything else non narcotic and it has not worked, thus the pain management doctor. I don't care what it takes I refuse to NOT be treated just because I have addiction history, I have a right to have pain relief and I am well aware about narcotics addiction and treatment and obviously know the risks, but when you have exhausted all other options there is no other choice. Doctors have an obligation to treat pain regardless of history, but thank you for your very pessimistic post. It's attitudes like yours that make me feel the way I do. I was never a child growing up thinking, hey, I want to be a heroin addict! And you obviously didn't read the post because I currently am in outpatient treatment and have been a year.


I guess I should have been more clear seeking suggestions rather than opinions of what the doctor will or won't do

[dmoonchild]

I am so sorry for your situation and your pain. Unfortunately, I think that the pain Dr may judge you just because of your past. But, you never know. Do not lie about your past, they will find out. I would not mention anything to the receptionist when you make the appointment. This is a private thing you talk about with your Dr. Tell him/ her  everything. How did you get clean? Did you go thru therapy? The Dr may insist that you remain in therapy if they give you opioids for your pain. Just be as honest as you can be. I dont think that you should be punished for past use, but you know, using narcotics can induce a relapse on heroine. You must be very careful if a Dr would give it to you. Im sorry but I dont think a Dr would give it to you. But there are other non narcotics that can help.  I wish you the best...............God speed................